Author Archives: Sarenka Smith

Doctor Burnout: Part II

July 11, 2017

In response to the growing problem surrounding physician burnout–a national epidemic that impacts not only the health of medical practitioners, but also patient care–Stanford Medicine has hired a chief wellness officer.

In an unprecedented first move for a U.S. academic medical center, Tait Shanafelt, MD will lead Stanford Medicine’s pioneering program in the field. At a time when physician burnout “nationally has reached an all-time high,” Dr. Shanafelt will direct the WellMD Center at Stanford Medicine, while serving as associate dean.

Shanafelt has paved the field of wellness in medicine, overseeing multiple national surveys since 2008 that have included over 30,000 U.S. physicians, and 9,000 U.S. workers in other fields. The surveys have indicated increasing rates of burnout among doctors; in 2014, more than 50% of those surveyed were suffering from “emotional exhaustion, loss of meaning in work, or a sense of ineffectiveness and a lack of engagement with patients.” Shanafelt’s studies have confirmed that while physicians suffer, patients do also, as burnout leads to increased errors and increased rates of mortality among hospitalized patients.

Shanafelt has stated that the trend is “eroding the soul of medicine.” While many leaders in healthcare recognize that physician burnout is an imminent threat to their organizations, many do not know how to effectively address it. Shanafelt will work to build Stanford’s innovative WellMD Center, established in 2016, which has engaged more than 200 physicians through programs aimed at peer support, stress reduction, and a variety of ways to cultivate compassion and resilience. Furthermore, the center seeks to relieve some of the burden and pressure on physicians, through improving efficiency and simplifying workplace systems.

The conference will host the first American Conference on Physician Health in October, co-sponsored by the American Medical Association and the Mayo Clinic. This event will support opening up a national dialogue on the issue of physician burnout, while creating efforts to address physician distress through programs that promote “physician autonomy, efficiency, collegiality, and a sense of community.”

Nutrition Education in Medical School

July 7, 2017

Recent statistics show that more than two-thirds of Americans are considered to be overweight or obese. With diabetes and obesity on the rise, in addition to spikes in other lifestyle-related diseases, it has become critical to highlight the necessity of self-care and healthy living habits. Yet while physicians are generally considered to be reliable sources regarding nutrition, more than 50% of graduating medical students continue to rate their knowledge as ‘inadequate,’ and only one in eight patients receives counseling from their doctors on dietary health benefits.

A study designed to quantify the required number of hours of nutrition education at U.S. medical schools, in addition to an investigation regarding the types of courses offered, reaffirmed the supposition that medical students receive an inadequate amount of nutrition education. Only 27% of surveyed schools required a course dedicated to nutrition; on average, U.S. medical schools only offer 19.6 hours of nutrition education—across four years of medical school.

A 2016 study in the International Journal of Adolescent Medicine and Health assessed the basic nutritional knowledge of fourth-year medical and osteopathic school graduates entering a pediatric residency program. On average, the incoming interns were only able to answer 52% of the 18 questions correctly. Marion Nestle, a renowned professor of nutrition, food studies, and public health at New York University, chalks much of this up to the fact that there is a primary focus on treating–rather than preventing–diseases.

Throughout the past several decades, there has been a push towards improving the medical nutrition education that students receive. With suboptimal knowledge about dietary habits, future physicians are selling both themselves and their patients very short. It is imperative to equip health practitioners with the necessary tools and information that they can utilize in their practices, ultimately addressing the root causes of real, pervasive problems.

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Tick Town: Increasing Occurrences of Lyme Disease

July 5, 2017

First recognized in the United States in 1975 after a puzzling and unexplainable outbreak of debilitating health issues near Lyme, Connecticut, it was not until 1982 that doctors identified the correlation between deer ticks and Lyme disease. The disease is caused by several strains of the bacteria Borrelia burgdorferi, transmitted to humans through the bite of an infected tick. Once a tick emerges from an egg, it frequently becomes infected during its larval or nymph stage, as it feeds off small animals like squirrels, mice, or birds that carry the Lyme-causing bacteria. During the tick’s subsequent feeding cycle, it passes the bacteria to a human, or another animal.

Early symptoms of the disease often manifest as a flu-like illness, with accompanying fever, chills, muscle aches, and joint pain. While the characteristic ‘bulls-eye’ rash called erythema migrans is often present, many people develop a different type of rash, or none at all. Moreover, a host of Lyme symptoms occur in other diseases, and as a result, many patients suffering from Lyme disease are misdiagnosed with conditions like fibromyalgia, multiple sclerosis, and other psychiatric illnesses, before being correctly treated.

If Lyme is not diagnosed or treated in its early stages, it transitions to a chronic, highly problematic late-stage disease, and symptoms increase in their severity. Untreated Lyme disease will eventually infect joints, the heart, and the nervous system—causing nerve paralysis and meningitis, and difficulty with memory and concentration.

There are approximately 329,000 new cases of Lyme disease each year, and the number of those infected is expected to increase. According to Rick Ostfeld, a disease ecologist at the Cary Institute of Ecosystem Studies, the illness is on track to produce its worst numbers in 2017. Moreover, many experts believe the true number of Lyme cases is higher than reported, as the Centers for Disease Control and Prevention require ‘objective measures’ like positive blood tests or rashes; therefore, estimates indicate that CDC surveillance only captures approximately 10% of reportable Lyme cases. There is currently no vaccine for Lyme disease, and most researchers note that the FDA-approved blood tests are often inaccurate.

Because of the multi-faceted and complex nature of Lyme, neither standard nor functional medical treatments work very well in this patient population, nor is it enough only to treat the infection in many patients. Andrew Heyman, MD, MHSA, a renowned expert in chronic infections and Lyme disease, states: “Common complaints such as fatigue and weight gain can be wrapped in a much deeper problem such as Lyme that may be underlying the clinical presentation. To successfully treat Lyme patients, one must eradicate the infection, resolve the chronic inflammatory response and repair the injury to the brain – all of which is possible with targeted therapies to restore patients back to health.” A true specialist in this field, therefore, must have an extraordinary ability and capacity to treat the patient as a whole, with experience and skill in not only hormonal balance, stress management, microbiome health, and detoxification, but also genomics, brain trauma and injury, chronic infections, and mold exposure—along with managing other complicated factors associated with Lyme disease.