Top healthcare and psychology podcasts from 2019

2019 was the year I discovered podcasts. I’m not alone – it’s estimated that there are currently 800 000 podcasts, an increase of 250 000 since the middle on 2018. Here, I share some of my favourites. While most of these aren’t targeted specifically at health or psychology audiences, they all tackle events or issues likely to appeal to people working or studying in these areas, including everything from healthcare scandals to recorded counselling sessions.

 

Dr Death

dr death podcast
This was the most shocking podcast I listened to in 2019. It charts the story of
Christopher Duntsch, a US neurosurgeon who claimed to be the best in Dallas. He has since been convicted of maiming one of his patients and sentenced to life imprisonment. Altogether, he is thought to have caused the death and maiming of 33 patients. The show has been criticised for sensationalising the story for entertainment and is certainly not told in the style of a documentary. However, for anyone interested in healthcare safety, it’s a horrifying, absorbing cautionary tale on what can happen when adequate safeguards are not in place to ensure professional standards. From Wondery, Dr Death is hosted by Laura Beil and is available to download from Apple podcasts and Spotify.  

 

PsychCrunch

PsychCrunch podcast

If you’ve ever wondered how you can improve your commitment to exercise, eat less chocolate, persuade others of your viewpoint or make yourself more attractive to others, PsychCrunch is for you. From the British Psychological Society’s Research Digest, each episode is around 15-20 minutes long and features interviews with experts on different topics. The podcast is published quarterly and is presented by Dr Christian Jarrett, Ginny Smith and Ella Rhodes. It’s snappy, informative and evidence-based – an easy and engaging way to keep up with developments across psychology. Psychcrunch is available to download on Apple Podcasts, Stitcher and Spotify.

 

The Drop Out 

From ABC Audio, The Drop Out explores the story of Elizabeth Homes and her company, Theranos. Holmes’ goal was to create the first blood test which could provide multiple test results using only a drop of blood – the amount that would result from a pin-prick. This technology would make testing cheaper and more convenient and was widely described as ‘revolutionary’. Her idea drew enormous investment and made her the youngest self-made female billionaire. The only problem was that it was never more than an idea: Holmes’ company Theranos did not even manage to produce blood testing devices which were as accurate as machines already on the market, using the standard amount of blood required. For anyone working in healthcare, the story is an insight into the world of healthcare technology innovation: how it can happen, and where it can go wrong. From a psychological perspective, it considers the mind and motivations of someone dedicated to a goal, regardless of the situation and the cost. The Drop Out is available to download from Apple Podcasts, Google podcasts and Spotify. 

 

Where Should We Begin? With Esther Perel

Esther Perel is a Belgian-born couples therapist whose podcast episodes are unscripted, one-time counselling sessions. The names of the couples have been changed to help provide anonymity, but the voices and conversation are real. Perel now has a huge library of previous sessions, covering relationship challenges ranging from impotence too infidelity. Perel initially trained in psychodynamic therapy before training in family systems therapy. Her website states that she offers training in ‘psychodynamic, attachment, and systemic theories, as well as sex therapy, psychodrama, and body-oriented approaches’. In truth, as a UK-based, CBT-trained Clinical Psychologist, I’m not sure exactly what her approach is or how it is supposed to work, but it certainly makes for a good podcast. I’d recommend this show for anyone interested in relationships, the concept of one-time counselling sessions or the use of therapeutic models for couples therapy. From Audible, Where Should We Begin? can be downloaded from Spotify, Stitcher and Apple podcasts. 

 

I Hear Voices 

From BBC Radio 1, this podcast covers 27-year-old Alice’s experience of hearing voices. Alice has multiple voices, each of which has a different personality and may be more likely to occur in relation to different events that happen. For example, there is one set of voices that she only hears when she is cooking and another that occurs after she has self-harmed. Each episode is brief, lasting less than 10 minutes, and explains one of these voice-hearing personalities. The series is told entirely from Alice’s perspective and provides a window into what life is like when you hear voices which can be hard to ignore. Alice’s insight and perception into her own experiences are utterly illuminating for anyone working in mental health or psychology – highly recommended. I Hear Voices is available to download from BBC Sounds and Apple podcasts.

 

Bad Batch 

In the US, stem cells are big business. Touted as the cure-all for everything from joint aches to Parkinson’s, they can now be purchased in the form of non-controversial birth stem cells (taken from the umbilical cord blood of live born babies) and injected by medical professionals for just $5000 a pop. Bad Batch focuses on this industry, highlighting the lack of evidence to support the lofty claims made by stem cell distributors. It also highlights the risks, focusing on one company, Liveyon, which distributed stem cell vials which led to a group of treated patients falling gravely ill. They also happened to contain almost no active stem cells. Laura Beil, host and reporter, delivers some compelling insights into the factors which have enabled such an industry – and such a patient safety debacle – to occur. First, she highlights inadequate regulation of stem cells, as they are not treated as drugs by the Food and Drug Administration (FDA). Second, she highlights the nature of the profit-based US healthcare system, where treatments are marketed directly to patients using flashy advertising. For anyone interested in healthcare systems, it’s an engrossing insight into the problems that come when healthcare becomes a marketable commodity. From Wondery, Bad Batch is available to download from Spotify, Stitcher, Podtail and Apple podcasts.

 

The Last Days of August

Jon Ronson’s podcast, The Last Days of August investigates the death by suicide of porn star August Ames. Ames was aged just 23 at the time, and her death immediately followed a social media ‘pile on’ regarding a comment she made on Twitter. Ronson has long been interested in the effects of public shaming, and his investigation begins there. However, before long he moves away from viewing the Twitter storm as the main reason for Ames’ death. His investigation leads him to explore her childhood, adolescence, marriage to 43-year old porn producer, Kevin Moore and a recent traumatic film shoot she was involved in. As a Clinical Psychologist with a PhD in suicide research, I was a little frustrated that Ronson didn’t include any interviews with experts in suicide, which could have informed his investigation and provided a framework to put the puzzle pieces together. Despite this, it’s a deeply engaging podcast. Sensitively handled by Ronson and his producer Lina Misitzis, it had me gripped to the end. This podcast is likely to be of interest to anyone with a background in mental health or  suicide research. It suitably comes with a warning at the start of every episode though – listeners should be warned that it contains bad language and frequent sexual references, in addition to covering an extremely sensitive topic. From Audible, The Last Days of August is available to download from Stitcher, Apple podcasts, PlayerFM and Podbay.

 

The Shrink Next Door

From Bloomberg and Wondery, The Shrink Next Door tells the story of the relationship between Marty Markowitz and his therapist, Dr. Isaac Herschkopf. The story is told by long-time journalist Joe Nocera. Nocera had a house in the Hamptons and believed for years that the neighbouring house was owned by Herschkopf. He was invited to house parties by Herschkopf, who also happened to have his name on the mail box. Herschkopf was affluent enough to employ a handyman, whom Nocera regularly saw taking care of the pool and back garden when the Herschkopfs were not staying there. The first twist, of course, is that the house was never owned by Herschkopf: it was owned by Markowitz, who was also mistaken for being the handyman. The Shrink Next Door explores the progressively controlling, isolating and unhealthy ‘therapeutic relationship’ between Herschkopf and Markowitz which gradually saw Herschkopf taking control of Markowitz’s relationships, finances and business. As a mental health professional, this story made my jaw drop. I once agonised over whether it was appropriate to accept the gift of a DVD from a client who wanted to say ‘thank you’ at the end of therapy; the concept that a therapist could break every professional boundary going was utterly astounding to me. This podcast will interest anyone with a background in mental health or a concern for the oversight of therapeutic relationships in health systems. The Shrink Next Door is available to download from Stitcher, PlayerFM and Apple podcasts.

Healthcare workforce crisis: Why are so many staff leaving the NHS?

The NHS has a healthcare workforce crisis. It is estimated that 40,000 nursing and midwifery posts currently stand vacant – enough to fill Hong Kong Stadium. Furthermore, 68% of junior doctors report that staffing gaps occur often, which they suggest sometimes put patients’ safety at risk. To try and plug these gaps, there has been a focus on upping recruitment, with strategies aimed at funding training places in the UK and attracting more staff from overseas. However, it has been suggested that rather than being a problem of poor recruitment, the crisis is primarily driven by too many staff leaving. A quick look at the data supports this view: around 200,000 staff have left their NHS jobs every year since 2011, adding up to a combined total of 1.6 million over 8 years. Why is this? Here I explore the NHS dataset on ‘why staff leave’ to try and understand this problem.

The dataset

The data on ‘why staff leave’ has been recorded in a consistent manner since 2011/2012 and is available to download in a single excel file. There are 38 categories, ranging from ‘Death in Service’ to ‘Voluntary Resignation – Promotion’ (to download the original dataset, click here).

Concerning trends 

Overall, the number of staff leaving jobs every year has been fairly stable with around 200,000 leavers per year. However, given the workforce crisis, there is a need to increase staff retention, and there is no sign that this is happening. There is also evidence that staff are increasingly leaving for specific negative reasons:

  • More staff are leaving due to poor work-life balance. In fact, more than twice as many cited this as their main reason for leaving in 2018-19 than 2011-12. This fits with broader data indicating increasing rates of burnout (see my previous blog post on burnout in mental healthcare staff for more on this).
  • More staff are leaving due to a lack of opportunities. Over 4800 cited this as their main reason in 2018-19 – more than twice as many who cited this as their reason in 2011-12.
  • More staff are resigning for health reasons. Similar to patterns seen with work-life balance and lack of opportunities, over twice as many staff cited this as their main reason for leaving in 2018-19 compared with 2011-12 – 4479 compared with 2126.

 

reasons for leaving

 

Positive trends

Sometimes staff leave their jobs for positive reasons, and the dataset reveals trends in some of these areas.

  • More staff are resigning due to gaining promotions. Over 15000 cited this as their main reason for leaving in 2018-19 – double the number who did in 2011-12.
  • More staff are leaving to take up education and training opportunities. Remarkably, the pattern is similar to that seen with promotions. Nearly 5000 left for this reason in 2018-19 – twice as many who said this was their reason in 2011-12.

 

positive reasons for leaving

 

The need for caution

These results highlight some concerning trends which suggest that dissatisfaction with work is one factor contributing to the current healthcare workforce crisis. However, they also reveal some positives – more staff than ever are leaving for education, training or a more senior post. When considering this data, there are two key issues to bear in mind. First, just because a staff member has left their job, it doesn’t mean they’ve left the NHS or even their organisation – they may simply have switched to another role. Second, if a person has had a few job changes over this 8-year period, they will be represented multiple times within the dataset. Both these issues could inflate the overall impression of the problem provided by this analysis.

Breaking bad news in healthcare: why we shoot the messenger

Breaking bad news is a cornerstone of healthcare delivery. From the doctor delivering blood test results in cancer services to the sonographer communicating the discovery of a pregnancy loss, healthcare professionals regularly find themselves in this challenging situation.

But why is it so challenging? In theory, the healthcare professional is simply the messenger: the person relaying information about an event they did not cause and had no influence over. The reality is nothing like this, though. Research tells us that healthcare professionals find these situations highly stressful, particularly when the news is unexpected or seems unusual or unjust. Some end up coping in unhelpful ways; distancing themselves from the patient by using technical language, delaying the communication of the news or avoiding it altogether and passing the task on to someone else. These coping tactics often backfire by creating a more negative experience for the patient and further increasing the stress the healthcare professional feels.

breaking bad news

A recent study has shed light on these conversations, identifying some of the underlying reasons for why these events are quite so difficult for healthcare professionals. This study conducted a series of 11 experiments, which together showed that:

  • After receiving bad news, people feel a need to try and ‘make sense’ of it
  • To help them ‘make sense’ of bad news, people dislike the person who told them, even if they clearly are not to blame for what has happened
  • People dislike the messenger even more if the news is unexpected, or if it is particularly unjust or unusual
  • The reason that people dislike those who tell them bad news is because they think these messengers have bad motives: they mean badly
  • This effect is reduced if recipients of bad news have reason to think the messenger has benevolent motives or means well

This study used a range of news delivery scenarios, including one where a person was told that they had not won a $2 bonus and another where their scheduled flight was running late. However, I think this study has important implications for healthcare settings for three main reasons:

  1. It brings a new perspective to why these events are so challenging for healthcare professionals. It’s not logical, but the truth is that patients will like professionals less when they deliver bad news, and consciously or subconsciously, professionals know this. Building good professional-patient relationships is a key part of healthcare delivery, and having to deliver bad news works against this.
  2. It highlights the situations where delivering bad and difficult news is going to be most challenging. Specifically, these are likely to be where the news is unexpected or where it is particularly unusual or unjust. I think that two key settings where staff should be better supported with this task are obstetric ultrasound and maternity services more broadly, as the news is often unexpected and paediatrics, where bad news could be more likely to be perceived as unusual and unjust. In these situations, the recipients of bad news may have to work harder to make sense of the information they have received, and as such, may be more likely to ‘shoot the messenger’.
  3. It offers a suggestion for how healthcare professionals can reduce the ‘shoot the messenger’ effect: namely, by communicating their benevolent intentions. For example, this could involve saying ‘I’m so sorry, I hoped to bring you better news than this. This must be so difficult for you to hear’. However, doing this requires professionals to be forthcoming and open. Unhelpfully, the impact of stress often has the opposite effect: it inhibits people, making them more careful and wary of saying ‘the wrong thing’; therefore increasing the chance that they’ll say very little. What this research shows is that by going against the natural instinct to say little in stressful situations, healthcare professionals can reduce the ‘shoot the messenger’ effect and help create a better experience for both themselves and their patients. It is also consistent with findings of a review I conducted which showed that training healthcare professionals in breaking bad news works: it enhances their confidence of how to manage these difficult situations and improves their skills.

Thalidomide: Nine things you didn’t know about the ‘poisonous pill’

Thalidomide was marketed to pregnant women as an antidote for morning sickness in the late 1950s, but the results were calamitous. An epidemic of babies born with various disabilities including limb, organ and neural damage led to its withdrawal from sale in November 1961. There were over 5000 known thalidomide survivors living worldwide in 2003, including 500 in the UK.

As a healthcare researcher, I had come to understand the thalidomide catastrophe as a systems failure: the disastrous outcome of an inadequate medications approval process. My dad, Dr Martin Johnson, was Director of the UK Thalidomide Trust between 2000 and 2014, and through him I had come to learn about its terrible impacts upon individuals and their families. I also understood that many survivors were still awaiting justice. However, in 2018, together with his co-authors Professor Ray Stokes and Tobias Arndt, dad published ‘The Thalidomide Catastrophe’, the first and only comprehensive history of thalidomide. Reading it led me to realise I had been seeing through a glass darkly. When laid bare, the thalidomide story is stunning, shocking and almost unbelievable. Here I share with you nine things I learned from the book:

Ed, aged 3

Ed, aged 3

  1. The full number of people affected by the drug reached tens of thousands. It is well known that thalidomide caused babies to be born with disabilities. However, it is highly likely that many other children died in the days and months after birth and that even more were miscarried or stillborn because of thalidomide. Johnson, Stokes and Arndt estimate that altogether, between 87,600 and 275,500 babies were affected.
  2. A single tablet had disastrous effects. Researchers have been able to link the days on which tablets were taken with specific forms of damage. For example, a tablet on days 21-22 after conception could cause damage to, or loss of the eyes. A tablet on day 24 could cause loss of the arms and a tablet on day 29 could cause loss of the legs. The key message from this is that the babies who survived thalidomide were those whose mothers took a tiny amount of the ‘poisonous pill’.
  3. Key players in the development of thalidomide are linked with the Nazi regime. The book explores this issue in meticulous depth and it is hard to summarise the evidence briefly. However, two things are clear. The first is that the Chief Scientist of Chemie Grunenthal, the Germany company who patented the drug, was Dr Heinrich Muckter. Muckter spent World War 2 (WW2) at an institution which tested drugs on Buchenwald concentration camp prisoners. The second is that Otto Ambros was a consultant for the Distillers Company, the British organisation which distributed Thalidomide in the UK. Ambros was sentenced to 8 years for his war crimes during WW2, which included using slave labour from the Auschwitz III-Monowitz concentration camp.
  4. Thalidomide seriously harmed adults too. When taken for more than 2 weeks, thalidomide could cause adults to contract ‘polyneuritis’, nerve damage involving symptoms such as tingling, numbness, excruciating muscle cramping and even partial paralysis. It could affect coordination, balance and the ability to walk. Altogether, around half a million adults were probably affected. “The Thalidomide Catatrophe” provides the response from Chemie Grunenthal to one affected surgeon who used the drug. “Thank you for your letter of 8th March 1960 in which you tell us you are increasingly suffering from paraesthesia and… probable polyneuritis… We wish to advise you that we have received no such reports to date” (p110). This letter was a lie: the company had received several reports and their false reassurance may have caused the surgeon to keep taking the harmful drug. As Johnson, Arndt and Stokes comment, these effects probably cost this surgeon his career.
    TIna Gallagher

    Tina Gallagher in 2002

  5. Warnings the drug was dangerous were ignored. To this date, Chemie Grunenthal claim that they could not have known about the harmful potential of Thalidomide. The evidence presented by Johnson, Stokes and Arndt makes this almost impossible to believe. For example, there is clear evidence Grunenthal’s Chief Scientist, Heinrich Muckter, received warnings a year before thalidomide even went to market from Dr Piacenza, an Italian doctor who undertook trials of the drug. Writing in 1956, Piacenza reported that the drug was unsuitable due to its toxicity. He described side effects in adult patients which included a whole-body rash and peripheral nerve damage. Reports from concerned physicians continued to be sent to Grunenthal, but the drug was not removed from market. Concerns were also raised about the potential harmful effects of thalidomide on unborn babies. For example, in 1959, scientist Dr Randolph Riemschneider raised concerns that thalidomide was causing birth defects in tadpoles he was experimenting with. As he later recorded, “we sent this information with photos to Chemie Grunenthal… Unfortunately, no answer was forthcoming” (p115).
  6. Even when its impact was known, Chemie Grunenthal continued to sell thalidomide. There were warnings that thalidomide was harmful before it even went to market. However, Chemie Grunenthal did not publicly acknowledge its harmful potential until 1961. In a speech on 14th July that year, Heinrich Muckter, Grunenthal’s Chief Scientist told his staff, “if I were a doctor, I would not prescribe Contergan [trade name for thalidomide] any more. Gentleman, I warn you… I see great dangers” (p41). Yet he didn’t withdraw the drug from sale until November that year. If he had pulled it immediately after his speech, more than 25% of the babies who were affected would have been saved.
  7. The impacts of thalidomide are sometimes invisible. Not all survivors were affected by the limb damage which is characteristic of thalidomide. As a toxic nerve agent, it also caused devastating hidden damage. Johnson, Stokes and Arndt report the situation of Julie Lane, whose mother had been supplied with the drug. Outwardly, Julie only had minor hand damage. However, at a young age, she developed epileptic fits. In her teens, she lost the use of her legs and later on, her arms. She also gradually lost her hearing and her sight. As her epileptic brain activity was not typical, her symptoms were misdiagnosed as being psychosomatic, and not of physical origin. This caused her problems to be stigmatised. However, a post-mortem conducted after she died aged 44 showed evidence of major internal damage which had been there since birth.
  8. Survivors still wait for justice. Chemie Grunenthal, the company which patented thalidomide, has never been held to account. A trial was called in 1968 but later suspended, apparently on the basis that “public interest in a continuation of the criminal prosecution no longer exists” (p.131). In the UK, Distillers, the company which distributed the drug paid out some compensation following a lengthy legal battle. However, survivors in some other countries have never received compensation, and all survivors are still waiting for an apology from Chemie Grunenthal.
  9. Some countries protected their populations from thalidomide. Several countries which considered licensing thalidomide denied or significantly restricted the sale of the drug. These included Turkey, East Germany, the USA and France. In Turkey, Dr Aygun undertook tests involving tissue cultures and concluded the drug was unsafe in 1960. In East Germany, the relevant officials had concerns based simply on the information supplied in the patent. They noted that due to the structure of the molecule, an “embryo-toxic effect” (p124) was possible. They refused a licence. In the USA, Dr Frances Kelsey resisted significant pressure from the prospective American licensee company (Richardson Merrell) and managed to delay the approval of the drug until it was removed from sale in 1961. Her delay meant that only around 160 babies are estimated to have been affected by thalidomide in the USA. What these countries show is that the toxic properties of thalidomide were possible to identify using the technologies and processes of the time. Those governments which failed to prevent the distribution of thalidomide are partly to blame for the disaster, and should also be held to account.

 

In 2019, the generation of thalidomide survivors is turning 60. What “The Thalidomide Catastrophe” makes clear is this: the international sale of the drug was preventable. Its risks should have been identified by the company which patented the drug, those which distributed it and by the governments which allowed its sale. The damage which was initially caused has been extended over six decades by a failure to acknowledge and apologise for the harm that was caused. The need for an apology remains.

Reflective practice groups for liaison psychiatry nurses: are they helpful? Our study

Liaison psychiatry nurses have a tough job. They are based in the Emergency Department and work with individuals experiencing acute distress; these patients may have recently self-harmed or attempted suicide and could be at high risk of further harm. Liaison psychiatry nurses contact gatekeepers to other services while under the pressure of national waiting-time targets. They usually have no continuity with patients after they are discharged and may be left wondering how their patients’ situations turned out in the end. Both mental healthcare staff and emergency department staff are high risk groups for burnout (Johnson et al., 2018; Potter, 2006); liaison psychiatry nursing combines each of these elements and so these nurses may experience particularly elevated stress.

In order to provide liaison psychiatry nurses with more support, one hospital introduced reflective practice groups. The groups were a protected hour: the liaison psychiatry nursing team left the department to go to a quiet room in another building where they could not be contacted. The groups were facilitated by a clinical psychologist already employed by the hospital. I particularly liked this feature; too often I hear about outside consultants being paid hefty sums to deliver wellbeing packages with hazy evidence bases, when most healthcare organisations already have a group of highly trained professionals employed in their  psychology department who can do this work. The psychologist enabled dialogue between the team members and facilitated their conversation but did not impose an agenda.

When I was invited to contribute to the evaluation of this intervention I was delighted. We interviewed 13 liaison psychiatry nurses who had attended the group. They identified four main benefits of participating:

  • Sharing and learning. Participants found that sharing their experiences in the group helped them to feel less alone. They realised that other people in their team were experiencing similar challenges and they left the group sessions feeling clearer-minded and lighter.
  • Grounding and perspective. Participants said the group allowed them to take a step back and gain perspective on the difficulties of their work and the risks involved. It reminded them of the value their work has.
  • Space. Participants described the group as a safe space; they felt able to ask for help or to say they were unsure of things and seek advice from their colleagues.
  • Relationships. Participants said the group supported some positive interpersonal experiences between team members. The fact that they had an external facilitator and were guaranteed to be free from interruptions led them to feel they could raise difficult issues with their colleagues, in the knowledge they would be able to resolve these before the conversation ended.

It should be noted that not all nurses found the group beneficial. Some felt that the types of discussions they had during reflective practice were already happening elsewhere and they believed a protected space was not necessary. However, these nurses recognised that some of their colleagues benefited from the group, and were willing to participate in recognition of the overall team benefit.

We weren’t able to quantitatively evaluate the group as the number of participants in the study was too small. However, our qualitative data suggested that overall these groups provided a range of benefits which would have been hard to get from another forum, and some participants believed that sickness absence in the team would have been higher without them.

Practical tips for running reflective practice groups

For anyone wanting to run reflective practice groups, our study suggested a few things should be considered:

  • Groups shouldn’t include managers. The presence of managers changed the nature of the group and inhibited open discussion.
  • Protected time is key. Nurses stated that the groups were the only time they were guaranteed to have a conversation at work without interruption, and this was an absolute necessity for helping them feel able to discuss sensitive issues.
  • The facilitator must be external to the group. Previous research suggests nurses trained in reflective practice can supervise these groups and there can be benefits to having someone of the same discipline provide this facilitation. However, experienced clinical psychologists should be sufficiently trained to offer this in the absence of trained nurses. Our study suggests this is acceptable to nurses and the important thing is that the facilitator works in healthcare but is external to their team.

A practical and cost-effective solution

Further research is needed to establish the effectiveness of reflective practice groups for supporting staff wellbeing. However, the evidence base for burnout reduction interventions in general is still small (see my previous blog on this here), and the best methods for supporting staff are not yet established.  While we wait for evidence-based recommendations, reflective practice groups are a cost-effective form of support for liaison psychiatry nurses: they require no special equipment, no long periods of staff absence from work and can be facilitated by in-house psychologists, so no expensive outside consultants are required.

To read this study please see here