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September Newsletter!

September 2021

Welcome to the September issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being. 

 

1. COVID and…
The impact on Pediatric Hospitals in the US:  In Time, veteran health reporter takes us into a busy New Orleans children’s hospital, and the reality that has emerged: Delta is different. Children are not spared. Cases are rising, as are deaths. With vaccine approval pending, stronger mandates may be all we have left.

Vaccine incentives:  Since consulting for Twitter’s health design team, and now serving on their incentives advisory board, I’ve gained a new appreciation for how to incentivize for healthier behavior both online, and offline. Offline, I specifically mean public health behavior. As reported by the CBC, it’s clear that mandating vaccines for social activities like eating at restaurants, is effective in incentivizing those who have held out from being vaccinated. It provides people with a choice: if socializing in private institutions is of value and can supercede any residual mistrust in public health, vaccine rates can increase.

Vaccines — they aren’t a panacea:  In STATNews, an excellent explainer on the COVID19 vaccines, how they work, and the limits.

The brain and mind: From NatGeo, an incredible deep dive into how SARSCoV9 may impact the brain, even or especially in those who had mild respiratory symptoms.

Learning to live with COVID19: echoing the Atlantic, it’s here to stay (and a nice buffer for this poorly titled piece in the same outlet — can we do away with these sorts of forecasts once and for all? Have we not learned to take things one week at a time? 😔). 

2. Podcasts (and shows) worth listening to/watching 
It’s no surprise that most of us are facing trying times mentally and emotionally; this is a time of collective trauma as we face what appears to be a never-ending pandemic. A great podcast with Ezra Klein, interviewing The Body Keeps the Score author Bessel van der Kolk about trauma and the body. Follow this up with Gabby Bernstein’s discussion with the founder of Internal Family Systems Therapy founder, Richard Schwartz. An excellent PDF handout on IFS, as it could apply to *you*, by Canadian psychotherapist, Derek Cook is excellent and found here.

I also had a chance to watch the Susan Sontag documentary, Regarding Susan Sontag, on HBO — what an incredible life! She was a writer who spent time between NYC (West Village) and Paris, bucked the status quo (especially for women) and was insatiably curious. Definitely worth a watch.

3.On…Afghanistan through a renowned author and an inspiring athlete
The situation in Afghanistan is troubling to say the least. This is why both this article, featuring author (and doctor!) Khaled Hosseini in the NYT and another article, also in the NYT, about a ParaOlympian from Afghanistan named Abbas Karimi is timely and inspiring.  

4.Sound (and wise) reflections
~What public health communication can learn from advertising and marketing, in Business Insider. (twitter thread here).
~A powerful essay, in the NYT, about being a full-time caregiver for a loved one during a pandemic

5.Miscellany 
A frightening tragedy in the Bay area, which hit close to home after having recently spent time in SF/Oakland, which included hiking. Thankfully, Pulitzer-prize winning journalist Matthias Gafni, of the SF Chronicle is on the case, hoping the mystery gets solved soon.

I learned a new term in August: “Japandi” — thanks to Better Homes and Gardens. Those who know me know my interest in all things design and design-thinking. For a long time I wondered if Japanese industrial design was more similar to Bauhaus (German) or Scandinavian. Perhaps this answers it, or simply suggests that there’s a different approach that melds it all together. 

Shine Theory came up during a recent Op-Ed Project call. Worth reading (and ideally, integrating!). 

6.Best tweets of the month goes to…

@White_Owly, referencing Oscar Wilde  😜. 

“It is absurd to divide people into good or bad. People are either charming or tedious.”

@Saahil_Desai on diversity in newsrooms — not just reporters but the editors as well (though a quick look at the Atlantic’s masthead suggests it’s not much better  — potentially actually less diverse editorially — than the WaPo) 🙃

“I know we’re all over the Indian Food Discourse, but fundamentally, this is a diversity in journalism problem. If for no other reason, hire nonwhite editors so they help ensure that your publication doesn’t clown itself”

And this clip from Jimmy Fallon/Kit Harrington, because it made me laugh extra hard.

7.Products/Services that have made a meaningful difference during the pandemic:

I’m trying something new this month — this newsletter is not sponsored, but I love sharing products/services (including books, workshops) that have made a meaningful difference in my day-to-day, i.e. things I’d share with my friends. So I thought I’d share one with you each month. This month, I’m sharing the Harmoni standing desk converter. The standing desk craze is a few years old now, and became more popular since work-from-home/WFH began 18 months ago. It’s a good craze overall: sitting for hours on end *isn’t* healthy for us!

That said, I’m a stickler for design, and I try not to buy things that seem too trendy (i.e. what we could get bored of, and what might end up collecting dust), tough to assemble, or bulky and not pleasant design-wise (think lots of metal, plastic etc). So when I heard about the Harmoni desk I knew I found something that would work. It even has a “Japandi” design! A quick search online (amazon, etsy) has a few others that are similar but either require more assembly, are more expensive, or the reviews suggest the wood might be a bit flimsy.

The Harmoni comes in 4 pieces that slot together, which follows the Japanese tradition of “kanawa tsugi,” which means wood joinery via slats. In other words: no tools, nails etc. It takes 15 sec to assemble and disassemble, and stores flat or vertically when you want to use your desk the ‘regular’ way. Best part is that it’s affordable: from approx $250 Cad ($200USD) and up, depending on the finish. Displayed below is the cork mat which I added on to ensure it doesn’t slip. Combine with an anti-fatigue mat to stand on (which you can purchase anywhere), and you have a great WFH setup! 

Again, this isn’t sponsored, so I don’t have a discount code to share, but let me know if you’re using a standing desk or a converter or just improvising (for awhile I just used a lapdesk on top of books). 

In My Own Words…

For STATNews, I wrote about a topic I’ve been a bit obsessed with since December 2020, after an offhand comment a friend made (about being ‘resistant’ to COVID19) caused me to wonder if there were, indeed, people out there that may have true genetic resistance to the virus that has killed millions, crippled economies, and has left the vast majority of us anxious/unwell/uncertain. Indeed, there are — but researchers are only beginning to understand it, and what role this knowledge might play in terms of therapeutics for this pandemic, and others in the future. The response to the article has been great — I continue to receive emails and letters from readers believing they could be resistant (classically: having been exposed to multiple family members, sharing a home, etc but never having a positive antibody or PCR test) and wanting to participate in a North American trial, if the Brazilian trial is replicated. The one question I have left is: now that vaccine rates are high, does this pose issues for discerning who may be resistant?    

I also recently got invited to give a keynote talk at a major conference in November, and now my mind is busy imagining *what* I could talk about and *how* to make the topic compelling. Thankfully, I have time, and will likely build on a recent article I wrote!

A few weeks ago I read the late Susan Sontag’s beautiful New Yorker short story about the time of AIDS, “The Way We Live Now,” published in November 1986. It’s well worth a read as the themes certainly resonate today as well. And, September is National Yoga Month (more information about the evidence here) — try to get out, stretch and move if you can. Earning my yoga teacher training certification in 2016, was one of the best decisions I’ve made, for my body, mind, and spirit.

Have a healthy, joyful, and safe September (and upcoming labor day weekend),


Amitha Kalaichandran, M.D., M.H.S.

When Recovery Requires Rest

By backing away from major sports tournaments, three high profile athletes have prioritized their healing above all else

 

Credit: Rawpixel

Indeed, all three high-ranking athletes have set a precedent for professional athletes to speak up about the need to take a break as part of their healing, placing their mental and physical health above the push to perform. They also offer a chance to revisit the science of why it’s crucial to promote rest for recovery — not just for sports but for all of us.

In 2019, Michael Grandner, a sleep researcher who directors the Sleep and Health Research Program at University of Arizona, found that athletes rated as having clinically moderate to severe insomnia were at a higher concussion risk.

**Originally published in Elemental July 2021**

August Newsletter!

**For photos and access to hyperlinks, please subscribe**

 

August 2021

Welcome to the August issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being. 

Some things that had me wondering this month:
 

1. COVID and…
Delta and Children :  What to be aware of when planning for late summer and Fall.
The CDC reversal “flip flopping” on masks:  And what it means for trust in public health  [and this relates to a piece I wrote for Wired several weeks ago].
On the WHO booster shot moratorium, and imminent pandemic ‘booster shot’ inequality
The role of the media in COVID coverage and public health communication

2. Podcasts (and shows) worth listening to/watching 
A great podcast with Tim Ferris and Michael Pollan on his latest book about plants/plant medicine, and ties to the drug war (including an interesting origin story that harkens back to a never published essay in Harpers).  And one with Ezra Klein in conversation with two giants in understanding the history of race in America, reflecting on the debates around the 1619 Project.

3.On…headaches
A reported Op-ed by Thomas Zellar, on headaches, delves into the realities and research. Complement with the wonderful Joan Didion, whose essay, “In Bed,” is an ode to migraines, and just an excellent model for a science essay.

4.Sound (and wise) reflections
By BF Skinner, on ‘how to discover what to say

5.Miscellany 
~An incredible UCSF study which translated a paralyzed/nonverbal man’s ‘brainwaves’ into words.

6.Best tweets of the month goes to…

Simone Biles, on being more than her occupation. 

“the outpouring [sic] love & support I’ve received has made me realize I’m more than my accomplishments and gymnastics which I never truly believed before.”

Rebecca Carroll, on Issa Rae’s OOO response 🙂

“Issa Rae’s out of office email message says “I am unavailable, unreachable and uninterested for the next two weeks” and I love it.”

and James Clear (who has an excellent Newsletter)

1. Do great work. 2. Share it publicly. 3. Cold email people 2 steps ahead of you. 4. Talk about your work and trade ideas. 5. Host events and meet in-person. 6. Become friends. 7. Rise together.

In My Own Words…

For Elemental, I wrote about recovery and rest, which is more timely now, after the Olympics, as Simone Biles also notoriously stepped away from several gymnastics events (and went on to medal).                     

This has been a trying few weeks, with the emergence of Delta and new lockdowns/restrictions. We’re in a marathon, clearly, which is easier together.

Have a healthy, joyful, and safe August,


Amitha Kalaichandran, M.D., M.H.S.

 

Changing Minds About Why Doctors Change Their Minds

After Covid, being open with patients about uncertainty may be the surest way to build trust in medicine.

IN 2001, when the pediatric allergist Gideon Lack asked a group of some 80 parents in Tel Aviv if their kids were allergic to peanuts, only two or three hands went up. Lack was puzzled. Back home in the UK, peanut allergy had fast become one of the most common allergies among children. When he compared the peanut allergy rates among Israeli children with the rate among Jewish children in the UK, the UK rate was 10 times higher. Was there something in the Israeli environment—a healthier diet, more time in the sun—preventing peanut allergies from developing?

He later realized that many Israeli kids started eating Bamba, a peanut-based snack cookie, as soon as they could handle solid foods. Could early peanut exposure explain it? The idea had never occurred to anyone because it seemed so obviously wrong. For years, pediatricians in the UK, Canada, Australia, and the United States had been telling parents to avoid giving children peanuts until after they’d turned 1, because they thought early exposure could increase the risk of developing an allergy. The American Academy of Pediatrics even included this advice in its infant feeding guidelines.

Lack and his colleagues began planning a randomized clinical trial that would take until 2015 to complete. In the study, published in The New England Journal of Medicine, some children were given peanut protein early in infancy while others waited until after the first year. Children in the first group had an 81 percent lower risk of peanut allergy by age 5. All the past guidelines, developed by expert committees, may have inadvertently contributed to a slow increase in peanut allergies.

As a doctor, I found the results unsettling. Before the findings were released, I had counseled a new parent that her baby girl should avoid allergenic foods such as peanut protein. Looking back, I couldn’t help but feel a twinge of guilt. What if she now had a peanut allergy?

The fact that medical knowledge is always shifting is a challenge for doctors and patients. It can seem as though medical knowledge comes with a disclaimer: “True … for now.”

*

MEDICAL SCHOOL PROFESSORS sometimes joke that half of what students learn will be outdated by the time they graduate. That half often applies to clinical practice guidelines (CPGs), and it has real-life consequences.

A CPG, usually drawn up by expert committees from specialized organizations, exists for almost any ailment with which a patient can be diagnosed. While the guidelines aren’t rules, they are widely referred to and can be cited in medical malpractice cases.

When medical knowledge shifts, guidelines shift. Hormone replacement therapy, for example, used to be the gold-standard treatment for menopausal women struggling with symptoms such as hot flashes and mood changes. Then, in 2013, a trial by the Women’s Health Initiative demonstrated that the therapy may have been riskier than previously thought, and many guidelines were revised.

Also, for many years, women over 40 were urged to get annual mammograms—until new data in 2009 showed that early, routine screenings were resulting in unnecessary biopsies without reducing breast cancer mortality. Regular mammograms are now suggested mainly for women over 50, every other year.

Medical reversals usually happen slowly, after multiple studies shift old recommendations. Covid-19 has accelerated them, and made them both more visible and more unsettling. Early on, even some medical professionals presented the coronavirus as no more severe than the flu, before its true severity was widely described. For a time, people were told not to bother with masks, but then they were advised to try double-masking. Some countries are extending the intervals between the first and second vaccine doses. Of course the state of the pandemic, and of our knowledge about it, has been shifting constantly. Still, throughout the past year and a half, we’ve all experienced medical whiplash.

It’s too early to say how these reversals will affect the way patients perceive the medical profession. On the one hand, seeing debate among medical experts conducted openly could give people a heightened understanding of how medical knowledge evolves. It could also inculcate a lasting skepticism. In 2018, researchers analyzed 50 years’ worth of polling data on trust in medicine. In 1966, 73 percent of Americans reported having confidence in “the leaders of the medical profession.” By 2012 that number had dropped to 34 percent—in part, the authors surmised, because of the continued lack of a universal health care system.

 

*

THE ANCIENT GREEK sea god Proteus was able to see the future, but he was forbidden from sharing his prophecies unless he was captured. This was challenging, because he was a shape-shifter: He could become a young man, a tree, a bull, a flame. No one has explored the protean nature of science more prominently than the Viennese scientist and philosopher Thomas Kuhn. In The Structure of Scientific Revolutions, published in the early 1960s, he proposed that science shape-shifts, or advances, through five sequential phases.

The first involves accepting “normal science,” the prevailing theory or “paradigm,” and conducting experiments that merely verify and reinforce the paradigm. During this phase, skepticism is often suppressed. Phase 2 involves finding an “anomaly” that doesn’t fit with the paradigm, but treating it as an outlier. In phase 3, a critical mass of threatening “anomalies” lead to a “crisis”—which prompts phase 4: “revolution,” by way of a series of new experiments to test alternative theories. Finally, a new worldview emerges, a “mature science.” The phases then repeat.

Remarkably, Kuhn didn’t argue that science is in search of “truth,” but rather that it “moves away from” an outdated, problematic, and “primitive” worldview. Also key is that what scientists and non-scientists understand in the new paradigm is reflective of what they see, as well as what they have been taught to see from experience. A switch in gestalt may be “I used to see a planet, but now I see a satellite”—referring to points in time and assuming that the initial observation may have been true. A paradigm shift, on the other hand, may word it as “I used to see a planet, but I was wrong, as it’s actually a satellite.”

Kuhn based his phases primarily on physics. What happens when we apply them to medicine and health care? When we deal with human lives and preventing illness, “advancement” can look a lot like “flip-flopping.” Is a changed recommendation an admission of harm? And where does that leave us with large public health efforts? Medical reversals place doctors in a bind. Improved medical knowledge represents progress, but honestly admitting to a past error may lead patients to see them as incompetent, breeding mistrust.

 

*

What if we got rid of reversals? That’s what University of Chicago Medical School professor Adam Cifu and oncologist Vinayak Prasad propose in Ending Medical Reversal: Improving Outcomes, Saving Lives. In many cases, they conclude, recommendations are simply issued too soon and are based on low-quality trials. Guideline committees may succumb to groupthink or feel pressured to reach a consensus where none exists. “If we look at something like peanut restriction,” Cifu told me, “the initial recommendations were mostly based on theory—good immunology theory, but theory nonetheless.” If doctors “stick with what’s evidence-based, our advice will be less likely to be overturned.”

Yet diseases don’t wait for evidence. Doctors must sometimes make medical decisions even if good data is rare or unavailable. Cifu and Prasad draw a sharp distinction between evidence- and theory-based recommendations, but in practice, doctors often adopt a looser framework. They may use lower-quality (often theory-based) recommendations until they can be replaced with higher-quality ones. Doctors combine this knowledge with their own personal experience in making clinical decisions.

Medical guidelines are similarly a composite thing, often seeking to balance new evidence with deference to established authority. And decisionmakers may also consider how a revision will affect trust in the system as a whole. In the 1990s, for example, the rotavirus gastroenteritis infection killed more than 130,000 children globally each year. In 1998 the pharmaceutical company Wyeth released a vaccine, called RotaShield, that dramatically reduced the mortality rate. Within a year, however, doctors and patients poured in with complaints. Among the inoculated, there seemed to be a small increase in a bowel condition called intussusception, which in rare cases can be deadly. In 1999, after 15 reported cases of vaccine-related intussusception, both the Vaccine Adverse Event Reporting System (VAERS) and the Centers for Disease Control ordered that RotaShield be withdrawn from the American market. It’s worth noting that VAERS is limited by the honor code: Adverse events are not confirmed.

*

In a 2012 paper titled “The First Rotavirus Vaccine and the Politics of Acceptable Risk,” Jason Schwartz, then a fellow at the University of Pennsylvania, explored the thinking behind the withdrawal. In his view, the decision wasn’t purely evidence-based. Schwartz told me that while some “argued that keeping the vaccine would have, in absolute terms, saved more lives,” the decisionmakers weighed trust: “You can’t have a vaccine out there with a notable risk of a harmful condition.”

According to this reasoning, the RotaShield reversal should increase our trust in vaccines: It shows that the system we use to monitor them works. (Two safer rotavirus vaccines have since been introduced and remain in use.) Vaccines such as MMR have been monitored for decades by the same system, and observers have seen no alarming signs—proof of their extraordinary safety. We’ve recently seen similar safety processes play out with the AstraZeneca and Johnson & Johnson Covid-19 vaccines. Still, a paradox of medicine is that the steps we take to make the system more trustworthy can make it seem less so.

THE FLIP SIDE of that paradox is that getting doctors to be comfortable expressing uncertainty may be the surest way to instill patient trust. Steven Hatch, a professor of infectious diseases at the University of Massachusetts, argues that medical reversals unsettle us because both medical professionals and patients are too fixated on being sure. “The public often thinks that they go to their doctor, the doctor runs the test, and the test reveals the truth,” Hatch told me. “But most of the time, we weigh sets of data and arrive at weighted possibilities which are not rock-solid.”

Doctors might approach different kinds of patients differently. Some people are comfortable with uncertainty and risk; others, says Hatch, struggle “to deal with ambiguity in their lives in general.” With the latter, doctors must resist the temptation to create a false sense of certainty, because “it’s really when things go wrong that a patient may feel cheated by the system.”

Hatch’s observations made me think of Diane, a woman I met a few years ago at a yoga retreat. Now in her sixties and retired, Diane is healthy, active, and cheerful, but she’d gone decades without visiting a doctor. She’d avoided preventative screenings of all kinds, in large part because it seemed to her that medical advice is always changing.

A few years ago, one of Diane’s friends—a woman who’d also avoided routine screenings—died of colon cancer. This inspired Diane to make a few doctor’s appointments and, in December 2019, she had her first physical exam since the early 1990s. Still, she found herself confused about how much uncertainty was normal in the doctor-patient relationship. She told me that when she asked her doctor if a prescribed skin cream would make her skin sensitive to the sun, her doctor told Diane that sun sensitivity wasn’t a side effect. Later, at home, Diane looked up the medication and found a warning that the cream actually did make people more sensitive to sunlight. “The doctor admitted to being unsure, which didn’t bother me,” Diane said. “But then she ended up telling me the wrong information. It’s hard for me to overlook that.”

Diane has struggled with the changing recommendations during the pandemic, and with figuring out how they should shape her behavior. “It almost seems like no one knew what they were talking about,” she recently told me. “First, it was no mask, then it was mask. Now, it’s two masks. It’s hard to keep up.”

Diane’s husband is a pilot, so I suggested a flying analogy. Sometimes a pilot who has been flying the same route for years has to shift because of severe turbulence or weather, perhaps flying thousands of feet higher or lower than what was originally planned. Usually the pilot announces the change to the cabin, and the passengers understand. Most don’t see the pilot as newly untrustworthy or incompetent; on the contrary, they’d worry if the plane shifted course and no announcement was made. Changes are inevitable when new information arrives, and transparency should increase trust, not erode it.

 

The Re-Emergence Effect

It will take time and patience to reemerge from the collective crisis of the pandemic with our mental and physical health intact.

When I met Darren Sudman six years ago, at an event in Palm Springs, I didn’t expect that his story would be one that I would return to time and again as I began examining what makes us thrive and heal after difficult times.

Sudman introduced himself as a former lawyer and a founder of a nonprofit. In 2004, Sudman and his wife, Phyllis, experienced every parent’s worst nightmare: Their three-month-old son, Simon, was found motionless in his crib. He had passed away from sudden infant death syndrome (SIDS), later deemed to be secondary to a heart rhythm disturbance called “long QT syndrome.”

Sudman’s nonprofit, Simon’s Heart, was created with the purpose of screening children early in life. It has kept us in touch over the years. But it was what Sudman shared about how he emerged from this unspeakable tragedy, and was able to move forward, that has continued to stay with me — particularly during this time as I reflect on our collective reemergence after the pandemic.

“My daughter was two and she needed me to get out of bed every day. She was really young and didn’t have a grasp of what was going on, and I had to take care of her. That forced me to wake up and live every day as best I could — she was my motivation,” Sudman told me. He also shared advice his co-worker provided at the time: “‘When you feel grief, let it pull you under and don’t resist it — it’s temporary and when you’re ready, you’ll come back up.’ This idea continues to work for me.”

In March 2021, a survey from the American Psychological Association found that 49% of adults reported feeling uncomfortable about returning to in-person interactions when the pandemic ends, and this included those who were vaccinated.

In China, after lockdowns lifted and people reemerged, over 10% met diagnostic criteria for post-traumatic stress disorder (PTSD). Indeed, for roughly 14 months most of us adjusted to a modified sense of “normal,” in much the same way a person living in a cave for a year may adjust to the lack of cognitive and light stimulation.

Change — even if it comes in the form of freedom — is still uncomfortable. So, it’s no surprise that some doctors are admitting to their own reemergence anxiety, that this summer terrifies a lot of people (perhaps especially introverts), and that many are worried about returning to work. Things will get better and the pandemic as it stands will end and Covid is most likely transforming into an endemic seasonal virus, yet all signs are clear that we must prepare for a reemergence effect.

Javeed Sukhera, chief of psychiatry at Hartford Hospital in Connecticut, shared that the reemergence process may feel similar to grief. “Especially for those who struggle with tolerance for ambiguity and when circumstances are not in their control,” Sukhera shared, “They will either adapt to the stressor and reflect more on the meaning of things, or risk of falling back into maladaptive ways of coping.”

*

Reemergence effects are not new.

We can look at butterflies as an example from nature — a caterpillar spends up to two weeks in a cocoon dissolving into a stew of cells, which it then partially ingests before swiftly emerging as one of our most prized insects.

I think back to a training in humanitarian emergencies I took at Harvard several years ago. The crisis situations were almost always in developing countries, where we needed to sort out food, water, and safety (for instance, from civil war and infectious diseases). A core part of our training was how to reemerge from the crisis with our mental and physical health intact. This involved time and connecting to resources to integrate back into the societies we had left — lessons I took to heart and applied during research or clinical work in low resource settings.

There are also examples from history.

Some Holocaust survivors, once freed from Auschwitz, marched across the camp and to freedom, but promptly returned: Writer and psychologist Edith Eger suggested, “They didn’t know what to do with their freedom,” and a return to life was challenging.

We see this in medicine as well.

compelling case of a man who spent decades legally blind had his eyesight restored only to suffer a psychological breakdown as he reemerged with the vision he had become accustomed to not having. The criminal justice system is also illustrative: The recent release of Joe Ligon, who spent 68 years of his life incarcerated, suggests that his true sense of freedom may be linked to how well he is supported during his reintegration into society. Indeed, once we start looking, we see “reemergence effects” everywhere — moments when, after spending a length of time in one state and having adjusted, we are forced to shift to another. Even if our new state is objectively better, our minds are still impacted.

Rachel Yehuda, a professor of psychiatry at Mount Sinai who specializes in trauma, expected many would seek therapy during Covid, the numbers were not as high as expected, which suggests to her that there may be an immense need after the crisis as part of our reemergence.

Joy Harden Bradford, an Atlanta-based clinical psychologist, agrees. “Many people may experience a post-traumatic stress response several months after we emerge that may take them by surprise as they may be getting through this difficult time by not fully acknowledging and processing what’s been happening, likely because it was their only way to keep functioning,” Bradford said.

As such, part of planning for our reemergence will involve anticipating our future mental health needs. Reconstruction after a humanitarian crisis is common, and often provides an opportunity for mental health reform; this was echoed in a UN report published last year. The idea of “building back better” for children’s mental health is instructive and could apply more widely.

“If I had a magic wand, in terms of building unlimited capacity for healing, I would initiate a campaign called ‘Let’s Talk About it,’ meaning, talk about the challenges, and the pain, and how we felt at the time. And it wouldn’t necessarily have to be with a mental health provider,” Yehuda told me. “Ideally, we would come together with people we know in our communities, in places of worship, the gym, yoga studio, or book club and ask each other, ‘What was it like for you?’”

And we may very well emerge better in some ways, perhaps a bit surprised by our own resilience, a point Yehuda wants to underscore.

“Time does heal, and the desire to flex our resilience muscles is powerful. That most of us will recover is an important public health message,” she shared.

*

With butterflies, it turns out that my understanding of their reemergence was incorrect. There’s more to the process. When a butterfly emerges from the cocoon it’s still a goopy wet mess. Its wings are too small to fly. To expand them, it must actively pump in fluid from its abdomen — a bit like blowing up a balloon. Then its wings must dry under the sun. And then — as anyone who has spent a prolonged length of time in a hospital bed, and experienced muscular deconditioning, knows well — the butterfly must exercise its fragile wing muscles enough to ensure they stay up against gravity in order to fly.

In other words, a butterfly’s reemergence isn’t swift at all: it takes intention, time, and effort.

Our collective reemergence may be similar. It must be handled with care, patience, and ideally capacity to receive our mental health needs on the other side of this pandemic. Engaging in a collective reenvisioning both around what capacities should be built now, in preparation for that reemergence is part of our collective post-traumatic growth, and goes beyond resilience to involve creating of meaning from crises, which could perhaps buffer some of the harmful elements of the reemergence effect.

Though I didn’t appreciate it six years ago, this was perhaps the biggest lesson I learned from Darren Sudman, which I hope we can all put into practice today as we reemerge stronger and more whole. Sudman’s intentional efforts to steer his family’s crisis into one that could help other parents helped offset his personal horror of reemerging as a parent who had lost a child.

“We had just suffered one of the worst tragedies but through it we [created] new narratives that involve helping prevent this from happening to other children, meeting families with similar experiences. When Jaden, our third child, came home, he brought another ray of sunshine to our house and reinforced the fact that life goes on and there’s still goodness.”

**Originally published in Elemental in May 2021**

May newsletter!

May 2021

Welcome to the May issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being. 

Some things that had me wondering this month:

1. COVID and…
India:  The situation in India is devastating, to say the least. I’ve written about the role of large companies in helping us address the pandemic in North America (I wrote about some ideas in Fast Company last March, and for Medium). After an initial block on raw materials, the US lifted the ban, which was wonderful news. Companies like Salesforce and Apple have also stepped up to help, and the diaspora has spoken out as well (Toronto Star)

Brazil: The plight of COVID children was meticulously described in NBC News — what might explain this pattern in Brazil, but not North America?  And, in the Globe and Mail, the tragic story of Emily Victoria Viegas, a 13 year old who died In Brampton Ontario

Vaccine Hesitancy: Some ideas on how to re-think it, in the New York Times. Two years ago I tackled the challenge more generally in the LATimes — it’s not about knowledge as much as it’s about understanding, the influence of our peers/social network, and our personal experiences intersecting with our values.

The Color Line: I’ve been waiting for someone to take a deep dive into the disproportionate element of race during this pandemic. Ibram Kendi did just that, in The Atlantic, and it’s worth a read.

To Mask or Not to Mask (and risks):  Nikole Hannah Jones’ Tweet suggests that masking may be a social good in more ways than one. For the Globe and Mail, Andre Picard places the salience of risk assessment, as it relates to the vaccines, in perspective.

Organized Chaos: In Canada, a big batch of vaccines from Johnson and Johnson was held back for inspection (note they arrived from the same US factory that was problematic), the National Advisory Council on Immunizations provided mixed messaging regarding two tiers of vaccines, meanwhile the US is looking to expand vaccine eligibility for the Pfizer vaccine to 12-15 year olds (though herd immunity is looking more unlikely).  That said, the W.H.O. had *finally* deemed COVID airborne (GREAT news) just weeks after an urgent an op-ed by the head of the W.H.O. that was timely and important.

2. Podcasts to listen to:
On her Dare to Lead Podcast, Brene Brown’s interview with Michael Bungay Stanier was brilliant. One big take-home (and there were many) was how to handle requests for giving advice, in a way that places the onus on the asker. It made me think a *lot* about  motivational interviewing: the aim being to help clarify the person’s goals, and reminding them of their own agency. Another interview, on the same podcast, with Angela Duckworth was also a worthwhile listen, especially near the end, when both Brown and Duckworth share experiences with envy and how best to channel that sentiment productively.

This Tim Ferris podcast episode, with Balaji Srinivasan, was from the end of March, but I listened to it in early April (late to the party). It’s well worth the 3.5 hour listen (in chunks!). Some highlights: how autonomy can help offset cancel culture, the future of cryptocurrency, and what work/purpose may eventually look like for each of us. I also appreciated Srinivasan’s orientation towards legacy building, and ‘giving back’ after his success.  

While not a podcast, an incredible Audiobook to make time for is: What Happened to You, by Oprah and Bruce Perry (a psychiatrist) which takes a deep dive into trauma. Over the last year I’ve realized how much is secondary to trauma — how we respond to things and how others respond for instance. These traumatic events, as Gabor Mate shared during a chat earlier this year, can seem minor at the time but they all lead to patterns that underlie how we understand the world and how we interact with others and respond to others. It has deepened my understanding of others and myself. The book wraps up with Oprah doubling down on post-traumatic ‘wisdom’ with some words around making ‘trauma your power.’  

3.On…re-examining medical culture (from 2017)
In the American Academy of Family Physicians — a nice framework for shifting medical culture, both as a leader and someone who is being ‘led.’ 

4.Sound (and wise) reflections
~On languishing, by Adam Grant in the NYT (who humbly shared a counterpoint by Austin Kleon)
~Newark police reform seems to have worked, in NJ.com. 
~Why the dental ‘system’ is so broken, in Canada at least, via The Walrus. It’s a great title too.

5.Miscellany 
~From STATNews: while diversity and inclusion efforts have expanded in most industries, medical education/medical schools is not one. And, in Time, how medical journals remain resistant to writing about systemic racism
~Cancel culture x Shame, by Ezra Klein in the NYT. I’d love to see/hear Brene Brown’s take on this topic.
~The history of the Rubik’s cube — I’ll have more to share in due time (it’s briefly in my book)! 

6.Best tweets of the month goes to…

Via Tim Ferris:
“Let me never fall into the vulgar mistake of dreaming that I am persecuted whenever I am contradicted.” — Ralph Waldo Emerson

By @ProductHunt — your brain on Zoom (without breaks)

A lovely cartoon by one of my favorite children’s book illustrators, Debbie Ridpath Ohi on ignoring writing competition, and focusing on your own journey and pace

Viral viral thread on imaginary New Yorker covers — this one made me cry (a perfect depiction of grief).

And by @JamaalBowmanNY
Addiction requires love — not jail.

And last: @EzraKlein, on anxiety

And then came the pandemic. Reality was objectively terrifying, and many of us were trapped inside, severed from social connection and routine, with acres of time to fret. It was a bad mix. I know a lot of people who didn’t have an anxiety problem before, but do now.


In My Own Words…

For the last year, I’ve been perplexed by the role of medical expert witnesses in the criminal justice system. I didn’t have a reason to explore it until the Chauvin/George Floyd trial, and came across an excellent law review paper by David Faigman (Chancellor of UC Hastings School of Law) which got me thinking. It was truly a page turner!! 
I shared my thoughts in an opinion/analysis piece for Scientific American here.

This was a month with lots of *editing* of my first book draft; I completed the second draft in early May. One of the best books I’ve read over the last few months was by Ashley Bristowe, My Own Blood, which explores how, as a mother of a child with a rare health condition, she was able to navigate both the medical world and the personal world. I highly recommend it — we rarely get insight into these struggles from the ‘patient’ side of things.

It’s promising to see that in some places–parts of the US, things are opening up and vaccine rates are high. Canada still has issues with the vaccine supply, and places like India do as well. I had COVID last year and tested positive for antibodies before receiving the first dose of Pfizer — surprisingly I didn’t become ill but will have to see what the second shot will show. I’m feeling more optimistic than I have in over a year that things will start to open up in the Fall in most places in North America. Hopefully the whole world will be in a position to see the end of this terrible pandemic very soon as well — there’s no ‘them,’ just us, and if there was ever a time for vaccine diplomacy and general regard for global health, this is it.

Have a healthy, joyful, and safe month,


Amitha Kalaichandran, M.D., M.H.S.

December/January Newsletter!

 

December 2020/January 2021

Welcome to the December/January issue of WonderWell, a newsletter intended to gather the most groundbreaking research and insightful commentaries in evidence-based medicine, wellness, healthcare leadership, writing, and innovation to help you live and work in alignment with your purpose and well-being.

*Please note that to access hyperlinks of articles, resources, and other tidbits referenced , please subscribe on the website.*

This month only, the hyperlink to the official newsletter may be found here (why April? no idea): https://mailchi.mp/781be024f030/wonderwell-april-9496693

"In Flight" -- Vancouver, BC, November 2020.

 

Some things that had me wondering this month:

1. COVID and...vaccines.
November was a big month in terms of vaccine development, with vaccines from
Pfizer and Moderna/BioGen -- both are similar in terms of efficacy (not to be confused with effectiveness -- primer on the difference re: trials here, and with vaccines here), but one is more 'stable' than the other in terms of logistics. Logistics is HUGE when it comes to vaccines, as the global health world has shown us for decades. If an adequate cold chain is not maintained, the vaccine is effectively ineffective. It will be an interesting 'race' to watch which gets picked, for where and whom.

As well, vaccine distribution -- in both Canada and the U.S. -- is a tricky topic. This piece in NBC news is interesting as it does get to the idea of distributive justice...without going all the way. It's a topic I've been thinking a lot about.

2. A podcast to listen to:
This episode from the #AmWriting podcast is excellent, as it covers themes that every journalist (and health professional) must grapple with: boundaries. Here, journalist Lauren Sandler discusses her book, in which she is an 'immersion journalist' covering a young homeless woman during her pregnancy and after her delivery, as a window into the issues homeless women in general (and pregnant homeless women specifically) face in America. I'll admit, I cringed at parts, because I personally don't think I would be able to embed myself in that way, and I've embraced the movement away from what's known as "poverty porn-- that said, kudos to Lauren for openly speaking about the challenges, the ethical aspects, and how she is reconciling it (part of it includes setting up a way to donate to the cause on her website here). She also makes a key point that made me rethink my position -- how are we meant to advance change or become aware of some struggles without having stories that capture our hearts (and minds)?

3.On...being misunderstood...and asking if you're ok?
This is probably the best essay I've read in months, and it's a little like a Rorschach test (I sent it to a few friends and we each took something different away). To me, it's about being on the spectrum and having experienced sexual abuse, but not wanting to make those aspects overshadow her identity. But the *way* the piece was written, without using terms that we feel tend to be loaded, makes it particularly interesting and perceptive. I've been thinking a LOT about how some of us need more information in order to understand another, whereas often this 'other' just needs acceptance (and understanding might come later). I've noticed it with one person in my life in particular, and it's been a tricky thing to navigate but an immense opportunity to learn.

And this, by Duchess Meghan Markle, is well-worth the read in that it's timely and applicable to all of us especially as these dark days of Winter approach. She's an admirable woman who successfully extricated herself out of a toxic situation where she wasn't able (or allowed) to thrive, but the point here goes well beyond her devastating experience with a miscarriage. It gets to why simply asking "are you ok" can make all the difference.

4.Sound (and wise) reflections
~From the BrainPickings newsletter -- more on William Blake, whom I wrote about in September. Fascinating artist/poet who wasn't appreciated until years after he died.

~Great reporting by Canadian healthcare journalist, Wendy Glauser, on the psychosocial aspects of the pandemic.

5.Miscellany
~An expose into McKinsey -- but specifically because I can't stop thinking about their hiring process, which I, and many others have personally experienced. It's case-based, but heavily math-based (i.e. long-hand division) and timed. Imagine if consulting companies looked at other aspects, e.g. ethics and integrity, and ability to solve problems or think in unique ways. Could the outcome here have been different? Could this crisis be the beginning of something really great for McKinsey in terms of how they approach solving tough problems, now that they're coming to terms with a big one of their own?

~The untimely and tragic death of Zappos CEO, Tony Hsieh hits close. Part of his personal story is featured in my own book, and his book (Delivering Happiness) is a must read for anyone interested in workplace culture and organizational psychology. Hsieh certainly left an influence on the world, that goes beyond tech and entrepreneurship -- placing customers first and looking at how to make workers thrive -- could do wonders if we applied those principles to healthcare. Above, I've linked the audiobook because it's Tony reading it himself, and I loved hearing his energy and excitement, but most importantly his commitment to those he worked with. He was a true example of "servant leadership."

6.Best tweet of the month goes to...
Holland Stanton, a medical trainee -- only because I've been personally obsessed with the idea of compatibility as it relates to the Match.
Can you do a story on The Match? & Med School education in America?

But I also REALLY loved this, as Charles is a new friend and his success is incredible to watch (and inspiring) -- his book Interior Chinatown will make you laugh (and cry) and is so deserving of a National Book Award. More info on his book here, and our interview here. And, related to this -- another from Jacob Weisberg, only because Penguin Random House is *my* publisher (so I very much am interested to know if the imprint might be, indeed, Simon's Random Penguin 🙂 ).

Ok, and I REALLY loved this -- I had to mention something about the election, right!

 

In My Own Words...
This month, I'll share one last image -- that of my book manuscript, which, thankfully I'll be submitting on deadline. All 300 pages (100,000 words) of Draft 1 are here...in print. Keep in mind this is the first draft of what will likely be around 10 at the minimum. The marathon begins (or continues?). Can't wait for you to read it once it's ready.

 

Draft uno...

This past month was also interesting for another reason, in terms of a cool opportunity that cropped up to not report on a problem I've been noticing, but actually be part of the solution. And it deals with tech and healthcare. Stay tuned next month for more details...at least what I might be able to share, but it's really exciting... 🙂

Can you believe we're at the end of the year that felt like a decade? 20/20 vision in optometry (and opthalmology) means "perfect" vision. For what it's worth, none of us had foresight that 2020 would be filled with a pandemic, massive social unrest (but for racial justice, which was a long time coming), and even more unusual political happenings (with a still 'contested' election in the U.S.). But we DO have the hindsight now -- of the many lessons this year has given us. With that in mind, we're entering 2021 with perhaps new priorities, restructured plans and goals, and perhaps a lot more hope.

Resilience, I've learned, is earned, not given.

Have a wondrous & well (and healthy, and safe!) Holiday season, in fact *make* it
especially so,

 

Amitha Kalaichandran, M.D., M.H.S.

Interview Series: Bryant Terry

Interview Series: Bryant Terry

Bryant Terry is a James Beard Award-Winning chef, educator, and author renowned for his activism to create a healthy, just, and sustainable food system. Since 2015 he has been the Chef-in-Residence at the Museum of the African Diaspora (MoAD) in San Francisco where he creates public programming. Alice Waters has remarked, “Bryant Terry knows that good food should be an everyday right and not a privilege.” San Francisco Magazine included Bryant among 11 Smartest People in the Bay Area Food Scene, and Fast Company named him as one of 9 People Who Are Changing the Future of Food. Bryant’s fifth book, Vegetable Kingdom, will be published on February 2020. His last book, Afro-Vegan, was published in 2014 and was named one of the best cookbooks of 2014 by amazon.com and was nominated for an NAACP Award in the Outstanding Literary Work category. Bryant is also the author of the critically acclaimed Vegan Soul Kitchen: Fresh, Healthy, and Creative African-American Cuisine, which was named one of the best vegetarian/vegan cookbooks of the last 25 years by Cooking Light Magazine. www.bryant-terry.com

1. You had an interesting journey before being a food activist What prompted you to begin your work as a food activist?

Years ago, in high school, I first heard the rap song “Beef” by the hip hop group Boogie Down Productions. The lyrics discussed the impact of eating meat on human health, the environment, and animals. That was the first time I realized that I held all of these assumptions about how animals are treated in our food system, and I began eating less meat. I learned a lot about the many reasons to maintain a plant-based diet from lots of older Black vegetarians and vegans. While I was doing doctoral work at NYU in American history I learned about the “Survival Programs” created by the Black Panther Party in the 1960s that addressed the intersection of poverty, malnutrition, and institutional racism—mainly their grocery giveaways and Free breakfast for Children Programs. I realized that historically marginalized communities were still dealing with many of the same problems in regard to food access, so in 2001 I founded a non-profit called b-healthy to raise awareness among young people about the politics of food and give them the tools to improve access to nutritious foods in their communities.

2. How does that inform how you approach healthcare?

I think health ‘care’ system is a misnomer since it often doesn’t refer to caring for people’s health. Mostly we see this medical system responding to illness. I’d like to see a system that is putting more resources into giving patients tools to prevent chronic illnesses and truly “care” for themselves and their families.

3.You had an experience with being challenged with your well-being not that long ago? Can you share more about that?

While working on my last book a few years ago I had lots of time and space to disappear in the writing and recipe testing, which was really exciting. At that time I didn’t have kids and was newly married, and it was all about the hustle. Raising my children and working on my forthcoming book was hard because writing and testing was limited to weekends, holidays, and times when my kids were out of the house. So the struggle of balancing it all felt overwhelming. Things I used to rely on to stay balanced, like my meditation practice, fell away. So now that the book is done I’m preparing to spend the better part of 2020 touring by spending lots of time working on self-care.

4.What does thriving mean to you?

It means different things at different points in life. As a husband with two daughters now, thriving means taking care of my family, preparing my children for the future, and creating space for them to have an enjoyable childhood.

5.What are you most looking forward to in 2020?

I’m very excited about further inspiring people to work towards a more healthy, just, and sustainable food system.

Resolving to Be Coached

Resolving to Be Coached

The secret to sticking with your resolutions may be having a coach to help strategize and cheer you on.

My teenage patient looked nervous as I reviewed her glucose readings from her glucometer and her glucose logbook, which people with diabetes use to track their blood-sugar test results. There were a lot of high levels — ranges in the 12’s and 14’s, when the goal was around 7 or 8. The peaks were mostly in the middle of the day and on weekends. (This was in Canada; blood glucose readings of 12 to 14 are equivalent to 216 to 250 mg/dL in the United States.)

“What do you usually eat at home?” I asked. She said that her mother was careful to make her a breakfast that balanced carbohydrates with protein. Her dinners were similar.

“What do you usually eat at lunch?” I asked. My patient started tearing up. She ate whatever her friends were eating in her high school’s cafeteria that day — like spaghetti, hamburgers or pizza, and something like a cupcake for dessert. This was probably what led to her readings being so high.

She had met with diabetes educators before, and she knew what uncontrolled glucose does to a person with diabetes, from speeding up nerve damage in the feet to hastening blood vessel damage in the back of the eyes and the kidneys, to increasing her risk of heart disease.

I knew she could have told me all of that, so lecturing her wasn’t going to help.

Instead my patient needed empathy and the tools to help her make healthier decisions, and part of that required understanding what was important to her, specifically “fitting in” with her friends in high school, the ones who didn’t have a chronic disease. It also would have involved helping her find the motivation within herself to make the change.

But my skill set for helping her was limited, especially on top of everything else I had to cover within our allotted time of 45 minutes.

Research suggests that behavioral and lifestyle factors are a big part of what contributes to chronic disease. In medical training, we learn a lot about the body and how to prevent and treat disease, but little about how we can motivate a patient to change old habits or even stick with a current management plan.

It struck me that what my patient really needed was a coach. At this time of year when many of us have made resolutions to get healthier, working with a health coach might be one way to reach those goals.

A health coach is someone trained in behavior change, who primarily uses an interview style called “motivational interviewing” to help patients see their ability to make change. While some may have clinical training in fields like nursing or medicine, they hail from a wide variety of disciplines or train in health coaching as a secondary career.

As a relatively young field, it’s still finding its footing — for instance, a systematic review found that the definitions of “health coaching” varied widely, though the authors recommended that health coaches take a patient-centered approach to help with goal setting while encouraging self-discovery and accountability.

The evidence that health coaching may spur general lifestyle changes is mounting. A 2018 study looked at clinical trials for coaching for nutrition and weight management and found that over 80 percent of these studies found improvement. And a 2017 study found that coaching can lead to increased physical activity in older adults. Studies suggest that health coaching may also provide benefits for conditions such as obesity and diabetes as well as attention deficit hyperactivity disorder, chronic pain, hypertension and high cholesterol. A recent review found that health coaching can improve quality of life and reduce hospital admissions among patients with chronic obstructive pulmonary disease, and it may help patients to become more engaged in the health care system.

It may even improve health outcomes through encouraging patient adherence to medication.

“Health coaching recognizes that we cannot help people by expecting them to act if that person is not ready to act,” said Leila Finn, a health coach based in Atlanta. “We help people take big goals and break them down into accessible, bite-size pieces — not by telling clients what to do but by helping clients figure out what will work for them.”

Health coaching gets to the heart of what providing good health care is about: acceptance, partnership, compassion, and helping patients feel respected and understood.

Though my clinical training is in pediatric medicine, inspired by what I had read, I recently completed a certificate in health coaching myself. The experience was eye-opening and humbling. I learned new ways of communicating with my patients, specifically ways to encourage them to see their own ability to make lifestyle changes while setting manageable goals. I also learned ways to cheer them on when they reach their goals, without shaming them if they relapse: Both pieces are critical to the process of making sustainable change.

While research is beginning to show the value of health coaching, the principles of communicating with the intent to inspire and motivate are transferable to all health professions — and could reap dividends if taught early on in the training of nursing students, medical students, pharmacy students, and other allied health professionals.

And when I think back to my teenage patient with diabetes, while I was empathetic, that was only half of the solution. The second half could have involved coaching her to see which small changes she could begin to make moving forward. I’m hoping that choosing my words more effectively, even within the pressures of time, may make all the difference for my other patients.

**Originally published in the New York Times**

Interview Series: Dr. Neel Desai

Interview Series: Dr. Neel Desai

Dr. Neel Desai is a primary care physician based in Fort Mitchell, Kentucky. He is a contributing member to The Happy Doc podcast. He wrote a book called The O.I. Connection about the rare condition osteogenesis imperfecta, a rare genetic condition of faulty collagen and bone synthesis [summary of condition]. Dr. Desai spoke with me in September from Fort Mitchell, Kentucky.

We connected because I was working on a ‘medical mystery’ article about O.I., and had, by chance, come across the Happy Doc podcast, which I loved. But you had an interesting journey in medicine that prompted you to co-develop the podcast. Share a bit of that with readers.

I’ve been working as a primary care doctor for 15 years, and about 5 years ago, it got to a point where I was becoming frustrated with medicine. I was losing autonomy to administrative burden and inefficient electronic medical records. So I wanted to look for ways to build (digital) creativity into my life and regain some autonomy. Writing my book and being part of the podcast led me to some powerful insights. I realized creative pursuits helped me address frustrations with the current medical system. I also observed another common pattern: the rigorous process of becoming a physician can suck the creativity out of doctors in training. Conversely, we observed doctors, residents, and medical students working on a creative endeavor regained energy and fulfillment in their training, as well as in their personal and professional lives.


1.What is the HappyDoc Podcast?

The Happy Doc Podcast was started by Dr. Taylor Brana, as a third-year medical student, at a time when he was becoming disillusioned with his medical training, and as a result was just very unhappy. He began asking the question, ‘are there any happy doctors out there?’. Most of what he was seeing in his attendings was not good: burnout, lack of joy in medicine, and just disillusionment with their current station in life. He connected with me online, seeing that I had been out in practice, and asked me if I was happy. I had a unique answer to that question (I was happy when it came to initiatives aimed at educating the public about OI through modern technology ). He asked me if I wanted to join his podcast. The aim was to find happy physicians, discovering what helped keep them fulfilled in their work, and give listeners practical tips to do so in their own lives. I agreed to partner with Taylor and became the guest recruiter for the podcasts, and I also run social media engagement.

2.Let’s talk about what happened in Fall 2008 which led to your interest in O.I.

My wife and I were trying to conceive our first child and she had two miscarriages prior to this third pregnancy. This third one, a son, had made it to 17 weeks. During the ultrasound, the normally chatty ultrasound tech looked at the left femur (thigh bone) and fell dead silent. She abruptly left the room. She came back with the Ob/Gyn on call. He pointed out our son’s left femur was curved and not growing. He recommended we see a maternal-fetal specialist to set up an amniocentesis. We saw the specialist the next day. I’ll never forget how she delivered her diagnosis and prognosis: she said the findings were consistent with a skeletal dysplasia incompatible with life. She shrugged her shoulders, and said “I’m just being honest.” And left us in the room overwhelmed, heartbroken, shocked, and devastated. lt’s a great teaching point for any medical professional. Don’t ever deliver news that a person’s loved one is going to die without some compassion. That life changing moment prompted me to write an ebook called “The O.I. Connection,”. I found writing was very cathartic for me, helped to process my emotional trauma, and accept my son’s diagnosis. It also inspired me to help others in similar circumstances by bringing together resources for other OI families and caregivers in a practical and interactive way.

3.What can you share about getting to your ‘new normal’ after that diagnosis

My wife and I were obviously stunned with the diagnosis. But we wanted to educate ourselves as much as possible about OI. We found an online OI family community of support on Yahoo health groups. The group included several health professionals, physiotherapists, and an emergency room doctor. They had children with OI and first hand experiences dealing OI. They gave us hope as they had successfully navigated the road ahead of us. They told us about revolutionary treatments for O.I., specifically, medications like intravenous bisphosphonates to prevent fractures and reduce pain, as well as telescoping rods which expand like curtain rods to straighten out the bones. They educated us on how these interventions help children gain more strength to grow, improve function, activity, and have a happier and healthier quality of life. Ethan was born with at least 7 fractures (unknown if he had more). He required the rods, the medication, physiotherapy, occupational therapy, and started these early after birth. By 18 months he took his first steps with a walker. By 2 years old, he was running independently. It’s interesting, because as difficult as all this was, and still can be, at 10 years old today he can walk, swim, run, jump, dive, and dance. He still has to use his walker or wheelchair occasionally for safety or longer distances. He also academically functions at a higher level. He’s really into computers and space, for instance. I think even if there are physical limitations, many of these kids often adapt with their minds.

4.What is the biggest misconception about being a parent with a child with a chronic condition. Has it changed how you see your own patients?

The last thing any child with a chronic condition like O.I. wants is pity. What they want is compassion, understanding, kindness, dignity, and respect. A lot of people also assume that the subject is off limits for discussion, but we as an OI family embrace curiosity and asking questions, which is how all of us do better. I want people to ask questions and not be afraid to ask questions. I think keeping it taboo causes more problems. Asking questions leads to more understanding and acceptance. This goes for children with OI and answering their questions about OI as well. In regards to answering a child’s question about feeing less than or bad about why they have a chronic medical condition, I use the example of a parent I know explaining O.I. to her daughter with OI. She likens it to having blond hair or brown eyes or a birthmark: it’s just something you have, and nothing to be ashamed of. OI or any chronic illness can be hard as it affects how a family functions, but it can also affect marriages, jobs (especially with needing to take time off for fractures, surgeries, doctor, therapist, hospital visits), and can be very isolating and lonely for all involved. So one of the core lessons for me personally and professionally is the power of having a very strong supportive community to communicate with.

5.Switching gears how has this experience helped you approach your work as a doctor interested in advancing change.

All of this has really made me value strong communities. The role of community, as in having strong support networks and teams, is really important, and The Happy Doc community has been a huge part of that for me personally. A more proactive, as opposed to reactive, approach is really powerful as well.

In regards to advancing change, I think it’s time for us all to evolve in medicine. From what I’ve seen, it’s like medicine is dated and still stuck in the 20th century: there’s so much resistance to being innovative — poor EMRs, rigid traditional hierarchies, and using technology from the 20th Century (pagers, fax machines, etc) are barriers to where we could and should go. It’s 2019, and it’s time to practice medicine in the century we live in. We should embrace being proactive, innovative, and collaborative. We do this by amplifying what we value most: meaningful human connections. This occurs by reconnecting with our colleagues, our communities, and most importantly, with ourselves.

I use an analogy of it being like the medical profession was in the desert for most of the 20th Century, but now we’re in the 21st Century rainforest. The world expects us to just adapt to all the rapid changes over the last 20 years and thrive. But we can’t do this if there is immense inertia and if we don’t value questioning, curiosity, and creativity. Having outside interests – like podcasts or journalism—and integrating those creative outlets is important to develop current and future systems for the 21st century.

6.What does thriving mean to you?

Thriving means living your best life on your terms. Playing and loving your game unapologetically, unconditionally, and on your terms. Loving what you do, doing what you love. Waking up so energized that you can’t imagine doing anything else. And paying it forward and sharing your good fortune with the ones you care about most through the ups, the downs, and all the in betweens.

7.What are you most looking forward to now in general?

Creating a healthier, happier, wealthier, and wiser medical education system. A system where as healthcare professionals and patients, we are energized, enlightened, connected, and inspired. And most of all, to just enjoy the serendipity of the journey to the unknown and connecting to amazing people all over the world.