Workplace burnout is now classified by the WHO as an
occupational phenomenon. This term was coined in the 1970s by Dr Herbert
Freudenberger. He took the analogy of a burned out house. The outer
shell may look intact., but if you look inside "you will be struck by
the full force of the desolation." A burnt-out person may look intact
externally but "their inner resources are consumed as if by fire,
leaving a great emptiness inside."
Workplace burnout has three key features: feeling of
exhaustion, feeling of negativity related to one’s job, and reduced
professional efficiency. The burnout prevalence is estimated to be
40-55% across medical specialties. It may result in more medical errors,
rapid job changes and poorly managed personal life issues. The problem
is global and across all professions. The Japanese call it Karoshi,
which means, death by overwork. In India, recently resident doctors in
many states have started a campaign "I am Overworked" to sensitize the
government to regulate working hours.
However, burnout is not just overwork. It occurs when
the demands, deadlines and duties outstrip rewards, recognition and
relaxation. The survey of over 15,000 physicians in the US reported the
top causes of burnout to be an excess of bureaucratic tasks (56%), too
many hours at work (39%), lack of respect from administrators or staff
(26%), and the electronic health record (24%). Sleep deprivation is also
a well-recognized cause of burnout.
Interventions include minimizing mindless tasks that
can be done by less qualified personnel, improving workflows, and
institutional support to make physicians feel more valued. Finally,
doctors must eat well, sleep well and exercise regularly to keep healthy
and centered. Recently, a research platform called The Pediatric
Residency Burnout–Resilience Study Consortium has been formed to address
burnout in Pediatric Residents in 41 US programs. Indian doctors also
need to introspect and take pre-emptive action at all stages of their
career. (https://www.who.int/mental_health/evidence/burn-out/en/28
May 2019; The Print 5 June 2019)
ICMR Warns About Vaping
Vaping – a process where the user inhales the vapor
of an aerosolized liquid containing variable degrees of nicotine and
other flavoring agents – is now fashionable among the millennials. And
pediatricians need to be in the know. It hit headlines recently when a
surprise checks in an East Delhi school unearthed several vaping pens or
e-cigarettes. E-cigarettes or Electronic Nicotine Dispending Systems
(ENDS) are manufactured to resemble cigarettes or digital devices like
pen drives. There are more than 460 different brands available in the
country.
On 31st May which was No Tobacco Day, the ICMR
released a white paper strongly condemning its use and warned that if
strong action is not immediately taken it will end in a public health
disaster. They have clearly said that it has significant medical risks,
including cardiovascular and respiratory diseases at every stage of life
including the unborn fetus. The two big myths about e-cigarettes are
that they are safe and are useful in attempts to quit smoking.
E-cigarettes increase the chance of trying out smoking and even passive
vaping is harmful to bystanders. The devices cost anything between Rs
3,000 and Rs 30,000 besides refill costs.
Pediatricians need to send a strong message that
nicotine is harmful even when it is disguised in fruity flavors or cute
containers. (https://www.icmr.nic.in/sites/default/files/press_
realease_files/Press_Release_2.pdf; The Times of India 26 may 2019)
Predicting Rebound Hyperbilirubinemia
A new study published in the journal ‘Pediatrics’ has
given a simple prediction model to predict rebound hyperbilirubinemia in
neonates receiving phototherapy. Rebound was defined as bilirubin levels
reaching phototherapy threshold within 72 hours of stopping
phototherapy. In neonates >38 weeks when phototherapy was stopped with
the bilirubin falling 2 mg/dL below threshold, the rebound rate was
2.5%. In sharp contrast for babies <38 weeks, when phototherapy was
stopped with the bilirubin level 2 mg/dL below threshold, the rebound
rate was 10.2%. The study seems to suggest that we continue phototherapy
for a little longer in babies born below 38 weeks. (Pediatrics. 2019
Jun 13. pii: e20183712)
Kardashian Index
Kim Kardashian is famous for being famous. Her
inexplicable celebrity status is compounded by her 140 million followers
on Instagram. In 2015, when she posted about the benefits of Diclegis (doxylamine
succinate – pyridoxine) for morning sickness, there was a 21% hike in
drug sales over the next few months.
Neil Hall, a scientist in the University of
Liverpool, was concerned that a similar phenomenon existed even in the
scientific community. To quantify this discrepancy between a scientist’s
social media profile and publication record, he created the Kardashian
Index. This is a ratio of the number of citations of a scientist and the
number of twitter followers. Scientist with a K-index more than 5 can be
considered ‘Science Kardashians.’ As Hall says "Social media makes it
very easy for people to build a seemingly impressive persona by
essentially ‘shouting louder’ than others. Having an opinion on
something does not make one an expert."
Social media influencers command considerable clout
due to their millions of followers, especially among the young. This is
being monetized and possibly utilized by the pharmaceutical and even
more by the wellness industry. Is the loud noise of social media
drowning out truth?
(BMJ 31 May 2019; Genome Biology 2014;15:424;
http://genomebiology.com/2014/15/)