Summer Wellness Roundup!

By Brad Zehr, MS4 

Below is a curated set of items pertaining to wellness in medicine and medical training that I highly recommend as we savor the end of summertime. 

Morning report (“Becoming a Physician” series, NEJM, June 2017)
http://www.nejm.org.ezproxy.bu.edu/doi/full/10.1056/NEJMp1701939
Sonia Singh, MD, a general internist and primary care physician at Stanford Health, recounts her early-morning routine as a Medicine resident. Her essay beautifully captures the shared experience of being an overwhelmed and overworked medical trainee. In the daily crush of tasks that one must complete before 10 a.m. Morning Report, Singh extolls the value of deliberately stopping one's frantic mental checklist and internal ticking clock to be present with a patient every day, even at the expense of perfectly executing the task list.  

#pinksocks
http://pinksocks.life/about-us/
Pinksocks is a community of health care professionals striving for change in the culture of medicine. They advocate for greater emphasis on humanistic thinking and behavior among hospital teams, which starts with having more fun. The concept went viral when Nick Adkins, a digital health entrepreneur, wore pink socks at the HIMSS 2015 conference and Eric Topol Tweeted a pic of them to his nearly 100,000 followers. 

#CrazySocks4Docs
http://www.bmj.com.ezproxy.bu.edu/content/357/bmj.j2727.long
Yes, there is a 2nd relevant fun socks hashtag. Geoff Toogood, a cardiologist and physician mental health advocate in Melbourne, Australia, created the hashtag and designated June 1, 2017, as a day to advocate for physician wellbeing. Health care professionals across Australia (and a few from the U.S.) posted pics of their crazy socks to show solidarity, as did Australian Minister of Health Greg Hunt. Looking forward to June 1, 2018!

Characterizing the source of text in electronic health record progress notes (“Physician Work Environment and Well-Being” series, JAMA Internal Medicine, May 2017)
http://jamanetwork.com.ezproxy.bu.edu/journals/jamainternalmedicine/fullarticle/2629493
Many have cited the current generation of EHRs as one root cause of the growing physician/trainee burnout problem. Others have cited our current style of EHR note-writing as a root cause of medical errors that can potentially harm patients. In this innovative and important study, the authors analyzed 23,630 inpatient progress notes written by 460 hospitalists, residents, and med students in UCSF's Epic EHR from Jan-Aug 2016 by classifying characters in the notes as one of three possible types: 1) Fresh (manually entered), 2) Imported (smart phrase auto-populated), or 3) Copy-Pasted. On average, 18% of text was fresh. More systems science research is necessary to assess how we are actually practicing medicine on a daily basis and how we can leverage technology to improve physician satisfaction and protect patient safety. 

Association between indulgent descriptions and vegetable consumption: Twisted carrots and dynamite beets (JAMA Internal Medicine, June 2017) 
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2630753
Wellness incorporates both psychological and physical wellbeing, and nutrition is fundamental to both. This paper describes an experiment in a large cafeteria at Stanford University wherein the language used on veggie labels was the independent variable and amount of said veggies purchased was the dependent variable. Use of “indulgent descriptors” such as “sweet sizzlin' green beans and crispy shallots” increased the number of people selecting the veggie by 25% compared to basic descriptor (“green beans”) and by 41% compared to healthy-restrictive descriptor (“light 'n' low-carb green beans and shallots”). There was a similar effect on the amount of veggies taken per person. Any thoughts on an “indulgent descriptor” of exercise?

The hidden dying of doctors: What the humanities can teach medicine, and why we need medicine to learn it (Los Angeles Review of Books, May 2016)
https://lareviewofbooks.org/article/the-hidden-dying-of-doctors-what-the-humanities-can-teach-medicine-and-why-we-all-need-medicine-to-learn-it/
In her commentary on Paul Kalanithi’s “When Breath Becomes Air," Lois Leveen pauses at one particular passage in the book: the point where Kalanithi describes the suicide of his resident physician colleague, “Jeff." Leveen examines the power of art and literature to frame one’s personal struggles, just as Kalanithi used a simple 7-word Beckett passage to find meaning and purpose after his terminal cancer diagnosis. 

Do you have more recommendations? Send them to me so we can feature them in our next post. My email is brzehr@bu.edu.