Month: July 2017

Living Your Best Life

Ob/Gyn by Day, Rock Star by Night!

July 25, 2017 by 0 Comments
Norway, Maine

For the past year, I have had a recurring assignment in Norway.  Norway, Maine that is….  Norway is a small town about one hour northwest of Portland.  It’s nestled in between other European treasures like Poland and South Paris.  The people here are genuine and inviting.  Last July was my first time spending any time in the state of Maine.  I was promised that the summer would lovely and that it would be beautiful in the fall. A promise fulfilled.

My first impression of the practice here was that everyone liked their job and liked their co-workers.  Now remember, one of the benefits of locums is that we often get to stay outside of the office politics and personality dynamics.  Nevertheless, in the year I’ve been here, I continue to feel the same positivity I felt on my first day.  I imagine some of that cohesiveness is due to the longstanding leadership of the department.  The practice is busy but works to provide the ever elusive work/life balance for all the employees.  Everyone seems just as happy in their home life as they do in their work life.  The people here seem to be living their best lives.

One such example is Carolyn Costanzi.  Dr. Costanzi is a compassionate, no nonsense Ob/Gyn, wife, mother and rock star! She knows all her patients and their families by name, gives straightforward and honest care, loves to hike, knit and sing! The Cobblestones formed in 2015 and have been playing together across Southern Maine ever since.  She is the vocalist for this band composed of a guitarist, bassist and occasional pianist. As physicians, we often wonder how we can accommodate our interests outside of medicine when our careers tend to consume all of our time and then some.  Today, we’re going to find out how Dr. Costanzi makes it work.

 

  1. Tell us about yourself.

 

I met my husband, Carl Costanzi, while working as a lab tech. He was completing a PhD in biochemistry at Hahnemann University (now Drexel). We had two children together (Nick, during my first year of med school…oops and Daniel, during my second year of residency). Carl has a son from his first marriage and so I am also a stepmom to a third son, Ben. I completed my medical training in the Philadelphia suburb of Abington, PA and stayed there for over a decade as an attending. I really wanted to return to New England and so my whole family moved here in 2004. I searched for a rural practice with good quality of life and Norway, Maine was everything I wanted. My husband graciously gave up his career as a researcher at University of PA to start a new life in rural New England. He is a native Pennsylvanian, so this was a huge change for him. He loves Maine now and neither of us can ever imagine leaving.

 

  1. When did your interest in music start?

 

I grew up in rural Massachusetts in a big family. The focus of our family was on academic excellence and not so much the arts. Music was a “hobby” that took a back seat to athletic and academic success, so my love for music and singing was confined to school projects and community theatre. I actually didn’t make the try-outs for chorus in the third grade because I wasn’t a soprano…when I tried out the following year they felt bad for me and let me in. I sang with the boys frequently and took boy’s parts in musicals! Music took a huge backseat from college until about six years ago. Suffice it to say that’s a LONG time! I completed college, medical school, residency all while raising a family, and that left no spare time for outside interests like music. I have always been appreciative of music and as a family we valued going to musical events, listening to music at home and nurturing our sons’ desires to learn instruments.

 

  1. Please describe your band and its members.

 

Over the past few years I would attend open mic events in the Norway area with friends and sing from time to time. Very casual and nothing too formal. I met Mike Plourde (my guitarist and co-founder of The Cobblestones) in 2015 at an open mic at the former Tucker’s Pub in Norway. We both just happened to be there to listen to music and to play a little. Mike has been a musician since childhood and has played from time to time in various bands. He spoke to me at the open mic after I sang with a friend and after he performed solo. We started communicating via e-mail and that was the beginning of our music collaboration. We just seem to have voices that blend well, we like the same music, we are both perfectionists and he is an amazing guitarist. We thought we would just mess around and go to the occasional open mic, but we started getting asked to play and things just took off from there. We now have a keyboardist (Danielle Tran, a pediatrician), a bass player (Ken Lloyd) and a drummer (Mark Plourde). We all have “day jobs” but somehow find a way to squeeze in second careers in music. Probably because it’s addicting and keeps us sane!  I never thought I would actually form a band and get paid to do something I love so much. It’s like a dream come true! We have started writing original music, which is something I’ve always wanted to do. I write the lyrics which is right up my alley since I love poetry. We also made a demo CD together at a recording studio in 2016.  CHECK another thing off my bucket list!

 

  1. How do you balance your medical career, family and your commitment to music?

 

My children are grown and my nest is almost empty. I have no little ones to cook for (most of the time), and my husband and I are free to pursue our own interests now that the boys are grown men. I can selfishly use all my spare time pursuing music, and I do it without guilt;  I have earned this opportunity. I practice with the whole band once a week and try to sing almost every day on my own for an hour or two. We play gigs two-three times a month and most weekends. I also manage the band financially and book most of our gigs, so I spend a lot of my spare time on these tasks, which I do with pleasure.

 

Singing is something I can do into very old age. Music brings such happiness to folks’ lives and lucky me if I can be a small piece of that happiness. I plan to be 100 years old and singing to all my peers in the nursing home.

 

  1. What advice do you have to other physicians who struggle to maintain interests outside of medicine?

 

I was not great at balancing when my children were young, especially because I chose the specialty of OB/GYN. It is a career of chronic exhaustion, which makes it not for the faint of heart. My husband is incredibly supportive and we have always co-parented equally and without any gender lines. I have had to learn the importance of taking whatever time I can for myself in order to stay healthy and to protect myself from the stress of medicine. I truly endorse that scheduling time for yourself has to be of the same priority as taking the kids to doctor’s appointments, cooking meals and caring for patients. If we as physicians, we constantly put ourselves at the bottom of the list of priorities, we suffer. I have also learned to say “no”. No to family stresses, excessive work-loads and social obligations that are more than I can handle without compromising my health and well-being. It took me years to decline work or tasks that I thought I would be judged for not doing: once I got past that guilt of disappointing someone, I felt pounds lighter.

 

This is my advice…take care to place yourself occasionally at the top of your to-do list. Eat healthy and go after your outside interests. Do not let medicine consume you. Let it be one part of who you are.

https://www.thecobblestones.net/

Lake Pennesseewassee
Lake Pennesseewassee
Lake Pennesseewassee
Life Lessons

Warning…System Collapse: Signs of and Coping Strategies for Distress

July 25, 2017 by 0 Comments
Baltimore, MD, Inner Harbor

I recently posted about physician burnout and what role the system plays in our overall satisfaction with our careers.  As professionals, we are trained to handle complicated medical situations, as Ob/Gyns we often deliver news that affects two patients.  Counseling a woman through a stillbirth or fetal demise never gets easier. In discussing one such patient in a meeting a few weeks ago, the office social worker asked, what do we do to cope?  To whom do physicians talk to manage their stress and emotions during difficult times?  I must admit, as a group we do not prioritize this area well.  Too often, we hear of physicians who abuse drugs and alcohol or even commit suicide when the pressure to perform, to strive toward perfection gets too great and the support is not enough.

While doing locums full time, my friend graciously offered to house my belongings in her basement.  She is a psychologist working specifically with undergraduate and graduate students. With any highly regarded university, that produces excellent graduates and professionals, students arrive on campus highly motivated and prepared to succeed.   To say the least, the demands of college curriculum can be daunting. Across the country, medical school admission standards are high and require disciplined study habits.   As physicians, most of us were once these same ambitious college students who kept late hours, ate erratically, exercised infrequently, not placing enough emphasis on our personal well-being.  These habits we create while training are often the habits we continue when practicing.  These habits are not always healthy or easily broken.

Today, we talk with Dr. Leslie Leathers about the mental health conditions she believes are particularly pertinent to young professionals, warning signs and viable coping mechanisms.  As we spend most of our days caring for others, it is just as important to dedicate the appropriate time and attention to ourselves.

 

  1. Tell us a little about yourself.

 

I am from North Carolina originally, and growing up in my Black American, middle-class, Christian family, certain values were instilled in me. Values most pertinent to our topic today include the pursuit of formal education, collectivist ideals, and helping others. These values were a natural fit with the field of Counseling Psychology with its emphasis on helping people improve their quality of life while acknowledging and respecting multicultural realities. I moved to Baltimore for my job doing psychotherapy with university (undergraduate and graduate) students. This position entails a specific focus on supporting students of color. It’s a privilege to be able to support students as they begin to navigate young adulthood. As a woman of color who benefited from wisdom and guidance of professionals who came before me, it is particularly gratifying to be able to provide support to students of color as they pursue their higher education goals and work to improve their quality of life, both in the short and long-term.

 

  1. In counseling professional students, are there any common themes that you can address?

 

One theme that leaps to mind is the pressure to succeed and secure employment in academia where job applicants far outnumber available positions. Another theme is learning to manage (what are often) new levels of stress adaptively.

 

  1. For friends and loved ones, are there any warning signs that indicates someone needs professional support?

 

Significant changes in ones’ behavior may indicate the need for extra support. For example, increased irritability in someone who usually is easy going or social isolation from someone who typically is outgoing and social. Someone could begin shirking responsibilities or, alternatively, one could start taking on more commitments in an attempt to distract oneself from one’s experience of distress. Additionally, one could experience distress somatically and emphasize physical aches and pains. A more complete list of potential signs may be found at

https://www.nami.org/Learn-More/Know-the-Warning-Signs

 

  1. Different cultures intersect with mental health differently and recently, conversations around racism, mental health and self-preservation have been more common in popular media and on college campuses.  How has your work contributed to increased awareness and strengthened relationships across campus?

 

There does seem to be a groundswell of momentum to acknowledge and redress patterns of inequity. My own direct work with, and indirect work in support of, students who represent diverse backgrounds has benefited from this momentum. One thing we know from research is that students who feel marginalized within a campus environment can benefit immensely from having distinct spaces that are affirming of their marginalized identity/ies. My work contributing to such spaces on my own campus have been among my most valued work experiences to date.

  1. What resources do you recommend for someone who is feeling overwhelmed?

Well, being a psychotherapist, who at various times in my life has also been a therapy client, I wholeheartedly recommend therapy. A couple of good resources for assistance identifying a therapist are

http://www.apa.org/helpcenter/index.aspx

and

https://therapists.psychologytoday.com/rms?utm_source=PT_Psych_Today&utm_medium=House_Link&utm_campaign=PT_HomeTopB_find

That said, there are a number of other strategies one might try. For instance, engaging in regular self-care that nourishes the important parts of oneself is often helpful. Prioritizing commitments and determining the limits to one’s control within a specific circumstance may help alleviate excess pressure that can lead to feeling overwhelmed. Although it is often hard to do so, it can be very helpful to remember that we are all human and doing the best we can considering the resources and knowledge available to us at a given time. If we’re feeling overwhelmed, that may just be a signal that we need to improve our existing resources/strategies or try to acquire some new ones. Here is a link to a list of apps that could be useful in bolstering or adding to existing strategies for managing distress:

https://psychcentral.com/blog/archives/2013/01/16/top-10-mental-health-apps/

Finally, social support, whether from one’s best friends, gym buddies, spiritual group or leader, family, etc. can help one feel connected to a community and/or to something(s) greater than oneself. None of the aforementioned resources/strategies are mutually exclusive and there often is a process of trial and error in figuring out what works best for you. So, if you find that one strategy or combination of strategies does not work for you, know that it may take some time to identify your own unique path to good mental health maintenance.

Baltimore, MD
Living Your Best Life

Burnout or Just Burned?

July 4, 2017 by 2 Comments
Where do we go from here?

When you envision the classic American TV doctor from yesteryear, what do you see?  An older man, with silver gray hair, dark suit, white coat and doctor’s bag right?  He was a solo practitioner who worked long hours, made house calls, neglected his home life and garnered respect by the entire community.  Popular culture depicts a younger, more diverse workforce in medicine, with complicated personalities, drama filled personal lives, who save the day at the end of every episode.

The constants across the decades remain; doctors feel called to do work that requires self-sacrifice.  Most physicians I know, will always put a patient’s needs before their own (yes most, not all).  We stay late, come in early, miss lunch, skip bathroom breaks in order to take care of our patients.  We take charts home (now, electronically), read medical literature in bed and neglect our own physical health.  The reward of this self-sacrifice is creating the ideal environment for patients to seek and receive the best care.  Another constant that draws us into medicine is the possibility of autonomy.  Having autonomy is at the core of being a physician.  Many of us are natural leaders. We want to be the pilot, the quarterback, the conductor. We thrive from being captain of the team. We want to make the final call, have the difficult conversations and shoulder the responsibility when things go awry.  Every captain requires a good team.  And, we all know team work makes the dream work… 🙂

The changing landscape of medicine is altering the composition of the team.  I’m not the biggest fan of the word hierarchy, however we cannot ignore that it has historically been a large part of medical culture.  This changing landscape is far removed from the solo practitioner who only answered to his/her patients to top down decision making from large health systems and accountable care organizations.  I hear more and more physicians describe increasing requirements of outpatient office visits and surgical cases. Complaints of complicated coding and long nights charting after hours in the EHR (electronic medical record). Meetings discuss decreasing overhead and maximizing reimbursement.  Don’t get me wrong. These things are important.  Our national healthcare expenditures have to be reeled back.  However, in this transition, it seems our title as captain has been stripped away.  Many feel more like factory worker #226, as there are days when we feel like cogs on a wheel churning out patient encounter after patient encounter.  These are the days when we return home feeling defeated, feeling burned.

I feel incredibly concerned about our profession as younger and younger physicians describe the symptoms of burnout and contemplate leaving medicine.  As I travel around the country, the shortage of physicians is palpable, what happens if we cannot retain or recruit future physicians. The system needs to change.  Change is not bad.  Change is necessary.  This change requires us to redefine ourselves in this new system.  We have to reclaim our title as captains.  We need to harness our innate abilities as teachers and leaders.  We need to use our voice to advocate for our patients and ourselves.

Cape Town, South Africa

Resources:

Medicine is not a Job

Dr. J Nwando Olayiwola, MD, MPH, CPE, FAAFP

http://www.prweb.com/releases/medicinenotajob/release/prweb12825753.htm

http://www.inspirehealthllc.com