Google’s new mental health tool is a good idea. But there’s more work to do.

Google has just come out with a mental health tool for those who query “depression” on its site. The Patient Health Questionnaire 9 (PHQ-9) is a series of nine questions that help assess depression symptoms. Doctors use it when screening for depression and use the results in conjunction with additional history from the patient to make (or not make) a diagnosis of Major Depression. Now anyone can access this same questionnaire on Google but is preemptively “encouraged to  talk to a care provider or doctor about what your score may mean for your overall health.” A link to the National Suicide Prevention Lifeline is also provided.

Depression, recently reported to be the world’s most widespread illness, has far-reaching implications when left untreated: from strain on personal relationships to disability and worsening of chronic conditions to an economic cost to society. As an internist, I saw many patients who were never diagnosed but wondered if they had depression. Some sought help even when their spouses or parents didn’t “believe” in depression and told them to “think positive” or “get over it.” I am thankful for those in the public sphere who bravely share their mental health struggles and help remove the stigma of mental health issues. And I applaud Google for designing a way to bring additional awareness to its users.

Google’s PHQ-9 feature is just a first step, however. Those who search the term “depression” likely represent a population who suspect or have been told they might have this diagnosis. But bringing awareness to the completely unaware is where the greatest impact can be made. I can’t count the number of times that patients have said – after diagnosis and when their depression is better controlled – that in retrospect, they likely had depression for many years and just didn’t realize it.  With platforms like Google, Facebook, Twitter and Instagram plus advancements in AI, we just might see that awareness occur sooner.



Kids get it.

Children never cease to amaze me.

During the holidays in our office, we had on our checkout desk a simple white Christmas tree the size of an 8oz paper coffee cup. It lit up and was a small part of our festive décor. As one of my patients checked out after an appointment, her daughter went right up to it, took in an audible and pleasantly surprised-sounding breath, and couldn’t help but exclaim, “Oh. It’s so beautiful!” A medical assistant and I just looked at each other and exchanged touched glances at the purity of the emotion.

Children are surprisingly forgiving, too. One minute they are upset about something a friend did, and the next, they can quickly find a way to look past it and be playful again. They are more resilient than we give them credit for. They want to be happy and they want others not to be sad.

Which is why I was both touched – yet not that surprised – at how some 1st graders in Minnesota supported the Viking kicker who missed what should have been a winning field goal in the last few seconds of last week’s football game against the Seahawks. I was happy for my Seattle team, but couldn’t help but feel for Brian Walsh. Anyone who’s ever worked in any field (medicine or otherwise) that involves making and executing critical decisions in an instant understands that type of weight. And like medicine, though football is considered a team sport with many players, in the end, it can be one person who ends up shouldering (or feeling responsible) for a bad outcome. Even the understandably upset Vikings coach, who should lead his team as an example of sportsmanship, made an unsupportive, frustrated quip to the media after the game. Since then, he has provided a better perspective to his team’s loss of the game. And, of course, may people used social media as a platform for malicious commentary without consequence.

As someone who lived and breathed Bulls basketball in Chicago years ago, and now is exposed to some of the real tough challenges in peoples’ lives,  I can truly say that, in the end, “it’s only a game.” And we are – each one of us – human.

Those first-graders know that. Kids know how to bounce back. They know how to rally and support. We should all learn from them in this very real and important game of life.

#DearPatient, just thought you should know


It’s midnight.

I’m still up…


and reviewing your chart.

Trying to find out what ails you.

Just thought you should know.

I am not Marcus Welby.

But I am your primary care doctor.




Useful links on Measles and vaccination (supplementing Seattle Times column)

My column on measles and vaccination appeared in this past Sunday’s Seattle Times.

Here are some informative links to articles to help continue to inform/educate the reader on this important topic:

CDC information on measles

Benjamin Franklin’s story


5 GIFs That Show Why Herd Immunity Is So Important

Measles Outbreak with a Baby at Home


Can a Food Delivery Service’s Business Model be a Solution to Food Deserts?

This post expands on the topic discussed in my latest (July 2014) column in The Seattle Times: “In a dietary rut? Here’s how to escape it.

Food conversations occur multiple times a day for me. I talk to patients frequently about dietary changes. I enjoy various cuisines and am fortunate to live in a city with an abundance of locally sourced food and a booming restaurant scene. However, as is the case for many people, figuring out weeknight meals while working full time is always a challenge.  Long clinic days don’t allow for much time pouring over a recipe or spending much time in the kitchen. An easy solution is to order food for delivery. But, even in Seattle, what’s quick is not always healthy. Besides, I happen to rather enjoy cooking. With time just as scarce on the weekend, what’s a healthy, fresh food seeker to do?

I discovered and signed up for a meal delivery service called Blue Apron at the beginning of the year. Blue Apron sends you a box of the ingredients you need to cook a meal for two (or 4 or 6, etc) three nights a week, along with instructions that fit one side of a glossy, 8×11 inch recipe card. You provide your own cooking oil (usually olive), salt, pepper, and water. Most items are premeasured, but you do have to do some prep work (chopping, slicing, dicing etc). It prices out to $10 per person per meal. While this is cost-prohibitive for some people (I can certainly whip up less expensive meals myself), it is unlikely I can have a set of recipes as varied as what Blue Apron provides. Discovering new vegetables, herbs, grains, and foods from other regions is invaluable. You learn to make things like salad dressings and pickles from scratch (with much fewer ingredients and preservatives!). It never feels boring to eat these meals. I can control the oil and sodium content of the food.  And since I grocery shop much less, I spend less on overall by not picking up extraneous items. I also don’t waste bulk ingredients for a specific type of cuisine that I might only make once. This service also eliminates my personal pet peeve, which is the “oops, I forgot to pick up an ingredient” emergency in the middle of cooking.

Blue Apron 1

Blue Apron 2

Can a system like this – at a lower price point – be an answer to food deserts across America? Food deserts are areas where people have limited access to fresh produce due to financial and/or geographical reasons. There has been a push (as part of First Lady Michelle Obama’s Let’s Move! Campaign) to try to engage Americans in healthier eating, with grocery stores being set up in such food deserts to make healthier items more accessible to residents in these areas. The results, however, have been disappointing. Reports state that the people living in those communities were more aware of the new store, but they never actually changed their purchasing or eating habits. Seattle, where I live, is the complete opposite of a food desert, yet some of my patients [and myself when I was younger and much less aware] seem to virtually live in one.  It might be due to cost, ethnic/familial culture, lack of time, or habit. I recently went to a cooking class where everyone in the group other than myself did not cook much. Though they had been to a few cooking classes, they never reproduced the dishes they learned. Perhaps a food delivery service like Blue Apron might provide the missing piece for healthy eating in food deserts and elsewhere by bringing the produce and the instructions to the individual.

Another plus with Blue Apron: you can engage your kids in healthy eating, too. The glossy handout with bright pictures is a great way to have kids go on a “treasure hunt” for different ingredients. They are naturally drawn to the little packages and surprise treasures in the box. They will learn about different foods along with you, and, if you include them in the process, you can draw them into eating foods they have never seen before, starting them on a lifetime of food exploration and awareness and less food anxiety than we have been experiencing in our current generation.


A few notes: 

While there are more food delivery services (like Plated), I haven’t tried them, so I have limited this piece to my experience with Blue Apron.

Be aware that if you have dietary restrictions or preferences, food delivery services may accommodate some but not all restrictions. If your doctor has placed you on a specific kind of diet, this type of service may not be right for you.

If you do want to try your hand at using Blue Apron, there is a fair amount of chopping and peeling involved. Taking a knife skills class can help you be safer and more efficient in the kitchen.

Also, I found that I prefer to eat more vegetables in a meal than what is provided with Blue Apron, so I occasionally supplement with vegetables procured from my local farmers market (a great thing to do in the summer). I could also sign up for vegetarian meals on the service, as a solution.  


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International Women’s Day 2014 in one single picture

Photo taken by Julie Smolyansky at Nakivale Refugee Settlement in Uganda. (If you care about the issues of women and girls in the U.S. and around the world and are not yet following Julie Smolyansky, you should. She is an inspiring voice and role model.) share this via: Advertisements


You’ve Come a Long Way, Baby

50th Anniversary of the Surgeon General's Report on Smoking and Health

Yesterday marked the 50th anniversary of the landmark Surgeon General’s report on smoking and health. It really wasn’t that long ago that smoking was a way of life. As the author points out in this piece on why people smoke, even doctors had cigarettes in their mouth while examining patients back then. The Surgeon General himself, Dr. Luther Terry, was a smoker until a few months before he made his speech in 1964. And for something so deeply ingrained into the culture, so addictive, and a major part of the economy – the report was given on a Saturday in fear of a negative stock market response – we really have seen a remarkable decline in smoking.

The antismoking campaign is a major public health success with few parallels in the history of public health. It is being accomplished despite the addictive nature of tobacco and the powerful economic forces promoting its use.

–          CDC

We now have a better understanding how diffusely tobacco affects the body. People who smoke are at higher risk of everything we worry about getting: cancer, heart attack, stroke, vascular problems leading to leg amputation, and looking older. I see many adult children of smokers who have never smoked, deterred by their parents’ habit. But many children and young adults continue to experiment with smoking, often thinking that they can quit anytime. Unfortunately, smoking continues to be glorified in other settings. Hollywood practically gives them away, somewhat reminiscent of cigarettes being provided to US soldiers in the past.

We’ve come a long way, but we’ve got more work to do.