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Wednesday, December 31, 2014

The war on cancer: A public health triumph

In the war on cancer, the American Cancer Society announced in a yearly report by Stacy Simon that over the last 20 years, 22% fewer people have died from cancer, representing 1.5 million avoided deaths.  The biggest single reduction occurred in lung cancer, according to the Society’s Vice President for Surveillance and Health Services Research, Ahmedin Jemal.  There are fewer smokers, as millions quit, and millions of others never started smoking.

This was not primarily the result of medical care, though doctors certainly advised many of their patients to quit.  Rather, quitters used a variety of methods over multiple attempts to quit, including advice from doctors and others, smoking cessation products like patches, gums, etc., reading generic or individualized materials, quitting cold turkey, etc.  So this wasn’t “patient engagement” by the medical system per se, as quitters were not primarily benefiting from their doctors’ active medical management of their smoking.  They weren’t patients; for most quitters, cancer had not developed to the point where they required treatment for cancer.  Rather, in most cases the successful quits came from multiple self-initiated efforts by the “worried well,” often with nudging by family members.

There is much credit to share for all the lives saved, e.g., for doctors who advised patients to quit.  Yet this victory seems due more to public health efforts than to the medical system. 

Efforts to meliorate the toxic effects of other lifestyle choices about alcohol, drugs, overeating, inactivity, etc., might also benefit from focusing on public health efforts addressed to the worried well, in similar ways. 

Advice:  Have a happy New Year!   Give a hug to your public health friends, and let’s celebrate!   

Tuesday, December 30, 2014

Skype psychotherapy and pets: It brings us closer

Joseph Burgo’s story:
I’ve been a clinical psychologist for over 30 years. Trained in the psychoanalytic method, I spent most of my career in an office seated behind clients who lay on a couch. Then, three years ago, after several followers of my blog asked if I would be willing to work with them by Skype, I started practicing face-to-face video psychotherapy with clients all over the world. Usually I “meet” them in their homes.
Often, I meet their pets as well.
Noelle, a 42-year-old woman living in the Australian outback, reached out to me for help coping with a midlife crisis. She had recently learned she would never be able to bear children and was in profound grief. She usually spoke with me from her bedroom, where she would sit cross-legged on the bed. Often I heard her dogs, three Shelties, barking in the background. One day when they seemed especially obstreperous, she gathered them onto the bed with her. I will never forget the agonized expression on her face as she told me, “These are my children.”
As she wept, she held one of them close and buried her face in his fur. My chest ached and tears came to my eyes. Rather than the existential loneliness of weeping on a couch, staring up at a blank ceiling, hers was a grief shared with her animals. Although across the world and thousands of miles away from her, I shared it, too. We were together, all five of us, in the pain.
After all my years in practice, I’ve come to understand that the greatest influence on the healing process in psychotherapy, at least the way I practice it, is the love I feel for my clients and the love they come to feel for me. As a professional, I’m uneasy speaking this truth aloud, and my clients often don’t feel entirely comfortable with it either. The love we feel for our pets helps ease the way. I witness the affection they feel for their pets, they see mine for Alice, and it brings us closer.
Although Sigmund Freud’s psychoanalytic method encourages the analyst to present a blank screen, concealing all details of his personal life, thoughts and feelings, Freud himself practiced from his home and included Jo-Fi, his favorite Chow Chow, in many of his sessions. Freud supposedly relied on his pet’s reaction to a client for help in assessing the person’s character. He also felt that a dog’s presence helped to calm his clients.
I’m sure that if my teachers and supervisors from analytic training were to hear about the work I now do and my views on the healing power of love, they would shake their heads in disapproval, concerned that I had gone to the dogs.
Read another post about the therapeutic power of love. 
Thanks to Joseph Burgo, whose New York Times article and Opinionator blog post are excerpted here.  He is the author of the forthcoming book The Narcissist You Know: Defending Yourself Against Extreme Narcissists in an All-About-Me World.

Monday, December 29, 2014

Medical decision-making among treatment options: The signature medical mistake of my life

     Dr. Jerome Groopman and Dr. Pamela Hartzband wrote a clear and insightful book, Your Medical Mind:  How to decide what is right for you.  They illustrate decision-making through stories about themselves and their patients.

     Dr. Groopman’s father died from poor care for a heart attack, back in the days when some doctors thought that removing the heart attack patient’s blood would unburden the failing heart.  As a reaction, Dr. Groopman became a “maximalist,” believing that modern medical interventions were generally good things.  Following that belief, when suffering from persistent excruciating back pain, he opted for aggressive surgery—spinal fusion--when merely waiting might have been preferable.  The surgery gave him lasting pain and debility; he called it “the signature medical mistake of my life,” with disastrous consequences.  It also gave him a long-term belief in making more nuanced decisions about treatments for himself and his patients. 

     Years later, his doctor advised him to take a statin to reduce his high cholesterol.  In light of the heart disease in his family, he knew he had to do something.  However, Dr. Groopman knew of a friend who had incurred lasting muscle pain, a common side effect of statins.  So he negotiated with his doctor to take a smaller dose of statins, and found that the smaller dose was great enough to lower his cholesterol, and yet small enough to avoid any muscle pain.  

Advice to patients:  Learn from the experiences you and your friends have had and your family history.  Consider them and your biases when making decisions about your medical treatment.