November 2022 – Tarrant County Physician Online

Medical Student Syndrome

By Sujata Ojha, MS – III

This article was originally published in the July/August 2022 issue of the Tarrant County Physician.

As medical students, we have an incredible opportunity to discover a vast amount of medical knowledge, learn about the normal and the pathological, and to immerse ourselves in clinical settings where we witness the complexity of diseases. In the process of learning about life-threatening diseases, the risk of nosophobia, or illness anxiety disorder, can develop. More commonly termed “Medical Student Syndrome,” it is a concept that medical trainees are well acquainted with.

What is Medical Student Syndrome? It is the phenomenon that causes fear of contracting or experiencing symptoms of the disease that the students are studying or are exposed to.

Medical students learn the pathophysiology, the diagnosis, the treatment, the prognosis, the best-case scenario, and the worst-case scenario of diseases. We learn about teenagers diagnosed with melanoma and hear stories about patients in their early 20s diagnosed with breast or cervical cancer. The worst-case scenario tends to grab our attention. This reinforces us to not ignore a patient or symptom that doesn’t follow the general pattern of the disease, allowing us to widen our baseline scope of clinical suspicion when it comes to debilitating pathologies. The constant medical stimulation and limited clinical experience earlier on in our education can cause students to become preoccupied with symptoms and construct connections between what we are experiencing with the worse-case scenarios we learn about.

“I booked an appointment with the dermatologist because I thought I had a melanoma,” said one classmate after we shortly finished our dermatology unit. After undergoing a biopsy, the classmate discovered that the melanoma in question was a benign nevus. During the cardiopulmonary block, another medical student said he went to the ER after experiencing mild epigastric pain and tachycardia, thinking he was experiencing symptoms of atypical myocardial infarction. He had recently encountered a patient in his late 30s with a history of MI who presented with similar symptoms, further reinforcing the “worst-case scenario” in this trainee’s mind. After hours spent in the ER, he was diagnosed with gastritis and sent home with a prescription for a proton-pump inhibitor.

Throughout my medical training, I have heard countless stories resembling these. This is not an uncommon phenomenon that trainees experience. It is a topic that everyone in medicine is familiar with, whether through personal anecdotes or through stories discussed with classmates, mentors, and acquaintances. Understanding the complexity of medicine takes more than four years of medical school. Medicine is a field that requires life-long learning and an internal motivation to be updated with evidence-based practice. Expertise comes with clinical experience and after encountering numerous successes and failures. I believe that these experiences can help future physicians connect with their patients more effectively. If we as medical trainees can fall victim to an overwhelming fear of vague symptoms, how can we expect our patients with limited medical knowledge to be immune to this? With Dr. Google, a benign tension headache can be escalated to look like brain cancer. Understanding these fears and reflecting on the days when we experienced these uncertainties can bridge the gap in patient-physician encounters. It allows us to effectively address the patient’s fears without judgement, urging us to educate our patients about their symptoms instead of dismissing or minimizing them.

TCMS Legislative Committee Kickoff

Join us for a night of fun and advocacy training as we kick off our 2023 TCMS Legislative Committee meeting.

In partnership with TMA lobby staff, you will learn about the top issues, challenges, and techniques we will use to advocate on behalf of physicians and patients during the upcoming session.

The TCMS Legislative Committee is one of the most active advocacy groups in all of Texas, and we need a strong bench of leaders who continue to be involved here in Tarrant County, Texas, and Washington D.C. Please RSVP to Elizabeth Bowers at elizabeth@tcms.org.

TMA Report

The development of TMA policy

by Gary Floyd, MD, TMA President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Over the past year, the Texas Medical Association has had to weigh in on one sensitive topic after another—from issues impacting the patient-physician relationship to how physicians practice medicine and the prevention of further cuts in the Medicare program.

Often, after TMA publishes its stance in the association’s daily newsletter, Texas Medicine Today, we receive inquiries from members on how TMA came up with that position since no one surveyed them individually or asked for their opinion. This has made me realize many of our members don’t understand who runs TMA or the process TMA uses to develop its policy, which drives the association’s communications and advocacy.

The association is governed by a 500-member House of Delegates, the legislative and policymaking body. The House is made up of elected county medical society delegates (one delegate per 100 members or fraction thereof) and the following ex officio members: members of the Board of Trustees; 15 councilors; Texas delegates and alternate delegates to the American Medical Association; members of the Council on Legislation and chairs of the other councils; delegates from the Young Physician Section, International Medical Graduate Section, Resident and Fellow Section, Women Physician Section, LGBTQ Section, and Medical Student Section; and delegates of selected specialty societies.

The House of Delegates meets every year at an annual session held during TexMed in the spring. In 2023, TexMed will be in Fort Worth on May 19–20.

The best way to get your idea adopted as TMA policy is to begin at the grassroots level.

1 Present your idea or change to an existing policy at your county medical society meeting. Ideas and actions also are developed by association boards, councils, committees, and sections. You can work with these groups to develop a policy recommendation.

2 If the county society, section, or other entity agrees, it can submit your idea as a report or resolution to be considered at the next meeting of the House of Delegates. Instructions for writing a resolution are at http://www.texmed.org/Resolution.

3 Every report and resolution is assigned to a reference committee that vets it further through open hearings at which any TMA member can testify. The reference committees then send their recommendations on each report and resolution to the house. If you would like to serve on a reference committee, let our House of Delegates speakers know by filling out the form at tma.tips/refcom.

4 If your idea is adopted by the house, it is incorporated into the TMA Policy Compendium (www.texmed.org/Policy). If it has nationwide appeal, it may also be forwarded to AMA for action.

As TMA president, I am obliged to represent our TMA policies. As you can imagine, we have members on both sides of several very sensitive issues. Some members would like TMA to issue an immediate, strong opinion favoring their stance. However, by working with our legislators, we have learned that calm, measured, commonsense approaches are far better received than knee-jerk responses. Therefore, in our responses we tend to emphasize areas of commonality for our members, like protecting the sanctity and privacy of our patient-physician relationships and creating a safe environment for our physicians to exercise their best medical judgment in providing the appropriate standard of care for all their patients.

Please reach out to your county medical society and learn more about TMA’s policymaking process. We want to hear from you!

Linda Siy, MD, named Texas Family Physician of the Year

Linda Siy, MD, of Fort Worth, Texas, has been awarded the highest honor among Texas family doctors by the Texas Academy of Family Physicians. She was named the 2022 Texas Family Physician of the Year during TAFP’s Annual Session and Primary Care Summit in Grapevine on Oct. 29. Each year, patients and physicians nominate extraordinary family physicians throughout Texas who symbolize excellence and dedication in family medicine. A panel of TAFP members chooses one as the family physician of the year.

“It truly is an honor to join the ranks of those who have received this distinction, and I’m very humbled to be considered with those distinguished colleagues who previously were Family Physicians of the Year,” Siy said as she accepted the award.

Siy has been a family physician for over 30 years, and currently practices at John Peter Smith Health Network at the Northeast Medical Home in Tarrant County, a practice she’s been a part of since 1995. She is also faculty at the University of Texas Southwestern School of Medicine, the University of North Texas Health Science Center/Texas College of Osteopathic Medicine, and the Texas Christian University Burnett School of Medicine.

Throughout her years in organized medicine, Siy has served on many committees and councils for both TAFP and the American Academy and has been president of the TAFP Foundation since 2017. She serves on the Acclaim Multispecialty Group’s Physician Board of Directors, and previously served as president of the Tarrant County Medical Society and TAFP’s Tarrant County chapter.

Siy has spent her career in medicine treating her loyal and multi-generational families of patients, many of whom are underserved, suffer from housing and food insecurity, and struggle with mental health and substance abuse. Many of her nominators mentioned her willingness to speak up and ask the questions others are too afraid to ask, as well as her dedication to teaching the next generation of family physicians.

“I think what’s kept me in the game for so long at the place where I work now are those rewarding relationships with your patients, with your staff, with your colleagues,” Siy said of her career in family medicine. “It’s really not a job. It’s a calling.”

It’s Not Okay

President’s Paragraph

by Shanna Combs, MD, TCMS President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

On June 23, 2022, the Tarrant County medical community lost an amazing physician, who died by suicide. He was a remarkable person whose work touched so many lives—he was always willing to help others. He is greatly missed by all who knew him.

Unfortunately, physician suicide has become an all-too-common occurrence in the United States.

• Approximately 300–400 physicians die by suicide each year in the U.S.

• Among male physicians, the suicide rate is 1.41 times higher than the general male population.

• Among female physicians, it is even more pronounced at 2.27 times higher than the general female population.¹

As terrible as this sounds, there is hope. Physicians who are proactive about their mental health are able to take better care of their patients as well as have more resilience in the face of stress. However, this is not so easy to accomplish.

There is already a stigma associated with mental health, and it is made even worse for physicians due to the concern of needing to report a diagnosis to our medical boards, licensing organizations, as well as to credentialing offices in the hospitals and health systems we work in. We as physicians also have difficulty taking care of ourselves in general, let alone when it comes to mental health, as we are the healers and must be perfect.

The truth is, being a physician is hard. We train for many years to be able to do the work that we do. We often share our war stories about medical school and residency, but when it comes to the deeper struggles we have, we tend to keep those to ourselves. We push them down and hide behind a smile (or a mask) and continue to pretend that everything is okay.

But it’s not okay.

We as a profession need to start taking care of ourselves and looking out for our colleagues. It is okay to tell someone when you are struggling and to seek out help when you need it. A psychiatrist friend puts it best—“Everyone needs a therapist. I have one.” At some point we all learned the physiology of the human body, and of the brain specifically. Sometimes that brain needs a little extra help from chemistry, and that is okay as well. If you have a thyroid problem, you do not put up a fight about taking a thyroid pill. The same goes when our brain chemistry needs a little help. We also need to reach out to one another, to check in and see if our colleagues are really doing okay and if they need any help or support. It’s okay to not be okay, but we need to recognize this and seek out the help we so desperately need, and to help our colleagues obtain the help that they need.

We also need to work from an advocacy standpoint so that physicians can seek the help that they need without the fear of needing to report their illness. All other aspects of medicine and healthcare are taken care of in a private manner between a physician and a patient. Why should mental health be any different? Until this changes, no number of wellness programs, resilience building, etc., will be able to fix the problem.

I encourage everyone to seek help when needed and to reach out to our colleagues, partners, and friends. We have worked tirelessly to get to the point we can practice medicine, and those around you want you to stay here.

References
¹John Matheson, “Physician Suicide.” American College of Emergency Physicians. Accessed August 3, 2022.

https://www.acep.org/life-as-a-physician/wellness/wellness/wellness-week-articles/physician-suicide/#:~:text=Each%20year%20in%20the%20U.S.,times%20more%20often%20than%20females

Mental Health Resources

National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Available 24/7

Crisis Text Line
Text TALK to 741-741
Available 24/7

Physician Support Line
1 (888) 409-0141
Open seven days a week,
7:00am – 12:00am CST
Psychiatrists helping their U.S. physician colleagues and medical students navigate the many intersections of our personal and professional lives. Free and confidential. No appointment necessary.

Emotional PPE Project
emotionalppe.org
The Project connects healthcare workers in need with licensed mental health professionals who can help.