Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes.
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Posts tagged "depression"

Pediatrician phone call: Hey Dr. Wayfaring, I have a patient of yours here in the Peds ER. 

Me: Ok, who is it?

Pediatrician: Sally Teenager. She brought her baby here for a cold. But Sally’s also here as a patient. With postpartum depression. In the peds ER. 

Me: mmmkay, is she suicidal? 

Pediatrician: I don’t think so, but um… I’m not well equipped to deal with post partum depression… because I’m a pediatrician. 

Me: oh…. yeah. Well set her up to see me tomorrow then. And make sure she’s not suicidal! 

Hi WMD. How do you approach patients who are seeking treatment for self harm? Is it something you see often? Have you seen instances where the fact that a patient self-injures has affected the way they were treated or the attitude of medical staff towards them? How do you handle it? - anon

I see self-harm occasionally. So far, it’s always been in teenagers. When patients are seeking help for it, I generally start them on medication or refer them to a counselor. 

Yes, self-harm probably does affect the way some patients are seen. I know many doctors hear “cutting” and automatically label the patient as having borderline personality disorder. While self-mutilation is a symptom of the BPD, not all cutters are borderline. Some docs hear cutting and roll their eyes, excusing it away as “teenage drama.” 

In my experience, many people self-harm because they don’t know any other way to cope with or express their feelings. So my job as their doctor is to provide them with better ways to cope.

*Soapbox*

I think to some small degree, the publicity that some celebrity cutters have gotten has led to an increase in the activity in teenagers. Cutting has become so visible in the media and online that when a person gets depressed and doesn’t know where to turn for help, it suddenly becomes an option in their mind.

 ”This is what people do when they’re depressed.”
"Maybe this will help me feel something other than numbness."
"I just need an outlet." 

Unfortunately, depression is a self-perpetuating process. The more one dwells on the funk, the nastier it gets. People get depressed, do or think about things that disgust them, then feel guilty about it, and then get more depressed.

The solution is to break the loop. See a doctor. Start a medication to help you get out of the loop of funk. Talk to a counselor and figure out ways to deal with your oppressive thoughts and actions.  I see so many people that stay entrenched in depression simply because they’re too afraid or embarrassed to ask for help. How many times do I have to say it? Do something. 

So I have a question. Does being treated for depression while in medical school affect your ability to get into a residency program? I was told that there’s a spot on the ERAS application or something where they ask you if you’ve been treated for depression. - anon

I know that there was a question about it on my state medical license application, but I can’t remember about ERAS. I think there was. I tried to look it up, but I didn’t find anything. Maybe someone who has filled it out more recently than me can remember?

I believe the question is worded in a way to ask if you have any medical or psychiatric diagnosis that would affect your ability to take care of patients. My state, like many others, can limit a physician’s practice if they report a psychiatric condition on their license. Now this is usually investigated heavily, and state boards work more on treatment and rehabilitation so they can keep doctors in practice, rather than kick them out.

As for residency programs, it’s probably the same deal. I would imagine that if you clicked “yes” on the question, it would ask for an addendum to your application explaining your answer. I’m honestly not sure how it would affect getting into residency. 

Asker Anonymous Asks:
Hi WMD! I was just wondering about your advice regarding students with depression. I know you've written in the past about how it's best to take a break to get your head together...but... have you known someone who has got through med school regardless of depression/anxiety/suicidal thoughts? How did they manage it?? Sometimes it just seems (and sometimes it is) impossible to get myself out of bed and to school but I really don't want to take time off :( thank you always for posting <3
wayfaringmd wayfaringmd Said:

The one person I know who was suicidal during med school took time off, but I do know several people who dealt with pretty severe anxiety in med school. Those folks mostly got professional counseling or medication to get through. If you’re to the point where you can’t get out of bed, you need help, friend. I know that the idea of taking time off sounds bad and scary, but so does failing school because you can’t get out of bed. Seriously, find a counselor, a doctor, something. 

Asker Anonymous Asks:
Were you taught any particular ways to encourage patients who are having a tough time coping with ongoing illness and might appear to be depressed? Is this something that you think is your responsibility to notice/question or does it fall outside your duty (and in the hands of perhaps a psychologist)?
wayfaringmd wayfaringmd Said:

We don’t have any set technique that we learn in med school. We’re just taught to be aware that your patient may have issues beyond the physical. But in general I would encourage patients to talk about their difficulties coping and would encourage them to seek counseling of some sort, whether formally in a series of visits with me or a trained counselor, or informally through a pastor or friend. 

It is absolutely my responsibility as a doctor to notice a patient’s change in mood and worsening depression. Mental illness affects physical health and well being. Plus, I’d add that the majority of patients suffering with mental illness do not seek help from a psychologist or psychiatrist first. They usually go to their family doctor about it. And many patients either don’t realize that they’re depressed, or they are unwilling to recognize it in themselves. That’s when we family docs, who have the benefit of continuity of care and know our patients well, can step in and be a big part of helping a patient heal physically and mentally. 

Dr. C: How can you know the difference between depression and burnout in residency?

JB: By how you act when you’re on vacation. 

I am a senior in high school and I want to become a doctor, but medical school seems… Tiresome and depressing. I feel like once I get there I’ll be so isolated and alone that I will give up. How does one handle that? It just seems so daunting to me. But medicine is my passion and I don’t want to give it up! -scienceofthes0ul

Well friend, you have judged medical school correctly…sort of. It absolutely can be tiresome and depressing, and it is at times (and residency moreso). But the cool thing is that when you’re tired and depressed, most of your friends are probably feeling the same thing. 

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That doesn’t sound very comforting, but it kind of is. You will be surrounded by people who are just as miserable as you are, and they can empathize with you and you can use each other to get through. It’s funny, I spent less time with my friends in med school than I did with friends in undergrad, but I was much closer to my med school friends, and I think it’s because of this miserable dynamic. 

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Take my best good friend, for example. We somehow managed to get every 3rd year rotation together, which was a godsend. She kept me sane, for real. And during our 4th year when we parted ways for much of the year, we still called each other almost daily to share crazy patient stories, catch up, and commiserate. 

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But just in case you’re not lucky enough to find a best good friend in med school, here are some tips to avoid isolation, depression, and burnout. 

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Yet another picture tagged with #drugs and #depression and #bipolar to shock and gain attention, and yet these are birth control pills. Last I checked, Yaz was not an effective treatment for bipolar disorder. 

Yet another picture tagged with #drugs and #depression and #bipolar to shock and gain attention, and yet these are birth control pills. Last I checked, Yaz was not an effective treatment for bipolar disorder. 

Today my pastor’s sermon was on depression, and while the overall message was very good, I got a little bent out of shape about one comment. He talked briefly about some folks he knew who had attempted or committed suicide, and he said “and these weren’t single people. They had families and stuff to live for”.

Good to be told I have nothing to live for. 

wayfaringmd:

Can you give me tips on dealing with depression? I’m a second year med student (on a international university, so is second year of six) who really loves medicine, especially surgery, but feels that does not have what it takes to be successful, to be a good doctor. I’m constantly thinking, “I’m not good enough, not that smart, I don’t have the abilities…” :S (can you please answer this on anon?)

I once told my mentor (and imo the best freaking doctor in the history of ever) that I didn’t feel like I was smart enough to be a doctor. This was like late in my fourth year of medical school, so I should have felt more confident, right?

Her (very wise) response? 

“I wake up every day and think I’m not smart enough for this job. That’s what keeps me reading and learning.”

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The point is, none of us feel good enough, smart enough, compassionate enough, competent enough, etc, at least at some point in time, if not all the time. The people who claim they do have everything under control are the ones most in danger of hurting someone because of their arrogance. Shoot, I have the “I’m not smart enough to be a doctor” thoughts at least weekly, and I’m already a doctor. 

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wayfaringmd:

Lately I’ve been seeing a lot of posts on my dash where people talk about misusing their anti-depressants. Some take an extra because they had a bad day, while others will go without for a few days just to see if they can. These posts really bother me and worry me, and I’d like to clear some things up.

1. Anti-depressants (SSRI’s) are not magic. Please hear me when I say that their purpose is not to make you happy. Their purpose is to treat depression. They are there to get you out of the funk so you can function like a productive member of society. Presumably they bring you back to a physiologic baseline, which you can then improve upon with prayer, counseling, meditation, lifestyle changes, etc. Happiness cannot be found in a pill. 

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yourcraysisterinchrist:

I got so many questions the last week about my thoughts on antidepressants and anxiety medication.  And 99.9% of the people I were talking to, were reluctant to seek professional help, because it would mean that they have failed.


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THIS!!!

As another example, would you get mad at your immune system if you got the flu? No, you just take medicine and get back to your old self!  You can’t kick yourself or blame yourself for not being able to will healing into existence, whether the disease is the flu, cancer, or yes, even depression. 

What is your advice for encouraging medical professionals to pay more attention to the patient in front of them and less to their preconcieved notions regarding their diagnosis? (Mostly mental health related)

-sweetnessspokane
I’m not real sure what you’re looking for here, but this is what I came up with: 
  • Depression or anxiety can look wildly different in different people. A 75 year old widower will present very differently than a 15 year old girl, 40 year old housewife, or 35 year old businessman. Don’t expect everyone to come in complaining of SIG E. CAPS type symptoms.  You have to dig for that
  • image
  • Don’t assume they’re not taking their medicine just to spite you. Ask them. Maybe they can’t afford it, or they’re having unpleasant side effects, they don’t understand how to take it correctly, or it’s just not working for them.
  • Don’t forget that their psychiatric diagnosis can affect their other medical diagnoses and vice versa.  
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This is why I love primary care: I get to form relationships with my patients, learn about their struggles, and watch them change and grow. 

I have a patient who has treatment-resistant depression and multiple medical problems. I’ve seen her 3 times in the office since I started residency in July. Every time I see her, she looks like the “textbook” depressed person we learn about in medical school: slumped over in her chair, slightly disheveled, eyes trained on the floor, making very few facial expressions (flattened affect), talking & moving very slowly—if she moves at all (psychomotor retardation).

The first time we met, I asked if I could pray with her. She was, like many of my patients, both surprised and delighted by my question. At the end of my prayer I looked up and she was smiling. Not a full smile—the type that shows in the eyes—but an upturning of the corners of her mouth nonetheless. She asked if she could give me a hug, and I obliged. Our second visit ended on a very similar note: half grin, hug. 

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wayfaringmd:

Can you give me tips on dealing with depression? I’m a second year med student (on a international university, so is second year of six) who really loves medicine, especially surgery, but feels that does not have what it takes to be successful, to be a good doctor. I’m constantly thinking, “I’m not good enough, not that smart, I don’t have the abilities…” :S (can you please answer this on anon?)

I once told my mentor (and imo the best freaking doctor in the history of ever) that I didn’t feel like I was smart enough to be a doctor. This was like late in my fourth year of medical school, so I should have felt more confident, right?

Her (very wise) response? 

“I wake up every day and think I’m not smart enough for this job. That’s what keeps me reading and learning.”

The point is, none of us feel good enough, smart enough, compassionate enough, competent enough, etc, at least at some point in time, if not all the time. The people who claim they do have everything under control are the ones most in danger of hurting someone because of their arrogance. Shoot, I have the “I’m not smart enough to be a doctor” thoughts at least weekly, and I’m already a doctor. 

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For those who missed it due to late night posting.