"How Sweet It Is" Cover Art Created By Dr. Priscilla Sarmiento-Gupana

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SweetPreventing Spot 17th - COVID19: Vicarious Trauma & PTSD 24th- Unionizing & Physician Independence 31st – Fighting Back: Legislation, Lawsuits & More HOW COOKIES AND OTHER HOBBIES ARE INSPIRING PHYSICIANS TO # TA K E B A C K M E D I C I N E

Wri t t en by Dr. Ma rl ene W ü st- S mi t h

THE FILM: A groundbreaking film about the hidden epidemic of do cookies have to do That’s because we put patients first. we don’t have a union. I have witnessed an suicide andhat burnout.

Doctors take an oath to do no harm but with fixing healthcare?

Always. Until we are told that we can’t. thousands of doctors signing a petition taking their ownIf your lives at isan alarming trapped health answer “nothThe rate, COVID19 crisis has in beena atoxic demanding the kind of workforce proing,” puts you’d betheir wrong. lives at risk as blessing that the for many of us physigranted to first responders post stem that wellin as patients theytections serve.

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Actually, these cookies, and what they represent, have EVERYTHING to do with healthcare reform.

So many people—not just physicians— have hidden almost super-hero like talents. It takes a certain amount of what we LatinX call “chispa” or “moxy” to let others see and appreciate that creativity.

Physicians are no exception.

One thing that may separate us from non-physicians is that we tend to be perfectionists. We are likely less apt to let the world know about our “super-talents” until we are at our breaking point.

cians, the pandemic has become OUR COLLECTIVE BREAKING POINT. Never before have I seen physicians rising for “the cause.” How in holy hell did we not have enough PPE to protect us when we have 7-10 administrators for every doctor in the US? Isn’t that their job? What do you mean we are being furloughed without pay? Why are physicians being asked to volunteer for front line duty in places like NYC when nurses, respiratory therapists and physician assistants are being offered lucrative locum contracts I have seen a multitude of physicians joining together wondering why

9/11. I don’t care that it flopped, that it was a bad bill—I LOVE that we have collectively become “woke” and are speaking up. We are not only speaking up, we are showing up in ways that show off the tremendous “hidden talents” among us. The cookie masterpieces featured in this issue are the creations of Dr. Sarmiento-Gupana (a pediatrician from Chicago) and her sister Angela (a software marketer). Follow them on Instagram, Twitter, Facebook and YouTube at Sarmie Sister Sweets. 1

"Excellent film. Just the right balance of compassion but call to action.”

"That was an amazing experience! What a great way to connect with a larger community.”

is a wonderful film -- on so many levels. I was moved to tears multiple times, and it reminded me of the whole range of emotions from residency and med school that I have stuffed and repressed for decades. I'm so glad I attended the event, and so glad for the panel afterwards.”

Dr. Marlene Wüst-Smith Publisher

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Original "she-ro" painting by Dr. Anu Gupta, ObGyn

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Table Of Contents F ROM THE PUBLI SHE R

The Sweet Spot

By Dr. Marlene Wüst-Smith / p.2 V I PP SPOTLI G HT

All I Learned About Being A Medical Spouse I Learned From My Mom

By Nathan Eckel/ p.6 Where Are Physicians Finding Their Happily Ever After?

By Alli Wittbold/ p.8 BA BBLI NG S

The Sekhmet Writing Project

By Dr. Megan Babb/ p.12 NE W NE W S

Why The Oxford CHADOX1- NCOV-19 Vaccine Is So Promising And The Concept So Exciting

By Dr. Nana Dadzie Ghansah/ p.16 Corona Conundrum

By Dr. Nelson Nicolasora/ p.18 The Hydroxychloroquine Quandary

By Dr. Mark Lopatin/ p.20 The Good, The Bad And The Ugly

By Anonymous/ p.24 COVID-19 Can Cause ARDS, And AFDS

By Stephanie Wottrich, MS4/ p.26 Bravery Is Being An Ally To People Of Color

By Dr. Niran Al-Agba/ p.28 A DVOC AC Y I N AC TI ON

When Did We Become Our Own Worst Enemy?

By Dr. Daniel Waters/ p.30 No-Work-From-Home Policy During The Covid-19 Pandemic

By Anonymous/ p.32 OF F I C E SPAC E

Using Technology To Put Physicians In Control - Part 2

By Dr. Leah Houston/ p.34 Patient Consumerism

By James N. Giordano/ p.36 7 Ways To Turn Patients Into Your Biggest Fans So You Can Grow Your Business

By Dr. Brent Lacey/ p.38 TI M E F OR YOU

How To Jog Beyond Negative Thoughts About Running

By Dr. Michelle Quirk/ p.42 Taking Back The Meal

By Dr. Lynn Stiff/ p.44 Stop Giving Yourself The Pandemic Pass

By Dr. Katrina Ubell/ p.46 I NTE LLI G E NC E ON THE M OV E

Operation Reclaim - A Short Story

By Dr. Nana Dadzie Ghansah/ p.48 The Scope Of Practice Podcast

By Dr. Brent Lacey/ p.51 Healing The Healer

by Dr. Rupali Chadha/ p.52

Cookies on this page created by Dr. Priscilla Sarmiento-Gupana and her sister of SarmieSisterSweets

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V IP P S P OT LIG H T

Loving Your Physician Spouse Well ALL I LEARNED ABOUT BEING A MEDICAL SPOUSE I LEARNED FROM MOM Wri t t en by N a t ha n Ec k el

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or many if not all physician spouses, this has been a particularly trying month. My wife practices (infectious disease) in two hospitals in two COVID19 hotspot states in either direction of our home state (our accountant loves us).

And after 10 years of marriage, my secret confession is not that I am a particularly great spouse… in my case there is a secret advantage influencing me.

Everything I learned in life about loving doctors was learned from watching my mother. My mom (RN) is the secret weapon behind my father’s 40 years of faithful 80-100 hour weeks 6 | M AY / J U N E 2 0 2 0

as a solo Family Practitioner. Her love and affection made the difference as our family watched dad weather the struggles of the solo Norman Rockwell-type country doctor. This sounds like a historic cliché - yet dad lived the life.

Believe it or not, there are significant advantages and privileges that come when you come from what many would call an old fashioned family. My parents aren’t the flashiest folks around, nor are they close to perfect, but they gave all of us some tough love when it counted.

1979 was a cool year, because it was the 70s. And we closed out the decade by hanging up my father’s sign for his

rural clinic just a mile from his residency program. Although I would be derided as a skinny “rich doctor’s kid” in school, my peers had no idea my father willingly drove a purple VW Beetle for the first 3 years of his startup to meet payroll. Or that the waiting room patients read the magazines in was a floor below the bedroom my brother shared until the age of 10.

What non physician friends don’t know is that during the best of times, the invisible pressures on physicians and their families are extremely challenging.

And in a pandemic everything becomes exponentially more difficult. So if asked to give a red-carpeted signature talk

about what to do in these times, I might take a cue from Sesame Street and pick a sponsoring letter to illustrate the three things to do as a physician spouse, pandemics be damned.

So let’s pick the letter L - here are three simple L words that describe what I learned from my mother about how to love physicians over the long term.

L Is For Listen The first L word is to Listen. Steven R Covey famously said “seek first to understand, then to be understood.” As a physician spouse there is a time and a place to speak up - but it’s usually not when they walk in the door.

As a longtime teleworker, when my wife comes home I am ready for her. Even in the pre-pandemic times we have learned to be flexible around this time. During the pandemic era, our foyer doubles as a decontamination zone and there are various buttons for me to press for the washer and the sink etc to help streamline the new normalizing to home life.

Some days are easier than others, so my intent is to be flexible enough to hear her and take time to let her decompress.

Earlier in our marriage my mistake was to try to fix or “man-splain” her problems instead of just listening. I won’t do that again! Instead of trying to fix her perplexing situations, listening works wonders, plus a nap if she needs one.

As someone with many traits of an Enneagram 4, one thing that we do well is to stay in the difficult and uncomfortable places when a loved one is sharing them without changing the subject or minimizing their experience. We call it “authenticity” and believe it or not, it’s not always easy to find someone to help you process the difficult places.

The good news is that even if you don’t naturally share these traits the skill can be effectively learned.

Your partner will appreciate having a non-judgmental space to share and process their day.

L Is For Learn Let’s face it, it can be tough on the male ego to learn something new. Especially when it’s something silly like when my wife doesn’t like the way I wash my hands for example.

Recently, while hurriedly washing up with extra splashing to keep the virus away, my wife did not approve of my rinsing routine for some strange reason. The more rigorously my hands moved, the more she disapproved.

As a former adjunct Instructional Design lecturer, my request was for her to send me some sort of training video that might help me see the washing protocols through the eyes of a surgeon.

Perhaps I could gain an acceptable level of proficiency on what until The Year 2020 has been a routine act of washing my hands. Including constructs such as sterile fields and how to refrain from breaking them.

Although it took more time to adjust my attitude than my ego would admit, we are now closer aligned after the decision to apply new habits.

L Is For Lead My guess is that for many male spouses of physicians, the roles are somewhat reversed, especially from the old fashioned standards mentioned earlier.

Part of the way to make sense of it all is to acknowledge my wife is much better suited for this kind of work, and if my role as cheerleader and confidant is more helpful to her, that’s great because my strengths work better at that kind of role. If this means “leading from behind” in your book, so be it.

Even very small things like writing “I love you” on a post-it note with a date on it and putting it on her headboard has an impact. It baffles me that something that tiny makes a difference.

Being raised old-fashioned, I keep some traditions alive by being attentive to our emotional and spiritual needs as a family. Since we are in the middle of a global contagion right now, we step this up even farther. I pray for my wife

when she leaves the house and then when she returns. We try to keep any bad energy from our day outside the door.

It doesn’t matter so much what you do, as how you show up. Leadership in a medical family is about who you are and how you show up for your family by your actions.

As a physician reading this, you have very little margin for error and it seems like things are more difficult than ever before. My hope is that you will believe me when we tell you there are many of us out here cheering you on from the sidelines. And if you’re married to medicine, my hope is that these simple L words - Listen Learn Lead - will help you run your lane effectively. 1 Nathan Eckel is a sustainability designer born and married to MD. He hosts the Patient Paperwork Podcast at patientpaperwork.com Follow him on social media: Instagram =/nathaneckelTV LinkedIn = /nathaneckelTV Facebook: /NathanEckel WWW.PHYSICIANO U T LOOK . C OM | 7

P HOTO C RE DIT OF IN GRA M IM AGE S

V IP P S P OT LIG H T

Where Are Physicians Finding Their Happily Ever Afters?

O N E M . D.’ S V I R A L P RO P O S A L S PA R K E D INTEREST IN DOCTORS AND THEIR LOVE LIVES

Wr i tte n by A l l i W i t t bo l d

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ast year ended with a big surprise for cardiologist Sthuthi David, a current resident at the University of Virginia, when her high school sweetheart boyfriend, Lee Loechler, gave her the marriage proposal of a lifetime at an independent cinema in Brookline, MA. Loechler, a filmmaker who resides in California, shared on his Instagram page that he spent six months working with an illustrator and animator to alter the ending to 8 | M AY / J U N E 2 0 2 0

David’s favorite Disney movie, Sleeping Beauty, for his elaborate proposal. It will brighten your day to watch the proposal on YouTube.

At the movie’s end, when the prince breaks the sleeping spell placed on the princess with true love’s kiss, the characters were swapped for animated versions of the couple. The on-screen Prince Lee pulls out a ring and tosses it to real-life Loechler where he proposed to David in front of a theater secret-

ly filled with her family and friends.

“I love you with my whole heart, including its ventricles, atriums, valves,” he paused. “She’s a cardiologist,” and laughter filled the theater. “Sthuthi David, MD, will you live happily ever after with me?” and, not surprisingly, he was met with an enthusiastic yes.

Lee Loechler and Sthuthi David’s viral proposal story got us thinking-where are other physicians finding their happily ever afters? The reality of the

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many years of required training, the demanding, often unusual working hours and the mental exhaustion associated with the lifestyle of a physician can bring unique challenges to their romantic relationships—yet marriage rates among physicians are higher than the national average, and the majority of single physicians seem to be dating.

What’s the story?

A look at physician relationship status We turned to social media to get a glimpse at doctor love lives with an informal survey in the Facebook group, Doctors On Social Media. We posed the question, “What’s your current relationship status?” and invited members to share their experience with dating, marriage, and love. With a little over 300 responses, here’s how it broke down: 57% are married to a non-physician, 27% are married to a physician, 7% are single and dating, 4% are single and not dating, 2% are in a relationship with a non-physician, 2% are divorced or separated, and 1% fell into an “other” category. The overwhelming majority of respondents are married (85%) and of those that are married, 67% are married to a non-physician, and 32% are married to another physician. About 11% fell into the category of single (whether dating or not), 2% are unmarried with a partner, 2% are divorced or separated, and one respondent is widowed.

While our survey did have a range of unknowns including the age of 1 0 | M AY / J U N E 2 0 2 0

participants, their gender, and where they’re at in their medical careers, our small sampling actually wasn’t too far off from larger findings. A 2014 survey

by AMA Insurance of 5,000 physicians ranging in age from 30-69 reported that roughly 80% of participants were married, 10% were single, 6% were unmarried and 4% were separated, divorced or widowed. They also reported that 40% of physicians are likely to marry another physician, and that number may be higher among those under 40. In a 2008 survey of roughly 8,000 members of the American College of Surgeons, 90% of participants had a domestic partner and half of those partners did not work outside the home. 16% of the respondents’ domestic partners were physicians and around 35% of partners were non-physicians.

How do physicians compare to the American public at large when it comes to relationships and marriage? According to research published in the Mayo Clinic Proceedings, physicians are more likely to get married, less likely to be single or never marry, are slightly less likely to get divorced, and are slightly less likely to be widowed. So despite the demanding years of schooling and training, odd hours, and high rates of burnout, physicians are finding love.

Physician love stories It’s no secret that physician relationships are faced with unique challenges compared to many other professions, yet their marriage rates are higher and their divorce rates are lower. Michael F Myers, a specialist in doctors’ health writes, “Marital challenges are ubiquitous in the relationships of doctors. Common issues include overwork, a need for control, self-neglect, perceived and felt stigma, being a ‘wounded healer’, trouble with boundaries, chemical dependency, depression, and more. Knowing the hallmarks of a healthy relationship, recognizing warning signals of trouble, and taking action through suggested strategies can be salutary.”

With the overwhelming majority of physicians married or in domestic partnerships, where did their love stories begin? Many participants’ stories included stints of long-distance, like Lynn Stiff, “We’ve been together more years in our lives than not, which is crazy to think.

He’s a non-physician. We did distance during college, got married and lived together, and then did distance again while married during two years of medical school. He’s super supportive, stays home with the kids and is basically a saint,” she goes on to share about the challenges of prioritizing her marriage with the demands of life, work and three kids under five years old. She says that emphasizing monthly date nights ensures alone time together.

Others, like Emily RW Davidson, have significant others that traveled with them on every step of the way, “[I’ve been] married to my drama teacher husband for ten years this year. [We’re] college sweethearts, married during M3 year, had our son PGY4 of OBGYN residency. He’s done every move with me— left LA to join [me] in CHI during med school, followed me to NC for residency and CLE for fellowship.”

PHOTO CREDI T: DR . LYNN STIFF

The reality of the many years of required training, the demanding, often unusual working hours and the mental exhaustion associated with the lifestyle of a physician can bring unique challenges to their romantic relationships

PHOTO CREDI T: D R. LYNN STIFF

Jzika Ln Waznik’s story of marriage to another physician went like this, “[We] met in the anatomy lab when I was in med school. [We] got married in med school, first baby in residency, second right after,” She goes on to say, “I love being married to a physician. The hours can be tough, but family is our priority, and I love discussing all the fun things we see at work and learning together.”

Some participants have others to thank for their now marriages, like Stephanie Benson Page, who was set up on a blind date in medical school 17.5 years ago. “Married now 15.5 years, he is a stay at home dad to our three children.

He’s amazing, so grateful to our friends who set us up.” And Physician Outlook founder Marlene Wüst-Smith who shared her love story, “Married Almost 21 years to my non-physician hubby. Set up by my patient—his niece (who was four years old at the time),” She writes, “[I] had dated physicians and kissed a lot of [frogs]; had almost given up on finding a soulmate and having a baby until I met him.”

Marion Mass’ love story began when she met her now-husband, Steve, at her roommate’s dinner party. At the time, Dr. Mass was in a long-distance

relationship, but the two become fast friends. Three years later, she finally started dating Steve. She shared, “It was this thunderclap of realization for both of us.

Like, oh, wow, I love this person.” Then came the variable of the match, which for some physician relationships, can be the demise. Fortunately for these two, things worked out favorably.

Due to a scheduling mix up while traveling together for residency interviews, they had extra time to spend in Chicago. She explained, “We had a wonderful time…we were young and childless and flexible. I remember sitting in this window seat in this adorable Italian restaurant…and I said to my husband that if we didn’t match in Chicago, I for certain wanted to come back and visit anyway,” Well, luck was on their side.

Her now-husband matched early in Chicago, “Because ENT is one of those early matches,” and Dr. Mass had applied to only one program in Chicago, “So, that’s what I put in for, [and] 25 years later… he’s still my one!”

And what about the single physicians among us?

Not every physician in our survey has been lucky in love or even wants a significant other to be a part of their happily ever after. Two participants stated their relationship status as “surrounded by dogs” and one as a “technosexual”, which the internet tells me is an individual with a love for gadgets. A few chimed in that they were happily divorced, or divorced with no desire to date at the moment. Of the 11% of respondents in the single category, the majority are actively dating. But dating as a physician, no matter where you’re at in your career, isn’t a walk in the park. Some physicians just don’t see it as a priority.

Jessica Lynne wrote, “Single and not even dating because it’s practically impossible as a locum. Men have a hard time with successful women, and my track record is finding ones that try to put you down to make up for their insecurities.

Still looking for my unicorn.” Sadly, her experience isn’t unique. My own sister-in-

According to research published in the Mayo Clinic Proceedings, physicians are more likely to get married, less likely to be single or never marry, are slightly less likely to get divorced, and are slightly less likely to be widowed. law, an Attending Emergency Physician, has had her fair share of relationships end because male physicians and non-physicians alike feel threatened by her success.

Own your happily ever after, whatever that means for you Happily ever after looks different for all physicians. Some have found it in marriage and children, and some in fur babies or gadgets. Others are loving the single life or are happily divorced. Some of you may still be looking for a partner to share your life’s successes, dreams, and challenges with. And, hey, you never know—maybe, like Sthuthi, your prince charming will surprise you during a screening of your favorite film. Whatever the case may be, own your happily ever after—practice self-care and make an effort to say no to some of the stresses and demands in your life in order to make room for more love, whatever that means for you. 1 References AMA Insurance. (2014). Work/Life Profiles of Today’s U.S. Physician. Chicago: AMA Insurance Agency, Inc. Dyrbye LN, S. T. (2010). Physicians Married or Partnered to Physicians: A Comparative Study in the American College of Surgeons. American College of Surgeons, Abstract.

Myers, M. F. (2004, October). Medical Marriages and Other Intimate Relationships. Medical Journal of Australia, 181(7), 392-394.

Rachel L. Perlman, M. P. (2015, June). Having It All: Medicine and a Family. Mayo Clinic Proceedings, 90(6), 713-715.

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B A B B LIN G S

The Sekhmet Writing Project O N E | T W E LV E : T H E I N N O VAT O R S Wri t t en by D r. M ega n Fro st B a bb

S

itting atop a window sill in my bedroom is an Egyptian statue which stands about 3” tall. Sitting below it is my unadorned leather chair which has been the absorber of many stressful days. My children refer to it as the sulking chair. To me it is simply a quiet place for pause and reflection when the day has been hard.

The statue in arm’s reach is a miniature version of Sekhmet, an Egyptian goddess. Her head is that of a lion with a sun disk resting atop it. To the common on-looker she is odd, but to me she is exquisite.

Sekhmet is one of the oldest of Egyptian deities. She is the goddess of women empowerment. She is the strength in all women, allowing even the 1 2 | M AY / J U N E 2 0 2 0

most fearful to stand against injustice.

She is the cornerstone of unbridled rage allowing even the most weak to fight against oppression. She is the source of our empathy, our courage, our capabilities. When we see ourselves in one another, it is her spirit we recognize. When we stand for one another, it is her presence we feel.

Historically the practice of medicine has been male dominated. Although the tides are beginning to shift, many women still find themselves amid the center of an Old Boys Club where survival for them can sometimes mean betraying their own. While I was on a clinical rotation in my third year of medical school, I found myself at the center of one of these clubs.

I was assigned to work with a male surgical subspecialist who was wellknown by the student body as an attending to avoid. It didn’t take long for me to understand why. The way his eyes moved up and down my body while his top teeth bit into the corner of his bottom lip did nothing more than send a wave of disgust through me.

Within a matter of days I developed a deep seated resentment towards him for distracting me in such a way that removed any meaningful opportunity to learn. Even worse, an opportunity my tuition dollars were paying for. Instead of learning, I would spend the majority of the time inching myself away from him as he inched towards me. Pulling my hand out from under his when he

able soul. The day the glue had finally set was the day I had a thought. If I could find an avenue to inspire women to support women, perhaps none of those coming behind me would have to experience a similar event.

Enter, The Sekhmet Writing Project.

This is a longitudinal writing series consisting of twelve essays over twelve months designed as a collection of essays highlighting all the unique ways women are positively changing healthcare. Simply a means for women to empower women in healthcare.

One | Twelve: The Innovators Describe the essential characteristics shared by the fierce and innovative women in medicine.

tried to teach me a surgical technique.

Watching the piteous stares from others while their inner thoughts could be heard reverberating throughout the operating room walls, Thank God it’s not me.

No one did or said a thing. Until one day, an unwanted hug was taking form as an unwanted advancement. I instantly pulled myself away and demanded that he fuck off. I was relieved to see two female surgeons witness the incident but when they approached me to say, “You are a medical student.

You shouldn’t have spoken to him that way,” I broke. None of what he did hurt worse than those thirteen words. I would spend months gluing the broken pieces of what once was a strong and

1) They Do Not Allow Functional Fixedness to Determine Their Path.

I want you to finish the following statement: when I think of a woman, I think of her as a <fill in the blank>.

For the majority of you reading, you will likely insert the word mother or the word wife. Now this one: when I think of a man, I think of him as a <fill in the blank>. How many of you answered with either the word father or husband? Unlikely to be many. This is an example of functional fixedness, the propensity to identify an object, or in this case a sex, by its most common use.

This is a concept studied widely that unfortunately is strongly present in the discipline of medicine.

Enter Dr. Sabine Hazan.

Dr. Hazan and I first crossed paths when I was beginning my work as a writer not so long ago. Her story is inspiring. What makes her story so unique is she was the first female Gastroenterology fellow at the University of Florida nearly twenty-five years ago during a time when men not only dominated graduating medical school classes but when becoming a specialist was rarely an opportunity available to women. Historically, the mere presence

of a uterus was (and in some specialties still is) a perceived inconvenience.

Functional fixedness contributes largely to the implicit bias against women in medicine. Those with a uterus are often seen first as a mother and second as a physician colleague. This causes an inherent bias towards women as to avoid an increased workload if a fellow female resident is out on maternity leave. But that did not inhibit Dr. Hazan. She refused to accept that her uterus could be a source for others to define her capabilities. To date not only is she a fierce advocate for physician autonomy but also an integral part of the physician community.

Along with her clinical practice she also contributes immensely as a principal investigator in large clinical trials. Only 11% of lead principal investigators of pharmaceutical clinical trials are women; yet to date, she has contributed to more than 500 and has successfully led 150. She is founder and CEO of Ventura Clinical Trials, Malibu Specialty Clinic and ProgenaBiome. With patented intellectual property, she is the mind behind the hydroxychloroquine/azithromycin/ Vitamin C/Vitamin D/Zinc protocol against COVID-19. She is also spearheading the microbiome movement to allow for a better understanding between the effects of disease on gut flora and conversely how healthy gut flora can treat if not cure disease.

Dr. Hazan is redefining roles in medicine that are often held by men.

“From my perspective as a GI physician, on the inside we are no different from one another. A colon is a colon.

Regardless to whom it belongs, they all look the same, therefore, why should gender determine anything?”

2) They Challenge Tradition.

Tradition is everything in medicine. It is where the right of passage of being a physician gets handed down from one generation to another. From my perspective it is the embodiment of nothing more than disguised hazing WWW.PHYSICIANOU T LOOK . C OM | 13

It is my hope that this project will shine light on the immeasurable influence we hold if together.

Especially when we as women, choose to support each other.

lieve we are selfish, money seeking tyrants. Yet this projected image is nothing more than their own. The shambles of our healthcare system can be owned by them. Dr. Corriel is the conduit giving physicians the confidence they need to escape the impossible conditions they are forced to practice in, finally giving them an opportunity of hope to be seen as human again.

practices led by a body of physicians who long for the brotherhood of a fraternity. Physicians who used to spend their time in the physician’s lounge patting each other on the backs for being masters of their universes are now being challenged by a younger generation of physicians who are using cyber technology to bring our profession into the twenty-first century. Historically physicians rarely contributed to published internet dialogue nor to personal social media platforms. Perhaps deep down there loomed a fear of litigation for saying the wrong thing. Regardless, it was a resource many professions benefited from yet rarely benefited by physicians.

3) They Shatter Ceilings by Placing the Interests of Community Above the Interests of Self.

The first time I became a mother, I had recently graduated from medical school and was in my intern year of residency. I struggled with finding a balance between these two new roles.

The two large communities in which I belonged, the physician community and the mother community, contradicted one other. My work as a physician dominated my time making it nearly impossible to converse with other moms. Yet, when I did have an opportunity to do so, I found it difficult for other non-physician mothers to understand my unique situation.

I was working eighty hours a week barely finding time to sleep, let alone having the time to be a fraction of the mother they projected to be. I often felt judged, shamed, and guilty for so desperately wanting to be both mother and physician.

Enter Dr. Dana Lazarovici Corriel.

Dr. Corriel is the creator and founder of SoMeDocs, an organization meant to help physicians restore control of their brand. She is innovating change in a highly unique way. She is helping physicians take back control of their autonomy by teaching them what it means to have a presence in social media. Her innovation has allowed physicians to become comfortable with showing the public a more humanistic side. Physicians are no different than any other human. We laugh. We cry.

We are not always right. We cuddle with our kids. We snuggle with our spouses. For the first time, she is showing physicians how to reveal this side of us often hidden from society.

Her hope is to restore control of the physician brand, to the physicians.

For decades now, corporate healthcare has controlled society’s image of who we are. They would like America to be1 4 | M AY / J U N E 2 0 2 0

Enter Dr. Hala Sabry Elnaggar.

When I first met Dr. Sabry Elnaggar, she had just launched a Facebook group called Physicians Mom Group (PMG) consisting of a couple thousand members. Like me and so many other physician moms, she struggled with balancing both her roles as a physician and a mother. Fast forward to today, PMG has nearly 80,000 members and was one of the first cross-bred community groups on Facebook to succeed.

It was a community she created that continues to provide a common place where physician mothers connect with one another.

Her ability to grow community is a reflection of her selflessness to put community above self. Medicine has historically been innovated by white men for their benefit. Every detail down to the way scrubs are designed are created with a man in mind. What she has done is take her knowledge of online community building and turned it into a business that ensures the physician profession moves forward in healthcare with a strong voice present in the conversations. This is a way our community is represented in all aspects of healthcare. She consults with corporations, their CEO’s, on how to include physicians in future innovations. She is breaking out of the box her profession originally put her in and is now making sure physicians are given a seat at the table where healthcare decisions are being made.

4) They Provide a Voice to Those Who Often Go Unheard.

The history of America’s healthcare system is a complex one. One that has removed physicians from positions of leadership, replaced by corporate executives causing their voices to be silenced. Through the course of this time, physicians have been forced to keep their heads down, do as they are told while these invaders disrupt the very intricate practice of medicine.

This transition has been demoralizing, detrimental and discouraging to patients and physicians alike. Many are afraid to speak against the systems that employ them for fear of retaliation.

This has shattered many physicians’ ability to advocate for themselves, patients and colleagues. And for those who still had the voice to advocate, it removed any bit of avenue they had to do so.

Enter Dr. Marlene Wüst-Smith Dr. Wüst-Smith is the creator and innovator behind Physician Outlook, a magazine written by physicians, for physicians. As one herself who has been in practice for many years, she has found a

way to spread supportive information to physicians of all generations, including those who struggle to find a presence in the social media community. Both online and in print, this magazine is exactly what physicians have needed in order to regroup and find ways of supporting one another, to voice their struggles with the systems that censor them, so they can be seen and heard by society. The magazine has also become a source of centralized, vetted information about the healthcare system that has rarely been shared outside the system. No censorship. No silencing. Simply, the truth.

Her dream to create a magazine providing a voice for physicians, by physicians came to fruition when the first edition was released earlier this year. Dr. Wüst-Smith is doing something very unique and innovative by bringing different generations of physicians together using words in both paper and online form. These words are those of inspiration, encouragement and honesty. Physicians finally have a space to be heard and to share what we all have wanted America to hear but have struggled with finding a way. We now have a place where physician-led solutions have a platform to be explored and discussed.

5) They Rage Relentlessly Against the Machine When I close my eyes and envision the physical form of corporate healthcare all I see is a steel wall. A wall which spans miles both wide and tall. It is a wall that feels impossible to penetrate.

Guarded behind it are all the forged connections between corporate America and healthcare administrators. Over the course of time, these alliances have slowly eroded away the joys that came with being a physician. Mostly because these joys are neither respected nor deemed economically important by those who are the decision makers. These individuals sit behind this wall knowing all too well, the physician community is yet to find the means to dismantle it.

Enter Dr. Leah Houston Her startup company HPEC and the technology they are developing is the best opportunity physicians have to secure the Trojan horse needed to penetrate this wall. Using blockchain technology, it restores control of physician credentials and allows physicians and patients to be the sole owner of their health information. Tirelessly Dr. Houston studies the wall to understand it, in all its magnitude. This allows her to see its flaws, it’s weak spots making her HPEC’s secret weapon. I have had the privilege of interfacing with many wonderful and forward thinking physicians. There are very few however who have quite the tenacity and drive she does. She has taken everything she believes as the solution to restoring autonomy to the practice of medicine and has laid it at the feet of physicians. I have no doubt that HPEC and the name Dr. Leah Houston will be a name known by every American physician in the near future. She will be remembered as the one whose horse took down healthcare’s Trojan army.

Enter Sekhmet At the center of each of these five women is Sekhmet and all she represents. While interviewing each of them, I couldn’t help but think about those two female physicians I encountered when I was still just a medical student. As a physician now and a mother to four children, I often wonder why on that particular day, they choose not to support me. For centuries men have been using men to further their own agendas and unknowingly or not, women have silently been allowing it to happen. It is my hope that this project will shine light on the immeasurable influence we hold if together. Especially when we as women, choose to support each other. #The Sekhmet Writing Project To learn more about the incredible works of these five innovating women, you can find their information here:

For decades now, corporate healthcare has controlled society’s image of who we are.

Dr. Sabine Hazan: Website: https://progenabiome.com/ Twitter: @SabineHazanMD Dr. Dana Lazarovici Corriel: Website: https://doctorsonsocialmedia. com/ Twitter: @somedocs Dr. Hala Sabry Elnaggar: Website: https://www.facebook.com/ halahsabry Twitter: @TechDOC18 Dr. Marlene Smith: Website: https://www.physicianoutlook. com/home Twitter: @thePOmagazine Instagram: PhysicianOutlook Dr. Leah Houston: Website: https://hpec.io/ Twitter: @HPECio To read more of Dr. Megan Babb’s written works, you can find them by following her on Twitter and Instagram and by clicking on the following links: Twitter: @MeganBabb1522 Instagram: Mbabb1522 Vocal.Media: https://vocal.media/authors/dr-megan-babb Physician Outlook Magazine: https://w w w.physicianoutlook.com/ home WWW.PHYSICIANOU T LOOK . C OM | 15

NONPLUSSED BY ARTIST DR MAYCIE ELCHOUFI

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Why The Oxford Chadox1-Ncov-19 Vaccine Is So Promising AND THE CONCEPT SO EXCITING Wri t t en by Dr. N a n a D a dzi e G ha nsa h

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he Oxford ChAdOx1- nCoV19 vaccine holds a lot of promise, not only as a way to deal with COVID-19 but also with future viral outbreaks.The method of using a viral vector as a way of presenting antigens into the human body allows for a very novel and fast way of getting new vaccines.

Let’s say Virus X has caused an outbreak of a disease and you need to make a vaccine to fight it.

Classically, to get a vaccine against it, you have to introduce a piece or all of virus X into the human body. You could also use another virus (a piece of it or the whole virus) from the same family that Virus X comes from. Now if you use the 1 6 | M AY / J U N E 2 0 2 0

whole virus, you need to either kill it, inactivate or weaken it so it does cause disease.

Once the virus or a piece of it gets into the human body, the immune system recognizes it as something foreign and builds antibodies against it. These antibodies last a long time so the next time you get an infection caused by Virus X, the antibodies attack the virus and inactivate it before it makes you sick. Thus, you can use it to prevent disease in those who haven’t fallen sick yet.

The Oxford team used another method. Instead of using the SARSCoV-2 virus or even a piece of it, they use a vector to get a part of SARS-CoV-2

into the body. The vector they use is another virus. This virus is called an Adenovirus and they use the type found in chimpanzees.

Once they have that adenovirus, they modify it to the point where it is unable to replicate anymore or make any mammal sick. It becomes basically a shell. Once they have that adenovirus shell, they get the RNA from the SARSCoV-2 virus and get out the part of the RNA that makes the Spike Protein that SARS-CoV-2 needs to get into the cells of the lungs. Once that piece of RNA gets into the adenovirus shell, it causes the building of the Spike on the outside of the shell. (Remember, RNA and DNA

Original artwork created by Dr. Maycie Elchoufi

PHOTO CREDI T OF INGRAM IMAGES

code for the building of proteins. If you get them into the right environment, and they have the right materials, they’ll build the proteins they are coded for.).

So now the team has a modified, inactivated adenovirus with the Spike Protein of SARS-CoV-2. When they inject that into the human body, the immune system sees the Spike Protein and recognizes it as something foreign. The adenovirus shell does not cause any immune reaction, only the spike. Antibodies are then made against the Spike Protein.

Now since this is the Spike Protein from SARS-CoV-2, if the virus should attack, there are already antibodies against that. Since that is what SARS-CoV-2 needs to enter the cell, once the antibodies attack and destroy it, it will be unable to enter the cell and thus unable to cause COVID-19.

Using using the spike protein is genius because in all the variants of the virus found in the bat RaTG13, in pangolins, in SARS or MERS, the Spike Protein has stayed largely constant.

The piece or part of the virus used has to stay unchanged over time to ensure the vaccine works for a long time. There is always a risk that the virus can change that part through mutation.

The question now is whether the modified adenovirus + spike protein contraption will get the human body to mount a powerful enough immune reaction in humans. It did in monkeys.

Also, since they are using the whole virus, there is no need to find out what works best - killing it off or weakening it.

Since the team already had the adenovirus shell, all they needed was the genetic info from SARS-CoV- 2 and they could get the RNA sequence for the Spike Protein and plug it in.

This also means they could do this for other diseases. They can even do this for any viral disease that may break out in the future, as long as they can isolate the virus from bats, birds or pigs and sequence the genomes.

That is why the Oxford ChAdOx1nCoV-19 vaccine is so promising and the concept so exciting. 1

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Corona Conundrum Wri t t en by Dr. N el so n N i c o l a so ra This piece was written in response to Coronavirus and the Fallacy of the False Dilemma | American Council on Science and Health https://www.acsh.org/ news/2020/04/22/coronavirus-and-fallacy-false-dilemma-14736

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he conundrum we are experiencing is by all means due to the drastic deviation from our norm, and the challenging, adaptive measures that we initiate to continue functioning as individuals, and as a society. The very opinionated will, understandably, react in a more dramatic and diverse fashion, oftentimes expressing concerns about the extent by which our individual liberties, motivations, and goals are affected.

As we continuously navigate through this crisis, the protracted and strenuous measures that people endure will generate significant stress upon certain segments of the population, especially those who find their personal interests--including one’s economic status, in jeopardy. Not surprisingly, after months of lockdown, we observe an outpouring of various opinions. Moreover, the release of ques1 8 | M AY / J U N E 2 0 2 0

tionable data, whether in favor of or against the lockdown, has created a further divide within our society, comprised of different special interest groups.

Patience and acceptance of discomfort/inconvenience represent quite a challenge to those who typically function best under more optimal conditions, subject to minimal annoyances and struggles.

The novelty of every pandemic will always test a society’s capacity to adapt, and how it responds is not necessarily culture-specific. This is further magnified by preexisting, polarizing beliefs amid a collective distrust towards those in positions of power and authority, along with individual and group perceptions about the available facts, news, opinion, or scientific data. Unfortunately, the existence of misinformation, or lack of good information, often influences our politi-

cal views and proclivities, and how that corresponds to personal experiences and socioeconomic status.

Being an adult immigrant who came to live in this great country, I think I offer a slightly different perspective from what the author conveys, certain aspects of which I have already outlined. One has to take into account that digital technology now plays a significant role, greatly intertwined in the lives of at least a billion or so, among the world’s 7+ billion population. This phenomenon appears to be more pronounced in the United States given its socioeconomic status, in particular, allowing for relatively easier access to electronic platforms, often for the purpose of expressing ourselves. Incidentally, it seems that the author partly undermined the very same platform used to propagate his message.

ART BY MARKO BELLO

It is not unusual in this day and age of information explosion that social media becomes the driving force for disseminating various points of view, and making these easily accessible. We can surmise that the opinion of just one individual, catering or even pandering to the personal feelings and beliefs of a particular group or groups, can easily go viral on Twitter, FB, YouTube, and other online media environments, thereby triggering strong, emotional reactions that can translate into accompanying behaviors.

I have never seen a “virus” with a R nought higher than what I have observed as it pertains to the spread of certain ideas on social media, and how that can affect human response actions. The transmissibility of opinion can now be accomplished with just a short, written message and the click of a button. On Original artwork by Dr. Nicolasora’s friend Marko Bello

serious topics of discussion, like the controversy surrounding this lockdown, we may feel empowered and/or influenced by available information, which we can then use to formulate our own personal opinions, allowing us to even cast votes as to whether we believe this policy is doing more harm than good, whether it was actually necessary in the first place, and whether it remains necessary moving forward.

How did Americans actually respond to these lockdown initiatives? Have we been more compliant or belligerent? Have we noticed a decline in public transport or movement, public gatherings, and/ or hospital visitations? Have we freed up the supply of masks by not masking when initially told not to do so or have we started masking, in compliance with the supporting wave of data and opinion?

Now, I think we should tolerate certain contrarian views as a way of conforming to our democratic ideals, although extreme recommendations or suggestions should be construed as outliers that are, sometimes, seen as inevitable. Situations that call for draconian policies in the interest of the public good could border on violating individual civil liberties no matter how well intentioned they are. These also have the power to cause dire consequences to the economic, social, and personal well-being of those who are already marginalized. We are operating within tight or limited windows of opportunity, related to this unique environment.

Personally, I think the best we can do is to support measures that, hopefully, will lessen this widening social divide that has existed even before the outbreak of this pandemic.

Attaching disparaging labels to members of our society certainly does not help. The author who, with all due respect, may be a hundred times more eloquent than many of us should have expounded more on his “3rd option,” however, he falls short of doing so. His interest in what the 3rd option has to offer was also not evident as he failed to solicit other ideas or pose a rhetorical question

Should we open up the economy immediately or remain on lockdown indefinitely until a vaccine is made?

Believe it or not, there are other options. that would have encouraged viewpoints similar to what he proposes, an important feature of a good op-editorial. What good are observations that analyze society as a whole if they only seek to elevate the author or the audience that endorses the opinion presented?

What we should work on during this pandemic is to call for more transparency and more concise messaging from our leaders and public health officials. We should demand facts and work on the logistics and accurate scientific process to gather the much needed data (e.g. well-conducted immunoprevalence/ immunoprotection data followed by longitudinal surveys to see how robust the post-infection antibody response is). We should harness creative forces to help protect the vulnerable segments of our population (e.g. HCW, the elderly, those with comorbid conditions, and those affected severely by the economic downturn).

We should implement measures that would allow different parts of the economy to resume their functions. We should support and utilize technology, alongside government, as well as non-governmental measures that will help keep the economy afloat, assist our young population in becoming properly educated, the vulnerable population protected, and the able-bodied citizens, employed and generating income. We should also be gearing up to prepare for the next wave of infections, whenever it may be and in whatever magnitude it may present itself.

A crisis can always bring the best and, unfortunately, the worst in us. I fervently hope and pray, that we can agree that in the process of achieving our goals, most of us need to be part of the solution. 1 WWW.PHYSICIANOU T LOOK . C OM | 19

The Hydroxychloroquine Quandary

“From Fox News, a Big Dose of Dumb on Hydroxychloroquine”

“THE DRUG WAS “A GAME CHANGER” IN THE FIGHT AGAINST THE CORONAVIRUS.”

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ted a e p m u r T Stars s w e N dn’t” i x D y “Fo e h T l i g, Unt u r D a i r a l Ma “miracle turnaround” — “like Lazarus, up from the grave,” ioned Anyone Who Quest y Was The Drug’s Effic ac “In Total Denial” “Why Are Media Pundits Tr ying To Discredit Hydroxychloroqui ne?”

“Tr ump , Fox New s tou t potentially deadly drug” ”They ( The Press) Opposed Finding A Cure For Corona Virus Because They Feared It Might Give The President Some Political Advantage”

Wri t t en by D r. M a rk Lo pa t i n

A

s a rheumatologist, I write many prescriptions for hydroxychloroquine (HCQ) for my rheumatoid arthritis (RA) and lupus patients. HCQ used to be a quiet drug minding its own business, avoiding the limelight. Until now.

With the onset of COVID-19, HCQ has suddenly taken center stage, with many opinions on using it to treat COVID. Our president has declared it a “game changer,” and he has recently admitted to the world that he is taking the medication himself as prophylaxis after having been exposed. There are no well done studies looking at efficacy, but many observations have been reported.

The Marseilles study,1 the most frequently cited study promoting HCQ, 2 0 | M AY / J U N E 2 0 2 0

was a small study assessing the presence of virus on nasal swabs at six days. 26 patients received HCQ, but data was excluded in six patients. Clinical status was not assessed. Six patients also received Azithromycin (AZ). Eight of the 14 patients who received HCQ alone had negative viral swabs at six days. All six who received both drugs cleared the virus. This study was contradicted by another French study2 which showed no change in viral presence in 8/10 patients treated with both drugs.

Dr. Vladimir Zelenko has reported great success3 in treating several hundred patients with a regimen of HCQ, AZ and zinc. His report has been criticized4 for lacking adequate diagnostic

information and for not being of long enough duration, but it does represent a larger sample size than other studies and shows excellent results. It is unclear whether his observations constitute adequate evidence of efficacy.

A Chinese study5 assessed 62 patients with COVID. 31 received traditional therapy and 31 received an additional five day course of HCQ. The study6 cited improvement in time to clinical recovery, changes in body temperature and cough in the HCQ group.

81% of the patients in the HCQ group demonstrated improvement in pneumonia compared with 58% of the control group. Furthermore all 4 patients who developed severe illness were in the control group.

Another French study7 of 1061 patients treated with HCQ and AZ found that only 4.3% had poor clinical outcomes with only 8 deaths. The study was retrospective with no control group. The poor outcome patients were considerably sicker at baseline and had a mean age of 69, compared with a mean age of 42 in the patients who did well. The study suggests benefit for HCQ/ AZ, but has significant flaws as noted.

Other support for using HCQ8 comes from the Indian Council of Medical Research, which recommends a prophylactic regimen9 for health care workers caring for COVID patients. It is unclear what data was used to make this recommendation.

A subsequent trial was done in China looking at prophylaxis.10 205 patients with a known exposure to COVID were treated with HCQ 400 mg/ day for 14 days and were quarantined. None were + for virus at 14 days. There were no significant adverse events although 32 patients reported minor side effects. The study supports prophylaxis with HCQ in people with known exposure.

Alternatively, The Centre for Evidence-Based Medicine at the University of Oxford noted 142 ongoing trials11 evaluating HCQ and chloroquine in the treatment of COVID. They reviewed the five studies with published results and concluded that: “Current data do not support the use of hydroxychloroquine for prophylaxis or treatment of COVID – 19. There are no published trials of prophylaxis. Two trials of hydroxychloroquine treatment that are in the public domain, one non peer reviewed, are premature analyses of trials whose conduct in both cases diverged from the published skeleton protocols registered on clinical trial sites.

Neither they, nor three other negative trials that have since appeared, support the view that hydroxychloroquine is effective in the management of even mild COVID-19 disease.”

A VA study12 retrospectively analyzed 368 patients who received either HCQ, HCQ + AZ or no HCQ (32% of these

patients received AZ) and reported a higher incidence of death and mechanical ventilation in the HCQ and HCQ + AZ groups. The study is seriously flawed however as there were significant differences between the 3 groups in terms of blood pressure, lab tests (creat, ALT, Hct, CRP) and baseline respiratory status. Hydroxychloroquine, with or without azithromycin, was more likely to be prescribed to patients with more severe disease.

The next question is whether HCQ is “safe”. My patients typically take HCQ for a number of years. I do not get screening EKG’s and do not routinely discuss cardiac risks as they are felt to be minimal. My rheumatology colleagues concur in this regard. I have had only one patient who had to stop HCQ due to a prolonged QT interval. Eye toxicity, although unlikely, remains the major concern with prolonged use. I feel the drug is safe enough to use empirically in some patients in whom I suspect RA or lupus even without proof.

There are potential downsides however in using HCQ to treat COVID. Our president has stated “what do you have to lose?” First is that although the drug is relatively safe, the risk of adverse effects is not zero. I have had patients experience gastrointestinal (GI) side effects and severe rash.

One study examined 84 COVID patients13 treated with the combination of HCQ and AZ, looking at the incidence of QT prolongation. It is unclear how to interpret the results. 11% of these patients had an increase in QT interval to greater than 500 ms, placing them at high risk for arrhythmias, yet none of these patients actually developed arrhythmia. One cannot draw any conclusions from this study regarding risks of HCQ alone.

Another report concluded the following:14 “Worryingly, significant risks are identified for combination users of HCQ+AZ even in the short-term as proposed for COVID19 management, with a 1520% increased risk of angina/chest pain and heart failure, and a two-fold risk

of cardiovascular mortality in the first month of treatment.” This study was retrospective with 62 authors looking at over a million patients. The sheer volume makes the conclusions suspect in terms of consistency.

A trial in Brazil15 compared the risk of toxicity of Chloroquine using high and low doses. The study found that those in the high dose group had a significantly increased incidence of death and the study was stopped prematurely on that basis. This has been used as an argument against the use of chloroquine and by proxy HCQ, but the question remains as to whether we should not be using these drugs at all based on toxicities noted with very high doses, or whether we should simply not use those high doses.

Finally, a study done at Beth Israel16 looked at the incidence of QT prolongation in 90 patients receiving HCQ or HCQ + AZ. They found that 21/ 90 patients developed either prolonged QT intervals greater than 60 ms, or QT intervals greater than 500 ms placing them at greater risk for arrhythmias. One of these patients developed Torsade’s, which the authors state has not been noted elsewhere in the literature.

In view of these and other studies, the American Heart Association, American College of Cardiology and the American Heart Rhythm Association have concluded that we should avoid using both HCQ and AZ in patients with baseline congenital long QT syndrome or QT > 500 ms and that patients using both should have monitoring of their cardiac rhythm and QT interval.

A second downside separate from possible adverse drug reactions is that promoting HCQ as a potential cure sets patients and their families up for disappointment if reality fails to meet expectations.

Finally, the most significant downside is the inability of some lupus and RA patients to obtain HCQ. Additionally, prior authorizations, now required when prescribing HCQ, can result in further delays for patients even if the drug is available.

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The main question here is whether there is “enough” evidence of efficacy of HCQ in treating COVID to warrant the potential downsides. That depends on one’s definition of the word “enough”.

What is especially troubling is that how one defines “enough” seems to depend on their political leanings. Those on the right tend to be staunch supporters of HCQ while those on the left emphasize the downsides. Both the efficacy and toxicity of this drug have been amplified in order to serve individual political narratives.

I oppose this “politicization” of medical treatments.

Despite strong opinions on both sides, we do not yet know how well HCQ works in treating COVID, and if so, exactly when and how to use it. That does not preclude its use. There are numerous circumstances where physicians treat patients empirically. Not knowing if a drug works is different than knowing that it doesn’t. Ideally, we should wait for a properly designed study, but in a crisis situation, can we afford the delay? Again, it depends on how one defines “enough.”

Medications should not be used for political capital. HCQ should not be promoted as a “game-changer” based on a “good feeling”. Politicians and media should not be cherry-picking the data to suit their underlying agendas. Treatment decisions should be made by physician and their patients without interference. Public policies forbidding the use of HCQ and threatening physicians are not appropriate.

Ultimately we will have answers to the HCQ quandary, but for now, physicians must care for our patients as best we can with the information available to us. Physicians are the ones who must do risk/ benefit analysis and inform our patients. That is what we are trained to do. That is what we do every day.

COVID-19 should not change that. 1 Note: since the writing of this article, there have been new studies reported on HCQ, which are not reflected in this article.

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What In The Heck Is A Prolonged QT? The electrocardiogram (also known as an EKG or ECG) is a tracing that consists of different hills, peaks and valleys that are named alphabetically from the letter “P” through “U.” The P wave represents the electrical activity present when the atrial muscles contract.

T Wave Abnormalities Normal QT interval Broad, slowly generated T wave Wide-based, notched T wave

The QRS complex represents the left and right ventricle depolarization

Prominent U wave

The T wave is the time that it takes for the ventricles to repolarize.

Indistinct termination of T wave

The qT interval is the time between the Sinusoidal T wave beginning of the QRS to the end of the T wave. It represents the time in which the ventricles contract and then relax.

Late-peaking T wave If a qT interval is too long or too short it puts the person at risk for abnormal Photo adapted from Circulation 1995 article. heart rhythms.

Some people are born with an inherited form of an unusually long qT interval.

Others can develop a long qT when they become dehydrated, develop electrolyte abnormalities or take certain drugs.

Those most at risk for arrhythmias are those with an underlying congenital form of prolonged qT who take drugs that prolong the interval.

Moss AJ, Zareba W, Benhorin J, Locati EH, Hall WJ, Robinson JL, Schwartz PJ, Towbin JA, Vincent GM, Lehmann MH. ECG T-wave patterns in genetically distinct forms of the hereditary long QT syndrome. Circulation. 1995 Nov 15;92(10):2929-34.

References 1- https://www.ncbi.nlm.nih.gov/pubmed/32205204 2- https://www.sciencedirect.com/science/article/pii/S0399077X20300858 3- https://docs.google.com/document/d/1SesxgaPnpT6OfCYuaFSwXzDK4cDKMbivoALprcVFj48/edit 4- https://www.jpost.com/diaspora/jewish-doctor-urges-israel-to-follow-his-off-label-coronavirus-treatment-623355 5- https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v3 6- https://www.nytimes.com/2020/04/01/health/hydroxychloroquine-coronavirus-malaria.html 7- https://www.mediterranee-infection.com/wp-content/uploads/2020/04/MS.pdf 8- https://www.herald.ng/india-adopts-use-of-hydroxychloroquine-for-prevention-of-covid19-in-health workers/?fbclid=IwAR2KAnqIqgbYqAgmRARbY4ICQYKROaTepxh8yIDwrF_QT_O2akeu1jm0kqY 9- https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloroquinasprophylaxisforSARSCoV2infection.pdf 10- https://www.sciencedirect.com/science/article/pii/S092485792030145X?via%3Dihub 11- https://www.cebm.net/covid-19/hydroxychloroquine-for-covid-19-what-do-the-clinical-trials-tell-us/?fbclid=IwAR0dC4EfUySoK1L8EZhLSFlcS4ho8jjW44uCb-AmbQkIzC4Wf6bRE21DTSQ 12-https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v1.full.pdf 13- https://www.medrxiv.org/content/medrxiv/early/2020/04/03/2020.04.02.20047050.full.pdf 14- https://www.medrxiv.org/content/10.1101/2020.04.08.20054551v1.full.pdf?fbclid=IwAR12o13O1ZUzFSMx2iQDMTm2rDkggTj696Jzqe_joaMfZ02KkwQJNogxRDk 15- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765499?utm_source=For_The_ Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=042420%ufeff 16- https://jamanetwork.com/journals/jamacardiology/fullarticle/2765631 WWW.PHYSICIANOU T LOOK . C OM | 22

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The Covid 19 Lessons Are Best Described As THE GOOD, THE BAD A N D T H E U G LY. Wri t t en by A no ny mo u s

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he good are the great doctors, nurses, responders, food handlers, postmen and all necessary personnel who risk their lives to save others. The good is the planet resting, animals feeling safe to come out, birds all over the place and ocean full of wildlife. Blue skies, fresh air. The good is being able to hang around our kids and appreciating being alive.

The bad are the companies that think of making money and taking advantage of a pandemic. Those who raised the prices of masks, gloves, and other PPE.The bad are the hospitals not protecting their drs and cutting their salaries. The bad are the people struggling financially because they can’t go to work.

The bad are the inconsiderate who only care about their own safety and walk 2 4 | M AY / J U N E 2 0 2 0

outside without masks, making others anxious and risking other people’s lives.

The ugly is the corruption pushing an agenda. The ugly is the narrative of the politics in this country not caring about lives but polls. The really ugly is the media who all of a sudden became doctors, giving advice or analyzing medical journals. The media touted poorly conducted studies (e.g., VA) that scared every patient from taking hydroxychloroquine and criticized a great study from France conducted by a well respected and admired scientist I respect and admire. None can understand what it took to get those results except those who do medical trials. Dr. Raoult took nasal swabs of patients daily, checked the genetic sequencing of all patients. 1600+ patients. He wasn’t serving hamburgers,

he was saving lives from a deadly virus that could have killed him. In fact, he saved 98% of the people he treated. The media made fun of his study, calling him a quack.

What’s the point of a medical degree? What’s the point of years of training, boards, sacrifices? What’s the point if no one will listen?

The real ugly is stopping doctors from prescribing an old drug and making patients scared of a drug that rheumatologists have prescribed in this country for 60 yrs without checking an EKG. Steve Jobs said “it doesn’t make sense to hire smart people and tell them what to do.” I say it doesn’t make sense to give doctors a medical degree and not let them practice the ART of medicine. 1 Original artwork created by Dr. Douna Montazer

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WWW.AHIMSAHOME.COM WWW.PHYSICIANOU T LOOK . C OM | 25

N EW N EW S

COVID-19 Can Cause ARDS, And AFDS (“ACUTE FINANCIAL DISTRESS SYNDROME”) Wri t t en by Ste p h a ni e Wo t t ri c h, M S 3

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he virus SARS-CoV-2 makes daily global headlines and has precipitated a de facto worldwide quarantine. When it began insidiously popping up in the United States, first in Seattle, then Los Angeles and Chicago, I thought, “Ok, this thing is here. We’ll get it under control.” As cases began to exponentially increase, I thought, “Quarantine, ok. It makes sense that to control the spread of this thing, we stay away from each other for a while.”

I never anticipated that, within a month, we would find ourselves in an altered reality in which seemingly benign things like hugging our grandparents or going to a concert would be considered a massive health risk. In these last few weeks, I’ve seen terms like 2 6 | M AY / J U N E 2 0 2 0

“social distancing” and “telemedicine” go viral (pun intended), and hashtags like #FlattenTheCurve, #RaiseTheLine, and #LowerTheBaseline sprinkled all over the internet.

Given that I am a second-year medical student, regardless of whether there was a pandemic or not, I would have found myself this season in “study quarantine,” given that my first board exam was scheduled for April 27. Even so, I never could have foreseen that things would become this extreme. Like everyone else, I saw my daily frequents close one by one – first my school, then church, part-time job, and gym. My board exam was pushed to the end of June due to test center closures, then cancelled altogether af-

ter being rescheduled five times. Upcoming elective periods no longer may involve direct patient contact. Every student panel and meeting has moved to Zoom, and even my brother’s wedding ceremony scheduled for the end of May was cancelled. Instead, it was live streamed from the courthouse with just the officiant and photographer present!

All the changes, cancellations, precipitated layoffs, and daily updates on the virus left me thinking in circles about the state of my own health and the healthcare system in the United States. I suffered from severe asthma in childhood and had several bouts of pneumonia over the years, so shortness of breath and hospital emergency rooms are very familiar. I was young at

that time, so I didn’t think a lot about the fallout, such as the bill. Regardless, I was aware even then that it was expensive to be sick, and my classes in my first year of medical school taught me how facets of our healthcare system favor those who can afford “good” insurance or paying out-of-pocket expenses, often leaving others with lesser care or none at all.

As a broke student with a lot of debt and a part-time job limited to 20 hours per week, I was appalled when I received the bill from my trip to the emergency room earlier this year after collapsing in my bedroom from extreme dehydration secondary to the flu.

The number on paper wasn’t unexpected, but it still burned. And I do know

that I’m one of the lucky ones; I am on my father’s insurance plan and, thankfully, had enough money from my job to pay the bill and be done with it.

This did not change the fact that I felt nauseated thinking about all the folks that need care right now amid layoffs, chaos, and financial insecurity that may not be able to afford it (or at least not without making huge sacrifices).

On top of money issues for patients, doctors are taking hits as well.

The overwhelming number of new cases coming into hospitals everyday forces cancellation of elective procedures and extensive use of resources, which burns through budgeting. There are some actions being taken to allocate and extend relief funds, but amid so many healthcare workers doing their jobs even without proper protection due to shortage of resources, there is still talk of pay cuts. One doctor in a recent article I read even described it as a situation of “shooting ourselves in the foot.” In the meantime, medical students like me are being recruited to volunteer to help with childcare, picking up groceries, pet-sitting, etc., for these heroic folks busting their tails every day so that they can’t manage these essentials themselves.

The question thus presents itself: There’s a problem of resource misallocation, but what is the solution? That was rhetorical actually; we know the solution. A deep-rooted problem requires deep-rooted changes. I’m not a politician, but given the infringement of our current system on basic human rights to life, it would seem that adequate access to medical care is not, nor should ever have been, a bipartisan issue.

It is unacceptable that we live in a state in which anyone with enough money can access life-saving medicines, but those who cannot afford it are faced with the decision of trading financial ruin for survival. Implementation of a system that provides healthcare for everyone is absolutely essential.

While the pandemic of this season is nothing short of a catastrophe, the

response to and outcomes of it have highlighted this issue of health access disparity arguably more than ever, at least in my experience. There is a very palpable fear of requiring hospitalization, not just from the risk of contracting the virus, but because of the cost to be treated.

And don’t worry, I will not segue here to speak on behalf of or against any one political candidate or figure based on their plans for making this a reality. However, I will urge you to consider the position of those who currently have jurisdiction over maintenance and reformation of the healthcare field, as well as those who may come to have jurisdiction. This extends not just to those in federal seats such as the president, but state and local governing bodies as well. There has never been a more important time to be involved in investing for the future in terms of our everyday actions. That includes washing our hands, not touching our faces, physically distancing, staying home, and staying informed. The future of our local and global community depend on it, so let’s “stay woke,” my friends. 1 Stephanie Wottrich is starting her third year of medical school She holds a bachelor’s degree in Microbiology, Immunology, and Molecular Genetics from the University of California, Los Angeles.

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N EW N EW S

Bravery Is Being An Ally To People Of Color Wri t t en by Dr. N i ra n A l -A gba

O

ver Memorial Day weekend 13 years ago, my younger brother, Laith, died in an accident.

He was 26 years old. Losing young people in their mid-20’s is particularly devastating because they are embarking on adulthood and their futures hold limitless hopes, dreams, and possibilities.

For the survivors, no holiday brings the same joy as it did before. Someone is not there, and never will be.

Wanda Cooper-Jones, the mother of Ahmaud Arbery, has endured unbearable pain. Gregory and Trevor McMichaels shot and killed her son while he was running down the road. They were not arrested and charged with a crime until 74 days later. A third man, William Bryan, stood by and recorded the murder of Ahmaud Arbery on his cellphone for more than 4 minutes. 74 days passed before he was charged with 2 8 | M AY / J U N E 2 0 2 0

committing a crime. The gruesome facts of this story have enraged me because I know a little something about the unrelenting grief associated with unexpected death.

My brother’s death was accidental, which made me incredibly sad. Wanda Cooper-Jones’ son was ruthlessly lynched and then this week George Floyd was killed in broad daylight by a police officer in Minneapolis, both of which make me unspeakably angry.

Enough is enough. This nation must stop tolerating lynching of black men and women. While racism is difficult to discuss, it is also necessary, valuable, and essential in order to bring about change. My previous column addressed white privilege and ever since, readers have been asking, “What now?”

Now, we need to become allies to people and communities of color.

But what does it mean exactly to be an ally?

First, we can listen more and talk less. There is no path to understanding without listening. If a person of color trusts you enough to share how discrimination and prejudice impacts them, stop talking. Listen. Watch. Learn. Tackling any problem requires awareness before action. White privilege can be a powerful tool for an ally to fight racial oppression.

We must acknowledge privilege without asking for absolution of our guilt about having it. If these conversations make you uncomfortable, own those feelings. Be careful not to lend support just to make yourself feel good — this is not about you or me.

As allies, we can acknowledge the history of institutional racism in America: a system of structural advantage favoring whites over non-whites in social,

C REDITS: #COLORBRAVE “BREA D A RT” C RE ATE D BY DR. JE SSIC A SO

political, health, and economic arenas. In truth, these are abuses of power artfully disguised as acceptable social constructs.

This racial hierarchy was built and reinforced over many generations, making inequality based on race, gender, or ethnicity, profoundly systemic. Dismantling them requires invalidating arbitrary biases each of us hold about those who are different from us.

Reject pervasive stereotypes which do harm. Allies look for connections between racism, economics, and other forms of injustice, but poverty is not a defining characteristic of being black in America.

The notion that racial disparity begins and ends with smaller black pocketbooks is incorrect. In fact, ample education and wealth cannot insulate black people against the harms of systemic racism.

Do your own work. Asking people of color to teach you more about racial Original artwork created by Dr. Jessica So

discrimination burdens those in need of support. Educate yourself. It relieves people of color who are exhausted by fighting oppression alone.

Advancing the opinions and ideas of others is a way to contribute without taking up space. The role of an effective ally is not to speak for others, rather to remove impediments which prevent those who are marginalized from speaking for themselves.

Become comfortable with being uncomfortable in the pursuit of equity and justice. Talking about race can be challenging, but isn’t that the point? No amount of white discomfort can match the danger of being black in America.

Remember that. Talk about racism, but resist the urge to take action on behalf of people of color without knowing what they need. Guard against being a savior to swoop in and fix communities of

color. Their communities do not need fixing. Instead, amplify voices of color.

Better yet, listen first and then amplify.

Endorsing racial equality often means taking a stand against injustice.

Call out friends or colleagues on their racial bias, even when no one is watching.

It can be disconcerting to do this, yet it is our moral obligation as citizens of a free and equitable society. Take the risk.

Never let the sun set on the endorsement of racism by someone you know.

Never deny, minimize or justify racism. Whitesplaining — or advising a person of color on how to deal with oppression — is not helpful. Offering suggestions places the onus on those who are marginalized, as if they have not already worked to overcome racial injustice. Instead, ask how you can support the safety and health of people of color.

Finally, let us admit we all see color.

Ignoring color is not the solution because seeing color isn’t the problem. The real issue is our conscious or subconscious action when we see color. Mellody Hobson, CEO of Ariel Investments, gave an inspiring TED talk about being color brave instead of color blind. She said, “We cannot afford to be color blind.”

She is right.

Racism is the most divisive issue facing this country. The mere fact that 74 days elapsed between the lynching of Ahmaud Arbery and the arrest of the men who murdered him demonstrates how tightly racial discrimination is woven into the fabric of America. Whites becoming allies to communities and people of color is the way we can change the heart of our nation.

It is time for all of us to become color brave. 1 Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular column for the Kitsap Sun. Contact her at niranalagba@gmail.com.

This article https://www.kitsapsun.com/story/ opinion/columnists/2020/05/29/niran-alagba-being-ally-people-color/5278238002/, first appeared in the 5/29/20 issue of the Kitsap Sun, four days after George Floyd was killed by asphyxiation in Minnesota beneath the knee of a white police officer.

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ADVO C AC Y IN AC TIO N

When Did We Become Our Own Worst Enemy?

Wri t t en by D r. D a ni el Wa t ers

Editor note: The problems facing medicine today need physician-led solutions. How will you lead? How will you take back medicine?

O

ver the last few weeks I have been coming across a new term.

Maybe you have seen it. “Vital Exhaustion”.

It appears that if orange is the new black, then vital exhaustion is the new burnout. Which means we somehow allowed ourselves to get burned out by, you guessed it, burnout. It’s OK – burnout was never really a great descriptor for what modern — and especially cor3 0 | M AY / J U N E 2 0 2 0

porate — medicine is doing to good doctors and other health professionals.

In the mind’s eye it conjures up a smoking hulk or a charred shell of something barely recognizable like, as a famous New Jersey songwriter put it, the skeleton frames of burned out Chevrolets.

And think about what we now know about the effects of this Vital Exhaustion on ourselves – increased rates of depression, suicide, substance abuse, even MVAs — a Litany of Sorrows that gets even worse if you’re a woman. Forget the slings and arrows of outrageous fortune; these are stone-cold killers we’re talking about. And our indoctrinated response for so long has been, “Thank you, Sir. May I have another?”

Why did we let this happen? To quote Walt Kelley’s “Pogo”: “We have met the enemy and he is us.” Perhaps not “us” in the usual sense, but those things within us that drive us to pursue healing as a calling and a career in the first place. Overachievement, altruism, kindness, a genuine desire to do good, and a willingness to sacrifice just to have the chance to improve the lives of others and feel the satisfaction that it brings. And let’s be honest, to make a good living and provide for our families. But I’d make the case that the dedicated physician also makes the perfect patsy. Programmed to never say no, encouraged (you know it’s true) to work beyond normal limits and capa-

IMAGE CREDIT OF APRIL BRUST FOR DOXIMITY’S OP-MED.

bilities and chastised for complaining; to be too often embarrassed and not infrequently resented for the fact that we’re paid well for a job exquisitely few people can do and responsibilities even fewer would be willing to shoulder. So when did we become our own worst enemy?

When we failed to start saying, “That’s enough.” That’s enough call; that’s enough cases; that’s enough patients scheduled in one day; that’s enough of our time wasted on EMR; enough taking orders from people with far less education, expertise, and experience; enough Dashboard Reports on our “performance” from CMOs whose career goals involve being as far away

from patients as possible; enough being treated as though “we are what we RVU;” and enough being told we’re merely providers.

Enough.

In a long career, I came across only a handful of colleagues who I was certain didn’t like medicine, didn’t like patients, and pretty much didn’t like people in general. But only a handful.

The hundreds of others I trained with, worked with, and taught all had the spark, the drive, the heart, and the will to be wonderful and caring physicians.

So how does it still manage to suck the life out of so many us? How does it exhaust our vitality? How does the thing we love to do end up hurting us? After all, it’s not exactly BASE jumping or Himalayan mountaineering.

Medicine is not really a business but it certainly has a business component. A successful business model always mirrors its product. Except in health care. Practitioners have been shunted aside by swarms of specialized accountants to whom patients are an abstract, a financial pro forma, and who lack any experience in actual patient care. Is it any wonder things function so poorly? Imagine an auto company run by executives who’ve never driven a car or an airplane designed by MBAs with no grasp of aerodynamics. Welcome to health care.

It is interesting to consider that there is not a naturally occurring straight line or even a true right angle to be found anywhere in the human body. Yet look at what administrators send you every day – org charts, performance reviews, care pathways and the dreaded multi-page spreadsheets – nothing but straight lines and right angles, rows and columns, squares and grids, plusses and minuses, profits and losses, all of it strictly two-dimensional.

Realize that this reflects their view of the world, their education, their training, and their thought process. We are the ones trained to analyze the articulations, compensate for the curvatures,

Imagine an auto company run by executives who’ve never driven a car or an airplane designed by MBAs with no grasp of aerodynamics. Welcome to health care. and suss out the synergies. And we don’t even need special lenses to see it in 3D. Physicians are better at health care leadership because they are better at health care. We need practicing physicians involved and leading at every level, especially the corporate. Do we need professionals with business education and acumen to help us navigate the intricacies of finance and reimbursement? Of course we do. But the leadership culture of so many health care organizations today often seems more suited to a bank, an investment firm, or maybe even a hedge fund.

Want to start fixing health care and put a speed bump on the road to Vital Exhaustion? First – say “enough.” Then get involved. Run for office. Make some noise. Irritate some higher-ups. Serve or encourage your respected physician peers to serve as true clinical leaders and patient advocates, not corporate lackeys. Demand that C-Suite administrators come from the practicing ranks of your institution and that their qualifications extend beyond a willingness to tow the line and cash the check. Let’s be shepherds instead of sheep. We don’t need every physician at once to make it happen. We just need enough. 1 Daniel Waters, DO, MA recently retired from active practice after three decades in cardiothoracic surgery and medical education. Dr. Waters is a 2019-2020 Doximity Fellow.

Original article featured in Op-Med, a collection of original articles contributed by Doximity members, February 24, 2020. Illustration by April Brust for Doximity’s Op-Med.

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ADVO C AC Y IN AC TIO N

P HOTO

No-WorkFrom-Home Policy During The Covid-19 Pandemic A N D T H E W R AT H O F C O R P O R AT E M E D I C I N E Wri t t en by A no ny mo u s

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early 8 weeks after enduring unfortunate organizational behavior, I gathered enough courage to leave a medical directorship role. My transgression? Raising concerns over the organization’s no-work-fromhome policy during the new COVID-19 pandemic.

For context, I serve as a clinical director for an outpatient mental health clinic within a community healthcare organization.

When I joined the organization, there were no standardized, outpatient mental health services. By leading hospital task forces, obtaining 6-figure grants and designing hospital-wide education strategies, I was closely involved 3 2 | M AY / J U N E 2 0 2 0

with creating a subspecialty clinic that would care for the mental health needs of a vulnerable population. Within a short period of time, the clinic was full.

I share this not to be boastful, but to shine light on the callousness of corporate healthcare.

For a long time, I noticed certain “organizational splitting behavior”.

From one day to the next, administrators dangle praise and dispensability in response to complacency or dissent, respectively. Knowingly, I continued my work until a time came when our principles were just too far apart.

At the beginning of March of 2020, I advised leadership of the need to expedite a telehealth solution, amid pandem-

ic warnings. I voiced personal challenges with having immunocompromised family members and limited childcare options. There was no response for a while.

After the release of emergency provisions from the Center for Medicare Services (CMS) and from the U.S Department of Health and Human Services (HHS), I was allowed to see my patients remotely. Clinic volumes increased and our no-show rates plummeted. When I tried advocating for other mental health team members (e.g psychotherapists) to see patients remotely, I was reminded of the new no-work-from-home policy. I was educated on employee equity and asked not to speak with employees about these matters. I found out that our pa-

C REDIT P HYSIC IA N A RTIST JU DITH H ON G

tients (at risk population for COVID-19 complications) were still being seen faceto-face for their routine, psychotherapy visits. This was already late April, 2020 with a fast-approaching local peak, no universal masking and severely limited testing. To this date, patients are still being seen face-to-face for these visits.

At this point, I politely suggested that employees were scared (I see many as patients). The no-work-from-home policy based on employee equity seemed to be sending a message of “if one is at risk, then we all need to be at risk”. I pointed out that such blanket policy may be posing unnecessary exposure. I explained that some employees with limited “frontline skills”, but who are still essential are Original artwork created by Dr. Judith Hong

most helpful if they could work remotely during the peak. After all, bringing our droplets into the center to provide faceto-face, routine, mental health visits is not the type of solidarity asked by public health officials. Again, no response.

Five weeks after my original request, I was told in a celebratory tone that an institutional video-chat account and smart tablets were approved. The fine print? I had to use the tablet on campus. No routine clinical care (not even phone calls) could be done from home.

The rationale du jour was “brand consistency.” Suddenly, employee equity was not catchy enough. The policy explicitly raised concerns over background noise, such as dogs barking. The rationale kept shifting with cyber-security and HIPAA taking a more central role, depending on who you asked.

With such little, science-based logic, I declined to use a portable tablet, on-campus, during the peak of a pandemic when my specialty can be easily tele-ported. Expectedly, my dissent resulted in a parade of phone calls from administrators, all with inflated titles. I was sent articles written by their own leadership on how the “fear epidemic” is going to endanger us all faster than COVID-19.

After this, I explained that training and duty called for sacrifice, but not without calibrating risks at every step of the way. Moreover, peer shame with “fear-demic” articles should not be part of the equation. I continued to give examples; My husband is an anesthesiologist. He cannot intubate via video-chat.

If he doesn’t intubate, the patient dies. If the patient dies, someone loses a family member and my husband is out of a job.

The risk of him staying at home is high in terms of lives lost, professional stance and job security. Considering his specialty and our household circumstances, he needs to be in the operating room. I even tried to speak the administrator’s favorite tongue; like business, I explained, we could transfer risk, eliminate it, mitigate it or accept it. In our home, we mitigated our risks; my husband wears PPE when he works and “disinfects” in a designat-

ed “hot zone” in the garage. We updated our life insurance and trust and, we stopped having grandparents care for our kids. In our two-physician household, the remaining parent (me) can still practice medicine and homeschool our kids with thoughtful planning. Again, no response.

After several days, I became aware of behind-the-scenes arrangements for a quick replacement. All without fanfare.

My new patients were given to someone else. Referring physicians came under the impression that “the psychiatrist declined to see patients”. I was reminded by an administrator that my contract stated “on site.” I was told they cannot accommodate for my “daycare issues”.

At this point, I reiterated my continued availability to care for my patients.

Given unforeseeable circumstances, I offered accommodations to fulfill my contractual duties and reminded them that the document was drafted before a global crisis. For example, for “brand consistency,” I secured a space without any external distractions during normal business hours. For Cyber-Security and HIPAA, I purchased a secure router to be used with the institutional tablet and the institutional, video-chat account.

All of this with a standard, telemedicine consent form. A system like this goes above and beyond the expectation of the emergency HIPAA provisions released by HHS in March, 2020. All of these accommodations were declined.

Our values were just too far apart, so I submitted a request to place the contract “on hold.” After a week of silence, they proficiently asked if my request was a resignation. While I knew this would absolve them of the burden of a wrongful termination, I was too tired and demoralized not to agree. They offered instead a “mutual agreement” to end the contract “sooner than stipulated.”

The moral of the story is... complacency with corporate medicine comes with an enormous moral cost. Courage comes with the risk of losing our jobs. I chose courage. 1 Anonymous WWW.PHYSICIANOU T LOOK . C OM | 33

P HOTO C RE DIT OF IN GRA M IM AGE S

O F F IC E S PAC E

Using Technology To Put Physicians In Control PA RT 2

I

Wri t t en by D r. Lea h H o u st o n

n last month’s issue, we introduced the problems caused by, and the history behind the meddlesome 3rd parties that impede physician and patient control over decisions and data. This month’s issue is about physician-led solutions.

So how do we fix this? The answer lies in putting those with the appropriate competency, training and compassion back in charge: The Physicians!

Data is the new gold, and physicians generate a lot of data that they currently don’t own or control. Furthermore they are often being forced to give away their patients’ digital protected health information to third parties that do not provide value to the patients or the physicians who care for them. In this impending digital era we need a digital way for physicians to own their data, and to organize, collaborate, and communicate free from third party oversight and interference. HPEC is building a decentralizing technology called self sovereign identity (SSI) that 3 4 | M AY / J U N E 2 0 2 0

can do that for us. SSI creates digital passports for the physician community to own their credentials, and their right to work and interact with their patients without oversight from third parties. See Figure 1 for an overview of how the technology works for physicians.

Once this is built, physicians will then be able to use their digital passports to interact digitally while owning and controlling all the information they generate. Importantly, this technology has an ability to create a sustainable business model that will restore control over the practice of medicine, and put it in the hands of practicing physicians. See Figure 2 for an explanation of how we plan to use this technology to generate a sustainable revenue for the physician community.

This technology has the ability to connect the physician community in ways never thought possible. We can bring agency and autonomy to the physician patient relationship again, by empowering

the physician community to control and own their data. The HPEC network will be decentralized, where the physicians own and control their data, and their ability to interact with their patients. Any practicing physician can participate and because we are rewarding physicians for joining the network, it is better than free and easy to join. See Figure 3.

The physician community has an opportunity to be the first to adopt this technology in order to build a healthcare future that we can be proud of. We can own our future, we can control the narrative, and we can do so while upholding the hippocratic oath and protecting our patients’ privacy. HPEC is a company with a sustainable business model, and it is currently 100% physician owned. We hope to keep it that way, and want you to be a part of this movement. Please follow us on social media @HPECid, and go to our website to learn more www.hpec.io. 1

Figure 1

Physician (Credential Holder)

The physician holds owns and controls the verified credential for life

MONETIZATION MODEL 2% FEE ON ALL TRANSACTIONS

Community

Patients & Payers

Physician Services, Credentials, Data Payment HPEC points rewarded in proportion to revenue

1%

Credential Issued 2%

generated on the network

Issuingtransaction fee from payment Institution

is re-invested back into

the physician community

• Physician receives payment for

write

read

services, data or credentials • Physicians receive points for generating revenue on the platform • Physicians can exchange points for

The decentralized data is automatically reading, services from registry the community writing and updating on a cryptographically secure Governance Secure Communication decentralized ledger Advertising Services

Physicians Angels | Family Offices | VCs

Figure 2

Verifying Institution

1/2 of the transaction fee

1%

The credential Investors issuing body (example: a medical school, residency, or state licensing board) issues the credential

Credential Presented

Network

The credential verifying body(example: a hospital, employer or insurance company) requests proof of Peer to peer payment the credential Credentialing

Data analytics

MONETIZATION MODEL 2% FEE ON ALL TRANSACTIONS

Community

Patients & Payers

Physician Services, Credentials, Data Payment HPEC points rewarded in proportion to revenue

2% 1%

1%

generated on the network

1/2 of the transaction fee

transaction fee from payment

is re-invested back into

the physician community

• Physician receives payment for

Investors

services, data or credentials • Physicians receive points for generating revenue on the platform • Physicians can exchange points for services from the community

Governance

Secure Communication Advertising Services

Physicians Angels | Family Offices | VCs

Figure 3

Network

Peer to peer payment Credentialing Data analytics

THE PHYSICIAN NETWORK 50%

Growth through aligned incentives

of all revenue generated is invested back into the community.

That revenue can be spent on needed services through utilizing HPEC points.

This incentives physicians to stay, participate and continue to grow the network

Physicians then invite their physician colleagues to validate their credentials

Physicians initially join the network, and upload their own credentials

For every credential upload and validation physicians get HPEC points

Those points can then be exchanged for services that the HPEC network provides

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P HOTO C RE DIT OF IN GRA M IM AGE S

O F F IC E S PAC E

Patient Consumerism W H Y T H E H E A LT H C A R E INDUSTRY SHOULD TA K E N O T E F R O M HISTORY

A

Wri t t en by J a mes. N. G i o rda no

mericans are confused, anxious and frustrated by rising and unpredictable copays, deductibles, and out-of-network expenses. COVID-19 has presented additional financial challenges and barriers to care. The patient financial burden continues to increase and most patients don’t understand why. What they do know is that it’s getting costly and it’s getting personal.

Patients find their specialty and primary care doctors are turning to out-ofnetwork models at a rapid rate. Patients utilizing in-network doctors and facilities are still faced with their insurance plan’s high deductibles, copays and coinsurance. The learning curve is steep and patients are just educating themselves.

NPR and Kaiser Health News “Bill of 3 6 | M AY / J U N E 2 0 2 0

the Month” article uses actual patient bills to educate their readers on how to be more active in managing their unexpected healthcare costs. Bills selected run the gamut of circumstance and cost to the patient.

What does this mean to the healthcare industry? Unfortunately, when increasing amounts of medical cost fall on the patient, the choice of providing care or pursuing payment weighs on all medical providers. The pursuit of payment is costing an average of 27% of total revenue for physician groups and 21% for hospitals, according to a recent brief by the Center for American Progress.

A patient’s access to care is no longer just limited by geography. Patients are forced to consider the cost of care even for preventative care. The financial afflic-

tion associated with a patient’s responsibility for their own care is forcing the healthcare industry at large to rethink the way they attract new patients, keep existing patients and collect on payment.

In this economic and socially shifting environment, it is more important than ever that the industry shift their current collection paradigm to a more customer centric model.

Learning from Other Industries Mortgages expanded the housing industry making homeownership a possibility for those lacking large amounts of capital at the ready. Retail credit cards transformed the way people shop and how shoppers engage with retailers.

In 1920, Americans were introduced to the first mass-produced, “af-

fordable” automobile, which left most wondering how they could ever afford to own one by paying upfront. It wasn’t until automobiles were considered a necessity that the idea of buying one on credit truly took off. Enter auto financing, and less than 10 years later, half of the United States population proudly owned one. By 1930, two-thirds of cars were purchased on credit.

Necessity drives consumerism in all industries: transportation, housing, utilities and now, healthcare. How can the healthcare industry learn, adjust and make healthcare more attainable and affordable to patients?

Payment Plan’s Role in the Patient Decision Process Consumers want payment choices and use these options as part of their purchase decision. In a recent survey, 93% of patients responding and willing to use payment plans also wanted providers to be proactive in offering such a plan. In addition, an overwhelming majority of patients (76%) who were offered and used payment plans said they would complete the plan on time. Consumer-centric patients seek non-predatory payment options as a reason to commit to a doctor’s care plan and see through including payment in full.

The Rise of the Patient Consumer The annual value of patients’ outof-pocket medical expenses is estimated at $63.7 billion. Private practice medical doctors and healthcare administrators need to learn from history in order to navigate the financial payment landscape that allows them to offer care to their patients and get paid for their services.

There is too much at risk not to conform.

As patients knowingly assume more financial responsibility for their healthcare, they will become more selective about who, where, when and if they will receive their care. The rise of healthcare transparency and surprise billing legislation will give patients new tools to make these decisions that much easier. When patients are armed with the ability to choose where they receive their healthcare based on price, those offering healthcare services will become considerably more proactive in marketing to patients.

The healthcare industry must pivot, analyze and rethink business as usual based on financial circumstance, decision making process and method of communication. Patients aren’t just shopping for their healthcare, they are shopping for medical doctors and facilities that value their business and prove it to them. Patients want the ability to pay their medical bills like any other expense today - without hassle and over time.

With $7.5 billion in medical bills going uncollected each year, what is there to lose?

Consumer-centric patients understand that unfortunately, all payment options are not favorable. Early players in the medical payment subsection thrived and continue to market as interest free to patients, but fine print tells a different story. Doctors and facilities should count on patients being aware of these practices, especially with online reviews and social media. In fact, 24.8% of respondents who used payment plans said that incurring additional fees was the reason they had previously avoided payment plans altogether.

Technology Offers Access to More Consumer Patients Beginning in the early 1990’s payment plans based on credit score allowed patients to pay for health care with a credit card model with interest rates risk of over 25%, retroactive. Consumer patients are increasingly more shrewd to the fine print of the predatory payment plans of the past, and are seeking out payment plans that benefit both the patient AND the healthcare facility.

Evolutionary risk assessment technologies can now assess a consumer’s ability to pay using thousands of social, behavioral and financial indices, not just credit score. By using alternative means to assess risk, non-predatory, truly inter-

As patients knowingly assume more financial responsibility for their healthcare, they will become more selective about who, where, when and if they will receive their care. est and fee free payment plans are now available to patients with credit as low as 400. Remarkably, these advancements can successfully lower the barrier of entry for patients while eliminating the burdensome administrative costs associated with traditional payment plans.

With the help of technology, interest and fee-free payment options do exist. Savvy consumers should beware of predatory impersonators in the form of credit cards and micro-lending “matchmakers.” Only medical practices and healthcare facilities who invest in the consumer-centric patient relationship will be willing to help patients get the care they seek and the means to make it more affordable. These are the practices and institutions that will thrive in the future healthcare market. 1 James N. Giordano is CEO and Founder of Care Cap Plus, the technology driven leader in interest-free financing and payment plans.

1- Bill Of The Month Julie Appleby - https://khn.org/news/tag/bill-ofthe-month/ 2- Excess Administrative Costs Burden the U.s.

Health Care System Emily Gee-Topher Spiro - https://www.ameri c a n p r o g r e s s . o r g / i s s u e s / h e a l t h c a r e /r e ports/2019/04/08/468302/excess-administrativecosts-burden-u-s-health-care-system/ 3- Auto Financing Changed Industry and Society Steven Finlay - https://www.wardsauto.com/ideaxchange/auto-financing-changed-industry-and-society 4- History Of the Auto Lending Industry https://lendedu.com/blog/history-of-auto-lending-industry 5-Healthcare Payments https://www.pymnts.com/study/healthcare-payments-study/ WWW.PHYSICIANOU T LOOK . C OM | 37

O F F IC E S PAC E

7 Ways To Turn Patients Into Your Biggest Fans SO YOU CAN GROW YOUR BUSINESS

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Wri t t en by D r. B rent La c ey

often meet a patient for the first time when I’m meeting them on the day of their endoscopic procedure.

My nurse practitioner sees a lot of patients ahead of time, so by the time I meet them they have already had some experience interacting with people in our clinic. I almost always get positive comments.

• “Your staff is just so nice!”

• “Everyone here is really professional.”

• “You guys are so efficient!”

• “Are you the doctor from Texas?”

We have worked hard to create an extremely positive customer service experience for our patients. Any time we get a complaint from a patient about an 3 8 | M AY / J U N E 2 0 2 0

aspect of our clinical service, we take steps to correct it. In a small, rural North Carolina community with one major hospital, reputations spread very quickly, and we have built a reputation for high quality, professional care.

I really enjoy spending time with my patients in clinic. It’s the best opportunity I get to make an impact with patients one-on-one. I realized a long time ago that a patient’s experience with our practice starts long before they ever meet me, and it’s crucial to address all of the aspects of that encounter to ensure that patients have a great experience.

If I serve my patients well, they become my most ardent supporters. I haven’t had to spend a dime on advertising or marketing. My whole practice has grown by word of mouth.

Here are 7 things you can do to create fans that will market your practice for you.

1. Hire the right team, and cultivate the right culture It all starts with hiring the right people and building a good team culture. As a physician, you are a leader in your business, whether you wish to be or not. We direct the flow of patient care. One of my mentors loves to say, “Your team will get the patients better, and the doctors aim their team.”

Depending on your employment status, you may not have a lot of say when it comes to hiring. However, you CAN influence your team’s culture. Build the culture that you want, set high expectations, and you’ll tend to see that people who aren’t a good fit will just leave.

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ing you online or through friends. Is your website easy to navigate? Do you have a clear process on your website to show people how to set up an appointment?

Your referring physicians should also have an easy way to send referrals to you. If they have to spend any time working through a complex administrative system to get to you, they’ll go somewhere else. Make this process easy and clear!

3. Spend more time with your patients This is easier said than done, especially in clinics where you may only have 10-15 minutes with each patient. Still, it’s true that the more time you spend talking to your patients, the better their experience will be.

Another thing you can do is start to set expectations early. When your team calls a patient to remind them about their clinic appointment, they can tell patients what their clinic visit will be like. If you have to see 30 patients a day and they only get 10-15 minutes of your time, let them know that so they can be prepared with questions and not spend half the visit on idle chit-chat.

Work with people who are friendly, hard working, and strong communicators. That will help fix >90% of your clinic’s issues.

You can’t be everywhere at once, and you can’t come up with ideas to fix every problem that arises. What you can do is hire great team members and turn them loose to do their jobs well.

2. Make it easy for patients to get into your clinic.

You are in a referral business. It should be easy for patients to get referrals to you. That should be a low-friction process for the patient. If they have to spend any time figuring out how to get in touch with your office, they’ll go somewhere else.

If you’re getting direct business (e.g., primary care), people are probably find-

4. Dress for success This can vary widely among specialties. In general, patients will expect business casual, business professional, or scrubs, so that’s a good place to start. I used to say, “wear whatever you would wear to church,” but sometimes that now suggests a level of formality below what would be expected at a physician’s office.

Scrubs may be more typical in surgical subspecialties, especially if you go back and forth between clinic and procedures all day.

White coat or no white coat? I find this to be an individual decision. I still wear mine to clinic every day, but not everyone does. I think it comes down to personal comfort for most people. The white coat is a symbol that adds a degree of confidence to the patient encounter, but it’s not something everyone necessarily wants to wear every day.

Offer patients an opportunity to promote you by giving them a story to tell.

Set expectations with your staff on a daily dress code. Again, business professional or at least business casual should be a minimum expectation. If you have theme days like coordinated colors, football jerseys or Halloween costumes, that can be a fun way to break up the monotony.

5. Clinic layout Think like a retailer. When you walk into a department store, everything is laid out meticulously. Signs point the way to the different departments. The floors are clean and lights are bright. You may be greeted by an energetic and bubbly salesperson. The checkout areas are obvious. You need to take the same approach to setting up your clinic.

Is it easy to find your building? If you’re in a large building, how easy is it to navigate to your office? If people tend to get lost, put up signs to show them exactly where to go when they get off the elevator.

When you walk into the office, your patients should see a person waiting for them (usually behind a counter).

The patient may be nervous or anxious, and putting a human face in front of them puts them at ease. This person sets the tone for the visit, so they should be smiling, caring, and have a helpful attitude.

Pay attention to the décor in your waiting room. It should be designed to put patients at ease. Invest in some comfortable chairs, since people may be waiting a while. Are there current (not 10 months old) magazines available for people to read? Also, you should think about having an area for kids to play.

Trust me, moms and dads will appreciate you so much if you have a way to help them entertain their kids while they’re waiting.

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Focus on the best parts of your personality as you look for ways to make your business more remarkable.

You probably had the patient fill out a form on a clipboard. Are the forms easy to follow? Are they highlighted and obvious? An even better option is to direct patients to an app or website where they can fill in this information electronically for you, saving time on data entry.

The best option would be to have them fill out this information before they even get to your clinic. If they can do that from the comfort of their own home, when they’re not wrangling three kids in your waiting room, they’ll be much more at ease.

When your team member gets the patient to walk them back to the exam room, what does the walk look like?

Are they walking past physicians’ offices that are messy and cluttered? Is the scale for the patients out in the hallway where anyone can hear their current weight being announced?

When they get to your exam room, they may wait for you for 10-20 minutes. Think about their experience. Is the room well-lit? Is the temperature comfortable? Are the decorations in the room nice?

The patients go back to the front to pay after the visit. Does someone escort them? Are those instructions clear?

These things matter. Think about the last time you went to a used car lot. Was it comforting and relaxed, or high-pressure and anxiety-inducing?

Take a deliberate approach to designing the patient encounter in terms of the physical space. Patients will definitely notice the difference.

6. Be different!

I remember the orthopedist who signed my leg cast in 8th grade. He signed it, “I’ll be back. – Arnold Schwarzenegger.” Did he set my broken leg better than anyone else might 4 0 | M AY / J U N E 2 0 2 0

have? I don’t know. I imagine he did it about as well as anyone would. But, I remember the experience because it was different.

That was a fun experience, highly memorable, and it cost him nothing.

How would people remember you if you did something that was different?

• The doctor who sings to his patients?

• The guy who always tells a “ dad joke”?

• Maybe you’ve got the wackiest scrubs anyone’s ever seen?

Offer patients an opportunity to promote you by giving them a story to tell.

Amplify yourself!! Amplify things that energize you. What gets you excited? Is it empathically listening to patients? Being the “funny guy”? Take the things that are exciting to you and do those things bigger, better, faster, funnier, or more creatively than everyone else.

Focus on the best parts of your personality as you look for ways to make your business more remarkable. What do people already enjoy about you? Ask your staff and patients for their ideas.

7. Make it easy for patients to contact you.

Almost nothing drives me crazier than spending 10 minutes navigating through an automated phone menu. If you have one of those to help you out, don’t make it an epic choose-your-ownadventure story. It shouldn’t take more than a few steps to get a patient to an actual person to talk to.

You should also have a way for people to contact your team by email or through an online service. Everything is electronic these days, and that’s how most people communicate now.

I don’t give out my cell phone number or personal email to patients, though I know some people who do.

I want to have the opportunity to enjoy time with my family when I’m not

working, and it’s hard to do that if 5,000 patients have 24/7 access to you and an expectation that you’ll respond right away.

When patients contact your team, you should try to respond to them as quickly as possible. Your team can help you triage these issues. Some administrative items can be handled by your front desk team, medication refills can be addressed by mid-level providers, and then truly complex issues can escalate to you. Be careful to delegate some of these patient contacts or you’ll get drowned by the deluge of calls and emails that will flood your office every day.

Do you have a way for people to give you feedback on their visit? Ask people to fill out customer surveys, either in the clinic or online. You do have to be a little careful how you do this.

Some people will post a bad review just because they have a bad disease that you can’t fix, regardless of how excellent your care is. Internal surveys are valuable because they offer a confidential way for patients to tell you how to make the encounter better.

Conclusion None of this happens by accident.

Highly successful people don’t wait for things to happen to them, they make things happen. If you’re just starting a practice, go spend some time with a physician you respect and see how their clinic operates. If you have been in practice for a long time, hire some people to be “secret shoppers” and secretly come evaluate your team and your processes. Get feedback from your patients on ways to improve their experience.

Make this a priority. After all, this is a business, so you have to think like a businessperson. If the patients have a bad experience, they’ll go to someone else and they’ll tell all of their friends to do the same. Make each encounter excellent, and you’ll build a loyal base of patients who enjoy coming to see you and make you excited to come to work every day. 1

Douna Montazer MD A

PHYSICIAN WHO DREAMS OF MAKING A DIFFERENCE IN HEALTH CARE THROUGH HER ART

TO ORDER PRINTS VISIT: WWW.DM-PHYSICIANARTIST.COM/PRINTS

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How To Jog Beyond Negative Thoughts About Running Wri t t en by D r. M i c hel l e Q u i rk

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rowing up, I was the kiddo struggling to finish the mile run, huffing and puffing my way around the track, and walking the last lap or two. My mind fed me some of these thoughts: “Running is too hard.

You’re not a runner. You can’t even go a mile. You’re not fit enough. You’re not lean enough.”

Fast forward twenty years later, to when I began running more regularly, and arrived at my first couple of start lines at local 5ks. The same thoughts from twenty years earlier came right up for me. Standing at the start, I’d look around and think all of those negative thoughts, with the common thread of: “I don’t belong here.”

During college, medical school, and residency, I started and stopped and started again with running. In the beginning, I was getting out there pure4 2 | M AY / J U N E 2 0 2 0

ly to practice what I was preaching to my patients. But each time I would take a long break from running and then get back to it, the same negative self-talk would creep in: “I’ve never been able to stick with this before, so why would I be able to this time around?”

There are many negative thoughts that come up for individuals when it comes to getting started with running, but they can all be overcome! *It’s too hard. When I started running, I thought I had to try to go out as fast and as long as possible to get a decent workout accomplished. This resulted in feelings of disappointment when I would get tired and out of breath quickly. And honestly, when I was huffing and puffing my way home with aching legs, running wasn’t much fun at all.

The game changer for me was learning how to run slowly. I found that I could run for longer and with much less fatigue. Instead of trying to run at the pace we ran for the elementary school 100 meter dash all those years ago, I would encourage myself to find a pace that I can comfortably sustain. By going more slowly, we find a pace at which we could have a conversation. Alternatively, finding a pace at which one could belt out Springsteen’s, “Born To Run,” without becoming short of breath, is also very much encouraged.

What if we embraced our current fitness, wherever that happens to be, and simply ran with it, however slowly?

“I often hear someone say I’m not a real runner. We are all runners, some just run faster than others. I never met a fake runner.” ~Bart Yasso

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*I don’t belong. We see runners in our neighborhood, and maybe we don’t think we belong right there with them for whatever reason. Or, maybe we’ve been at that start line before, looking around and thinking, “I don’t look like them. I’m not as fast as them. I didn’t train for this like they did.” The ideas that we have to be a certain size, shape, height, build; that we have to be fast; that we can’t walk; that we have to run a certain distance before we are considered “a runner,” are really just thoughts that our minds have created for a variety of reasons.

If we are running recreationally, for the purposes of exercise, fitness, and wellness, it is quite unlikely that other recreational runners are worrying about what we look like and how fast we are going. Most runners are concerned with their individual results and per-

sonal improvement. Just ask any marathoner what their best time is! Most of us have that PR (personal record) ready on the tip of our tongues! We can be competitive, but let’s be competitive with ourselves.

If we are out there running, we are runners. And we belong there. What if we allowed ourselves to remove the comparison factor with regard to other runners?

“Don’t compare yourself to other runners; focus on your own fitness and performance.” ~Jack Daniels, PhD *It’s too late. Many beginners say, “But it’s too late. I’m too old for this.”

My mom has been a brisk walker for many years now, but she took to the challenge of increasing her distance and completed her first half marathon in her late 60s! There are plenty more inspiring stories just like this one.

The brain loves to offer thoughts about our age, size, current fitness level, and on again/off again history with running or exercise. And maybe because of these thoughts, doubt bubbles up to the surface, causing us to quit before we even get started.

What if it was never too late to get started on our fitness journey, or to RESTART it? *I quit so many times before, so why try again?

We look to our past experiences with a running or exercise plan, and think, I’ve never been able to stick with it, so why would I be able to this time? Or, maybe we start running a few days a week for several weeks in a row.

But then one day, we miss a run. And then one missed run becomes a week of missed runs. And before we know it, our brains say, “You’ve missed a few already, so why bother getting out there tomorrow?”

This is a common thought distortion called “all or none thinking,” where anything short of perfect leads to a feeling of failure. It shows up often for me and for my athletes, but recognizing it is

key. In recognizing all or none thinking, we can then take a step back, and look for some balance and flexibility in our training. Does anyone really stick 100% to an exercise plan? We are human. Life happens. We aren’t professional runners.

We are working, doctoring, and parenting.

Insead of beating ourselves up about missing a training run or exercise that we had planned on our schedule, what if we agreed to cut ourselves some slack but to not make this a habit? What if we allowed a deep breath, and simply started again tomorrow?

The beauty of this sport is that all of us have to start somewhere, and that somewhere may be at mile 0 and time 0.

It is easy to look at a marathoner and think, “There is no way I could get there,” but the truth is, there is nothing wrong with starting from wherever we are and taking that first step. If we think of the journey as a marathon and not as a sprint, we change our focus to the long game and allow patience with ourselves.

The only way we assure we don’t get there, is if we never take the first step at all. I would encourage us to lace up our sneakers and to try an easy jog for a few minutes this week. See how it feels.

One foot in front of the other, consistently, will get us toward our goals. Let’s surprise ourselves by taking that first step. 1 The information provided here is for general information and educational purposes only and is not a substitute for professional/medical advice. Before taking actions based upon such information, please consult the appropriate professionals. Consult your primary care physician before undertaking any fitness or exercise regimen.

Michelle Quirk is a board certified pediatrician, certified run coach with the Road Runners Club of America (RRCA), marathoner, and triathlete.

She developed Mindful Marathon to help others discover how they can embrace running and prioritize their well-being. She develops customized training plans for every type of runner—new, old, somewhere in between—and helps to fit those training plans into busy lives. With her help, Michelle’s athletes find their edge and achieve their goals. You can find out more about Michelle, coaching with her, and her course for beginner runners at mindful-marathon.com

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TIM E F O R YO U

Taking Back The Meal Wri t t en by D r. Ly nn S t i ff

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t’s 1:00 pm and I haven’t eaten since 6:00 am. I’ve been running around the hospital seeing patients, talking to families and attending rounds. I finally have a chance to sit down at a computer and settle in with my lunch so I can begin to work through the eighteen notes I need to write. For some reason, I think that I’m able to type, click, dictate, and eat all at the same time.

In reality, this is impossible. Instead of eating a peaceful lunch at a table, I shoveled my lunch into my mouth between clicks. I didn’t enjoy the food and I barely accomplished anything on the computer. I shrug it off and am just grateful to not have to eat again for a few hours. Now I can get my work done and maybe get home at a reasonable time.

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Does this resonate with you? Please tell me I’m not the only one! PreCOVID this might have been your reality. Post-COVID, you might be still doing the same thing as you care for patients on the frontlines (but with 10x more handwashing) or it may have the struggles of working from home intertwined.

For me, this habit started in medical school after my first child. I felt I had to prove I could do as much work as a man who didn’t have any other responsibility and wasn’t nursing. I had two more children during training and these habits now feel like a well oiled machine. I remember sitting in the pumping room after my 3rd child; it was around 2pm and I was pumping

hands-free, talking to a nurse on speakerphone and eating lunch.

I did what I thought I had to do to get through. But it doesn’t need to be this way. Actually it shouldn’t be this way.

Mindful and intuitive eating are essential to achieve complete health.

Many times with our busy schedules we think of eating as a task that has to be checked off the list. We attempt to do this in the fastest way possible.

This may even be making a shake so we don’t have to chew (yes, I’ve tried this too). But this approach is all wrong.

Eating should not be considered a mundane task. It is how we nourish our bodies and minds so we can take on the challenges of the day. This mindset is

part of the problem with the health of our society. We go through our day and often never experience the food we’re eating. We eat what is necessary for life so we have the stamina to complete the next task; whether that food is nutritious is another discussion entirely.

We long for the day of having a nice quiet meal with our significant other. But we tell ourselves stories to prevent that from happening: • I’m not in that phase of life • This is not the job for that • That luxury is for other people What if I told you mindful and intuitive eating could transform the way you see food and your body? It’s true, it can. When you begin to eat mindfully, you reestablish hunger and satiety cues that guide your body in what it needs.

You begin to enjoy the food you are consuming.

Intuitive eating and mindful eating are two slightly different things.

Intuitive eating is paying attention to when you are hungry and when you are full. It is getting in tune with your body’s natural drive for energy.

When we are in alignment (stress management, regular physical activity, and adequate sleep) our hunger and satiety cues are quite accurate in determining how much and what we should be eating. Mastering intuitive eating is quite challenging at first. After all, it has been silenced for decades.

Think about a young child. Some days they can go without dinner, other days they can’t stop eating. This is because they are deeply in tune with their hunger and satiety cues. They listen to their body tell them what it needs.

Imagine what the health of our country would look like if we did this one thing.

Mindful eating is more about being present in the experience of eating.

This means no distractions. When you put something in your mouth, you are aware of how much and what

you put in your mouth. You savor each bite. You pay attention to the textures and flavors. You legitimately enjoy the food that you’re consuming. Allowing ourselves this pleasure actually reduces the craving we feel later. This is the piece that’s often missed on a day-to-day basis.

This brings in an important topic of cravings. The guilt and shame associated with eating something that we feel we shouldn’t eat prevents us from actually enjoying what we eat. Think about the infamous Halloween candy.

Did you happen to sneak a piece or two?

Why did you have to sneak it? Why couldn’t you just decide you wanted a piece? Why didn’t you take a piece, sit down at the table, open it up and eat it over 2-3 bites, enjoying each bite?

There shouldn’t be shame around eating something delicious from time to time. When the shame is removed, the coping strategies for dealing with the shame also go away. That means binge eating, mindless eating and emotional eating are eliminated. Instead we’re in tune with our bodies and we do what we naturally know is right.

Here’s my challenge for you - are you ready for it? I want you to commit to 1 week of mindful and intuitive eating. You won’t be a professional by the end of the week. But I am very confident you’ll notice a difference in how you feel and how you approach food.

And every week it will be easier and easier. In a month, you’ll wonder why you didn’t think of this sooner.

Are you ready to begin to experience this radical transformation of eating? Here’s how to get started: 1. Learn about the hunger scale. You can google this or check out a handout I made on my website for free download (nutritionhealthlife.com/free-stuff ).

Basically 0 is starving, 5 is neutral, 10 is stuffed.

2. Keep a hunger and satiety journal.

You can print off a handout for this from my website at the link above. You can also keep a little notebook or a note

in your phone. Date the top and list out each meal with a letter (B, L, D, S - for breakfast, lunch, dinner, snack). Next to each letter put the number for hunger before eating / number for hunger after eating. For example, B 3/8.

3. Turn off all distractions 4. Use your senses while you’re eating.

In addition to flavor, pay attention to the texture. Notice the nuances of the flavors. Smell the aroma of the food.

Visually notice the differences in the various items within the dish. Really be present while eating.

We can understand when our body needs nourishment. Through intuitive and mindful eating we can become confident in our bodies and begin to love them for how amazing they are.

Want to learn more? Check out my podcast called Medicine for Life. It’s all things lifestyle medicine presented in a realistic and relatable way to help empower you to reach your health and wellness goals through small, sustainable actions. 1 Some parts originally published on SheMD -https://www.shemd.org/post/taking-backthe-meal More ways to get in touch: Website/blog: nutritionhealthlife.com FB page: https://www.facebook.com/ NutritionHealthLifeLLC/ Women’s Only FB Group: https://www. facebook.com/groups/womenbecomingwhole/ IG: https://www.instagram.com/nutrition.health. life/ Dr. Lynn Stiff is a dietitian turned family medicine physician on a mission to empower individuals to implement realistic and sustainable diet and lifestyle choices to prevent, treat and reverse disease. She is passionate about demystifying nutrition, addressing weight bias, and moving past diet culture to achieve complete wellness. She believes health can be attained by all regardless of size and past choices. She works full-time as a physician and started her online education platform, Nutrition Health Life LLC, in September 2019. When she’s not working on her passions, you can find her enjoying the beautiful state of Colorado with her husband and 3 spunky and sweet children, ages 1-5. She is an avid runner, hiker, home DIYer and brewery explorer. She can be reached at this link: https:// nutritionhealthlife.com/lets-get-in-touch/.

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Stop Giving Yourself The Pandemic Pass Wri t t en by D r. Ka t ri na U bel l

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physician client of mine was recently talking with a few of her physician coworkers. She mentioned working on keeping her eating in check right now and was surprised by the response she was met with. “I can’t imagine trying to lose weight during this time!” one of them said. “It would be impossible to lose weight right now,” said another. “How could someone possibly get through this time without snacks and wine?”

My client smiled and nodded, but knew deep down that there really was another way; a way of coping that makes overeating unnecessary. As a member of my Weight Loss for Doctors Only program, she is learning how to eat in a way that tastes good to her, plays nicely with her body, and is easy to follow through 4 6 | M AY / J U N E 2 0 2 0

on day-to-day with her personal schedule.

She is also learning how to manage her mind so that she doesn’t need to ask food or alcohol to help her feel better.

So many people, including physicians, have been overeating and gaining weight over the last few months. They eat to comfort themselves because being at work is terrifying. They eat to deal with the stress they feel because their list of worries seems never-ending. They eat for pleasure because they haven’t had so much time to connect with their families and other loved ones in this way for as long as they can remember. And since so many physicians generally find little time for hobbies, many have taken up baking and cooking as a way to fill their free time.

Nobody could blame you for doing these things. After all, none of us have

lived through a pandemic before and we’re all figuring this out as we go along.

But when we allow ourselves to use food, and possibly alcohol, to cope with our day, we’re giving ourselves a pass. We tell ourselves that we’d be crazy to try to manage our eating and drinking at a time like this.

But this “Pandemic Pass” isn’t without consequences.

Giving ourselves this pass to eat whatever we want whenever we want is similar to how many women approach their pregnancies. When we aren’t feeling well and are generally living in a state of self pity, it’s easy to indulge on all our favorite foods. We tell ourselves we’ll deal with the weight gain later, after the baby is born. But once the baby has arrived, we always wish we wouldn’t have gained so much weight in the first place.

P HOTO C RE DIT OF IN GRA M IM AGE S

I had a pregnancy where I ate a lot of dark chocolate M&Ms. They tasted great and I ate them every day. When I felt a negative emotion that I didn’t want to feel, I ate some chocolate. The dopamine released in response to the sugar really did make me feel better. What I didn’t realize at the time was that my thoughts, not my circumstances, were what was creating my negative emotions in the first place. So the next time I had a thought that made me feel bad, I again asked the M&Ms to make it better. They happily complied. I allowed myself to believe that most of my weight gain was from the baby, placenta, and fluid. I told myself I’d easily lose the extra weight after the baby was born.

But soon after I’d delivered the baby, I realized that I had over 30 ex-

cess pounds on my body. I was none too pleased with my past pregnant self who had delegated the task of losing the weight to the present me, the one who was taking care of a newborn and a toddler. When I was pregnant and eating the M&Ms with abandon, I never stopped to consider what my future self might have to say about my eating habits. I figured she would be delighted to have a healthy baby and wouldn’t mind at all that she had to focus on losing weight in addition to all her other responsibilities. I had given myself the “Pregnancy Pass” to eat whatever I liked and now I had to deal with the consequences.

The same thing may be happening to you now, regardless of your gender or whether your childbearing days are

Practice processing your negative emotions rather than avoiding them by eating food. long behind you. This pandemic is not a sprint; it’s much more of an ultra-marathon. And we’re just a couple miles in. If you are living it up, eating all the things, and believing that you’ll get yourself in check once this pandemic is over, you have a lot more weight gain ahead of you.

When COVID has settled down, you won’t be happy you gave yourself the Pandemic Pass. Your clothes won’t fit, you’ll be up a size in scrubs, and you’ll feel uncomfortable in your skin. Worse yet, you’ll have created a pattern of overeating that won’t simply go away just because the virus did. When your brain gets used to using food and possibly alcohol to deal with uncomfortable emotions, this response becomes a habit that will continue long into the future.

The good news is that you can get this under control now. Simply creating awareness around what you’re eating and why you’re eating it is the first step. What emotion are you feeling as you reach for that homemade cookie? As you reach for another slice of freshly baked bread, take a moment to identify whether you’re physically hungry or just wanting more of something that tastes good. If you’re heading to the pantry for a snack after dinner, experiment with watching your show or reading your book without the companionship of food.

When we feel uncertainty and lack of control, we often neglect to manage the things that are actually within our control. Reframe negative thoughts about your current situation so that they feel true, believable, and serve you. Practice processing your negative emotions rather than avoiding them by eating food. Plan your actions so that you set yourself up for doing the things that create the results you want for your body and your life.

Stop giving yourself the Pandemic Pass. Your future self will be so grateful you did. 1 WWW.PHYSICIANOU T LOOK . C OM | 47

I NT E L L I GE NC E O N TH E M OV E

Operation Reclaim A SHORT STORY Wri t t en by Dr. N a n a D a dzi e G ha nsa h

December 25, 2017 Somewhere in the Amazon other Nature was livid. From where she hovered, she could see the fires raging. General Chiroptera kept his distance. He always sensed it when she was in a rage and lately, they had been quite frequent.

The butterflies who accompanied her everywhere circled Mother Nature and seemed to absorb her rage.

Finally, she turned and glared at the General. “Do you see that? To cap off a year of floods, hurricanes, and wildfires, this? Those humans are laying the planet to waste. Where is the weapon you promised me? The Ebola project was an abject failure!”, Mother Nature yelled.

“My Queen, we are working on a very capable system and we need some time”, General Chiroptera answered. “I hope

M

4 8 | M AY / J U N E 2 0 2 0

it is not the SARS system again. We have tried that twice already and the results were subpar”, Mother Nature bellowed.

Overhead, dark clouds were collecting as if matching her mood. “Queen, but it is our best bet now. Please give me time. Worst case scenario we still have the Influenza program and with the increasing aversion to vaccinations, we are bringing some old weapons systems back,” the General said. “Look Chiroptera, take a look at the planet. You travel all over the place. Look what the humans are doing to the planet. And with the leadership now, it is just going to get worse so I do not want ifs. Next year by this time, I better have a weapon or…”

A clap of thunder drowned out the last words of Mother Nature but the General could not miss the look in her dark green eyes.

Then suddenly, she was gone with the butterflies.

The General sighed and flew off into the rain.

Mother Nature kept flying. The planet was lit up with the lights of the season though there were some dark spots. In spite of that, her heart was heavy. Her planet was dying with a lot of her children going extinct like the tiger in Cambodia, the northern white rhino, the Amur leopard. She sighed.

These humans.

She missed the old days. She missed the generals from those days. Fighters with purpose. The greats — Rodentia and Siphonaptera. Architects of the greatest plague the world had ever seen.

Plagues — the only things that kept humans in check and thinned their herds.

She did not care much for their wars be-

C REDIT IMAGE TO A RTIST A LE XIS GH A N SA H

cause the planet suffered too but plagues worked. That is when she could unleash her weapons on them. Now all she had was Chiroptera and Natalidae. He had had some success with the Influenza program in 1918 but she wanted something more massive. Of course, the HIV and Malaria programs were still ongoing but those had lost their impact. Yet all he could talk about was the SARS program. They had tried that twice before with not very impressive results. She wanted the big one. Anyway, he had a year.

She sighed and flew on.

December 25, 2018 Somewhere in a Forest in Yunnan Province, China General Chiroptera was waiting at the edge of the clearing created by a ring

of trees. Beside him stood Colonel Natalidae. He looked nervous. Chiroptera understood. As head of the SARS program, he was not in the Queen’s good books. Too many failures, but from what he had seen so far, he had a feeling this new weapons system was the best Natalidae and his team had come up with to date.

Suddenly, the Queen appeared with her entourage of butterflies. All the animals fell quiet. Some had come from as far as the Outback for this meeting. He could sense Natalidae shaking.

“Chiroptera! It has been a year. What do you have for us?”, Mother Nature barked out. “My Queen, we have a system that we think you will be proud of. Colonel Natalidae will fill you in,” Chiroptera said and stepped back. “Ok, Natalidae, I am all ears,” Mother Nature said.

Their ICUs are going to be filled with critically-ill patients for days. It will crash all health systems.

Colonel Natalidae started: “My Queen, my team and I updated the SARS system. I am proud to say the new system is more lethal than ever. We took the old system and made a few tweaks. For instance, the spikes are sharper. The biggest problem with the old system was the ability of the spike protein to get activated so it could initiate cell entry. The old system depended on proteases in the cell. We found a specific enzyme called furin that can activate the spike protein. This means the virions can enter any cell along the whole respiratory tract. However, we want to aim them for the alveoli. We also have made them more able to then kill cells quickly initially.”

“Why?,” barked Mother Nature Colonel Natalidae continued: “We want to incite a massive cytokine reaction that can lead to a storm. A potent cytokine storm will do more damage than any the virions can do — sepsis, ARDS, DIC, thromboses, HLH, multi-organ failure...those are all possible.”

There was a look of keen interest on Mother Nature’s face. Colonel Natalidae glanced over at the General. Chiroptera nodded. Natalidae went on: “If that happens, their ICUs are going to be filled with critically-ill patients for days.

It will crash all health systems. Even if we cause this in 20% of all we infect, that is still a massive number. The attack will run rampant after that. Life in human societies will literally come to a standstill. This will lead to civil unrest that will compound the outbreak. The effects will be devastating.”

“You said that in 2000!”, Mother Nature retorted. Colonel Natalidae looked away and bowed his head. General Chiroptera stepped forward; “My Queen, I have seen the trials. They are impressive. If they fail, you can have my head.” “And mine too,” Natalidae said. A silence fell over the gathering. They had just heard the two most powerful bats in WWW.PHYSICIANOU T LOOK . C OM | 49

There was neither a vaccine nor a treatment in sight and overall, life was grinding to a halt. The fear was palpable.

Mother Nature’s elite squad of assassins possibly sign their own death warrants.

“So be it! What’s the plan,” Mother Nature asked. “We will use couriers again.

Our divisions in the Congo, Brazil and right here in China will distribute the virions into different couriers — civets, pangolins, grasscutters, rats, dogs and so on. As you know, those are the areas with the highest chances of a spillover…as they call it. We will keep delivering virions until we get a spillover. We will continue until we have 100 people infected in at least one area. We found out that is the number we need to kick start an effective outbreak. Then we’ll re-evaluate,” Natalidae said.

“I like that. So what do we call this operation?”, Mother Nature inquired.

“SARS 3.0”, Natalidae replied “No! I don’t like that”, Mother Nature said.

“I thought we always gave it a number and then replaced it with the name the humans gave it?,” Natalidae inquired. “Not this time. Not when Antarctica is melting.

We need to take our planet back. We need to reclaim what is ours.

Operation Reclaim it is!”, Mother Nature said.

The gathering broke out in applause and chants of “Reclaim! Reclaim!” When the noise died down, Mother Nature asked: “So when does this get initiated?”

“End of January. By then we’ ll have all teams in place,” Natalidae answered. “OK! We’ll meet back here at the end of March to hear a status report,’ Mother Nature said and then she was gone as quickly as she had appeared.

The animals slowly dispersed. A few came over to say hello to Chiroptera and Natalidae but the majority just avoided them. It was like they already smelt of death. The two bats finally flew off to set Operation Reclaim in motion.

5 0 | M AY / J U N E 2 0 2 0

October 19, 2019 Somewhere in the Congo Basin, near Equatorial Guinea The gathering was taking place underneath a huge mahogany tree. The meeting in March had gone well. Chiroptera had been able to report that all the battalions were in place. He had dispatched swarms of bats loaded with the new SARS virions to Southern China, Brazil and the Congo from their labs in those regions. Mother Nature was worried about simulation exercises going on in the US but Chiroptera and Natalidae were not worried. Like Natalidae said, the world was not unified anymore. It was each for himself now. There was no clear leadership from any one country anymore. That had satisfied Mother Nature.

Now he was glad to report that they were sure they had spillover in China and were waiting for a breakout. Mother Nature was actually smiling. There was a lot of cheering going on. No one saw her disappear. She knew where she was going to be for the next 3 months.

January 23, 2020 Wuhan, China Flanked by Chiroptera and Natalidae, Mother Nature watched as the city was getting shut down due to an outbreak of what they called the Wuhan coronavirus. The fear in the air was palpable. It made her so glad. She looked at Chiroptera and then at Natalidae. “I will let you live another month.” Then she was gone.

March 18, 2020 Bergarmo, Italy Mother Nature was actually smiling.

Her two top military officers by her side.

They had really come through this time.

The infections and deaths around the world were mounting. All calls for early action had gone unheeded — just like Natalidae predicted in March, a year ago.

There was neither a vaccine nor a treatment in sight and overall, life was grinding to a halt. The fear was palpable.

She was unhappy that the outbreak had been controlled in China but there was always the rest of the world…especially

the US and those Americans looked as unprepared as can be. She rubbed her hands together in glee. The bats looked at their queen showing more emotion than she had ever shown and they knew their lives were safe.

As if she was reading their minds, she said, “You two came through. Well done.”

“Thank you,” they both said. “So what do they call it?,” she asked, “Well, they call the virus SARS-CoV-2 and the disease it causes COVID-19,” Chiroptera said. Mother Nature laughed.

“Humans can really make everything complex, can’t they?,” she said. “Yes they can”, Chiroptera answered. “So we meet again in a week, right?,” Mother Nature asked. “Yes! In New York City.

Then we will unveil Phase II,” Chiroptera answered. “Phase II?,” Mother Nature asked, surprised. “Yes, My Queen, Phase II of Operation Reclaim,” Chiroptera answered.

Chiroptera could tell he had really piqued the Queen’s interest. He went on: “My Queen, have you noticed anything about the humans who end up in their ICUs and those who get really ill?” Mother Nature thought for a second…”They all seem older...”…then her voice trailed off as a look of realization crept over her face. “As the humans see mostly the older population dying, they will be lulled into a false sense of security that life can go on because that is a population they can sacrifice,” Chiroptera stated.

“The Children! Phase II is the children!,” the Queen exclaimed. Chiroptera nodded. “Who thought of this?,” the Queen asked. Chiroptera pointed at Natalidae. “I underestimated your brilliance, Colonel. See you in New York,” the Queen said. “We will, my Queen, but Phase II will not start there. That will be your surprise,” Chiroptera said.

“I hate surprises but I will make an exception this time,” the Queen said even as she faded away with the butterflies fluttering in her wake. 1 Originally published on March 23, 2020. https://medium.com/@ndghansah/operationreclaim-a0d860b46f91

Original artwork created by Alexis Gansah, 16 year old daughter of the author

IN TELLI G EN C E ON T HE MOVE

The Scope of Practice PODCAST Writte n b y D r. B re nt Lace y

H E L P I N G Y O U R P A T I E N T S I S W H A T Y O U L O V E M O S T. B U T P U T T I N G O N Y O U R W H I T E C O AT C O M E S W I T H M A N Y O T H E R R E S P O N S I B I L I T I E S , M O ST O F W H I C H Y O U W E R E N ’ T P R E PA R E D F O R I N S C H O O L .

Most physicians and dentists enter their profession with large amounts of personal debt.

And beyond that - they begin working with little to no knowledge of how to actually run a practice.

You should be able to help your patients and do what you love without being stressed by all the other obligations that come with managing your medical practice.

As a fellow physician, I understand how overwhelming it can be to step out of clinical training and into a career, and I have seen first hand the lack of education on how to run a practice and manage finances.

I was fortunate to grow up in a family where my parents were intentional about teaching me personal finance.

Working with colleagues who didn’t benefit from such early financial training inspired me to become certified as a Master Financial Coach. In this new role, my first 300 coaching clients paid off over $1.2 million of debt in just 2 months.

That’s why I started “The Scope of Practice.” My goal is to help you gain the knowledge you need to run your business successfully and manage your personal finances with expertise.

You don’t have to feel overwhelmed by the pressures of running your practice or by your own personal finances. Restore the joy you receive from helping your patients, knowing you have the knowledge and skills to handle all the other responsibilities that come with that. 1

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I NT E L L I GE NC E O N TH E M OV E

Healing The Healer

A

Wri t t en by Dr. Ru pa l i C ha dha

s physicians, as healers, we spend the majority of our days taking care of others. Taking the extra 10 minutes with a patient, calling insurance companies to advocate for those in our care, in policy meetings trying to reshape healthcare to serve the needs of the sick, and not corporations and middlemen. This is what makes our profession a profession and not simply a job. One does not simply stop being a doctor when one comes home from work.

A recent example of this in my own life was being called to assist on a flight back from Paris. Still in vacation-mode, I had to spring into action to help a stranger at 10,000 feet. So with all this caring, often physicians feel the 5 2 | M AY / J U N E 2 0 2 0

one person they cannot take care of is themselves!

Enter a pandemic. Physicians, now more than ever, are on the frontlines and in harm’s way. We are working under more stressful conditions, longer hours, and now often isolated from our families. So how can we recharge at the end of the day? How can we recharge during the day?

Truly the latter is more important in maintaining wellness. If we only perform self-care at regular intervals we miss being present and healthy all the time. Now don’t get me wrong! Definitely performing self-care with healthy routines like exercise, quality time with loved ones, or unplugging from devices at the end of the day are wonderful ways

to stay centered and well. But what if there was a way to always, or almost always, feel peaceful, fresh and healthy?

Surely can this be? Many people have heard of the phrase” mindfulness” thrown around in our holistic, new age culture. So what does it actually mean?

Mindfulness is basically a state of awareness. It is a consciousness where we are in a state of noticing. I think it is important to first define who is noticing or aware.

Many people think that we are actually our thoughts and feelings. With this identification, we go through the day often mindlessly, just a big blur of thoughts and emotions. We feel bound to these concepts and have no way of regaining control over how we, instead, process or perceive the world inside us.

P HOTO C REDIT OF P HYSIC IA N A RTIST H E TVI JOSH I M D

One does not have to be spiritual at all to grasp this paradigm shift. It has nothing to do with a higher power or soul, if you do not want it to be (though one is certainly welcome to those notions)! Even if consciousness comes from the brain tissue inside our heads, there is something that can notice or be aware of our thoughts and feelings. This means we are not (or not only) our thoughts and feelings. Let that sink in.

The reason this is so important is that this shift places you, the fabulous healer that you are, in the driver’s seat on how you process the world outside and inside. Burnout is real, but what if you viewed it differently? What if, instead of our thoughts and feelings being “us,” they became data to observe and then Photograph is the work of artist Dr. Hetvi Joshi

from a deeper place, we made quiet and healthier decisions?

To start this shift, all one has to do is notice and observe without labels or judgments. “Oh there goes my mind again worrying about the future or thinking about the past. Hmmm, isn’t that interesting?” With practice this makes everything in our life less heavy.

And isn’t that what enlightenment is?

To lighten up!

When we are in stressful situations, to remember we are not our thoughts and feelings gives us a beat. Some time.

Some space to breathe and process things from a lighter place. We all know that time and space often give great perspective. That time or space is not even required to be long, a beat will do!

We all know that time and space often give great perspective. That time or space is not even required to be long, a beat will do!

One will notice that the more this is practiced, the more it is helpful. And this concept is not new. Ancient faithbased systems, and more modern secular ones, have touted the benefits of being “present.” And the easiest way to be present is to move into a state of awareness. This can start with any of our five senses. We can pause to smell the hospital (ok maybe not ideal), see a table, a chair or feel the wind on our skin. This brings us back to now. Then from here we can notice, “oh that feels nice on my skin,” “oh now I am thinking how nice it feels and I am feeling calmer.”

And these observations of course do not have to be in the form of other thoughts!

Words are simply the only way I can convey this to you, the reader.

A fun experiment could be just to try this for a day. Or an hour! Then observe how you feel. And if the topic is of interest, so much has been written about this. A favorite is Eckhart Tolle who wrote, “The Power of Now.” In addition, he has many videos on YouTube freely accessible to all.

So try this today and see if it helps you enter a calmer and happier state.

Simply practicing slowing down, not identifying wholly with the body and mind, can help one be oh so present and much more intentional about our choices and reactions to the world. Remember it is hard to give or help anyone when we are operating on empty.

And being in the moment and aware is a quick and consistent way to be abundantly full. 1 Dr. Rupali Chadha is a psychiatric physician, practicing in Newport Beach, CA. She works in the subspecialty areas of forensics, prison psychiatry and spiritual psychiatry. She is an expert in care-giver and physician burnout and serves as a medical expert in the media.

WWW.PHYSICIANOU T LOOK . C OM | 53

St. Bonaventure has several avenues for students to pursue a

MEDICAL CAREER.

• FRANCISCAN HEALTH CARE PROFESSIONS www.sbu.edu/prehealth

• RN TO B.S. IN NURSING www.sbu.edu/nursing

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Publisher: Dr. Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Copyright Editor and Contributing Author : JR Hill VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Social Media Interns: Priscilla Contreras and Letitia Bottino Contributing Authors Dr. Marlene Wüst-Smith, Nathan Eckel, Alli Wittbold, Dr. Megan Babb, Dr. Nana Dadzie Ghansah, Dr. Nelson Nicolasora, Dr. Mark Lopatin, Stephanie Wottrich, MS4, Dr. Niran Al-Agba, Dr. Daniel Waters, Dr. Leah Houston, James N. Giordano, Dr. Brent Lacey, Dr. Michelle Quirk, Dr. Lynn Stiff, Dr. Katrina Ubell, Dr. Rupali Chadha, Original Artwork: Dr. Priscilla Sarmiento-Gupana, Dr. Douna Montazer, Dr. Maycie Elchoufi, Dr. Judith Hong, Dr. Anu Gupta, Marko Bello, Dr. Jennifer So, April Brust, Dr. Nana’s daughter Alexis Ghansah, Hetvi Joshi MD Published By “Physician Outlook Publishing” Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues. The views expressed herein are those of the authors and/ or those interviewed and might not reflect the official policy of the magazine. Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@physicianoutlook.com “Physician Outlook is a registered trademark” Cover art by Dr. Priscilla Sarmiento-Gupana WWW.PHYSICIANOU T LOOK . C OM | 55