A Few New Year’s Thoughts

If your holidays were like mine, they came and went in a blur. There were the usual family obligations, dinners, gifts to the children, phone calls to make. But also, some of the “time off” was needed to upgrade and maintain the clinical practice’s infrastructure. Few of you probably realize how much time is required outside of patient contact hours just to make the practice viable. This year, much time went into upgrading the practice’s computer hardware and software. New government regulations involving electronic record-keeping and electronic billing have required new software, and the new hardware to run them. But, more about that in a later blog.

With Chinese New Year’s festivities a few weeks ago, the holidays have finally closed. The last cards have been belatedly sent, and now we look forward to this new year. Sometimes a cliched expression sums it up best: Let’s make this year the best ever. If you are reading this, chances are you are experiencing unhappiness, dissatisfaction, and stress. If you are frustrated, you likely have good reason to be in these stressful times. Often, it is unclear how we can change our internal experience because they reflect real and problematic situations.

So, how can we feel better, let alone make this year the best ever? As a starting point, I do not suggest medication or psychotherapy. To start, I do suggest that we examine and reexamine how we live. Are we just busy without experiencing what we are busy doing? When our life is like this, we fail to experience the simple pleasures that come with just being alive, the experiences of eating a delicious meal or of connecting with others through conversation or of experiencing the blue sky and fresh air.

All New Year’s resolutions fail unless they are simple. The following daily directives are simple. They are certainly not original to me, but I have found that they are often forgotten in the search for a magic pill.

 1. Walk a mile a day. There is a clear connection between physical activity and mental well-being. When I worked at Baylor College of Medicine a few years ago, I walked a mile to and from work every day. I kept my weight down and I recalled feeling well in general. Last year, my weight went up 10 lbs and my blood pressure crept up into the borderline hypertensive range. I felt stressed and tired. A change was needed. I have tried to walk more, to use the stairs, to walk during the evening around the neighborhood, to walk to the local drugstore instead of using the car. I try to go to the gym 3-4 times per week, and I walk there from my house. My weight has declined and my blood pressure has dropped.

2. Avoid foods with added sugar. Impossible, you say. Well, I mean just try to avoid them, though it would be hard to avoid them completely. We often don’t realize how many calories come from sweeteners added to beverages and foods. The calories in these foods are sort of hidden, and dangerous. I can’t tell you the number of times very overweight patients have said to me “but I don’t eat anything, how come I am overweight”. While there may not be a clear connection between certain foods and mental states, the connection between chronic diseases (frequently associated with obesity) and mental health is clear and indisputable. For example, diabetic patients almost always suffer depression at some point.

3. Maintain a spiritual practice. A spiritual outlook improves our daily experiences. In my view, spirituality is about appreciating the essence of life. These days, life is often defined by production and consumption (or work and spend). Just think about it, the progress of nations is defined by measures of production and consumption. I think that, without a deeper awareness and appreciation of the everyday miracles that make life possible, we miss out on life itself. For many, spirituality is part of a religious practice; for others it is independent of religion.

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Giving Thanks

After this busy week on call for St. Joseph Hospital, I finally have a few moments to write down some thoughts that have been on my mind of late. Recently, I have experienced challenges, both personal and professional. Well, let me just describe a few issues in the office. We have had some staff turnover. Brenda Flores, our Spanish-speaking billing and reception assistant, has unexpectedly taken maternity leave. Then, Lien, our Vietnamese-speaking jack-of-all-trades office assistant decided to move on, seeking to cover new ground and obtain new experiences. That leaves me, Jim, the office manager, and Tiffany, our wonderful office assistant, to run the office by ourselves. Now Jim actually has to answer the phone, and if he seems a bit out of place, it’s because he’s having to do some things he hasn’t done in a little while. Fortunately, Tiffany’s mother is helping out while I am looking for another Vietnamese-speaking assistant. If you know of anyone fluent in English, Vietnamese, and Spanish, and who wants to work in a high-pace medical office, please refer them to me.

A few weeks ago, unexpectedly, our Dell computer server, which runs our electronic health record and practice management software, completely crashed. And it’s only 2 years old and still under warranty! We have resuscitated it, but as the cause of the crash remains unknown, I have ordered another server, this time from HP. But you will be pleased to know that our backups functioned perfectly, and allowed us to restore the system completely. No data were lost, only time lost as we struggled without a schedule for 5 days.

Despite all this, I am thankful. And why shouldn’t I be. Despite all the challenges, I have managed to see every patient that needed to be seen. And my work schedule has been intense, in excess of 60 hrs per week, mostly every week, sometimes more. Despite the hours, I am grateful that we have been able to provide quality care and that many of you have benefited from this care. I am grateful to have maintained my health, as I have worked without having to take any sick leave ever since I started working in 1993. I am grateful to have dedicated and resourceful assistants and associates. And I am grateful to have interesting and diverse patients, of diverse backgrounds, languages, and ethnicities. I am fortunate to be able to offer help in the psychological realm, to calm their nerves, to help lift their spirits.

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Notes from Mexico City

Dr. Tony Pham at El Pendulo Cafe

(April 25, 2011)  As you can see, I haven’t posted any writings in a while. Ambitious plans to write informative posts on psychiatry and mental wellness have been sidelined by an excessive work schedule of clinic appointments, hospital calls, and other clinical commitments. But providing quality care means more than just seeing patients. It also involves continuing to grow and evolve as a psychiatrist, to learn the latest advances in psychiatric medicine, and to broaden one’s perspective on social and cultural aspects of mental wellness.

And that brings me to Mexico City. First, it’s a much needed vacation. Second, it’s a chance for me to understand better the patients that I see who are of Mexican origin. I planned this trip thinking that, not having much time, Argentina or Spain are too far. La Ciudad de Mexico is the closest major Spanish-speaking city to Houston. Plus, it has a long, at times tragic, and fascinating history that dates back two millenia before the Spanish conquest (historia prehispana). But I must confess that as the day approaches for this trip, I became increasingly nervous. Nearly everyone that I met, including Mexicans, warned me of the dangers and seemed to think that I might be kidnapped or killed. Mexico is a dangerous place, they say. Surely, I thought, the warnings are exaggerated. Even if 10 people were killed every day in Mexico City, this is a city of over 20 million people (too many other potential targets, as they say). Besides, I have always felt comfortable with Mexicans and speak Spanish well enough to get by.

Today, my fourth day here in Mexico City, I feel fairly comfortable here. Walking around near the city center, on the Paseo de la Reforma, in the Bosque de Chapultepec, these places all feel pretty safe. I have met many friendly and helpful Mexicans who try to make me feel welcomed here. Clearly, the people live their lives differently than Americans. In general, they are more social and in many ways more open. It is a society of contrasts, of extreme wealth and extreme poverty, but Mexico is not a poor country.

Arriving during Semana Santa (the week before Easter), the city was quieter than normal. The air was less contaminated with vehicular exhaust and quite breathable. I was able to see the tall mountains surrounding the city. But I saw very few Americans, actually almost none at all. It would appear that Americans, and foreign tourists in general, have decided to stay away from Mexico because of fears of violence. I believe that these fears are overstated.

These fears are probably more rooted in our psychology than on the actual facts.  Our mind magnifies events that are high impact, yet of very low probability. Also, the fears may be related to our fears of all things foreign, which we term xenophobia. Foreign elements have the capability to harm us, so our instinct is to stay away from them. This is true whether they be foreign people, animals, plants, or things. But we also have a counteracting instinct that draws us toward novelty. This instinct leads us to explore and experience new sights, sounds, and smells. It leads us to discover and to understand that which is unknown. There is a biological need for novel genetic elements (i.e., foreigners to reproduce with). To survive, all populations need an influx of new genes, which enhances the genetic diversity of species and ensures their survival in the face of catastrophic change.

I count myself among the more novelty-seeking. In Mexico City, along parks and near bus stations, there are many stalls selling snacks, fruit, candies, drinks, all sorts of stuff. I wanted to look at everything, taste everything. If you go there, don’t be afraid of trying mangoes with lime, salt, and chilies. In Vietnam, we like to eat it this way too (more the green mangoes though) and it’s very tasty.

Time-permitting, over the next few months, I will write some articles about sleep, why we need it and how to improve it.

Eagle perched on cactus-symbols of Mexico

historic building in central Mexico City


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