Pamela Q. Fernandes's Blog, page 35
March 8, 2017
Women’s Day Cover Reveal
Happy Women’s day everyone! On this special day, let me reveal the wonderful cover for Ten Reminders for the Single Christian Woman. Yay! I love it! What do you think?
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The Ten Reminders series will continue with 2017 focusing on the Single Christian Woman. My amazing cover designer, Laura Gordon did this amazing cover and I’m so in love with it.
I’m so excited. We’re looking at a June release date. Stay tuned for more news on this, because we should have a pre-order date up soon. In the mean time, tell me what you think of the cover?
March 5, 2017
5 Powerful TED Talks for Authors
Last week I tweeted about a TED talk from an author. I absolutely loved the message. Occasionally, I do listen to TED talks for different reasons, inspiration, motivation, learning, fillers when I’m standing in a queue, struggling with writer’s block, burnout, etc. And I thought why not share them with you.
I’m sure there are many talks out there and I encourage you to share them with me, if you feel they could help. But these are the ones I’ve listened to, sometimes repeatedly. You may have heard them already, but they’re worth listening to and sharing with the community.
Elizabeth Gilbert, author of bestseller Eat, Pray, Love talks about the dilemma of whether creativity can survive success. She explains how her love for writing trumps her hatred of failing at writing. Her TED talk has also enlightened me about the disadvantages of overnight success.
2. Chimamanda Adichie, author of best-seller, “Americanah” talks about the dangers of over generalization and stereotype in stories. She also explains how good role models in story shape our perspective and view of the world. This TED talk is on every must-listen-for-authors list.
3. Andrew Stanton, film-maker of Wall- E and Finding Nemo,(I looove both movies) talks about what makes a great story. His mantra, “Make me care,” is fantastic advice for authors. He also mentions how scriptwriters and movie makers follow the 2+2 rule. He adds, you must know the spine of the story. This is a TED talk, I listen to every few months. His number one advice, is that your story should instill wonder in your readers and using what you know from your own life can make for a better story.
4. Seth Godin, the marketing guru, in this TED talk, explains how the focus should not be on the making of your book, but on making the ideas spread. He highlights the importance of a product’s remark-ability and uses the Japanese term, “Otaku,” to convey the desire of a remarkable product. Some of his examples are eye-opening. In a world with too many choices, marketing to the right audience is key.
5. Julie Bernstein, a radio producer whose own book, Spark: How Creativity Works has studied many successful, creative people. She uses their stories to explain how creativity is important to all human beings and how it can grow through the cracks and broken places of our lives.
Do you have any inspiring TED talks to share? Let me know, I could do with the extra inspiration.
March 2, 2017
QMC 4 Should doctors accept social media “requests” from patients?
I had a feeling I was going to get this question sometime. So I wasn’t surprised when Dr. AV asked me if it’s okay to accept Facebook “friend requests” from patients.
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The answer is NO.
Let’s look at all the guidelines & statistics first.
The BMJ research showed 73% of doctors surveyed had a Facebook profile, with 24% logging on several times a day. The survey also showed that 6% of doctors had received a friend request from a patient. Most respondents said they’d refuse the request – and rightly so – but 15% said they’d decide on a case by case basis. [1]
The British Medical Association said medical staff and students should reject any approaches by current and former patients to avoid the risk of blurring the boundaries of the doctor-patient relationship. A number of medical staff have been investigated and struck off for “improper use” of Facebook. [2]
The American Medical Association published a policy on professionalism in the use of social media, which addresses the importance of maintaining appropriate boundaries in the patient-physician relationship, refraining from posting protected health information online, and separating personal and professional content online.[3]The Journal of Medical Ethics has published more specific guidelines urging physicians never to invite a patient to become an online friend, or to accept a friend request from a patient. [4]
So, the rules say no. And you can lose your license in the UK, if you do happen to make an off the cuff comment or share a good old story online.
A Facebook relationship is not the same as a professional relationship, if you’re on the other side of this discussion. It is true that patients are starved for more personal relationships with their physicians. But that’s no reason pictures about me and my family on Facebook would be of any benefit to them. On the flip side, I already know all I need to know from my patients from my excellent history taking skills, thank you very much. I have no intention of gathering any more data from anywhere else.
Why not, you ask? A number of reasons:
You could accidentally reveal sensitive information. (HIPPAA violation everyone?)
The lines do get blurred. This is not a friendship. The doctor patient relationship remains objective when there’s that distance. You lose that objectivity when you get into a personal relationship and it clouds your judgment. It’s the same reason we remained detached in the ER.
Especially if you’re in mental health, you know it affects the physician-patient dynamic.
You could lose your license.
There is no advantage to this, that cannot be achieved through a website or an email.
Yes, I know doctors have lives and yes, those lives should be outside of their patients. But my advice would be:
Keep your professional and private life separate.
Privacy is a decision you have to make.
Always remember that whatever you post online, will be used to judge you, by your employers, colleagues and patients.
I’m extremely private. I don’t share images or details of my private life online. My writing struggles yes, but not my life. I have to admit I don’t like Facebook, but have to, for my publishers sake. My fans reach me everywhere else.
If you’re on the fence, I’d still say you can open a separate account, but be wary. Be very wary of what you post. Read Dr. Kevin Pho’s book,“Establishing, Managing and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices” for clarity on this subject.
Ask yourself, can I provide better medical care with Facebook?
What do you think? Are the rules wrong?
References
1.https://laboratorynews.wordpress.com/2010/12/17/doctor-please-accept-my-friend-request/
2https://www.theguardian.com/uk/2011/j...
3. American Medical Association. 2010 Interim Meeting of the House of Delegates. AMA policy: professionalism in the use of social media. http://www.ama-assn.org/ama/pub/meeting/professionalism-sociamedia.shtml. Accessed June 10, 2011.
4. Guseh JS II, Brendel RW, Brendel DH. Medical professionalism in the age of online social networking. J Med Ethics. 2009;35(9):584–586.
February 28, 2017
Published! My new short sci-fi story- “The Last Communication”
A tale of inter-species, intergalactic love amidst a backdrop of apartheid.
My sci-fi/ fantasy short story, “The Last Communication” is now available at the online magazine 40p website.
You can read an excerpt here. Each story sells for 40p, check out all the other wonderful short stories there.
I’m so excited, because this is my fourth speculative fiction short story that’s sold this year. It’s truly amazing. Thanks to my editor, Micheal and the rest of you fans. Let me know what you think.
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Image: Pixabay/ DasWortegewand, CC0 Public Domain
February 26, 2017
Are you Suffering from Writer’s burnout?
I never thought I’d say this. But I have. You know the symptoms:
Unable to concentrate
Unable to finish writing/editing
Neck aches
Frustrated
Chasing a deadline and missing said deadline
Procrastinating
Worn out before typing a sentence
Can’t think of the said sentence, when you’ve typed profusely the night before
Hating another round of edits
Hating your beloved manuscript
I never thought it would happen to me. I love writing and my imaginary worlds. I love my characters and their lives. So how come, it happened to me?
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Honestly, it creeps up on you. It’s coming, you know it. Insidiously, like the flooding waters, until you’re swamped. Last week after a round of family gatherings, out of town trips, and working constantly in the car and at home, and wherever I could type, I developed a crick in the neck.
Needless to say, my entire schedule of writing and editing went berserk. I could scarcely move without crying in pain. After endless massages with Voltaren, I was finally better. But I was also burned out. I needed the rest. Juggling a day time job, with two new novellas and two short stories currently in various stages of editing, my own Ten Reminder book draft and all the other work, I was overwhelmed.
I should have seen it coming. However, prevention is better than cure. I could have prevented it. Here are my tips to prevent Writer’s burnout.
Sleep: Get enough sleep. I was sleeping two to six hours on any given day. Two being the norm. You need to sleep, to let your body recharge. Your brain needs to rest as well. So get your 7-8 hours of sleep. No excuses. Get your rest.
Ergonomics: There’s a reason why MNC’s invest in good furniture for their staff. If you’re spending hours at the computer, it makes sense to get a comfortable chair and table, making sure your eyes are level with your computer.
Breaks: Take regular breaks. Jeffrey Archer writes eight hours a day, in two hour chunks. After two hours, he takes an hour long break reading the paper, going for a walk, you get the idea. Break up your writing session into time limited blitzes. Your body and brain will thank you for the break.
Desk Exercises: I can’t stress how important this is. Learn simple neck exercises. I often teach this to professionals when we do health camps, but neglect to do this myself. Your neck muscles need to contract and relax. Keeping them taut too long, will eventually weaken them.
Eat healthy: I know caffeine soon becomes my best friend when I’m chasing a deadline. Occasionally, I skip meals because I can’t be bothered with cooking, cleaning the pots and returning with the same focus to my writing. My solution, has been to get a load of seasonal fruits, that I munch on throughout my writing session. Eat well to write well.
Exercise: The endorphins of exercise do wonders for the mind. Yet, I hate exercise. If you’ve been sitting in one place the whole day, without getting off your butt for anything other than the restroom, you’re body will turn to mush. Haha. Do something. I do go on a few walks now when it suits me, and I know I should do more. But I find the walks calming and inspiring,especially if I’m not plugged into music or an audio-book.
Pay attention to your body: Sometimes your body tells you, “Enough. Take a break.” And we push ourselves the extra mile, the next deadline, another page, one more word. Stop. Restock. Plan well and if you’ve failed despite the plan, its because the plan was unrealistic anyway. So be realistic and watch out for the signs your body sends you. Writer’s burnout can be prevented.
I was reading Steve Chandler’s Time Warrior- How to defeat Procrastination– How to defeat Procrastination and he says, “Everybody gets 24 hours a day, if you can’t finish your work in 24 hours, it’s because you’re trying to please too many people and taking on other people’s work, without prioritizing your own.”
Are you taking on too much work? Are you pleasing too many people?
Image: Pixabay CC0 Creative Common License
February 23, 2017
QMC 4 Do doctors need to study?
Dr LC asked, “Do doctors study even while in practice and how do you go about it?
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Fantastic question. Any doctor worth his salt, knows he doesn’t know everything. I mean the stuff we spill out in front of interns and med students, is the stuff we memorized last night or material that has been hammered into us when we were clerks. Things like what’s minimum K levels for hypokalemia, indications for epinephrine, Glasgow coma scale, how to treat hypokalemia, signs and causes of hypokalemia. By now, you realize, I know all things hypokalemia! Because it was drilled into me.
We spew it out as if we’re some all knowing being, while the clerks stand in awe.
But with all the advances in medicine and the daily evolution of research in the field, I’m afraid if you don’t study your field, whichever it may be, you’re losing out.
My approach to continual learning is threefold.
Annual, Monthly & Daily Goals
1.For my annual goals, I review the year behind me and decide what is it that I don’t know and need to work on. Last year I knew I was starting to see lot’s of psych patients, I realized I didn’t know how to deal with these patients when they first approached me. And the answer is not, ‘refer to specialist.’ So I took a course on Psychological First Aid by John’s Hopkins, to help me triage these patients. Not because I wanted an extra credential, but because it would benefit my patients. You could also include conferences here.
Conferences are a great way of keeping updated with current trends in the field. I remember when I was a clerk, our OB HOD, Dr. Pantig made this statement in the delivery room, “I go to conferences to enjoy myself and learn. It’s a lot of fun.”
And all the residents, interns and clerks, rolled our eyes. My idea of fun is jiving, eating out, bowling, a good book or karaoke among other things. But conferences, nada. Now that I’m in practice, i realize that they are fun. Some are in really exotic places, but usually they’re all in nice hotels, the food’s good, the company is great, you’re seated with the heavyweights of the field, stimulating conversation, with people who understand you and the information is top-notch. You really come home with knowledge and cutting edge research. You also get to meet the rest of the community, in case you’re under the false impression that you’re the “only special one” in you’re field.
2.My monthly study goals are books, journals, podcasts and papers. The protocols are ten years behind the research and I believe that a successful practice is a healthy mix of evidence based medicine and clinical experience. This month I had a chance to read the research on Psychopathy Checklist by Dr. Hare and a few papers on hand hygiene compliance in preventing (HAI’s). I love the cases presented on Emergency medical minute.
3. Daily learning pertains to my everyday caseload. Doc’s gotta learn! Despite everything, there are still some things that won’t stick in my brain, like Rinne and Weber’s test. It’s so simple, yet, it just won’t stay in my grey cells.
If I’m on a tele-medicine call and I can’t figure out what’s going on, because of lack of vision, I use the Isabel online symptom checker, which is the most up-to-date. In fact I’ve exchanged emails with Isabel’s owner and father of Isabel Maude. They provide special discounts for group practices, its a very handy tool. In 2016, Isabel and Merck Manual announced an integration. Read his story of why he created it in the fantastic book by Yale Dr. Lisa Sander, “Every patient tells a story.”
Dr Lisa Sanders, discusses a few cases and Isabel’s case of necrotizing fascitis is among them. It’s a must read, in case you like to test yourself on differential diagnosis.
So that’s about it. How do you keep track of what’s happening in your field? Any tips?
Image: Pixabay/Cameonaton/CC0 Public Domain/ Free for commercial use
February 20, 2017
Joseon Fringe! Coming Soon
For all my spec fic fans, Joseon Fringe is set to be out in the summer of 2017.
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This book does celebrate Asian diversity and I’m absolutely blown away by the pedigree of some of my co-authors. I’ve seen the proofs and can’t believe I’m going to share my story with these awesome writers.
The best part about that this anthology proceeds will go to the Kids Help Phone. I feel proud to combine my love of writing and psychiatry into this endeavor. Its a wonderful cause.
If you read my good reads post, then you know when asked how I was inspired to write Joseon Fringe, I shared I was reading plenty about the Joseon dynasty and Jang Young Shil, the famous scientist.
I was also watching Fringe and Joseon X Files. So it spurred my imagination. I strongly believe that Jang Young Shil and King Sejong were much like Tesla and Einstein, far ahead of their time.
What influences you to write? TV, movies, books or history?
Watch out for this space. Because, I’ve sold two more stories and will post the announcements once we have cover work done! Till then, Cheers!
Images: From Laksa Media
February 15, 2017
QMC 3 Have a suicidal medical colleague, what should I do?
I received a very important question over the week, from a doctor who has a suicidal medical colleague, asking what to do?
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My answer is do everything and anything.
The data is heartbreaking, alarming even. 400-500 doctors a year kill themselves, in the US alone. Among all professions, the percentage of physician suicides is the highest. Medical school takes a tool. Internship takes a toll. Residency takes a toll. Practice takes a toll.
When a physician kills himself, I often hear the medical community say, “Who cares? He had the same resources we did, he could have gotten help, he’s weak, He had issues etc. It’s his problem.”
We judge. We blame. We leave whomever to their own devices. After all that’s what we do when we have trials.
But according to me when a physician kills himself, its not he who is weak, but us.
We failed, we gave up and we walked away. A suicide doesn’t demonstrate his failure alone, rather the failure of a community. Imagine how disconnected and unfeeling the community was to not have noticed this person’s suffering. So let’s not just blame the person. His failure is our failure.
If a doctor is suicidal and asks for help, we recommend mental health counselors. If we think they’re a danger to themselves or others we force them to see a psychiatrist. And then we go about our day, work our shift, laugh at the jokes people make behind his back and not give it a second thought.
So I laud the doctor who asked this, because dear friend, the malady of unconcern hasn’t touched you. You still care!
In this situation, let’s face it, the management doesn’t give a damn, patients are only concerned about themselves, the nurses MAY be out for your blood and that leaves YOU, my friend.
What do YOU do to help this doctor?
Don’t judge- Quell the eternal cynic in you. He may be weak, he may have made bad choices, he is struggling with simple decisions, but don’t judge him.
Offer hope- Most doctors kill themselves because they’ve lost hope. And when a man loses hope he loses everything. So offer hope, eternal hope. Show them the light at the end of the tunnel no matter how minuscule.
Offer Insight- Show them how this is not the end of the world. Their judgment is clouded and they fail to see things from a different perspective. Show them that perspective.
DON’T enforce an informed code of silence – Without breaking confidentiality, rally the staff, people, management around this person. Take the extra effort to make their world a better place(this is especially for toxic workplaces.)
Ease their suffering- If you can, then ease their suffering. Do they need references, another job, deal with grief, a broken marriage or illness, debt restructuring? How can you ease their suffering?
Don’t let them be lonely- You can leave them alone, but don’t let them be lonely. Learn the difference. Take them out bowling, a movie, or just a walk. It only takes a moment for perspective to change. And for that one light bulb moment, for them to see the alternative, you may have to spend some time. But kudos to your sacrifice.
Mental illness- If you suspect a mental illness, accompany them to a psychiatrist. Be a pillar of strength. If they have addictions, partner them through it. You may say that’s not my responsibility, but that’s exactly what a failed community does,leaves everyone to their own devices, when they need help.
This may seem like a lot of work, but our community is a reflection of us, of what we do. We can sit on our high horses and say, he or she has the same available resources, so if he chooses to end his life, “Boohoo.”
Pamela Wiggle a physician from Oregon, is championing this fight against doctor suicides. She offers plenty of advice on her blog. She has a heart wrenching book on suicide letters written by physicians. Check it out as well.
I know this may not be medical advice, but given my psychiatric bent, these are the best solutions I know. I encourage comments, but if they have actionable steps. Let’s not argue and place blame. We know the system sucks, we know that individuals are super busy, we know that people should develop stronger emotional quotients, we know there are a number of hotlines and self-help groups out there, and we also know the reasons why doctors don’t use them. So save the discourse on what and why and give us the solutions instead. The medical community is very small and we only have each other.
Image: CCO Public Domain, Pixabay AdinaVoicu
February 13, 2017
The Making of “A Raven’s Call”
As you know from my FB posts, my short story will be published in Fun Dead Publication’s “Night in New Orleans” anthology. New Orleans and ravens are both well known in folklore.
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Set for release on April 1st 2017, its all based in the spooky New Orleans, featuring some amazing authors including, Richard Pastor, Jonathan Shipley, Hillary Lyon, Klara Gomez, Ellery D. Margay, Erin Crocker, Pamela Q. Fernandez, DJ Tyrer, Corrine Phillips, Nathan Pettigrew, Cassandra Arnold, Joshua James Jordan, J. Benjamin Sanders Jr., P.L. McMillan, Brian Malachy Quinn, Jonathan D. Nichols, Bret Valdez, Brad P. Christy, and Laurie Moran
Take a look at the cover and you’ll get an idea.
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So how did I come to write this story? My story takes place on All Soul’s Day and since my own dad passed away recently, I started to look at this day with a different perspective. I was hurting and struggling. Through the pain I wrote “A Raven’s Call” with tears and heartache. It’s about a father’s love for his son.
I looked for beautiful plantation homes till I found the picture of one that I could set my story against, in St. Tammany’s Parish. I liked plenty, but this one seemed close to my imagination. The lush green of grass and trees. The river somewhere.
Once I found the house, I had the story. I did quite an extensive search on ravens and the rivers in the state. I don’t want to give away too much. What I want you to see, is that a little inspiration goes a long way.
What is your writing inspiration? What sparks your imagination?
Images: Alexa_Fotos CC0 Public Domain
February 8, 2017
QMC 2 -Should I accept referral fees?
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I received a question from a friend who is in FP (family practice) about referrals.
“The specialist is offering me a referral fee, should I accept it?”
My answer is no. And so is the AMA’s.
“Council on Ethical and Judicial Affairs of the American Medical Association (AMA)—Clinics, laboratories, hospitals, or other healthcare facilities that compensate physicians for referral of patients are engaged in fee splitting, which is unethical. . . . Offering or accepting payment for referring patients to research studies (finder’s fees) is also unethical.”
My understanding is, even if making a referral costs you time in ways of preparing a summary, discussing the referral or calling referring physicians, it’s not outside the scope of duties as a GP or FP. You’re the PCP, its part of your job description.
There are arguments on both sides of the fence. Check out this peer reviewed paper on “Paying Fees to Referring Physicians.” The article goes on to say that if you are taking fees you should tell the patient.
That in itself is a problem, because the patient is then left wondering if he’s getting referred to Dr. X for the fee?
What do I do? I usually pass on referral fees to my patient. I refer to some of the best specialists in Mumbai. As a rule I refer to doctors I’ve worked with or doctors with a solid reputation in their field. I can tell you from personal experience that these specialists are the best human beings on the planet.
Case in point, I was once referring a patient to Dr. Soonawalla in Kemp’s Corner, Mumbai. I picked the phone with trembling fingers, the script I prepared with the case history was shaking in my hands. When he finally picked up the phone, he quietly listened to me narrate the case. His answer was, “Do you want me to come to your clinic and examine or is he able to come to mine?”
It blew me away.
His first concern was the patient. We didn’t talk fees. The patient’s need came first. I never met him in person, because eventually the patient went to see him. For a very popular specialist in South Mumbai, he seemed to have his priorities right. Patient first.
As far as other referrals go, if the specialist does offer a fee, I usually pass it on to patients. So my patients can get a 10% discount or earlier appointments in exchange for the fee. No benefit is passed on to me. My patients benefit out of the referral completely. It also eliminates any niggling worry the patient may have, that I’m making a profit out of the referral. Quite contrary, but that’s what it is.
What do you think of “referral fees?”
References:
American Medical Association. Health and Ethics Policies of the AMA, http://www.ama-assn. org/ad-com/polfind/Hlth-Ethics.doc, accessed January 8, 2009.
Image: Pixabay/Valelopardo/ CC0 Public Domain
