University of Iowa Psychiatry Residents Get Shout Outs

Recently, University of Iowa psychiatry residents worked hard enough to get shout outs. One of them was exemplary performance on the consultation and emergency room service. The service was following over two dozen inpatients and received 15 consultation requests in a day. This is a staggering number and the resident on the service did the job without complaints. In addition, the resident was the only trainee on the service at the time. Other residents were working very hard as well.

This high level of performance is outstanding and raises questions about health care system level approaches to supporting it.

I read the abstract of a recently published study about Mindfulness Based Stress Reduction (MBSR) compared to medication in treating anxiety in adults (Hoge EA, Bui E, Mete M, Dutton MA, Baker AW, Simon NM. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. Published online November 09, 2022. doi:10.1001/jamapsychiatry.2022.3679).

On the day I read the abstract, I saw comments which were cringeworthy. The commenter is an outpatient psychiatrist in private practice who had some criticisms of the study. He thought the report of results at 8 weeks was inadequate because symptoms can recur soon after resolution.

Another problem he mentioned is worth quoting, “A course of treatment that requires as much time as the MBSR course described in the study would be out of the question for most of my patients, most of whom are overworked health care professionals who don’t have enough time to eat or sleep. Telling people who are that overworked they should spend 45 minutes a day meditating is the “Let them eat cake” of psychotherapy.”

That reminded me of a quote:

“You should sit in meditation for twenty minutes every day—unless you’re too busy; then you should sit for an hour.”

Zen Proverb

I know, I know; I should talk—I’m retired. Actually, I took part in an MBSR course about 8 years ago when I noticed that burnout was probably influencing my job performance on the psychiatry consultation service. I thought it was helpful and I still practice it. I was lucky enough to participate in the course after work hours. The hospital supported the course.

The residents who are being recognized for their hard work on extremely busy clinical services may or may not be at high risk for burnout. They are no doubt extra resilient and dedicated.

And the University of Iowa health care system may also be offering a high level of system support for them. I don’t see that University of Iowa Health Care is on the list of the American Medical Association (AMA) Joy in MedicineTM Health System Recognition System, but that doesn’t mean they aren’t doing the kinds of things which would merit formal recognition.

Anyway, they all get my shout out.

Watch Yourself

I watch the Weather Channel TV shows Highway Thru Hell and Heavy Rescue 401 and I hear a lot of the towing guys say “Watch yourself!” Often, they say this as they’re about to pull a jack knifed semi out of a ditch. Sometimes a rigging line breaks and a large hook will snap back at lightning speed, which can take your head off, even if you are watching out for it.

I notice many of the older tow crew members are now saying while grinning at the camera things like, “I think it’s really important to teach the younger generation the things I know because I’m not going to be doing this forever, and I’d like to retire sometime in the near future and let somebody else watch out for flying snatch blocks and tow hooks which can take your head off, which would not necessarily be painful because you might die instantaneously, but then there are those other inconvenient consequences like funerals and insufficient life insurance policies with bizarre exclusion clauses disallowing benefit payouts to grieving widows and children because of deaths caused by non-Underwriters Laboratories certified flying snatch blocks and tow hooks, unpaid mortgages and loans for things like exorbitantly expensive snatch blocks, tow hooks, not to mention multi-ton wreckers and rotators.”

Anyway, the expression “Watch Yourself” could also figuratively mean being mindful. Mindfulness meditation has taught me to notice more about what’s going on inside and outside my head.

I do daily sitting meditation, although I may miss a day here and there. And by sitting, I want to make it abundantly clear that I don’t assume the lotus position. My joints are stiff enough that, when I try to stand up, they might have enough spring steel energy stored to whip loose, similar to flying snatch blocks and tow hooks.

While I’m sitting, I do a lot of thinking. By the way, it’s not a mistake to think and feel a lot of different thoughts and emotions during mindfulness sessions. That’s one of several myths about mindfulness. It’s not mandatory or even possible to shut off your yammering mind. I can choose to focus my attention on it or not.

If I try to shut my internal talk off for any length of time, it’s like gripping a slippery valve. Sooner rather than later, my grip slips and thoughts explode like flying snatch blocks and tow hooks. I watch myself and I notice when I’m thinking my hands get tense. As soon as I notice that, my hands relax and I focus on breathing—or maybe it’s the other way around.

Watch yourself.

Loving-Kindness Meditation in the Real World

Today is the first day of Martin Luther King, Jr. Human Rights Week and I’m giving a shout-out for acts of kindness as well as the Loving-Kindness meditation. A neighbor with a snowblower helped clear our driveway a couple of weeks ago. A couple of days ago he did the same for his next-door neighbor. I’m going to go out on a limb and speculate the city snowplow driver was kind enough to avoid plugging the driveways on our street. No kidding, we watched the snowplow use what was obviously a different plowing technique which left our driveways relatively clear of snow.

The Loving-Kindness meditation is a mindfulness practice that Dr. King would probably have supported. It’s a way to send love to yourself and others, including those with whom you might be in conflict—even your enemies. King might say, “Now is the time” for something like that.

I’m reestablishing my mindfulness and exercise practice after a several month lapse. I first took the Mindfulness-Based Stress Reduction (MBSR) course several years ago through The University of Iowa Hospitals and Clinics. It made a difference in how I approached problem-solving and conflict. I was on autopilot most of the time and wrote a blog post about my experience before and after my mindfulness training experience, “How I left the walking dead for the walking dead meditation.”

Part of that program included instruction on the Loving-Kindness meditation. I’m still a beginner at mindfulness, although my approach to life is still ironically more like the expert’s in Shunryu Suzuki’s quote:

“In the beginner’s mind, there are many possibilities, in the expert’s mind there are few.”–Shunryu Suzuki

I need to keep working on being more open to different ideas, interpretations, and ways of getting things done—approaching challenges with a beginner’s mind.

One recent challenge is hanging pictures. Sena and I hung a picture yesterday. I wanted to measure everything and she wanted to estimate. She had misgivings about my measurements but went along with it. After the picture was hung, even I had to admit it was not in the right spot. Funny thing, after a short while, she admitted that the misplacement was not that far off and that she was getting used to it. If you’ve ever hung pictures, you know I’m leaving out a lot of the back-and-forth negotiation about how we finally arrived at that middle ground. It involved loving kindness on both sides.

We’ll see how the next picture hanging goes.

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