The joy is being sucked out of the practice of medicine. Here’s why.

Many providers — primary care physicians, physician assistants, and even many beleaguered specialists — are increasingly dissatisfied with their jobs.

What is happening to medical practice and what can we do to bring the joy back to being a health care provider?

She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable for all of her primary care needs. Since she had not received a mammogram that year, or received a diabetes screening, he incurred an end-of-the-year penalty for failing to meet these quality standards.

I am early into a one-year quest to connect with leading thinkers from inside and outside medical care, so I can better understand why many clinicians are miserable in their careers, and much more importantly, what can be done to help them thrive at work even though an increasing number of outside parties are looking over their shoulder, assessing the quality of the care they provide.

These increasingly burdensome rules and regulations are making it hard to enjoy medical practice these days. Several decades ago, physicians largely practiced as autonomous professionals, governed by standards developed by their professional peers. Physicians underwent intense and prolonged training to develop the knowledge and skills to know how best to help patients with their problems. And the world generally stood back and accepted, on faith, that most physicians would provide excellent care to most of their patients.

In recent years, however, outsiders have increasingly tried to assess just how well physicians are performing their jobs. Insurance companies and Medicare administrators are measuring the quality of care physicians provide, and even holding them financially accountable when that care is not up to standards. In part, these external accountability measures have been put into place because people paying for medical care — insurance companies, Medicare administrators, and even patients — realized that the quality of medical care wasn’t always as high as it ought to be. And since the profession wasn’t doing everything it could to promote high quality, they recognized that somebody from the outside needed to hold physicians accountable for their practice. As a result, medical practice has shifted from being autonomous to supervised; physicians have gone from being independent decision-makers to being bureaucrats forced to check boxes.

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Bipolar diagnosis in Mom makes pregnancy more risky

By Charles Bankhead, Staff Writer, MedPage Today

  • .
  • Women with bipolar disorder had a significantly increased risk of adverse outcomes in pregnancy, regardless of whether the psychiatric condition was treated, investigators reported.

Bipolar disorder was associated with almost a twofold increase in the frequency of induced or planned C-section and a 50% higher risk of preterm birth, according to Robert Bodén, MD, of Uppsala University in Sweden, and co-authors.

Microencephaly, small for gestational age, and neonatal hypoglycemia all occurred more often among infants whose mothers had bipolar disorder, they reported online in BMJ.

“Our findings of increased risks for several of the investigated outcomes also in the untreated women suggest that mood-stabilizing treatment is probably not the sole reason for the increased risk of adverse pregnancy and birth outcomes,” the authors wrote in conclusion.

“The role of treatment is, however, still unclear as the overall analyses of variation in outcomes generally did not support a significant difference between treated and untreated women. The possibility of an anabolic drug effect with increased risks of gestational diabetes and reduced risks of fetal growth restriction should be noted.”

Bipolar disorder has been associated with a small increase in the risk of pregnancy complications, preterm birth, and delivery of small-for-gestational-age infants. Previous studies had not separated the effects of the condition from potential effects of treatment for bipolar disorder, the authors noted in their introduction.

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Being grateful: Giving thanks helps with depression

By Gabrielle J. Melin, M.D.

Depression can zap your confidence.

Some days you may feel like you can’t even follow through with the smallest of tasks. Being grateful can do wonders for your mood.

This doesn’t have to be elaborate or detailed. I suggest that you write down three things each day that you’re thankful for. This can be three sentences or three words, the simpler the better. Keep paper or a journal by your bedside and jot in it daily. This can be at bedtime or in the morning, whichever works best for you.

What’s so nice about jotting down why you’re being grateful is that it doesn’t take a lot of effort and is very powerful. Looking back over what you’ve written can help you to evaluate and learn where you’ve been and who you have become. This is a simple, reasonable goal that you can accomplish. This will build up your sense of positive self worth. You can do it, and you deserve to invest in yourself.

Please share your thoughts in the comments section.

Mayo Clinic article

Cabin Fever – Seasonal Affective Disorder (SAD)

Source: Excerpts from Mayo Clinic Article


Definition of SAD

Like many people, you may develop cabin fever during the winter months. Or you may find yourself eating more or sleeping more when the temperature drops and darkness falls earlier. While those are common and normal reactions to the changing seasons, people with seasonal affective disorder (SAD) experience a much more serious reaction when summer shifts to fall and on to winter.

With seasonal affective disorder, fall’s short days and long nights may trigger feelings of depression, lethargy, fatigue and other problems. Don’t brush this off as simply a case of the “winter blues” that you have to tough out on your own.

Seasonal affective disorder is a type of depression, and it can severely impair your daily life. That said, treatment — which may include light box therapy — can help you successfully manage seasonal affective disorder. You don’t have to dread the dawning of each fall or winter.


Seasonal affective disorder is a cyclic, seasonal condition. This means that signs and symptoms usually come back and go away at the same times every year. Usually, seasonal affective disorder symptoms appear during late fall or early winter and go away during the warmer, sunnier days of spring and summer. But some people have the opposite pattern, developing seasonal affective disorder with the onset of spring or summer. In either case, problems may start out mild and become more severe as the season progresses.

Fall and winter SAD (winter depression)
Symptoms of winter-onset seasonal affective disorder include:




Loss of energy

Social withdrawal


Loss of interest in activities you once enjoyed

Appetite changes, especially a craving for foods high in carbohydrates

Weight gain

Difficulty concentrating and processing information

Spring and summer SAD (summer depression)
Symptoms of summer-onset seasonal affective disorder include:





Weight loss

Poor appetite

Increased sex drive

Reverse SAD

In rare cases, people with seasonal affective disorder don’t have depression-like symptoms. Instead, they have symptoms of mania or hypomania, a less intense form of mania, during the summer. This is sometimes called reverse SAD.

Symptoms of reverse SAD include:

Persistently elevated mood

Increased social activity


Unbridled enthusiasm out of proportion to the situation


The specific cause of seasonal affective disorder remains unknown. It’s likely, as with many mental health conditions, that genetics, age and perhaps most importantly, your body’s natural chemical makeup all play a role in developing seasonal affective disorder.

Specifically, the culprits may include:

Your circadian rhythm. Some researchers suspect that the reduced level of sunlight in fall and winter may disrupt the circadian rhythm in certain people. The circadian rhythm is a physiological process that helps regulate your body’s internal clock — letting you know when to sleep or wake. Disruption of this natural body clock may cause depression.

Melatonin. Some researchers theorize that seasonal affective disorder may be tied to melatonin, a sleep-related hormone that, in turn, has been linked to depression. The body’s production of melatonin usually increases during the long nights of winter.

Serotonin. Still other research suggests that a lack of serotonin, a natural brain chemical (neurotransmitter) that affects mood, may play a role. Reduced sunlight can cause a drop in serotonin, perhaps leading to depression.

When to seek medical advice

Most people experience some days when they feel down. But if you feel down for days at a time and you can’t seem to get motivated to do activities you normally enjoy, see your doctor. This is particularly important if you notice that your sleep patterns and appetite have changed — and certainly if you feel hopeless, think about suicide, or find yourself turning to alcohol for comfort or relaxation.


Some people with seasonal affective disorder benefit from treatment with antidepressants or other psychiatric medications, especially if symptoms are severe. The Food and Drug Administration has approved bupropion extended release tablets (Wellbutrin XL) for the prevention of depressive episodes in people with a history of seasonal affective disorder. Other antidepressants commonly used to treat seasonal affective disorder include paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac, Sarafem) and venlafaxine (Effexor).

Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take antidepressant medication beyond the time your symptoms normally go away. This strategy can help prevent worsening of symptoms.

Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try several different medications before you find one that works well and has the fewest side effects. Like other medications, all antidepressants pose the risk of side effects and some have health precautions that you and your doctor must discuss.


There’s no known way to prevent the development of seasonal affective disorder. However, if you take steps early on to manage symptoms, you may be able to prevent them from getting worse over time. Some people find it helpful to start treatment before symptoms would normally start in the fall or winter, and then continue treatment past the time symptoms would normally go away. If you can get control of your symptoms before they begin, you may be able to head off serious changes in mood, appetite and behavior that can disrupt your daily life.


Sad Bear picture is from