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It Must Be True Because…

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Spider web South Shore 8-23-14

NaBloPoMo 2018:  What I’m Learning

Funny how fear crops up sometimes.  It’s especially distressing when you fear your own ‘team.’  But we are here to learn and grow, so we step forward. My point in this post is to practice critical appraisal of research data before accepting or integrating it; especially if I am biased toward it.

BI fox news worse 2012

A fellow progressive Facebook group member posted this photo with a message of glee and encouraging everybody to disseminate.  I admit I also initially felt justified and righteous when I saw it.  But something kept me from sharing on my own page.  I should do this more often, perhaps—let something marinate for 24 hours before sharing, just to make sure it’s really something I want to engage with.  I ended up commenting that I think we should be careful about disseminating this kind of oversimplified graphic, as the data may not justify the claim.  I await the angry backlash.

After reading the article in Business Insider from whence the figure came, I had more questions than answers.  What are  Farleigh Dickinson University and Public Mind, anyway?  “Researchers asked 1,185 random nationwide respondents what news sources they had consumed in the past week and then asked them questions about events in the U.S. and abroad.”  What were the questions?  How were they chosen, and how do we know they represent broader knowledge of current events?  “With all else being equal, people who watched no news were expected to answer 1.28 [out of 5] correctly; those watching only Sunday morning shows figured at 1.52; those watching only ‘The Daily Show’ figured at 1.60; and those just listening to NPR were expected to correctly answer 1.97 [out of 4—why the ask one less for this?] international questions.”  Are these differences statistically significant?  And regardless, if the best we can do is answer less than 40% of domestic questions correctly, yikes.  How do we know this actually represents the population?  How does this data compare to similar research findings, maybe ones published in higher caliber, peer-reviewed journals?

The Business Insider article did link to the study report it referenced. I consider this to be a sign of responsible journalism—I look for it in the publications I read—access to the primary literature, so I can dissect and interpret ‘data’ for myself.  Turns out the study was a follow up in 2012 of an initial survey done in 2011 that reported similar findings.  The specific questions and statistical methods are included, as well as discussion of the results.  And while it’s not as rigorous as I am used to reading in peer-reviewed scientific journals, with sections for abstract, background, hypothesis, methods, results, discussion, and conclusion, I could follow the language and rationale of the authors, for the most part. I think they could have done a better job making a distinction between correlation and causation.  I also wished for a discussion addressing implications of the data and recommendations for further study.

Interestingly, I found a Forbes article entitled, “A Rigorous Scientific Look Into the ‘Fox News Effect.’”  I thought it was going to answer all of the questions I asked above.  It started out appropriately skeptical:

In 2012, a Fairleigh Dickinson University survey reported that Fox News viewers were less informed about current events than people who didn’t follow the news at all. The survey had asked current events questions like “Which party has the most seats in the House of Representatives?” and also asked what source of news people followed. The Fox viewers’ current events scores were in the basement. This finding was immediately trumpeted by the liberal media—by Fox, not so much—and has since become known as the Fox News effect. It conjures the image of Fox News as a black hole that sucks facts out of viewers’ heads.

I got excited when I read:

I have done similar surveys, both of current events and more general knowledge. In my research too, Fox News viewers scored the lowest of over 30 popular news sources (though Fox viewers did at least score better than those saying they didn’t follow the news). The chart’s horizontal black lines with tick marks indicate the margins of statistical error. Last Week Tonight with John Oliver, a news satire, had the best-informed viewers.

Turns out the rigor of this scientific look at the FDU data amounted to not much more than pointing out that correlation does not prove causation.  The author, William Poundstone, is a prolific non-fiction author and biographer of Carl Sagan, so I imagine he has formidable expertise parsing research data, though I don’t see any published research or surveys of his own.

In the end I’m satisfied, because I have done my homework on this topic.  I feel righteous again because, this time, I extricated myself from ‘liberal lemming’ (is that a thing? If not then I just coined it) mindset…  But it took some time.  And writing about it has cost me some psychic energy for organization and expression.

As I write this it occurs to me that it would be much more time efficient to just not believe anything I see or hear on any media platform—just be skeptical about everything and leave it at that.  Huh…  Nope.  That feels too much like willful blindness, which does not align with my core values.  It’s worth taking several minutes sometimes and disengagement, to verify the quality of what I take in on a daily basis.  I hereby commit to making this a regular practice.  I’ll let you know when I find anything really worthy of integration and dissemination.

 

How Not to Engage

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NaBloPoMo 2018: What I’m Learning

My friend Alex* posted about being a nurse and how she loves it despite having to always hold her pee, skip lunch, and get bled on, puked on, peed on, and yelled at, all while missing her family and taking care of yours.  One of her friends, we will call him Greg, commented that until nurses unionize and demand professional respect ‘just like physicians,’ nothing will change.

My impulsive (GRRR!) response:  “Trust me, physicians are struggling, too. I propose that we stand up for one another. Then we’d really be a strong force. And in the end it benefits us all–doctors, nurses, patients, the whole care team and, most importantly, patients. Also, I don’t know of any unions that physicians can join, but there are ones that nurses can: https://nurse.org/articles/pros-and-cons-nursing-unions/”  Okay, I know, saying, “Trust me,” is not a good way to get someone to trust or listen to you.  And my reply was defensive in its origin.  I sincerely believe what I wrote, though, that allied advocacy is an untapped force for good in medicine.  Physicians, patients, nurses, all healthcare professionals—why should we not actively support one another in all of our efforts to achieve a more cohesive, efficient, fair, and collaborative system, one that works better for all of us?  Why can we not embrace our connections and combine our voices to call for change?

Greg replied that basically he does not believe that physicians are “struggling,” and he does not see how we would stand up for one another.  After Alex described that I’m a physician “who will always help the nurses,” he wrote that doctors “can’t be in the business of supporting nurses.”  That we should “be in the business of supporting” ourselves, and “from all the research I’ve ever seen, they’ve continued to do a pretty good job of it.  Good for them.”  He expressed support for physicians’ right to advocate for ourselves.  In each reply, he continued to make his point that nurses should unionize.

I find this thread fascinating.  There are so many ways Greg and I could interpret each other’s replies.  When he talks about demanding respect ‘like physicians’ through unions, what benefits and outcomes does he imagine will follow?  When I say “struggling,” I wonder what he thinks I mean?  Actually he asks me, “How exactly are physicians struggling?”  He goes on to write, “Nurses are nurses and should be for nurses.”  All of his comments and the tone I inferred from them caused me to beg off of the thread.  Too bad, it might have been an interesting conversation—if we could have it in person.  Maybe we can later.

But it motivated me to look up some information to post here, in case anybody wonders ‘how physicians are struggling.’  The answer is burnout, depression, suicide, and leaving work that we love because it simply costs us too much—and I mean costs other than money.

Physician burnout is well described and referenced.

Doctors suffer from burnout in especially high numbers, according to the study, which was designed to offer a representative snapshot of doctors and the general U.S. working population. Nearly half of U.S. physicians – 49 percent – meet the definition for overall burnout, compared with 28 percent of other U.S. workers. More than 54 percent of doctors have at least one symptom of burnout, a more detailed analysis found.

Doctors also register more than one and a half times the general working public’s rates of emotional exhaustion and depersonalization. Working a median 50 hours per week, their satisfaction with work-life balance is far lower than that of others: 36 percent versus 61 percent.

medscape burnout causes 2018

Medscape Survey 2018

There are myriad causes for physician burnout, and most of them lie in the system, not in our inherent lack of resilience or because of some intrinsic defect in our collective character.  The electronic health record has accelerated our dissatisfaction with work.  It does so by creating innumerable clicks to accomplish menial tasks, burdening us with data entry that detracts from actual medical decision making and patient care, and putting a physical barrier between us and our patients, further separating us in relationship.  Burned out and dissatisfied doctors are distracted, less empathetic, and aloof, and we may even make more mistakes.  And when we aren’t well, our patients aren’t well.

A 2015 Mayo Clinic study reported that roughly 40 percent of physicians suffer depression each year and almost 7 percent had considered suicide within the prior 12 months. It is estimated that 300 to 400 doctors take their lives every year.

The pain and suffering those statistics only hint at is bad enough. But they are compounded by findings that burnout corrodes the doctor-patient relationship, resulting in lower levels of patient satisfaction, job satisfaction and productivity, as well as higher levels of medical errors and disruptive behavior.

Burnout is also connected to the decision to switch jobs or leave medicine altogether — an ominous trend as the U.S. experiences a growing doctor shortage.

 

I have not addressed here the challenges that nurses face every day.  My mom is a nurse, and I have worked with nurses my whole career.  I see how they are treated by the system and by patients, and also by us physicians.  And yes, my extracurricular activities focus solely on advocating for physician health and well-being.  Maybe I should learn more about nurse burnout and job satisfaction, and figure out ways to advocate for my nursing friends and colleagues better.

Or maybe it’s too much to ask for groups to stick up for one another.  Maybe Greg is right, and it should be every tribe for itself, let others take care of their own.  Maybe it doesn’t do any good for people to know how and how much doctors “struggle.”  I don’t know.  But I have learned now not to instigate such debates on my friends’ pages on social media.

*Not her real name

 

 

Running Strong In Our Lane

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NaBloPoMo 2018:  What I’m Learning

So the NRA tweets, “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

Hmmm, self-important.  Yes, sometimes.  After four years of college, four years of medical school, up to seven years of residency and then another 3 years of fellowship to earn the privilege of operating on the spines, nerves, organs, and blood vessels of gunshot victims, to maybe give them a chance to stay alive much less walk and talk, I can tolerate a little (just a little) self-importance in my emergency medicine, neurosurgery, trauma surgery, critical care and other colleagues.  They are f*ing rock stars.

Anti-gun.  I have yet to meet any physician, or any person, really, who is wholly anti-gun.  We are pro-gun safety, anti-violence by guns.  We would like for toddlers to not kill their siblings and parents by accident.  We would like for domestic disputes to not escalate to someone shooting their family and then themselves in an impulsive fit of rage.  We would like for depressed and suicidal patients not to actually kill themselves, which is too much easier to do with a firearm than any other method.  We just want to stop being the only country where so many die every year from being shot by guns.

The American College of Physicians (ACP), the internal medicine professional society and my home for professional communion and development, and the largest medical specialty organization, has published an updated position paper on reducing firearm deaths in the US:

In 2015, 9 (the ACP) joined the American College of Surgeons, American College of Obstetricians and Gynecologists, American Public Health Association, American Psychiatric Association, American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, and American Bar Association in a call to action to address gun violence as a public health threat, which was subsequently endorsed by 52 organizations that included clinician organizations, consumer organizations, organizations representing families of gun violence victims, research organizations, public health organizations, and other health advocacy organizations (2). Yet, firearm violence remains a problem—firearm-related mortality rates in the United States are still the highest among high-income countries (3).

Cited in their tweet, the NRA Institute for Legislative Action posted an article (no author identified) picking apart the ACP’s research citations and approach, stating, “This position paper leaves one wondering if the authors reviewed the evidence, or just found works that suited their needs. For all of the bluster about their own important role in the anti-gun movement and all of the misuse of research findings, the ACP makes one thing clear: they respect their own rights and opinions far more than they do those of law-abiding gun owners.”  *sigh*  As I have not read the primary literature on gun mortality and public health myself, I will not comment on that here.  I will just say that I wholeheartedly trust in the integrity of my colleagues and leaders at the ACP.  I’m proud of our advocacy for patients and, more recently, for physicians ourselves and our well-being.

My physician colleagues have posted a multitude of passionate responses on Twitter; you can read them here, here, and here.  And I just now saw this open letter to the NRA from the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) and signed it.  Below are highlights—please take a look.

I admit, I initially responded with profanity at seeing the NRA tweet.  My threshold for swearing is very low these days.  And I wanted to just post screenshots of the anti-NRA tweet storm and let them speak for me.  But that’s not me. I have yet to really decide how I want to design my public platform and conduct on issues like this.  For now, I can just say that tweets and articles like the NRA posted are disappointing.  I don’t want to follow that lead.

* * *

Dear National Rifle Association,

On Wednesday night (11/7/2018), in response to a position paper released by the American College of Physicians (ACP) Reducing Firearm Injuries and Death in the United States, your organization published the statement “Someone should tell self-important anti-gun doctors to stay in their lane.”

On that same day, the CDC published new data indicating that the death toll from gun violence in our nation continues to rise. As we read your demand for us doctors to stay in our lane, we awoke to learn of the 307th mass shooting in 2018 with another 12 innocent lives lost to an entirely preventable cause of death–gun violence.

Every medical professional practicing in the United States has seen enough gun violence firsthand to deeply understand the toll that this public health epidemic is taking on our children, families, and entire communities.

It is long past time for us to acknowledge the epidemic is real, devastating, and has root causes that can be addressed to assuage the damage. We must ALL come together to find meaningful solutions to this very American problem.

We, the undersigned – physicians, nurses, therapists, medical professionals, and other concerned community members – want to tell you that we are absolutely “in our lane” when we propose solutions to prevent death and disability from gun violence.

Our research efforts have been curtailed by your lobbying efforts to Congress. We ask that you join forces with us to find solutions. Help us in our non-partisan, physician-driven research efforts at AFFIRM Research.

We invite you to be part of the solution.

You dismissed the ACP’s position statement on preventing death and injury from gun violence by stating, “Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.”

We extend our invitation for you to collaborate with us to find workable, effective strategies to diminish the death toll from suicide, homicide, domestic violence, and unintentional shootings for the thousands of Americans who will one day find themselves on the wrong side of a barrel of a gun.

We are not anti-gun. We are anti-bullet hole. Let’s work together.

Join us, or move over! This is our lane.