Blog do Curso de Medicina da Universidade Estadual de Maringá para a discussão de temas de Educação Médica, Educação das Profissões da Saúde e áreas correlatas.
Blog of University of Maringá Medical School for the discussion of issues of Medical Education, Health Professions Education and related areas.
Like medicine, happiness takes practice. But when it comes to happiness, some say the deck is stacked against doctors.
While physicians can legitimately point to any number of concrete problems putting the kibosh on their joy, some of their problems may lay a whole lot closer to home.
"Nobody is saying there aren't happy doctors out there," says psychotherapist Richard O'Connor, author of Happy at Last: The Thinking Person's Guide to Finding Joy. "Of course there are." But doctors may be more vulnerable to unhappiness than people in other fields, he says. That's because the qualities it takes to earn a medical degree are the very ones that can impede happiness. Combine these characteristics with intense training, isolation, and a stressful work environment and the resulting day at the office can be anything but sunny.
The Physician Personality
First, let's be clear. Doctors aren't the only ones struggling to find happiness. In fact, when it comes to workplace frustration, they're in good company these days. Thanks to corporate downsizing, workloads are heavier and morale lower in offices and plants around the country. Still, with the national unemployment rate hovering around 8.6%, "in most fields just having a job makes you happy with your job," says Tommy Bohannon, a divisional vice president at Merritt Hawkins.
But medicine isn't most fields. Left unchecked, physician unhappiness can lead to major problems, including disruptive behavior, burnout, medical errors, health problems, addiction, depression, and failed relationships. It can also induce doctors to leave the clinical arena: 40% of physicians responding to a 2010 Merritt Hawkins survey sponsored by the Physicians Foundation say they plan to drop out of patient care in the next 1-3 years.
Second, it's important to note that human beings are not hardwired for happiness. As O'Connor notes, "The cavemen who liked to linger contentedly around the fire were more likely to get eaten by the bears, and thus were not available to be our ancestors. Instead, those who survived to be our ancestors were alert, competitive, never satisfied, always on the move -- and we've got their genes."
That's especially true of doctors, and other high-achieving professionals. It takes ambition, perfectionism and drive to make it into -- and out of -- medical school and while those qualities may be very useful for achieving goals, they don't tend to foster happiness and satisfaction.
Being a doctor also calls for critical thinking and a degree of pessimism, O'Connor says: doctors aren't trained to look at the sunny side of life. They look for what's wrong with a patient, not what's right.
While the people who choose to become doctors may have an abundance of these qualities, "Medical training sharpens them to a needle point," he says. The result: physicians often graduate from medical school with a degree, a tendency to be brutally hard on themselves, and a profound inability to relax.
An Unforgiving Work Environment
Transporting this Type-A personality into a workplace fraught with life-and-death decisions, litigious patients, reems of paperwork, constantly evolving technology, long hours, severe time constraints, and shifting reimbursement models simply turns up the heat.
Added to those more obvious stressors is a profound sense of isolation, says Michelle Mudge-Riley, DO, founder and president of Physicians Helping Physicians, a consultancy that helps doctors transition to non-clinical or non-medical careers.
"Becoming a doctor is such a focused, linear path that you don't get exposed to too much else," she says. "The world is not just medicine and doctors can feel lost outside the medical setting."
That sense of isolation and unhappiness is particularly profound for late-career physicians, says Neelum Aggarwal, MD, a Chicago neurologist who frequently lectures on stress and burnout.
The career they signed on for -- the one that consisted of independent private practices and personal relationships with patients -- is on its way out, according to 89% of physicians responding to theMerritt Hawkins survey. While younger doctors may happily trade the autonomy of the old model for the work-life balance and financial security of the new employment-based model, older doctors feel the rules of the game have been changed on them. To make matters worse, many have been forced to delay their retirement due to shrinking portfolios, so they unhappily toil on.
Nearly two thirds (65%) of the 2400 physicians Merritt Hawkins surveyed said their attitude toward medicine was "somewhat" or "very" negative, a precipitous decline from the 49% who said they had negative perceptions before the passage of healthcare reform legislation.
"They still love the practice of medicine -- the actual treating and diagnosing of patients -- it's the landscape they have a problem with: the bureaucracy, paperwork and loss of autonomy," says Bohannon.
A Happiness Primer
So how's a doctor to find happiness? The same way everyone should, says O'Connor: work on it. Find a way to be happy in the now.
"The greatest myth of human life is the belief that I'll be happy if I just get what I want," says O'Connor. "All the research shows that as soon as we get what we want, we'll just want something else."
Instead, O'Connor counsels doctors to cultivate the essential relationships in their lives. Most people derive much of their joy and satisfaction from their family and friends: relationships that too often suffer in the face of 12-hour days and weekend call.
He also advises them to practice mindfulness, both through meditation and in their daily living. Mindful living is about taking a step back and seeing events in light of the bigger picture. The practice -- and it takes practice -- enables people to keep perspective so they can make wiser decisions based on rational thinking and intuition, rather than impulse.
But to be mindful people must learn to quiet their minds and settle down and that's something with which many doctors struggle. Dr. Aggarwal says she frequently challenges physicians to sit and do nothing for as long as they can. Few can sit still for more than a minute or two. Rather than relaxing, they try to "solve" their way through stress and burnout by doing more.
Goals Also Help
Having clear, achievable goals is important as well. For many doctors, graduating from medical school and getting into practice was a single-minded pursuit.
"Once you're in practice there is a tendency to get into reactive mode and it's at that point that I think a number of doctors leave the field," O'Connor says. "They need another goal to achieve."
Setting a goal doesn't mean earning a PhD or running a marathon, counsels Dr. Aggarwal. When she conducts workshops on stress and burnout, Dr. Aggarwal always asks participants what activities they enjoy most.
"The doctors who are doing well -- the ones who aren't in a burnout or stress cycle -- have an answer right off," she says. "You hear, 'I like to fish,' 'I love to camp,' 'I go bowling.' But the sad thing is many doctors don't have an answer."
It may sound trite, but for those doctors, finding a fun or fulfilling activity is itself an important goal. After all, their happiness depends on it.
When it comes to optimizing your online survey, it’s important to consider the question formatting you’re going to use. While it might seem like a small detail, without using the correct format for your specific audience, you risk having your participants stop half way through, or abandon it half way through due to the complexity.
Multiple Choice (Select One)
The multiple choice selection is used for a one choice answer. This format is highly effective in terms of having your customer complete the survey, as it doesn’t require any form of additional answer. Radio buttons are the standard button used in multiple-choice questions. Your answer option orientation can be arranged vertically, or horizontally, depending on your preference.
Multiple Choice (Select Many) The multiple choice can also be arranged in terms of a multiple answer question. Use the check boxes in the event your prospects might want to choose more than one answer. This works when you’re looking to get as many answers as applicable, and can be arranged vertically or horizontally.
Drop Down Menu
The drop down menu is generally used when there are extensive options available to your participants (for instance, country) and can be used when you want the subject to select only one option out of a massive group.
Open Ended Text Questions
Open-ended text questions allow your users the opportunity to write in their own text, depending on the question. This means your answers will become more complex, but subjectively could prove a higher ratio of insight.
The comment box is an open-ended text type question that allows the user to input his answer into the answer field. This would be the ideal place to put an “additional information” subheading, and give your users the ability to expand upon what might seem like a clear-cut answer.
Single Row Text
The single row text is ideal for short or one-line answers to a question. This would work well for online surveys needing a name, city or address.
Numeric (Freeform) Input The numeric (free form) input allows a user to freely enter in any numeric (0-9) answer. This question is ideal for phone numbers, ages or date of birth.
Email Address This question form is solely used to collect email addresses. Upon entering and submitting, only valid email addresses will be accepted.
A matrix question is a series of questions that pose the same answer scale according to a uniformed block. This can vary from Poor- Excellent, Disagree- Strongly Agree, or even Not Likely- Very Likely.
Multi-point Scales (Matrix Single Select)
This question is often used when testing a large group of participants, hoping to easily analyze and report data. It allows for consolidated reporting by providing a workable scale for easy interpretation.
Check box / Multi-select (Matrix multi-Select) Like the standard single select scale, the multi-select is used when testing a large group of participants. The multi-select matrix allows participants to choose any agreeable option with ease.
Spreadsheet The spreadsheet matrix allows participants the opportunity to enter in their own (often numerical) data for specific questions. These questions work well when assessing specific financial amounts.
Rank Order The rank order scaling questions allow specific order of importance to be established, based on the user’s input. These questions can be based on a specific attribute (like order of importance while eating in a restaurant) or basing the preference on an item as a whole in comparison with like objects.
Constant Sum: The constant sum questions help collect the ratio data in terms of online surveys. These surveys can permit expressive relative values or importance of options based on the option order. This can help in establishing overall importance factors, or deciding on whether or not an issue is worth addressing.
The contact information screen provides a collective set of data directly related to your customer. These contact forms will help maintain an organized compilation of all survey user data, and can be assessed based on criteria like last name, city or ZIP code. This can help you in terms of database and in geographical networking.
Autoavaliação para Melhoria do Acesso e da Qualidade da Atenção Básica
O Ministério da Saúde tem priorizado a execução da gestão pública com base em ações de monitoramento e avaliação de processos e resultados. São muitos os esforços empreendidos para a implementação de iniciativas que reconheçam a qualidade dos serviços de saúde ofertados à sociedade brasileira, estimulando a ampliação do acesso nos diversos contextos existentes no País. Este material compõe um conjunto de ações e atividades desenvolvidas no âmbito do Saúde Mais Perto de Você, no qual se insere o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenç&ati lde;o Básica (PMAQ), como uma das principais estratégias indutoras de qualidade no Ministério da Saúde. Entre os objetivos do programa, destacam-se a institucionalização da cultura de avaliação da atenção básica (AB) no Sistema Único de Saúde (SUS). A garantia da qualidade da atenção apresenta-se atualmente como um dos principais desafios do SUS. Essa qualidade deve, necessariamente, compreender os princípios de integralidade, universalidade, equidade e participação social. Nesse contexto, o Ministério da Saúde apresenta a ferramenta Autoavaliação para Melhoria do Acesso e da Qualidade da Atenção Básica (AMAQ), reafirmando seu compromisso com os processos de melhoria contínua do acesso e da qualidade dos serviços da atenção básica em todo o País.
Using the first person in your writing humanizes your work. If possible, therefore, you should avoid using the first person in your writing.
I didn’t know whether to take my Ph.D. adviser’s remark as a compliment. “You don’t write like a scientist,” he said, handing me back the progress report for a grant that I had written for him. In my dream world, tears would have come to his eyes, and he would have squealed, “You write like a poet!”
In reality, though, he just frowned. He had meant it as a criticism. I don’t write like a scientist, and apparently that’s bad.
I asked for an example, and he pointed to a sentence on the first page. “See that word?” he said. “Right there. That is not science.”
The word was “lone,” as in “PvPlm is the lone plasmepsin in the food vacuole of Plasmodium vivax.” It was a filthy word. A non-scientific word. A flowery word, a lyrical word, a word worthy of -- ugh -- an MFA student.
I hadn’t meant the word to be poetic. I had just used the word “only” five or six times, and I didn’t want to use it again. But in his mind, “lone” must have conjured images of PvPlm perched on a cliff’s edge, staring into the empty chasm, weeping gently for its aspartic protease companions. Oh, the good times they shared. Afternoons spent cleaving scissile bonds. Lazy mornings decomposing foreign proteins into their constituent amino acids at a nice, acidic pH. Alas, lone plasmepsin, those days are gone.
So I changed the word to “only.” And it hurt. Not because “lone” was some beautiful turn of phrase but because of the lesson I had learned: Any word beyond the expected set -- even a word as tame and innocuous as “lone” -- apparently doesn’t belong in science.
I’m still fairly new at this science thing. I’m less than 4 years beyond the dark days of grad school and the adviser who wouldn’t tolerate “lone.” So forgive my naïveté when I ask: Why the hell not?
Why can’t we write like other people write? Why can’t we tell our science in interesting, dynamic stories? Why must we write dryly? (Or, to rephrase that last sentence in the passive voice, as seems to be the scientific fashion, why must dryness be written by us?)
I once taught two different college science writing classes in back-to-back semesters. The first was mainstream science writing; the students had fun finding interesting research projects and writing about them. One student visited a lab where scientists who were building a new submarine steering mechanism let her practice steering a model sub around a little tank. Another subjected himself to an fMRI and wrote about the experience.
But the second semester was science writing for scientists, in which they learned how to write scientific journal articles -- and it was a lot less fun. “Keep it interesting!” I told my students during the first semester. To my second-semester students, I said, “Well, you're not really supposed to keep it interesting.”
We’re taught that scientific journal articles are just plain different from all other writing. They're not written in English per se; they're written in a minimalist English intended merely to convey numbers and graphs. As such, they have their own rules. For example:
1. Scientific papers must begin with an obligatory nod to their own relevance, usually by citing exaggerated figures about disease prevalence or other impending disasters. If your research does not actually address one of these issues, pretend it does, because hey, that didn’t stop you on the grant application. For example, you might write, “Twenty million children die of scabies every day. OMG we built a robot kangaroo!”
2. Using the first person in your writing humanizes your work. If possible, therefore, you should avoid using the first person in your writing. Science succeeds in spite of human beings, not because of us, so you want to make it look like your results magically discovered themselves.
3. Some journals, such as Science, officially eschew the passive voice. Others print only the passive voice. So find a healthy compromise by writing in semi-passive voice.
ACTIVE VOICE: We did this experiment.PASSIVE VOICE: This experiment was done by us.SEMI-PASSIVE VOICE: Done by us, this experiment was.Yes, for the semi-passive voice, you’ll want to emulate Yoda. Yoda, you’ll want to emulate.
4. The more references you include, the more scholarly your reader will assume you are. Thus, if you write a sentence like, “Much work has been done in this field,” you should plan to spend the next 9 hours tracking down papers so that your article ultimately reads, “Much work has been done in this field1,3,6-27,29-50,58,61,62-65,78-315,952-Avogadro’s Number.” If you ever write a review article, EndNote might explode.
5. Grammar textbooks contain elaborate rules about when to use numerals and when to write out numbers. But numbers are really the only reason you’re writing your paper, and you don’t want readers to think you’re into something as lame as words. So make sure every single number is written in its numeral form -- otherwise, 1 day, you’ll awake 2 find that you’re 4got10.
6. Most journals use the past tense. To add flair to your writing, try writing your entire article in the Third Conditional Progressive Interrogative tense. Instead of, “We did this experiment,” you’d write, “Would we have been doing this experiment?” This may seem more convoluted than simple writing, but your article probably won’t be any less comprehensible than most other scientific journal articles.
7. Always write “we” instead of “I,” even if you performed the research yourself; the plural ensures that no feelings will be hurt when credit is attributed. For example, “We investigated these results, but then we had to use the bathroom, which is where we sat when our spouse called.”
8. Remember your audience. It consists primarily of graduate students who, 10 years from now, will include your paper in their own voluminous collection of superscripted references. So remember them, and make your name easy to spell.
9. Starting sentences with “obviously” or “as everyone knows” demonstrates your intellectual superiority. If possible, start sentences with, “As super-intelligent beings like myself know,” or “Screw your stupidity; here’s a fact-bomb for you.”
10. Your paper will be peer reviewed, so include flattering descriptions of all of your peers. Scientists call these “shout-outs” or “mad props.”
11. Too many results are reported using SI units. (For those unaware, “SI” stands for “Sports Illustrated,” and it is a system of measurement using units like RBI, Y/A, and, once a year, cup sizes.) Liven up your results by reporting them in furlongs, chaldrons, and fluid scruples.
12. If you’re co-authoring a paper, most of your notoriety will derive from the order of authors and not from the content of your paper -- so make sure to have vehement and petty debates about whose name goes first. Here are the general rules for authorship:
FIRST AUTHOR: Weary graduate student who spent hours doing the work.SECOND AUTHOR: Resentful graduate student who thinks he or she spent hours doing the work.THIRD AUTHOR: Undergraduate just happy to be named.FOURTH AUTHOR: Collaborator no one has ever met whose name is only included for political reasons.FIFTH AUTHOR: Postdoctoral fellow who once made a chance remark on the subject.SIXTH AUTHOR: For some reason, Vladimir Putin.LAST AUTHOR: Principal investigator whose grant funded the project but who hasn’t stood at a lab bench in decades, except for that one weird photo shoot for some kind of pamphlet, and even then it was obvious that he or she didn’t know where to find basic things.
Many scientists see writing as a means to an end, the packing peanuts necessary to cushion the data they want to disperse to the world. They hate crafting sentences as much as they hate, say, metaphors about packing peanuts.
But there’s a reason scientific journal articles tend to be dry, and it’s because we’re writing them that way. We hope that the data constitutes an interesting story all by itself, but we all know it usually doesn’t. It needs us, the people who understand its depth and charm, to frame it and explain it in interesting ways.
This is, in fact, one of the most appealing aspects of science: We’re more than just the people who push the pipette buttons. We’re advocates who get to construct and tell the stories about our science. I can’t think of a better lone career.
Especialistas dão dicas para a publicação de artigos científicos
Karina Toledo - Agência FAPESP
Editores de revistas científicas procuram trabalhos com resultados inéditos, escritos em inglês claro e conciso e que despertem interesse em seu grupo de leitores. Artigos que abordam temas quentes do momento levam vantagem, pois têm mais chance de serem citados em futuras pesquisas e de contribuírem para aumentar o fator de impacto do periódico.
Essas foram algumas das dicas apresentadas por Daniel McGowan, diretor do Grupo Edanz, durante o workshop “How to Write for and Get Published in Scientific Journals”, realizado no dia 16 de março pela FAPESP e pela editora científica Springer.
Desde 1990, o número de artigos submetidos para revisão teve um aumento 100% superior ao do número de novos periódicos, segundo dados do Grupo Edanz, empresa de consultoria na área. Com o crescimento da competição, de acordo com McGowan, “o mínimo que os editores esperam é ciência de qualidade e linguagem adequada”.
“A pesquisa brasileira é boa, mas vejo dois grandes desafios a serem superados pelos pesquisadores do país: a dificuldade com a língua inglesa e a falta de entendimento de como deve se estruturado um artigo científico. Muitos parecem não saber o que colocar na introdução, na discussão e na conclusão do trabalho”, disse McGowan à Agência FAPESP.
Durante sua apresentação no workshop, McGowan explorou o tema e deu exemplos de como estruturar um resumo, como inserir tabelas, gráficos e figuras no texto, como formatar referências e escolher o título e como elaborar uma carta de apresentação ao editor. Deu também dicas sobre o tempo verbal mais adequado nas diferentes situações e recomendou aos cientistas redigir frases na voz ativa e deixar sempre o sujeito da oração perto do verbo.
“Grande parte das pessoas que vão ler o artigo científico também não tem o inglês como primeira língua. O que elas desejam é ler rapidamente, apenas uma vez e conseguir entender a lógica do pesquisador”, destacou.
Para McGowan, ex-editor associado da Nature Reviews Neuroscience, o primeiro passo para melhorar a qualidade da produção científica é a leitura do maior número possível de artigos publicados.
“Isso ajuda o pesquisador a saber se está fazendo as perguntas certas, usando os métodos adequados, interpretando os resultados no contexto apropriado, citando os estudos mais relevantes da área e escolhendo o periódico com o perfil indicado para sua pesquisa”, disse.
Como cada publicação tem regras próprias para estruturar o texto e citar referências, a redação do artigo só deve começar após estar definida a revista para a qual ele será submetido.
“O pesquisador deve ser honesto ao avaliar o grau de relevância e novidade da pesquisa e escolher um periódico com fator de impacto compatível. Ela traz um avanço incremental ou conceitual? Afeta a vida de uma pequena população ou de milhares de pessoas? Melhora o conhecimento sobre um fenômeno ou apresenta uma nova tecnologia?”, exemplificou McGowan.
O pesquisador deve ainda considerar fatores como o perfil do público a ser atingido, o prestígio da publicação e se ela trabalha como sistema de acesso aberto ou assinatura. “Acesso aberto permite alcançar um número maior de leitores e, portanto, gera mais citações. Mas também tem um custo muito maior”, disse.
Segundo McGowan, um artigo nunca deve ser enviado a mais de um periódico ao mesmo tempo. “Por outro lado, se um pesquisador demora muito para publicar suas descobertas, pode ocorrer de outro grupo publicar antes. Recomendo, portanto, entrar em contato com o editor caso não receba retorno após seis semanas. Se depois de dois meses ainda não houver resposta, sugiro cancelar formalmente a submissão e só então enviar para outra revista”, afirmou.
Outra dica do consultor é relatar no fim do artigo os financiamentos recebidos de agências de fomento ou de outras instituições e empresas, descrever possíveis conflitos de interesse e as limitações do trabalho, como tamanho pequeno da amostra por exemplo.
“Os editores percebem quando há falhas ou limitações na pesquisa, mas ainda assim podem publicá-la se os resultados forem interessantes. Não mencionar esses fatores, porém, pode ser um motivo para rejeição”, disse.
Na abertura do workshop, o vice-presidente da editora Springer, Paul Manning, contou que o motivo que levou a empresa a abrir um escritório no Brasil foi o crescimento expressivo da produção científica do país.
“A Springer surgiu na Alemanha no século 19 e foi para Nova York após a Segunda Guerra, pois era onde a ciência estava acontecendo. Nos anos 1970, fomos para o Japão pelo mesmo motivo. Agora, percebemos que havia muita coisa interessante aqui no Brasil”, disse. A Springer atualmente está presente em 20 países.
Segundo dados apresentados pelo diretor da Springer Brasil, Harry Blom, a produção científica brasileira cresce a uma taxa de 17% ao ano – enquanto a média mundial é de 3% – e já corresponde a 55% da produção científica da América Latina.
Mariana Biojone, editora da Springer Brasil, apresentou as ferramentas gratuitas oferecidas no site da empresa para apoiar pesquisadores. Uma delas é o Author Mapper, que mostra os temas mais pesquisados do momento e em quais centros. “Isso pode ajudar o cientista a encontrar colaboradores para seu projeto”, afirmou.