One in Five

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By Vanessa Galli, MD

Nearly one in five women have reported experiencing rape in their lifetime according to the most recent data from the CDC. Statistics never mean as much to the reader as an “n of one” or a personal testimony. I myself am the one in five, a survivor of rape. That is not the point of this article, but rather serves as a context for a larger conversation.

I bring this all up at the beginning of this article because it shouldn’t be any different than talking about any other part of one’s life story. The shame and the embarrassment that these events are shrouded in stops us from having open conversations and prevents survivors from seeking the help that they need. I also bring this up to challenge your stereotypes about rape trauma survivors and for any of you reading this who share my experience to remind you that you are not alone in this journey. One in five means that many of you reading this unfortunately share this part of my life’s story.

Sexual assault can come in so many forms, both big and small. I have always been aware of gender biases in conversation, although have become increasingly aware of these throughout medical training. Each time I was called “Sweetie”, “Honey”, and “Angel” and told that I “looked like a Barbie Doll” by patients, it became harder to just shake it off and walk away. I attempted gentle correction, changing the subject and removing myself from the conversation. I never found a “good” solution and was left feeling guilty on some level. I found myself asking the question, “What did I do to bring this on?” I was experiencing some form of survivor’s guilt.

I also began see how often we do this to one another in the work environment. I began to notice that my female colleagues are frequently addressed collectively as “ladies” or automatically by their first name in conversation, while their male colleague sitting next to them may be addressed in the same breath as doctor. In the hospital setting, I have overheard staff complementing male providers for their “bluntness” and female providers with a similar communication style accused of being “harsh and unapproachable.” We live in a world of micro-assaults that are committed innocently in the work place every day.

So what exactly do we do about this? I do not believe in being overlying politically correct as that doesn’t further the conversation and leads only to frustration and tip-toeing around the true issues at hand. I believe in being direct and open in communication, a style that was born from my Northeast roots. So on that note, I challenge each person reading this to question your own preconceived notions and stereotypes. We are in a line of work that relies on solid skills in pattern recognition and judgement, although sometimes we need to leave that judgement at the door. We need to have open conversations with each other. We need to feel comfortable and safe correcting one another, whether it be a patient or a co-worker. Only then, will we create a work environment and a patient care environment that is safe for everyone.

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 Vanessa Galli, MD is a Chief Resident in the Family Medicine Residency Program in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.

 

Choosing Gratitude

By Kara Frame, MD

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I don’t remember the exact lecture or rotation, but somewhere along the course of my medical school education, I was taught this powerful lesson: a person is capable of changing how she thinks.  Of course, people have natural tendencies- leaning more positive or tending toward a more pessimistic outlook- but to some degree these preferences are pliable rather than fixed.

 

In a very rudimentary way, it can be explained like this: our brains are facile, constantly remodeling themselves.  And, if a thought becomes repetitive, it reinforces the nerve pathway that it triggers, essentially making the pathway stronger. The reverse can also be true, if we de-emphasize a certain pathway (thought process) it may become less prominent. This lesson resonated with me and the concept seems to resurface in my conscious at different intervals in my life.

 

As a family doctor, the idea has helped me offer hope to patients, many of whom, unfortunately, struggle with depression and anxiety.  Of course, I would never mean to suggest to them or to you that their disease can just be willed away, that simply reframing their thinking will make all of their problems disappear.  That way of thinking suggests the disease is completely within their control, something they might have caused or are responsible for, which is grossly false and is partly responsible for the stigma they often feel when it comes to mental health conditions. It minimizes their experiences.  However, when I talk about the multi-pronged treatment that I often recommend for depression or anxiety, it typically includes medication, good therapy, and lifestyle interventions.  The last part can be overwhelming but it can also be empowering.  When you are battling depression and/or anxiety, so much feels out of control.  You might feel at times as if you are “going crazy” or losing your mind.  It often comes with a sense of hopelessness.  So, the idea that there may be things within your control can be uplifting.

 

Eating well, being physically active, being rested, generally taking care of ourselves: these are the pillars of health that can be difficult to maintain even when we are not depressed, so trying to do this under the weight of depression can become impossible.  Therefore, I encourage my patients to start very small.  To choose one thing to focus on first and then we build over time from there.  Still, just wanting to exercise more or eat “better” doesn’t often get the desired results, so we often have to back up a few steps.

 

No one can make a change until she understands what is stopping her in the first place.  And, for many of us, that something that is in the way is often our own thinking.  “I am so out of shape, what’s the point?” “I can’t even walk to the mailbox-there’s no way I can run.” “I have already eaten half the bag, what difference does it make if I eat the whole thing now?”  These are all paraphrased examples of the negative self-talk, I have heard from patients.  When they start to think about change, some version of these negative thoughts will run through their heads. And, once these negative thoughts are recognized, the work of re-framing them can begin.  If we recognize the repetitive thinking as it begins, we can then stop it and shift to something different, replacing the negative with more positive and actionable thoughts.

 

As for us doctors, we are not above the negativity.  In fact, we are often more susceptible. It is generally accepted that doctors have a higher rate of burnout than the general public, and we certainly are at risk for depression.  People talk about the jadedness that often envelops physicians somewhere along their training- people who began a profession with total optimism and a desire to help too often becoming filled with negativity and, sometimes, contempt.  I have seen this in residents, young doctors going through the gauntlet that is residency.  There are times when it can become overwhelming and even the most positive can begin to falter.  And, I have seen this in seasoned physicians with many years of practice under their belts.

 

For my own part, I have been pretty fortunate.  I have been lucky to train, both in medical school and in residency, at places that were very supportive.  And now, I work in a program that places a very high value on personal wellness.  And yet, there have been times when I found myself slipping into negativity, too.  Something I subconsciously considered myself to be above happening to me, just as I had witnessed in other friends, colleagues, and learners.  I have always considered myself to be a positive person, so don’t like it when this new pessimism starts slithering in.  I try to practice what I preach and make an effort to change.  By consciously focusing on the countless things I am grateful for, at least once each day, there is less time for the negative chatter.  When I start this practice, sometimes it is hard to think of much, but as I become more practiced, numerous things pop into my head each day.  By choosing gratitude I also shift back toward optimism.
As I am writing this, I recognize that I am vastly oversimplifying a very complicated process, a process that often has many starts and stops, times of progression and regression.  Yet, in a time where there is a lot of uncertainty, when many feel lost and as if there is nothing in their control, I find it comforting to be reminded that we can do something pretty big: we have the power to change the way we think.

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Kara Frame, MD is an Assistant Professor (Clinical) in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.

Just Do It

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By Brian Hill, MD

I have a big interest in Sports Medicine, and I was recently chatting with someone who is involved in the field.  We had a brief discussion on the topic of doping in athletics.  This is an intriguing but unfortunate topic.  It has been a part of sports for years and is ever-evolving.  From blood doping and EPO to testosterone and performance enhancing drugs, there is a wide range of ways to get a leg up on the competition.  Research studies are constantly being performed to find better ways of detecting banned substances and to perfect the “athlete’s biological passport”.  However, as quickly as research is being done to expand detection, ingenuity and science work just as quickly to establish new methods of doping and ways to avoid detection.

It has always been fascinating to me to consider the variation in doping among different sports and countries.  Historically and recently, certain thoughts come to mind when doping is mentioned.  Because they have recently been in mainstream media, everyone is familiar with Lance Armstrong and the Russian Olympic Team scandal.  Doping exists in some form or another, in all sports, and in all parts of the world.  However, doping is intertwined with certain sports, while it is virtually non-existent in others.  Some major sports like baseball and football often have players being suspended for doping, while others like soccer and basketball rarely do.  Similarly in less mainstream sports, weightlifting, track and field, and speed skating have more frequent doping accusations, while rowing, swimming, and tennis are sports with similar physical demands but have much lower rates of doping.  Arguably, the sport most tarnished by doping is cycling.  Some have argued that during certain periods in professional cycling, doping was so rampant that cheating was necessary in order to be competitive.  The physiology of certain sports lends to greater benefits from doping; but even so, a crossover sport (one that has a similar strength, speed, and endurance profile) may have significantly less doping.  What is it that makes doping part of the culture of some sports, while it is viewed as unacceptable in others?  What can be done to change the culture of doping-predominant sports?

Doping carries with it some obvious consequences.  Athletes who dope are so caught up on winning that they are willing not only to cheat, but they are also willing to risk harm and deleterious health outcomes upon themselves.  Studies have shown that athletes are very aware to these risks, and that they feel increased performance is well worth these risks.  As Family Medicine providers, we stand at the forefront of evaluating and treating many medical conditions.  I would argue that we also could make a difference in the culture of doping.  We can screen for use and help counsel young athletes during well child checks and pre-participation physicals on the negative outcomes of doping and on the right way to perform and win.  It would be relatively easy to add a question about performance enhancing drug use to a visit involving a patient involved in competitive sports.  This could be used as an opportunity to educate athletes on the negative health effects associated with doping and to reinforce fair play in sports.

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Brian Hill, MD is a second year Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.