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The unceasing stigma

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picture from https://medium.com/@gabriella_evang/mental-illness-is-more-visible-than-ever-yet-the-stigma-remains-the-same-af69327af7dd

 

If I have not made it abundantly clear on social media and the landing page of this website, I have a book coming out in April 2020, Fallible: a memoir of a young physician’s struggle with mental illness (pre-order here). I have shared my mental illness publicly before in multiple places, so I figured this wouldn’t be a big deal to have the fuller story come out. But it is. This is actually harder than I thought it would be (shows my naivete), to have my innermost thoughts and faults exposed so openly to the world. As I’ve started to publicize the book, I’ve realized how much I hate being the center of attention.

It has also shown me how much the stigma of mental illness as a moral failing remains with me. The very fact that I am so open about my illness is to help break the societal stigma of mental illness as a biological and social disease like so many others; we shouldn’t be ashamed. But I still have twinges of embarrassment for experiencing depression and anxiety as I do. I feel like less of a person sometimes because I struggle with it. I fear many will look down on me. And many will…because the stigma exists. But I need to remember that that does not make me a failure.

All that being said, I don’t regret writing or publishing the book. Overall, sharing my story has strengthened me beyond what I thought it could. I am in a good place with my mental health right now, largely because of being freed of the burden of keeping it a secret. I write this because I want to encourage all of you to not keep any struggles you may have a secret. It’s okay. We all struggle with something(s), this is not a sign of weakness but of being human. Talk about your feelings, because there is release in the telling.

 

 

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What are we doing anyway?

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picture from cartoonbank.com

I’ve been thinking a lot lately about what influences the medical decisions that I make. As a physician, I want to make sure that my medical opinions are sound and based as much in what we know for sure as possible. But most medical decisions aren’t based in science, even when it is something that has been studied and is known. I’m not talking about making decisions based on experience or individual biases, but those based on cultural trends, political winds, or for financial gain such as pharmaceutical disease mongering. All of these factors influence us in myriad ways that we don’t often even recognize. I explored this (briefly) in a recent post on Doximity, but hope to explore it in more depth in the near future. I’d love to hear what you think about some of these issues that impact the practice of medicine for all of us, and what examples you can think of.

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How efficient is US health care?

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Picture from Centerforcoachingexcellence.com.

While I regularly write about various aspects of health care, I have been using my participation in the Doximity Authors Program to more specifically explore US health care efficiencies from different angles. This was initially inspired by Victor Fuchs, PhD, the preeminent health care economist in the United States, from an article he published in the Journal of the American Medical Association in September. He explored health care efficiency from the micro and macro levels, and provided some interesting insight. From this starting point, I elaborated a bit more of this topic. I started broad in my discussion, first looking at what efficiency means broadly in health care.

I have since looked at this from a macro level, as well as how our macro inefficiencies lead to significant societal injustices. I have some further ideas on exploring this more, and would encourage you to read these pieces and let me know what you think.

I have also continued to explore behavioral economical issues in recent months, looking at narrative fallacies in medicine, as well as the role of emotions in decision making. Even just being aware of these things can make a big difference in our behavior.