The Steeper Obstacles Faced by Women in Medicine

by Dhruv Khullar

Happy medical residents are all alike. Every unhappy resident would take a long time to count.

A new study in JAMA Internal Medicine suggests yes.* Dr. Constance Guille and colleagues analyzed the mental health of more than 3,100 newly minted doctors at 44 hospitals across the country. Before starting residency, men and women had similar levels of depressive symptoms. After six months on the job, both genders experienced a sharp rise in depression scores — but the effect was much more pronounced for women. A major reason: work-family conflict, which accounted for more than a third of the disparity.

The structure of medical training has changed little since the 1960s, when almost all residents were men with few household duties. 

This article is worth reading by all trainees, prospective physicians, and practicing doctors.

Someday, this may be the reality

 *  Work-Family Conflict and the Sex Difference in Depression Among Training Physicians. Constance Guille, etl a.  JAMA Intern Med. 2017;177(12):1766-1772. doi:10.1001/jamainternmed.2017.5138  

Conclusions and Relevance:  This study demonstrates that depressive symptoms increase substantially during the internship year for men and women, but that this increase is greater for women. The study also identifies work-family conflict as an important potentially modifiable factor that is associated with elevated depressive symptoms in training physicians. Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians. Given that depression among physicians is associated with poor patient care and career attrition, efforts to alleviate depression among physicians has the potential to reduce the negative consequences associated with this disease.

I thought I wasn’t thin enough to be anorexic

BMJ 2017;359:j5378

Caitlin S, 17, and her mother, Sally, talk about what helped, and what didn’t help, when Caitlin developed anorexia

Comment by Brian Maurer, PA-C

This piece highlights the issue of the distorted body image that patients with anorexia nervosa manifest.  Although this adolescent dropped her weight by 10 Kg, she didn't recognize that she had developed AN because (1) her BMI remained at an acceptable level, and (2) her perception of a desirable body habitus was reinforced by social media.

It is interesting to note that this adolescent started to buy into the fact that she was sick after her doctors and caretakers educated her about her eating disorder and supported the diagnosis with facts.  Many patients suffering from AN forcibly push back against the diagnosis, as they continue to perceive their distorted body habitus as normal and desirable.

This case also raises the issue of how a patient with a body image disorder might relate better to a clinician/counselor/caretaker of the same sex, particularly when the patient is an adolescent female.

Widespread use of social media among young people has resulted in an uptick of anxiety, depression, cyberbullying, and suicide in this age group.  Clinicians who care for adolescents need to be aware of these influences as they evaluate and care for patients who suffer from eating disorders, mental illness, suicidal ideation and abuse.

BTW, the latest eating disorder to hit the DSM-V is ARFID, avoidant/restrictive food intake disorder. While similar to AN, patients with ARFID lack the distorted body image component.  We follow a handful of kids who meet the criteria for ARFID in the practice.

Prions Discovered in Skin of Patients With Creutzfeldt-Jacob Disease

Abnormal Proteins Discovered in Skin of Patients With Rare Brain Disease

By Denise Grady

NY Times Nov. 22, 2017  NY Times Link.

Finding so-called prions in skin samples may lead to early diagnosis of Creutzfeldt-Jakob disease. But the discovery also hints at possible risks from surgery.

The discovery suggests that skin samples might be used to improve detection of the disorder, Creutzfeldt-Jakob disease, which now is usually diagnosed with much more difficult procedures, like brain biopsies or autopsies.

The researchers said that although the disease had been transmitted decades ago by corneal transplants and certain neurosurgical procedures, there was no definitive evidence that other types of surgery had ever spread it. And the levels found in skin are far lower than those in the brain.

Creutzfeldt-Jakob is the most common member of a family of disorders that affect people and animals called transmissible spongiform encephalopathies. The diseases eat holes in the brain, leaving it looking like a sponge (hence the name). The other human ailments include kuru, fatal familial insomnia and Gerstmann-Straussler-Scheinker disease.

Principal Investigator, Wen-Quan Zou, M.D., PHD, CJD Foundation.

Prions from BSE in green (from NY Times article)

What if You Knew Alzheimer’s Was Coming for You?

Simple blood tests may soon be able to deliver alarming news about your cognitive health.

By Pagan Kennedy

NY Times, Nov. 17, 2017

This profound and thought-provoking article appeared in the Sunday Review. You may find it to be worth reading.

What if You Knew Alzheimer’s Was Coming for You?

Comments:

Arrogance

Franz J. Ingelfinger
N Engl J Med. 1980 Dec 25;303(26):1507-11.
This is a classic article; well worth studying.
FULL TEXT:

Franz Joseph Ingelfinger  (August 20, 1910 – March 27, 1980) was a German-American physician. He served as Chief of Gastroenterology at Evans Memorial Department of Clinical Research, part of Boston University School of Medicine. He also served as Editor of the New England Journal of Medicine (NEJM) from 1967 to 1976.[1] His work was influential in the field of science journalism.

Notes from Arrobance.

FJI Obituary in BMJ

Don’t demonise prescription opioids

It is rare that we hear from those who use prescription opioids.  Their voices are important counterpoints to the loud and self-righteous jeremiads of physicians, politicians and law enforcement professionals.

This essay was published in the BMJ in October 2017.

Our preoccupationwith opioid misuse could become the tail wagging the dog

Bob Roehr biomedical journalist.  BMJ

“I use an opioid drug, hydrocodone, every six hours, and have done so for about a decade.“Demonising prescription opioids can come to no good end."

F.W. Peabody: Classic Articles

Francis Weld Peabody was a Boston physician who died in October 1927 at age 45 from gastric carcinoma. He was a humanistic physician whose article "The Care of the Patient" was published in JAMA in 1927 a few months before his death.

This article is one of the most widely cited publications in the medical literature. Two other of Peabody's articles are classics, however one of these has never been published.
 

Oglesby Paul's 1991 biography "The Caring Physician: The Life of Dr. Francis W Peabody is a classic but may be hard to find. Peabody's classic articles are found in the appendices to Paul's book.

For the readers ease, these articles will be linked here:

1. TheCare of the Patient.  FWP, JAMA 1927
This paper originally appeared in JAMA in 1927. It is as valid and inspiring today as it was 90 years ago.  It is the most cited and revered article in the medical literature. Peabody’s wife remembered him saying, “I am absolutely sure that this little lecture will be remembered long after anything of a scientific nature I have written has been forgotten.”

2. The Patient and the Man: (Presented by Francis W. Peabody, MD before the New York Academy of Medicine, November 22, 1922) 
Chemistry, physiology, psychology—these and other sciences are making the foundations of medicine stronger from year to year, but medicine itself can never become merely an applied science. The proper employment of the fundamental sciences in the study of disease has become an essential for good medical practice, but over and above this, there must be something which correlates the scientific findings with the actual problems of the individual case—the art of medicine, which carries us beyond the patient to the man.   

3. Notes on the Effects of Morphine (unpublished.  Finished 5 days before his death)

This unpublished essay is “[a]n example of how FWP the scientist used his

illness to make clinical observations on himself with his description of his reactions

to injections of morphine. This document was completed on October 8, 1927, five days

before his death, and is a unique and vivid record of one physician-patient’s response to the powerful narcotic.” This is an extraordinary essay. Why it was never published is a

great mystery tome; but may lie in the fact that morphine was and still  is a much-maligned drug. Herein, we see how it allowed FWP remain lucid and function masterfully until the his death.