Reflection on wellness

My individual responsibilities

1. keep my body well by eating properly and staying appropriately active.
2. to tame my mind so it works for me rather than against me, irrespective of external circumstances.
3. to share perspectives with others and to be open to others perspectives - realizing what I know is finite and what I don’t, infinite.
These are some perspectives I personally learned later in life.  I believe they can be formalized and shared...

Reflection on Harm reduction in Addiction.

I think there needs to be a clear distinction between treating symptoms and treating cause.  I believe harm reduction is necessary to delay death long enough to treat the cause. I also think maintenance programs are fantastic way to create a stable therapeutic relationship based on which patient transformation may begin.

I think in general treating symptoms only without addressing the cause has been harmful.  It’s financial cost is unsustainable and human cost staggering.

About research and evidence:

Having witnessed EBM about-faced many times in the span of my career, I am more cautious about “evidence”.  I am thinking of HRT for menopause, Oxycodone “The one to start with and the one to stay with”an evidence based solution to “Pain, the fifth vital”.  How about drugs that lowers glucose but causes heart failure? I think there are many more.

At the same time, I am also mindful that some solid intervention without the potential for profit will attract substantially less research fundings.
Furthermore, first-line non-pharmaceutical interventions even if backed by evidence and credibility of regulating bodies are still obscured by agenda of powerful profit driven marketing forces.  

First-line recommendations in “CANMAT 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments” and “CDA 2018: Section 7. Self-Management Education and Support” are seldom part of physician education I have attended (perhaps other have different experiences).
I would appreciate more attention on studies such as “Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis”. by Goldberg SB, et al. Clin Psychol Rev. 2018.
which showed the most consistent evidence in support of mindfulness for depression, pain conditions, smoking, and addictive disorders. Results support the notion that mindfulness-based interventions hold promise as evidence-based treatments.

UK-funded “Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial” published Dec 5th 2017 in Lancet revealed that more than a third (36%) of people with Type 2 diabetes who took part in the weight management programme, delivered in GP practices, are in remission two years later.  Should not this information be topic at every conversation about Type 2 diabetes management? I couldn’t find it in CDA 2018.

I appreciate EBM’s power in protecting me as a physician.  When it comes to really looking after the patient’s interest; I find that the rules often don’t fit and the solution requires common sense and individual considerations.

About addictions:

Every form of addiction is bad, no matter whether the narcotic be alcohol or morphine or idealism. Carl Jung
I think I used to be “addicted” to my work for its constant mental engagement anesthetize my mind’s fear of letting go (or mind’s equivalence to death);  I have since learnt to let go through mindfulness training. I now work because I am grateful and curious.

How to build capacity for transformation

“One starfish at a time” vs groups?
According to CDA 2018 Guidelines, Chapter 7: Self-management Education and Support, Recommendation 4.  “SME interventions may be offered in small group and/or one-on-one settings [Grade A, Level 1A”]
So I do both.  Group is a good way to build capacity and to teach medical learners.

Life Purpose:

My father have contently retired for many decades.  He still cooks every meal, plays Go ( a ancient Chinese board game), reads newspaper and looks after himself and my mom (still cooks for me!).  I think my father produces value by simply being; being healthy, being there for me. My mother retired and began studying; she is still taking classes at U of T.  She goes to coffee shops daily to sketch people. She is hard of hearing; yet, she connects with people through her being. I think producing value is a natural consequence of being well; so my work is to help others be well.  I also think one day I’d also learn to be ok with doing less; ok with thinking less; ok with simply being.

Gratitude

I am grateful for my patients for their diversity taught me to accept myself and their struggles taught me to appreciate life.

Education

I think distressed University students were all once school children ill prepared by a society ill prepared.  I think if I can learn to eat healthy, exercise appropriately, meditate and develop self-compassion at my age; a school child can learn these basic life principles as well, given the context.  Culture is the collective norm and behavior. So I think if we have a cultural problem then the solution must involve everyone. The people who lead, teach and heal need to be those who are willing to live and learn. I think positive changes are happening in schools.  One of my patient told me she now begins each class with meditation for her grade one students. She said the kids are behaving better and other teachers in her school are doing the same. Another patient who is taking Social Work at Fleming college told me that in her program, every class begins with meditation.  I think the idea that learning to manage the mind is important for everyone is no longer mythical. I think it’s gathering momentum and will happen with or without me.(like most things in life). I am just grateful to go for the ride. I am looking for a chance to share my perspectives with educators. Anyone have their ears?

Community engagements

I gave a talk to the Ajax garden club this past weekend on opioid crisis and diabetic crisis.  They appreciated my perspectives. I am to speak to PTA at a local school this month. I will meet VP in charge of employee wellness programing at our hospital systems next week.  I have offered to talk at large corporations (no takers yet) I think the MDs still have a privilege place in society; it can be leveraged to transform other leaders in our society.  Pain, suffering and illness affects everyone including our leaders; opportunities will surely present.

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