Does Your Doctor’s Gender Affect Your Care?

My patient, a 40-year old woman named Sally, broke into a wide grin when she saw me enter the room. 

"Are you my doctor?" she asked. I nodded and started to introduce myself, but she cut me off. "I'm so glad that I have a woman doctor! I think women are much better than men."

That's in stark contrast to the previous patient I had seen just before Sally. Frank, a 72-year old man, looked at me askance and asked me if I was sure I wasn't his nurse. His wife explained (nicely) that they preferred a male doctor. 

These preferences don't always abide by gender or age divisions, either; plenty of female patients have said they prefer male doctors, and vice versa.

A new study from the University of Montreal finds that there may be real differences between the care provided between female and male doctors. Female doctors are more likely to follow evidence-based guidelines, and they score higher on care and quality, according to the study. Other research has found that female doctors tend to show greater empathy and are perceived as being better listeners. 

Some researchers have hypothesized that the differences are cultural and rooted in our upbringing. From an early age, girls tend to serve as confidantes to their friends, which may then result in greater attention to listening in the clinical context.

At the same time, I have worked with many men who display great empathy and care deeply about their patients. I also know of female doctors who don't hold up to the traditional gender stereotypes and don't like to spend time listening. 

In selecting a doctor, gender is one component. For some people (like Sally and Frank), it may matter a lot, in which case it should certainly help guide your choice of doctor. Other people just want to find someone who they can trust; they aren't as concerned whether their doctor is male or female.

So how can you identify a good doctor? Here are some characteristics to look for—regardless of gender:

Your doctor should listen to you: Research shows that 80 percent of diagnoses can be made just by listening to your story. Listening leads to better care, and your doctor should make an effort to hear you out and learn about you.

Your doctor should view your relationship as a partnership: Today's medical care is not about the doctor telling you what to do; rather, your doctor should involve you in your care as an equal partner. He or she should actively involve you in every step of the decision-making process about your treatment. 

Your doctor should be willing to ask for help: There is so much information on diagnostics and treatments—one person cannot possibly know everything. A good doctor is one who isn't afraid to admit that he or she doesn't know everything. Asking for help doesn't mean your doctor is incompetent; rather, it should increase your faith in his or her abilities and humility.

Your doctor needs to be available: It's unrealistic to expect that your doctor will be at your beck and call 24/7; however, before you leave your doctor's office, he or she should communicate to you how you can get help if necessary. Make sure you understand your follow-up plan. Are there any specific signs or symptoms you should watch out for? What should you do if something new or worse happens? 

You should feel comfortable with your doctor: This is perhaps the most important of all. If you do not feel at ease with your doctor, you might not share critical information, and important pieces of the puzzle might be missed. That's the most compelling argument for choosing a doctor of a particular gender—and only you can decide whether that's a characteristic that matters a lot to you.

One of my heroes, the Nobel prize-winner, humanist, and cardiologist Dr. Bernard Lown, talks about how a doctor is someone who should always make you feel better after having seen them. You go to your doctor because you want to feel better. You should find someone—female or male—who helps you accomplish this goal.

This article was previously published in Women's Health Magazine (posted here with their permission).

What I Learned—1 Year After When Doctors Don’t Listen

One year ago today, my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, was published. My goal in this last year has been to travel around the country and talk about the book and its message of advocating to improve your health. I planned a 48-city itinerary where I’d crisscross the U.S. from Massachusetts to California and back. I’d speak at bookstores, libraries, nursing homes, universities, and community centers.

What I didn’t anticipate was that this “speaking tour” would turn into a “listening tour”. 

From Boston to Los Angeles to Lexington to Cincinnati, people told me about their experiences with healthcare. Some, like 62-year old Annie from San Francisco, thought of themselves to be “e-patients”, or empowered patients. “I have a rare rheumatological illness that very few doctors have encountered,” she told me. “I bring research articles and educate my doctors.”

Others avoid doctors, like Janet, a 48-year woman from St. Louis who believes in “prevention, prevention, and prevention.” However, like many others I met, she sees healthcare providers nearly every week because she’s a caregiver to her elderly parents and her three children.

Over 2,000 people shared with me their frustrations with doctors, insurance companies, hospitals, and the healthcare system. I listened and learned.

Here are 10 themes that emerged: 

People don’t know that they have options, especially when it comes to saying no. They are used to doctors telling them what they need; they are surprised when I mentioned that patients always have a choice to NOT get a test or NOT take medications. Few interventions are so emergent that patients need to obtain them immediately. Watching and waiting, discussing it further with the doctor, and obtaining a second opinion are reasonable alternative. 

People want to please their doctors. In general, people like their doctors. Many feel they have to do what the doctor wants out of fear of displeasing them. “I lie and say I take medications I can’t afford,” 75-year Tony from San Antonio said. Others expressed their need for doctors to support their decisions. “Give me real choices and mean it,” says 38-year old Teresa. “Don’t judge me as being noncompliant just because I have a different value system.” 

People don’t want more care—they want right care. People recognize the harms of overtesting and overtreatment, and know that more care isn’t always better. They know to be wary of industries with ulterior motives. “Drug companies and insurance companies aren’t operating out of the goodness of their hearts,” says Joseph, a 55-year from Providence. “There’s a lot of money to be made money from healthcare.” They also fear rationing, and caution that less isn’t more either. What they want is the right care, without personal or commercial interests getting in the way. 

People don’t expect perfection, but they demand transparency. They know that doctors aren’t omniscient; they just want them to share what they know. Uncertainty is fine, as long as they are told the truth. Also, people accept that doctors are human and that medical errors occur. They don’t aim for retribution, but they do want disclosure of the mistake and to know that the doctor is committed to addressing it. 

People want more information to choose doctors and hospitals. “It’s disgraceful that I can find all types of information on choosing a coffee shop but I know next to nothing about my doctor,” 35-year old Jenny from Cincinnati says. People want to know about their doctors, not only their credentials, but also any financial conflicts of interests, their values, and who they are. 

People know that hospitals aren’t hotels. They don’t expect valet parking and 3-course meals, but they do want to be treated with respect. If they’re cold, they want a blanket. If they’re thirsty, they want some water. Without compassion and addressing basic human needs, marble staircases and fancy MRIs are worthless. The same goes for doctors’ offices. Forget the fancy carpeting, but find staff who treat people with humanity and dignity. 

People will wait if they get what they need. The dogma based on patient satisfaction survey results is that higher wait times leads to unhappy patients. However, the people I spoke with are unhappy not because they had to wait, but because they did not get what they expected despite the wait. “I waited two hours, and the doctor just spent five minutes with me,” said 49-year Sophie from Plymouth. Studies show that patients are interrupted in about 12 seconds; it’s no wonder people feel ignored and not listened to! 

People aren’t lazy when it comes to their health, and don’t always want the quick fix. Most people don’t want to go to their doctor at all, and prefer to find ways to improve their lifestyle and prevent disease. The popularity of diet and fitness books is case in point. Many do not want “the easy way out” in the form of drugs or surgery, but would rather discuss fitness, diet, and use of alternative therapies with their doctor. “It’s my doctor who doesn’t want to discuss these therapies with me,” says 22-year old Sandra.

With Dr. Jocelyn Elders and advocate Patty Skolnik

People know that the current system is unsustainable. No matter the politics, people saw the healthcare system as being broken, and all of them as victims—and future change agents. “It’s just like the environment: there are finite resources,” I heard over and over. Since “free” and “cheap” weren’t synonymous with good care, people are willing to pay out of pocket for better value (as long as it doesn’t bankrupt their family). They are willing to share in the cost to society, because they recognize they already are.

People crave connection and caring. They want face-to-face interaction with “their” doctor. They want to be listened to and heard. Knowing their medical history is only the start; they also want their doctors to understand and connect with them emotionally, physically, and spiritually. This requires a sustained relationship; people do not want to go to “minute clinics” or use smartphone apps to access their doctor, but rather long for a long-standing relationship with an accessible, trustworthy provider.

By no means is this list meant to be exhaustive or intended to represent every one of the individuals I met. The very nature of healthcare is that it is personal and individual. These findings represent the thoughts and wishes of a broad spectrum of people across the U.S. They challenge conventional wisdom when it comes to what is needed in healthcare. For example, the rise of urgent-care centers and smartphone apps should be seen as failure, not progress. Similarly, reducing wait times or adding fancy office furniture is not the fix for patient dissatisfaction.

Reform proposals tend to target policy changes that become mired in rhetoric and statistics. What people want is more basic, and more achievable. Doctors need to be transparency and honest with patients. They need to move away sick care towards healthcare. 

In the words of the great humanist and cardiologist Dr. Bernard Lown, we need to “do as much as possible for the patient, as little as possible to the patient.” Medical students need to learn shared decision-making and integrated care. Patients—people—should be part of every healthcare debate. Ultimately, we must restore medicine to being a caring partnership that prioritizes basic human dignity and respect. 

My listening tour continues. Please share your thoughts below. I look forward to listening and learning.

What Do Patients Think About Transparency?

Since launch of “Who’s My Doctor” two weeks ago and my blogs in Huffington Post, British Medical Journal, and Psychology Today, I have had a number of queries. Many people want to know what is the reception to it so far. My next blog will address what doctors think about the total transparency initiative. This post focuses on our patients.

Here is what prominent patient advocates have said about this campaign:

Patients and families increasingly understand that health care varies. They want to know about the training, experience and ultimately the quality and outcomes of the doctor's they choose. "Who's My Doctor" and the "Total Transparency Manifesto" are wonderful first steps towards this goal.

--Carol Cronin, Executive Director, Informed Patient Institute

We have a transparency law in Colorado and the intent of the law is for consumers to have access to information about their physicians including conflict of interests so they can make more informed decisions. There is complete transparency regarding all 49 professions under DORA. What Dr. Wen is proposing is just this without having to pass legislation to make it a reality. Bringing to light vital physician information should be a given. Physicians should not allow a conflict of interest to influence their medical judgment. It is a human factor that it does so why not eliminate the temptation. All health professionals have a responsibility to their patients as well as to themselves.
--Patty Skolnik, Executive Director, Citizens for Patient Safety

Trust is vital for relationships. Patients place their trust in their physicians.  We trust the information our clinicians share with us will be free of error, bias and self-interest. Medical journals require disclosure statements and I believe the same standard of transparency must also be provided for patients. Leonard Kish reminds us “data enables decisions.” “Who’s My Doctor?” ensures patients receive the necessary information needed to make informed decisions that impact our health. I support Dr. Wen in her efforts to provide further transparency for patients. I’m passionately supportive of this movement and as a patient advocate have seen the need for this culture change for a long time.

--Lisa Fields, patient advocate and Co-Founder, Healthcare Leader Tweet Chat

Restoring integrity to medicine is a very important project, and I salute Dr. Wen for taking the initiative to start “Who’s My Doctor”. In the 21st century informed patients want to know -- and deserve to know -- if their doctors have any potential conflicts of interest. Commercial values pollute too much medical science and clinical care, but many doctors are independent and put integrity and professional values first. They will be proud to share their information on this website and it can become an important resource.

--Leonore Tiefer, PhD, Co-organizer, Selling Sickness; Convenor, New View Campaign

“Who’s my Doctor” is an innovative campaign that supports providers who want to demonstrate their commitment to integrity and ethics in all patient interactions. The public needs to know that the health care providers they entrust with their lives are free from personal bias and professional conflicts of interest. To date, finding this level of transparency about our providers has been close to impossible. “Who’s my Doctor” is a way for providers to be proactive about the information they share with patients and supportive of patient choices that originate from a foundation of mutual respect and trust.

--Julia Hallisy, D.D.S., Founder, The Empowered Patient Coalition

In the ER, my patients have responded positively to my disclosure. “I had no idea doctors get paid to do more,” some said, while others were surprised: “I thought all doctors got paid by drug companies.” Nobody has said, I wish you didn’t tell me, or why are you explaining this to me. The other doctors who are joining this inaugural campaign report similar anecdotes; you will be hearing their voices on this blog in the coming months.

I’d love to know what you think. Would you use “Who’s My Doctor”? What do you want to know about your doctor?

Goldilocks Medical Care: Not Too Little, Not Too Much….

In my last two blog posts, I discussed the harms of a new epidemic: too much medical care. We also don’t want the opposite, of enough care care. In fact, much of the driving force leading to overdiagnosis and overtreatment is this fear of rationing.

So what can you do to ensure that you obtain just the right amount of care?

It isn’t easy—if it were, if there an algorithm that would give us the answer, then we wouldn’t have the Goldilocks problem (“Is it too little? Too much?”).

Here are 5 suggestions that may help:

First and foremost, work in partnership with your doctor. The most critical key to getting good medial care is a trusting relationship between you and your doctor. This is not to say never question your doctor; but rather, develop a relationship of mutual respect such that you are the expert when it comes to your body, and the doctor is the expert when it comes to medicine.

Second, make sure your doctor listens. Study after study shows that the patient history will reveal the diagnosis in 80% of the cases, without the need for any tests or further interventions. If your doctor orders tests instead of listening to your story, that leads to unnecessary testing—and potential misdiagnoses. Prevent this by telling a good story, and making sure it’s heard.

Third, ask about your diagnosis. Understanding what you have is key to figuring out what should follow. Before you get any tests done, ask your doctor what he thinks you might have. This gives you some idea of what tests may be necessary, and also focuses your doctor to remember the important tests and have a justification for tests ordered.

Fourth, ask about every test done. Every single test has risks, so make sure you understand why each test is done. Ask about the risks. Ask about how it would change management: what happens if it’s negative? What happens if it’s positive? And, importantly—what happens if nothing is done at all? This helps you gauge how emergent (and also how necessary) a particular test is at this point in time.

Fifth, do your own research. This is particularly true when it comes to treatments. Look on the Internet and ask your friends and family. Be aware that not all information is equally credible, but at least this helps you formulate questions to ask your doctor. It might also help to look up your doctor and see if she has conflicts of interest that you may not be aware of: information about drug company affiliations, for example, can be found online. Write down questions, and ask them.

None of these suggestions are foolproof. These five steps can help begin the process for you and your doctor to work together to identify the right tests and treatments for you. If you have other thoughts or ideas that work, please write your comments below.

When More Isn’t Better

It was the beginning of my third year of medical school. I had just started my first clinical rotation. My very first patient was Ray, a middle-aged man with pancreatitis.

I presented his case to the team. “What are Ranson’s criteria?” the attending physician asked.

My mind went blank. “Uh, I’m not sure,” I said.

“Next time, you’d better be sure,” the attending said. He turned to my colleague, who promptly gave the correct answer.

On that first day of medical training, I learned that “I don’t know” is not an acceptable answer. If you don’t know, look it up. Make it up you have to. Whatever you do, never admit that you don’t know.

Not surprisingly, doctors end up not tolerating uncertainty. In our high-tech era, this means more is done. A patient has seemingly vague symptoms, so the doctor orders some laboratory tests “just to get a baseline”. A doctor doesn’t know what’s causing the headache, so she orders a CT or MRI “just to see”. Medical students are rewarded for pursuing obscure diagnoses, so they order increasingly esoteric tests “just in case”.

This insidious practice has resulted in a culture of overtesting and overtreatment. Studies show that 30% of all medical care—at the tune of $700 million per year—is waste. Not only does this impose a heavy financial burden on society and on patients, it also results in avoidable harm. Every test has risks and potential side effects. A CT scan has a risk of radiation, for example, that may lead to cancer later in life. And one test often leads to another, even riskier, test.

Recently, my husband had an itchy rash on his arms. He mentioned this to a dermatologist friend, who recommended that he come into the office for a skin biopsy. I asked how the biopsy would change my husband’s management: regardless of what it showed, wouldn't he still use a steroid cream? Sure, the dermatologist said, but at least we’d have more information.

Nothing against our well-intentioned friend, but this is a case where more information isn’t better. Why get a biopsy—an invasive procedure with risks including bleeding and infection—when it wouldn’t change the management or the outcome? Yet, tests are done all the time to quench the insatiable curiosity inherent in medicine: we just have to know.

Here’s another common scenario. A young woman comes in with abdominal pain. She’s able to eat and drink and looks well, but has a pain in her belly that’s bothering her. Many doctors would order a CT scan of her abdomen to make sure there’s not something bad going on. But what is this bad thing—how likely is it? How does the patient feel about the risks of the test, versus the risks of watchful waiting? If she’s fine waiting, then why expose this young person to unnecessary radiation, when it would be just as reasonable to wait to see if she gets better the next day?

More tests and better technologies are not the solution to improving clinical care. In fact, we know that 80% of diagnoses can be made without any tests at all, but by carefully listening to the patient’s story. I’m an emergency physician, yet even in the emergency setting, it is rare that a patient requires one particular test, and that test must be done right now.

Here’s what to do instead. Doctors: talk to your patients. If you’re not sure, tell them. Patients prefer honesty to false reassurance. Instead of reflexively ordering a test, discuss the benefit of the tincture of time. Remember that our first principle is to “Do no harm”. I just met two doctors, Tanner Caverly and Brandon Combs, who started an educational initiative to encourage doctors-in-training to write vignettes of medical overuse. To them, and to a growing number of physicians including the Lown Institute’s Right Care Alliance (of which I'm a proud member), preventing overuse is an ethical imperative.

Patients: insist on being an equal and active partner in your care. Ask “why” and “how”. Why is this test ordered? How will this test change my management? Make sure you know your diagnosis. Assure your doctor that it’s OK if she is not 100% sure; you don’t demand certainty, but you do expect transparency.

It’s taken me nearly ten years to unlearn the bravado I acquired in medical training and to learn that uncertainty isn’t bad; more isn’t always better; and less can be more. As the great cardiologist and humanist Dr. Bernard Lown says, you should always feel better after having gone to your doctor. We need to focus on healing by teaching and practicing the art of listening, compassion, and kindness.

Choosing Hospitals Wisely (Is There Such a Thing?)

Here’s a thought experiment presented a recent conference on healthcare consumer (ah hem, patient) advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but not all, of the cost. How do you choose which hospital to go to?

At the moment, there is very little information for you to make such a decision. Many people will choose the hospital they normally go to or that their doctor is affiliated with. For the purposes of this thought experiment, let’s say that the following information is available to you:

·      Type of hospital (large academic hospital versus small community hospital versus orthopedic specialty hospital)

·      Number of ACL surgeries per year

·      Rate of infection and complications

·      Length of stay

·      Patient satisfaction

·      Total cost to system

·      Total out-of-pocket cost to you

What factors would be most important to you in making your decision?

Healthcare choices are highly personal, and it’s not surprising that participants at the conference came up with widely different answers. Many said that they would rely on recommendations. Citing that user-originated online ratings of hospitals are not yet widespread, they stated that they would ask for feedback from family and friends.

“These are the people I trust, so I trust their judgment and experiences,” several group said. “If I ask a stranger, their values may be different from mine.”



Some looked at the potential negative consequences. “Hospital-acquired infections and complications are bad, and I want to avoid those at all cost,” a participant said. It’s not clear, though, whether data will be granular enough to provide specifics that are helpful in the comparison. What if hospital-acquired infections for the hospital overall are high, but complications for that procedure are low? Are there certain complications that are worse than others—maybe you’d put up with pneumonia, but not if your wrong knee were operated on?

Others tend to value the potential positives. Some like the idea of going to academic centers, which are seen as “better” than community sites; some others like orthopedic specialty hospitals because of their brand-name appeal. A higher number of procedures connotes confidence, as does greater patient satisfaction.

Interestingly, cost was much lower in the decision algorithm. Nobody cited cost to the system as a factor. This was not surprising, but what was surprising was that cost to individual was also not a major factor. As one participant put it, “I don’t want a discount surgeon.” There still seems to be the belief that the more expensive is better, or at least that no expenses should be spared when it comes to health—at least for those middle-class conference participants.

Finally, many would not even make the choice at all. They would go based on the recommendation of their doctor. According to multiple participants, asking their doctor about the possibility of a hospital different from their recommendation was difficulty. “How do I even go about addressing it?” they asked asked.

This exercise underscores an important realization: in the movement to empower patients, we must keep in mind that healthcare is not transparent, and not a true market. There is a difference between shopping for a TV and shopping for a surgeon. This is not to say that more information isn’t better; it is important for us as patients to get more information so as to make a better decision. But we must also be cognizant of the type of information that is available. Even in this information age, little is currently available to make a decision of what doctor or which hospital to choose. Ultimately, it will take time to develop trust in a source enough to rely upon it to supplant word of mouth and personal experience.

Guest Post: 3 Common Hospice Myths Worth Clarifying

This week, I am honored to host a guest post by Paula Spencer Scott, the Senior Editor at Caring.com, the leading online destination for caregivers seeking information and support as they care for aging parents, spouses, and other loved ones. Paula is a 2011 MetLife Foundation Journalists in Aging fellow and writes extensively about health, caregiving, and hospices.


Hospice care is an underused resource that can make a loved one's waning days more comfortable and less stressful. Unfortunately, misconceptions about hospice abound. As a result, many families avoid it or wind up having less-than-ideal experiences.
Frank conversations about hospice care are useful, whether you're wary about choosing hospice in the first place or you've decided to put a hospice plan in place.

The following three myths come up again and again, hospice providers say. If they strike a chord with you, use them as starting points to clarify what to expect from the experience.

Myth: Hospice is only for the tail end of life. 
When to start hospice? Usually, "earlier than you think," palliative care experts say. Sometimes families, or even doctors, are reluctant to bring up the subject for fear they'll be thought of as "giving up." As a result, their loved ones spend only a few days in hospice care, although it's designed to provide a peaceful end-of-life transition for weeks or months.

The general rule of thumb for admittance to hospice is that a patient is diagnosed with a condition that generally will result in six months or less of life. But nobody has a crystal ball -- and nobody gets kicked out of hospice because they're still alive six months and a day later. Many patients check in and out of hospice programs.

Ask your care provider: What comfort care options your loved one has at the same time you're discussing treatment options, especially if he or she wishes to have a noninvasive death experience at home. It's also possible to pursue both comfort care and curative care at the same time, so ask about that.

Myth: Hospice can't know what my loved one needs as well as his or her doctor. 
Hospice focuses on providing comfort and support, rather than curing an illness. It's a form of specialty care, although the patient's doctor can remain in the loop about care management. Regular medical treatment is not usually front and center, however, because the focus is shifting to allowing the person to live with as much privacy and dignity, and as little pain, as possible.

Hospice services differ by individual need and preferences but may include basic care management (such as chores, meals, personal care), counseling, physical or occupational therapy, caregiver respite, spiritual care, and bereavement support. There's some evidence that people at the end of life live slightly longer when enrolled in hospice than they would if not, possibly because there's less stress from futile invasive therapies.

Ask your care provider: What kind of services he or she recommends, how your loved one's primary doctor plans to interface with the case, how communication will flow between hospice and the medical practice, or whether a hospice doctor will now manage care.

Myth: The medication will "dope up" my loved one. 
Pain medication given as part of palliative care is meant to ease suffering -- not to hasten your love one's decline and demise. Dosages are carefully calibrated to manage pain, which makes it easier for your loved one to talk, rest, or spend time with family and friends. Uncontrolled pain is a common reason for poor quality of life at the end of life.

What's more, pain management is only one part of the full picture of comfort care. Your loved one can receive talk therapy, spiritual counseling, and physical support (even things as basic as help avoiding painful bedsores) that help him or her feel better than he or she might otherwise.

Ask your care provider: What the pain medication is for, how to use it, how to know when it's necessary, and what signs of pain and discomfort to watch for.

For more information about caregiving and hospice, visit Caring.com. Thanks to Paula for joining us at The Doctor is Listening!

8 Tips for Staying Healthy and Happy During the Holidays

Christmas, Hanukah, New Year’s—these are supposed to be times of celebration, togetherness, and happiness. Yet, they can bring challenges to our physical and emotional health. Here are 8 tips for staying healthy and happy during this holiday season.

1. Eat well. It’s common to pack on 5-10 pounds during the holiday season, but there are ways you can eat both healthy and well! Know which foods are high in caloric content and low in nutrition. Don’t deprive yourself of such treats, but indulge in moderation. Eat smaller meals instead of “saving yourself” for one huge buffet. Opt for healthy options at home, and when visiting others, bring a healthy dish to share. Be careful of liquid calories, including alcoholic beverages.

2. Stay active. Exercise is just as important during the holidays as any other time of the year. You should be active at least four to five times a week, preferably with some aerobic exercise every day. The weather may be cold outside, but the winter offers additional fun, too! Ice-skating, sledding, snow sprints—all of these can be great exercise. Enlist your loved ones to join you for quality bonding time.

3. Prevent illness and injuries. Colds and the flu are most prevalent in the winter. Prevent them by washing your hands regularly and urging others to do the same. Stay warm by dressing in layers. Sprinkle sand on icy patches. Watch young ones, and assist the elderly, who are at increased risk of falls and other injuries during this time.

4. Check your heating system. Making sure your heating works and is safe. Carbon monoxide emergencies can be fatal. Install a carbon monoxide detector and test it once a month. Keep grills and generators out of the house, and don’t run your car for long periods of time in the garage. Most residential fires also occur in the winter; never leave fireplaces, stoves, and candles unattended.

5. Travel safely. Whether you are going down the block or halfway across the world, follow extra precautions. Give yourself plenty of time in the additional holiday traffic. Never drink and drive. Be on the lookout for reports of extreme weather and heed warnings. If you’re traveling away from home, make sure to pack and take your medications. Know how to contact your doctor when you are away and have a medical problem, and where the local ER is.

6. De-stress. Holidays can be a stress time. You may be working, and feel the stress of managing your work duties along with additional commitments to your friends and family. You may feel the financial stress of gifts, and the interpersonal stress of conflicts. Try to anticipate sources of stress and develop a plan to manage them. This may involve committing to fewer get-togethers or setting a tighter budget. Don’t feel guilty; you have to take care of yourself before you can take of others.

7. Help others. Depression and suicidality increase during the holidays. Watch for signs of depression among your friends and family. Take an active role to support those in need. Invite those colleagues or friends who are alone over the holidays to spend them with you. Volunteer and give to those less fortunate.

8. Treat yourself. The holiday spirit is about helping others around you, but you also have to make time to take care of yourself. So treat yourself with something over the holidays. It may be something as simple as sleep. Sleep in and enjoy a day of rest; you need it. How about reading that book you’ve been meaning to for a long time, or getting a manicure or massage? Take the time to do the things that make you happy.

I hope these tips have been helpful! Do you have other tips to share? I welcome your comments. And happy holidays!