Are doctors on television just hams?

I recently came across a blogpost entitled “Everyone is Taking to the Camera- Pass the HAM please.” In it, the writer (a published author) says:

I have never seen more Doctors, Lawyers, Judges and ex-politicians on television than I have in the last few years….

Dr. Phil and Dr. Oz certainly must have been good Doctors, but think how much more they have learned on air with a staff and producers that can access any fact in minutes. Working for a producer doing new shows every day is much more demanding than working for patients. These Docs are quite camera friendly and seem to adapt well to the nuances of live TV; including pauses for commercials. Their message is popular and it seems that they here to stay.

….

What conclusions have I drawn from this diverse group of professionals that strayed into the small screen from other high paying professions? I believe deep down we are all HAMS looking for a modicum of fame.

I felt compelled to leave a response and, as you can see, it turned out to be a mini-blogpost. So I share part of it with you here and welcome your own thoughts and opinions.

I think I would have agreed with you on the “ham”-factor a few years ago. I guess I still do to some extent. Any person living in the public eye (including the one online) is likely to be craving an audience, after all. But, as a general practitioner earnestly interested in how accurately the media relays health information, I am less concerned these days about how people (doctors) got onto television and more concerned about the messages they are relaying.

A doctor might find himself deemed camera-worthy by producers after a stint on a matchmaking reality show. Or after being interviewed by Oprah. But what these professionals do with their position is ultimately what counts because their influence is huge. I cannot say whether working for patients or working for producers is more demanding, as I am in full-time clinical practice and have not done the latter. But to me, a big challenge is the fact that ratings (and not responsibility) drive content on television and that medicine discussed on television shows may be anything but “real” for the sake of viewership.

Luckily, more and more doctors are using social media to try to correct misinformation or relay more relevant medical issues without the sensationalism characteristic of television. These physicians might even use video to spread the word. We need good quality information, especially heath information, on television and it ultimately does not matter to me whether this comes from a HAM.

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Winners, Losers at the Golden Globes

Beautiful dresses, talented actors.… What’s not to like about last night’s Golden Globes? Well, how about this little detail from the NYTimes that surprised me:

 6:27 P.M. |To Smoke or Not to Smoke at The Globes

Here’s the difference between Hollywood on screen and off: cigarettes. On screen they are taboo. If you see one it’s accompanied by some carefully scripted moralizing about the ills of smoking. And even then the folks at scenesmoking.org are wary. But here, they give the things away. Seriously. Out on the smoking balcony where we saw Sean Penn pacing and puffing a couple of years ago, tables are thoughtfully stocked with little glass holders crammed with dozens and dozens of recessed-filtered Parliaments. As for drinking don’t even ask.

— Michael Cieply

I cast no judgment on individuals who smoke. In fact, I cringe when others refer to smoking as “ugly” or “disgusting,” both very strong and judgmental adjectives. My job as a physician is to teach people about the harms of smoking and to help them try to quit when they are ready.

Though Hollywood often seems to live by different rules than “the rest of us,” I am fairly certain they are no more immune from the dangers of smoking. That is why I found this “thoughtful” provision of carcinogens at the Golden Globes to be a poor choice from a health and health economics perspective. People should be allowed to smoke if they wish, but maybe the Golden Globes should reconsider having cigarettes readily available next year.

No one but Big Tobacco wins when it comes to smoking.

————

*As an aside -because I can’t help but comment on the fashion- my three favorite dresses of the Golden Globes were worn by Berenice Bejo (Elie Saab), Rooney Mara (Nina Ricci), and Nicole Kidman (Versace).

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Dear TV Producers, You Forgot to Say “Don’t Try This at Home.”

Confession: I have been watching the reality show The Real Housewives of Beverly Hills. I don’t typically have time to watch television, but I end up attaching myself to one reality series for a season. Most often, it is a design competition or cooking show that I watch once a week, such as Project Runway or Top Chef.

Quite frankly, I don’t take shows like The Real Housewives seriously and often wonder if it is bordering on obscene to have such lavish lifestyles displayed on the televisions of homes across America (and around the world) during these hard economic times. But I was particularly disappointed in some of the footage that was shown on last night’s episode. On the show, one of the castmembers took an unknown amount of xanax (a prescription drug that can cause drowsiness and is used for particular types of anxiety) for a flight and was also filmed drinking alcohol (also an unknown amount, though it appeared to be more than 1 drink) while on it. She was clearly affected by the combination, exhibiting psychomotor slowing and slurred speech that was surprisingly more inappropriate than usual for this particular person. What’s worse is that her friends found her all the more entertaining while overly intoxicated and never once cautioned her (or the audience) against combining xanax and alcohol. As a matter of fact, I would argue, this combo seemed to be promoted by portraying this person as entertaining and funny and by devoting a fair amount of air time to her intoxicated state.

The risks of xanax-plus-alcohol were dangerously downplayed here. Both substances depress the central nervous system and can cause coma and death whe taken in excess quantities or used together. The combination of even small amounts can lead to dangerous levels of sedation, poor judgment, and unsafe situations.

I did a web search on the topic of xanax and alcohol and this particular episode to see if anyone else had commented on the high risk behavior depicted in the show. None of the search results explicitly pointed out the dangers of mixing the two drugs. In fact, most blogposts and articles painted it as “awesome entertainment.” The unfortunate fact is, though, that we now live in a time where more Americans die from prescription drugs than from car crashes.  So what makes for good television ratings makes a doctor like me cringe. Xanax is a high-risk medication. Irresponsible use of high-risk prescription drugs should not be glorified on television.

Dear producers, if you want to put that sort of behavior on TV – which I would rather you didn’t – then at least include a stern cautionary warning about it, even if it is only in writing at the end of the episode.

Hopefully, this particular castmember’s own doctor is watching the show and reminds her at her next appointment not to mix xanax and alcohol. Hopefully.

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A Message Worth Repeating

I thought to myself, “I am not going to post a link to this article. It has been circulated many times already on Twitter over the past week.”

But I read it. Not once. Not twice. THREE times. I shared it on Twitter twice.

And I changed my mind.

When doctors recirculate a blogpost over and over again, especially one about such a thing as death, they are sending us all an important message.

So, I share it here with you, as well:

How Doctors Die. 

After you read the article, if you do not know what a POLST form is, please see this link.

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Happy First Birthday…

…to my blog.

It (I) survived a year of blogging. 

A very big THANK YOU to those who have been reading my blog.

Now, some cake….

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(photo by Will Clayton, from flickr creative commons)

There Are Side Effects to Attending a TED Event

This past weekend, I attended TEDxRainier 2011 , which was a very full day of inspiring, enlightening, thought-provoking, and humbling talks by speakers from various fields. I cannot speak highly enough about the experience. The interdisciplinary examination of ideas and the unifying themes that were explored brought back fond memories of my favorite course at Boston University: the two-year undergraduate Core Curriculum course. This was my first live TED experience and hopefully the first of many.

Today, I received a letter via e-mail from the curator of the event, Phil Klein. This general letter, sent to all attendees, thanks the attendee and provides links to videos and feedback forms for the event. However, it also goes on to say the following:

“Some people report that the few days after TEDxRainier can seem a little difficult or dull in comparison to the vivid intensity of the prior day. That is common, so don’t worry too much about it. It may help to take some time to relax and reflect, or to engage and connect with others on a project or adventure that inspires you.”

This oddly touching acknowledgment of a phenomenon that I did, in fact, experience sounded like something…well, something a doctor might say. Perhaps a new diagnosis is in order here: the post-TED-return-to-regular-life syndrome….

Except, I suspect that you do not go back whence you first started once you’ve attended a TED or TEDx event.

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The Power of the Story (or The Inadequacy of Stats and Data)

Here is a very common patient interaction I come across at least once every summer (truncated generic version):

A patient (usually a healthy woman somewhere between 30 and 50 years old) comes in with concern of swollen ankles for a few days. I make sure to assess for significant issues, such as heart failure, blood clots, etc. But her story is notable for eating more tortilla chips and salsa lately – it is summer, after all – and  vacationing (traveling via airplane) and eating out more. She has been walking more than she normally does in locations where temperatures reach 90+ degrees Fahrenheit in the summer.

I explain to the patient some of the causes of swollen ankles particular to her case: traveling, gravity, salt intake, heat, etc. The patient has skeptical look on face and says something that expresses doubt about my assessment. I explain more about the physiology of swelling in the legs. The patient continues to look quizzical. So I say, “This happens to me from time to time.”

What happens next? Bingo.

Quizzical look disappears. Patient: “OK. So what can  I do?”

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When I first started practicing, I was very “professional” (or so I thought). What I mean is, I was “all business” during the office visits, focusing only patients’ issues and interests and chit-chatting very little about my own. After all, they were not there to hear about me, right? Futhermore, talking about myself seemed to waste time that was already precious in a primary care physician’s workday. Over time, however, I realized I was wrong and that many of my patients did want to know more about me as a person, and it felt surprisingly nice, especially when it happened organically.

I recently realized that I divulge some of my own personal healthcare experiences now, things I normally wouldn’t reveal in regular conversation with friends. It seems that I have come to do this somewhat subconsciously not so that patients can get to know me, but rather to “validate” my recommendations (see above story). Now, as a – knock-on-wood – relatively healthy, young-ish doctor, I can only draw upon a very limited number of experiences. I am a bit too honest to make up stories. And though I’ve heard countless recommendations by patients that doctors should experience this procedure or that disease – and I completely understand this point –  exactly how many diseases does a doctor have to have for his patients to trust his recommendations?

The better question is: What is it about our stories that make them so much more impactful or appealing than medical knowledge or scientific data? This seems to be irrespective of demographic, as I observe in my practice. Male/female. Educated/uneducated. White/non-white. Younger/older. This effect has been demonstrated in all of these groups.

We see the power of stories in advertisements for fad diets or exercise gimmicks. We see it with new mothers who follow their own mothers’ “tried-and-true” wisdom even though it might be contrary to a doctor’s recommendations. We see it when people share naturopathic – or prescription, for that matter – medications with each other. “Try this, it worked for me.”

It can be mind-boggling and frustrating from a data-driven perspective. All this effort towards public and individual education for the empowerment and engagement of patients seemingly gets thwarted by simple, yet impactful, stories by people who have never even taken a biology class. Stories that may not even have any recognizable medical sense to them. This is not to invalidate The Story. (I feel there is a real place and an important role and a certain beauty to it. Stories in fitness magazines inspired me to become healthier years ago.) On the contrary, I am fascinated by the truth of the power of it…and the inadequacies of statistics and data in everyday clinical situations.

Data and statistics are most effective when gathered and used by objective individuals. They seem to lose relevance when we become the subject. When we are the ones with something even as simple as a sore throat, objectivity might fly out the window. And when we are the ones with illness, sometimes the underlying emotional/psychological aspects of our decision-making become amplified. For example, if we tend toward positivity, we might hear the success rates or the benefits more than we comprehend the risks. If we tend towards pessimism, we might lean towards the gloomier side of the medical equation, even if the chance is 50/50. If our nature is to overreact or always imagine the worst, we might dwell on the rarest side effect/outcome of a medication/disease. And, interestingly, sometimes the seemingly objective patient is one who is in denial.

This reflexive loss of objectivity when faced with a personal dilemma is such a human trait that it even applies to the very people who are trained to be medically objective – doctors. For example, a physician friend of mine was ill for a few days and asked my opinion on whether she needed antibiotics. Based on her reported symptoms – and without offering specific recommendations, as I did not examine her – I simply asked her if she might be reaching for antibiotics a little prematurely. She agreed that maybe she was. She needed a reminder to take a step back and reconsider her symptoms a little more objectively. I myself don’t feel I’m immune to this tendency though I am writing this post. Even though I might be able to treat myself for various things, I see my own primary care doctor for her assessment. I make sure to voice any worry that I might have about an issue, but I trust that she will remain objective, at least more so than I would be at that moment.

Statistics and data can be unglamorous. We can articulate them with various vocal inflections, but they are – (close your ears, statisticians) – still numbers, which do not have the same significance for everyone. But we do know that stories can last forever. They play over and over again in our minds. The story of the apple falling on Newton’s head was never true, but we as a society have held on to that image. It fulfills something within us. Religions “know” this. Cautionary fables, present in many cultures, reflect this. Modern medicine doesn’t. How do we make the data and statistics and the objectivity of our field more influential? Do we even need to? How do we as physicians “convince” patients to follow our recommendations? What do you think, fellow doctors? Patients, what was the most helpful thing your doctor did when you were faced with a difficult decision? I’d love to hear your thoughts.

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