The Surprising Lesson from My Cross-Country Book Tour

It’s been two and a half months since the publication of my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, and I’m exhilarated and exhausted. Since January, I have been traveling around the country to talk about why it’s so important for doctors to listen and how patient empowerment can transform medical care. The reception to these messages has been excellent, and I’m very grateful to my colleagues around the country for inviting me to speak.

Having given dozens of talks on When Doctors Don’t Listen, I can predict most audience questions. Invariably, someone will ask about medical malpractice: aren’t doctors just protecting themselves by ordering more tests? (My response: the primary cause of malpractice is lack of communication, and tests don’t replace communication.) There will be another question about how the medical profession has reacted to the book. (My response: quite well—who wants to admit that they’re the doctor who doesn’t listen?)

There is one more question that is consistently raised, from Boston to Los Angeles to St. Louis to Cincinnati, one that I wouldn’t have predicted. What do you think about integrative medicine, someone will ask. Why don’t doctors advise patients on other options beyond pills and CT scans? What about treating the whole person, and preventing disease from occurring in the first place?

This question surprised me, as did my lack of knowledge of how little I actually knew about integrative medicine. Even though I was born in China, a country steeped in combining Western practice with Eastern philosophies, my medical training has been exclusively from conventional Western institutions. I cannot recall one course during medical school or residency that focused on complementary medicine or holistic care, or anything other than the disease-oriented model of Western medical care.

In fact, it wasn’t until I was asked this question during my book tour that I began looking into the concept of integrative medicine. I learned that integrative medicine is not synonymous with complementary and alternative medicine, but rather is “healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.”

This sounds like the type of medicine that all doctors should all strive to practice, and all patients strive to receive! In the words of physician and noted humanist Dr. Abraham Verghese, integrative medicine isn’t “wedded to a particular dogma, Western or Eastern, only to the get-the-patient-better philosophy.” Indeed, millions of patients in the U.S. and around the world embrace this holistic medical practice, and the pioneers of integrative medicine, such as Drs. Andrew Weil, Bernie Siegel, Deepak Chopra, and Dean Ornish, are widely revered.

Yet, from my own experience, I know that integrative medicine is not something we are teaching future doctors. I can also see that, based the persistence of this one question asked around the country, patients are hungry for knowledge on what they can do that goes beyond our Western concepts of disease. Instead of prescribing a pill for blood pressure and cholesterol, what is an exercise regimen that I can try first? Is there an alternative to surgery for my back pain, including yoga and massage? How can doctors coordinate my care with more “traditional” healthcare providers like nutritionists and physical therapists, as well as more “alternative” providers such as acupuncturists and naturopaths? Health is not just about illness, but about prevention and maintaining wellness—how can patients partner in all aspects of their health?

I am in the midst of writing a series on medical errors that occur in the hospitals. We know that conventional Western medicine can save lives, but we also know that medical error happens far too frequently. We also know that 30% of all tests and treatments are unnecessary. Patients are seeking an alternative approach to health. They want information about prevention and natural approaches to health. They want to talk to their doctors about it, but are finding that their doctors—like me—know precious little about integrative care.

During my research in China last summer, I spent some time observing the practitioners of Traditional Chinese Medicine, who were adept at integrative medicine. Unfortunately, this, and my brief but educational visit to Emperor’s College, an oriental medical school in California, is the extent of my interaction and knowledge of integrative medicine.

Now that the book tour is coming to a close, I am looking to learn more about the surprising topic that has emerged and to think more about how to educate conventionally trained doctors like myself to practice a holistic approach to patient care. Please reply with your suggestions for resources. Include links. Recommend books. Suggest places for me to visit, virtually and in person. Contribute your experiences. I’ll post more from my journey in this blog.

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!

Physician, Seek Help--Don't Just Heal Thyself

In my second year of medical school, I attended a reading by Dr. Abraham Verghese, a physician, writer, and humanist. He had just written a book, The Tennis Partner, that was about his friend and then-medical student who lost a slow battle to drug addiction and mental illness. The book was about how their relationship developed—and how he found out about his friend’s problems, then failed to act on it. The reading was poignant because of his obvious emotional involvement, and because the topic hit close to home.

How many of you know medical students, residents, and doctors-in-practice who have been depressed? Who have thought about harming themselves or tried to numb their pain with alcohol and narcotics?

Studies have shown that physicians have a far higher rate of depression, substance addiction, and suicide than the general population. Medical students start out with similar mental health profiles as their age-matched peers. During medical school, one in four medical students become clinically depressed. One in ten entertain thoughts of suicide. Despite their ready access to healthcare, physicians-in-training seek help with lower frequency than other young professionals.

Researchers have come up with various hypotheses to explain these findings, including social isolation during training and greater tendency towards perfectionism. In a New York Times op-ed, surgeon-writer Dr. Pauline Chen discussed the problems with the “survival of the fittest” mentality that is prevalent in the medical profession. While in training, who wants to be the “weak” person who seeks help? Who wants to admit they want more support than someone else, or burden others with time off or shifts to cover?

I faced this issue myself in my second year of residency. My mother died after a long battle with cancer. She had fought it for years with surgery and aggressive chemotherapy until finally she was in remission. Then, during my internship year, we found out that the cancer was back. The last few months of her life were filled with terrible suffering. She fought despite the pain because she wanted to make sure my then-16-year old sister was OK. Finally, she agreed to enter hospice care, but she never quite made it home. She died in the ICU, at age 54.

As much as my family was prepared for her death, and as much as it was welcome because it put an end to her suffering, it was a very difficult time for us. Coming back to work was much harder than I expected. Every cancer patient or critically-ill patient reminded me of my mother and her last days. I cried after every shift. I was on an emotional rollercoaster: things would seem to be getting better, then an issue with my family, or a patient, or a patient’s family, would set things off, and the rollercoaster would come crashing down.

My experience is a pretty specific example of grief and bereavement, but I think the lessons I learned are applicable to other physicians who are coping with their own challenging situations. I share them with you now:

1) Accept the support of family and friends. This may seem obvious, but I made the mistake of shutting people out and burying myself in errands and busywork just to keep occupied. Thankfully, those closest to me didn’t allow me to isolate myself, and I learned that losing ourselves in our training is never a good solution. It may temporize the pain, but will only serve to alienate us from those who care about us.

2) Ask for help. This could be as simple as letting your school, program or hospital know of your need for time off. In my case, I didn’t tell anyone in my residency when my mother got sick. I wish I had, because I would have been able to spend more time with her in her final months. When she died, I even resisted taking time off. In retrospect, I came back to work too soon. I thought I was being strong and wanted to prove—most of all to myself—that I could do it. But the result was traumatizing to me, and I probably ended up delivering less than ideal patient care. There is really no shame in admitting that we need help, whether it’s help for specific things like covering shifts, or if it’s referral to a counselor or support group. Both Dr. Verghese and Dr. Chen wrote about how silence is what leads to deadly outcomes. “Physician, heal thyself” is a mantra that fosters bravado, not compassion.

3) Recognize and help address challenges that others around us are facing. Prior to my experience, I hadn’t realized how prevalent depression and addiction are in our profession. The Tennis Partner describes a very plausible scenario that could happen to any of us. After all, if one in four of all physicians-in-training are depressed at some point in their training, it’s likely that a couple of our friends or colleagues are having problems at this moment. As physicians—indeed, as humans—we have a duty to make sure that those around us are OK.

So do your part. On a personal level, reach out to your friends. If you suspect they are in trouble, reassure them that you’re there for them and that it’s OK to seek help. Make use of student support services in your medical school or hospital. Start your own support groups if none exist. In my residency, I helped to start the Emergency Medicine Reflection Rounds (EMRR) where residents meet to discuss personal reflections and give advice and support for each other. EMRR has been successful so far, and the feedback we’ve received reinforces the importance of establishing and fostering community. 

Medical training is not an easy process, but we are not alone. We can each do our part to preserve humanity, promote wellness, and approach each other, and our patients, with respect and compassion.

Parts of this article have been published in AAEM's Common Sense magazine and on Medscape.  I welcome your feedback and comments on this blog post.