The physical, emotional & behavioral *symptoms* of anxiety can often be more debilitating than the thing(s) we’re anxious about.

Of course, anxiety is part of the human condition. Some degree of anxiety is required for survival. Anxiety isn’t always “bad.”

A short 🧵 … 2. Anxiety can even be helpful if managed appropriately & channeled in a healthy direction.

But anxiety is a medical problem if & when it interferes with thoughts, behaviors, relationships and/or mental & physical health.

The question I ask patients isn’t “Are you anxious?”

19-yr case-control study of >40K breast cancer patients

📣 Estrogen does not seem to increase breast cancer risk 📣

It’s synthetic progesterone in hormone replacement that does.

It’s time to correct the record & get patients what they need. @smalonemd

journals.lww.com/greenjournal/F…

As we dig out from the last two years & transition to endemicity, we must invest in the unmet physical, behavioral & #mentalhealth needs of millions of Americans.

My ode to #primarycare & my latest for @thehill

A 🧵...

thehill.com/opinion/health… Last week, a federal judge overturned the Biden administration’s mask mandate for public transportation. When a reporter asked whether ppl should wear masks on flights, President Biden responded, “That’s up to them,” signaling another step toward the “new normal” ... 2x

🎉 Podcast announcement 🎉

Over the past few months, I’ve had the pleasure of being a guest on podcasts of friends, colleagues, & people I admire ...

A 🧵 ... ... For example, I spoke with my friend & colleague @VPrasadMDMPH about the relevance of mental health to our physical health, the harms of moralizing human behavior, & how to approach & appreciate varying/diverse POVs during a global health crisis. 1x

https://twitter.com/FlossObama/status/1479678438755741702?s=20&t=e0-qG0g8LYjCSWw8iOYczg

FAQs from some of my low-risk patients this week:

Wouldn't a 4th shot prevent me from...

... getting COVID?
... sickening my unvax'd child/immunosuppressed son/elderly parent?

These are excellent questions but demonstrate how woefully we've messaged the vaccine.

A 🧵 ... Sure, some patients are anxious. That's normal.

Sure, some patients get told by Google/a neighbor/TV pundit to get a 4th shot regardless of age & health. That's our world.

Sure, some patients truly *need* a 4th shot to reduce the risk for severe COVID. That's my job.

2x

I was honored to speak in front of @HouseScience committee yesterday abt the importance of trusted messengers in a crisis— & what we need to do for the next phase of #Covid_19.

Here is my opening statement … 🧵 1x

#Vaccines #VaccinesSaveLives #PrimaryCare As we inevitably face more C19 waves & variants, I worry abt the ongoing devastation from the virus *and* abt the collateral damage from the mitigations themselves. Mostly I worry abt ppls’ confusion & resulting anxiety abt not knowing who to trust in a global health crisis.2x

I was honored to testify today in front of congressional @EnergyCommerce committee:

"Lessons from the Front-Line: #COVID19's Impact on American Health Care."

My opening statement ... followed by congressional member questions...

#mentalhealthishealth

🧵 1x Mental, physical & behavioral health are inseparable.

The pandemic has laid bare our vast vulnerabilities.

#Primarycare is where ppl can be fully seen & heard, where trust is born & where we apply broad public health advice to pts' unique medical issues & lived experience ...2x

My tripled vax'd, COVID-recovered, PCR-tested, masked son in college w/ a 99% vax rate got to see the inside of the University's dining hall for 1st time in *2 yrs* last week.

Today? It closed again. Student dining is back to *outside* only - or alone. Socializing limited ...🧵 My son has been loathe to speak out, worried abt being shamed for not caring abt other ppl (this kid has a ❤️ of gold - a lover not a fighter) or being labeled anti- x, y, z. But watching his friends suffer from anxiety, depression, substance use issues, he spoke out tonight...2x

Just bc #mentalhealth is harder to quantify doesn't mean it's any less important to our physical health ... or to policy-making.

After talking teens & parents for the past 2 yrs, it's never been more clear to me (& my #primarycare colleagues) that #mentalhealth is health. 1x

https://twitter.com/KwadCast/status/1493646633308934147

Not every child, teen, or parent is suffering from mental health issues. Our lived experiences during COVID have been varied & diverse. Indeed, some kids are pandemic-proof. Some of my teen patients have actually thrived during COVID... but 2x

THIS WHOLE OP-ED is 🏅

“There is not a single right answer for how to proceed. Within the set of legitimate strategies, the choice of strategy is often less important than whether or not people follow and support it.” 🧵

nytimes.com/2022/02/04/opi… “Within the set of legitimate strategies, the choice of strategy is often less important than whether or not people follow and support it.” — @M_B_Petersen 2/n

"It is time to recognize the myriad threats to children’s safety – beyond that of a single virus – and to appropriately balance these risks."

Proud to co-author this piece w/ virologist @DrScottBalsitis, peds psych MD @carol_psych & peds MD K Walsh 👇👇

usatoday.com/story/opinion/… ..As scientists & MDs, we are concerned that COVID mitigation measures for children are doing more harm than good. Too many policymakers have viewed health as the mere absence of COVID-19, putting children into a loop of mitigation measures that are uncoupled from actual risk. 🧵

"Another approach, which I am beginning to favor, is to state that every person age 5+ can be vaxd & high-quality masks can protect individuals well. Therefore, masks can be optional, not required, even at high rates of community transm'n"

@DrLeanaWen 👏

washingtonpost.com/opinions/2022/… Thank you, @DrLeanaWen, for messaging the importance of *balancing* risk & reducing *total* harm.

I’m on call this weekend for my group medical practice. Lots of vax’d patients w COVID—cough, sore throat, headache, body aches, fatigue. Mild to severe.

Other top symptoms?

Guilt
Shame
Fear

“I did everything right.” “I feel like a failure.” “Doctor, I’m terrified.” 1/x Even if ppl know intellectually that their risk for severe illness is greatly reduced after vax, fear is natural & real. It’s *normal* to get scared when a rapid home test turns positive or when we’re notified abt a positive PCR test 2/x

We’re starting to reach the acceptance phase of the pandemic: a time when we must recalibrate our individual risk gauges, which have been completely thrown out of whack

My latest for @TheAtlantic 👇

theatlantic.com/ideas/archive/… The two things that patients want—reassurance that they won’t get COVID-19 and permission to engage in life—I cannot deliver, and I never will be able to. SARS-CoV-2 is here to stay. /2

Shielding my kids from danger is a fundamental instinct; tolerating risk for them is hard emotional work.

Fear is necessary for our survival. It can also do harm.

My latest for @TheAtlantic 👇👇👇

bit.ly/3yEMjf3 For people who thought that the pandemic was ending, @CDCDirector's July 27 televised statement was like the scene late in *A Nightmare on Elm Street* when Freddy Krueger’s claw reaches up from within Glen’s bed and pulls him in.

Now is the time to redefine burnout as the mental and physical fallout from accumulated stress in any sphere of life, whether that’s work, parenting, caregiving, or managing chronic illness.

My latest in the @TheAtlantic:

theatlantic.com/ideas/archive/… Burnout is usually reserved to describe *work-related* phenomena: exhaustion, feelings of negativism, and reduced professional efficacy.

But what if simply being human carries occupational risk?

At this watershed moment in the pandemic, the challenge right now is to recalibrate fear — to quiet fear when the facts don’t support it, and to redirect worry to areas where our health and well-being are *actually* at risk. That said, let’s acknowledge the universality of fear. It’s entirely normal to be afraid when faced with a threat like COVID-19. After all, fear is normal and part of being human. It helps us survive — to run from the proverbial tiger in the wild.

Today we are talking about the good, the interesting, and the upshot among the recent #coronavirus-related news. THE GOOD: Hope is alive! A promising vaccine is coming out of Oxford University. 1/13 Fingers/toes crossed it continues to look good in human studies+ can be out for use this fall. The @US_FDA will likely approve emergency use of Remdesivir (drug typically used to treat HIV) which has shown favorable results in #COVID__19 patients but warrants further study. 2/13

Hello and welcome to Day 4 of COVID 301—your daily dose of facts and guidance on the NOW and “now WHAT?” of #COVID19. Today we are learning about massive and widespread testing. 1/18 Currently there are two main types of tests: 1. The NASAL swab for the presence of ACTIVE virus. The goal is to help diagnose a patient currently sick with #Covid_19 or
a symptom-free person as a carrier of the virus. 2/18