Thanking Our ED and Hospitalist Group Schedulers for Their Support During the Pandemic

Posted on Apr 7, 2021 in Uncategorized | 0 comments

Written by Margaret Chiu, M.D., leader of our Gender Equity Task Force.

The Covid-19 pandemic has forced us to change and adapt many aspects of our lives both personal and professional. While thrusted upon us by unfortunate circumstances, some of these changes are positive and show how we can continue to improve work-life balance even after the pandemic is over. In the Gender Equity Task Force on occupational burnout, physicians have commented on what an outstanding job the schedulers in the Emergency Department and the Hospitalist groups have done in taking into consideration differing needs of members of the group.

In the context of the pandemic, “some clinicians required more evening/weekend shifts to ensure appropriate child care coverage, while others needed extended time in between shifts to quarantine before meeting older, high-risk family members,” shares Dr. Manj Gunawardane, Summit’s Hospitalist Director.

Typically, schedules are designed to produce equitable results where the concept of equitable means all shifts are shared equally across nights, weekends, and holidays. Dr. Aaron Barber, scheduler for Berkeley Emergency Medicine Group, shares about their group’s ability to adapt to the needs of their providers.

“Most groups of physicians include providers who have many different scheduling goals,” says Dr. Barber. “If an equitable schedule is instead thought of as one that meets the goals of providers… then it’s fairness depends on the members’ satisfaction with the schedule… If the scheduling method is transparent and providers feel that the burden is shared, then we gain the flexibility to adjust for individual needs. We have been able to accommodate providers who want a temporary fixed schedule, extended time off, and shift time restrictions.”  

The pandemic has scrambled lives and required a reordering of priorities for most clinicians. Providing individuals flexibility in their work schedules to accommodate for evolving obligations helps mitigate anxiety and stress, which in turn has significant impacts on quality of life, job satisfaction, and reducing burn out. The schedulers in the Emergency Department and Hospital Medicine groups had to stretch themselves and their processes to be nimble and elastic. They deserve recognition for the wonderful job they’ve done adapting to the evolving times and supporting their front line clinicians. In addition, every group has its own set of scheduling challenges and schedulers who are working hard to meet the dynamic needs of their group. Your work is appreciated!

We’re all eager to see the pandemic in the rear view mirror of history, but let’s hold onto the lessons we’ve learned from it. Let’s build on the spirit of understanding and flexibility, putting compassion first as we help all of our members live their best lives. 

President’s Message

Posted on Apr 6, 2021 in Uncategorized | 0 comments

A conversation with Joann Dominguez, MD:

As we close out Women’s History Month and celebrate Doctors’ Day, I felt it was appropriate to hear from one our female physicians. As I had previously started an interview series with members of our medical staff, this month I wanted to give some insight into Joann Dominguez, MD, one of our nocturnalists. I have always looked at night doctors as interesting people, with full lives outside of work, and have always valued them for being our guardians of patient safety while we are trying to get our zzz’s.

The following has been shortened or paraphrased in sections.

Me: Thanks for joining me today and giving up some of your valuable daylight. I wanted the opportunity to highlight your experiences as a female doctor, a member of the AAPI community, and a nocturnalist. I have a few prepared questions, but want this to go organically, so you can take it anywhere that you want.  This is meant to be insightful, but lighthearted.  But if you feel like you need to go down a dark hole, that’s ok too.

Ok, first question:  What prompted you to be a nocturnalist? Are you secretly a vampire?

Joann: Coming out of residency (working 80 hours a week with most of the daylight hours spent at work), I wanted my mornings. I wanted to know what is it like for normal people in the mornings. So I tried it out, it stuck. And I liked it. And part of me likes being alone. I love interacting with people, but I’m most productive when I am alone.

Me: When you’re not working, are you intrinsically a night owl?

Joann: No, I flip my schedule when I am off. Immediately after my last shift, I would take a short nap or stay awake, then go to sleep at night.

Me: How do you manage relationships with a night schedule, with friends, family, spouse?

Joann: When I first started, I was working a lot of nights, and I was working weekends which was hard on Peter, my partner. Then I realized I didn’t need to work that schedule. Now I have a set schedule Monday-Wednesday with an occasional Thursday.

With my son, Ben, working nights is better because I sleep when he is at school and wake up when he gets home. He falls asleep before I go to work and when I get back in the morning he’ll have just gotten up and it’s like I never left.

Me: But has he ever woken up in the middle of the night and asks “Where’s mommy?”

Joann: He knows I go to work, but it’s reassuring that I am there when he goes to bed. He has woken up in the middle of the night but dad’s home. It doesn’t faze him, it’s normal. In the beginning, it was tough, he asked “why can’t you be a normal mom?” but he’s getting the hang of it now.

Me: is it something you can do long term?

Joann: I’ve been thinking about that, it’s difficult, maybe just dropping down the number of days (that I work). I’m so comfortable now that switching to a rounding position would be so unfamiliar. Theres burnout, working nights. It’s so unpredictable, not knowing what you’re going to see and how busy you’re going to be is anxiety provoking, especially since there’s not a lot of support staff. Knowing who you work with, the nurses, the ER physicians, others who are around, can give a sense of comfort. I can trust their decisions, when they call me and give me information to help determine, hey is this really serious (speaking to teamwork!)

Me: I think you are alluding a culture of nocturnalists. Do you think that’s the case?

Joann: I think there is a culture of people who work at night. Again knowing who you work with, having a routine, how you manage or triage people are key.

Me: I’ve always looked at dedicated nocturnalists being the sentinels for the hospital, responsible for a tremendous amount of patients in the middle of the night, kind of like the Avengers, earth’s mightiest heroes (laughter ensues).

Joann: I like it the way you put it. My brother in law says “you’re just a glorified babysitter” (more laughter); he’s just forgotten how hard it is – he’s an endocrinologist.

Me: If you weren’t a doctor, what would you be?

Joann: Part of me wants to take away all the responsibility. Being a doctor is very intense, knowing that somebody’s life is depending on you. I have thought about working in a coffeeshop or a library, something calm and soothing. It may not be that way all the time, but just the total opposite of having too much on your plate.

Me: What’s your go to sustenance foodwise on shift – never mind, I know- Nutella a go go.

Joann: No. I’m one of those people that have addictions and then just stop. Right now in the hospital it’s cereal. Other than cereal, there’s nothing else that really soothes me. It used to be chocolate

Me: Sugar-y cereals?

Joann: No. It’s all fiber. It helps in other areas. (laughter)

Me: How has COVID affected you personally? Especially in family life.

Joann: In the beginning it was really hard, trying to identify people who had COVID, when to wear your PPE, thinking about bringing it home. I developed a good routine, stripping the top layer of clothing before getting into the car, then getting home and jumping into the shower. Peter (her partner) was worried. As for the rest of my family, well we don’t have family in the bay area. The last time we saw the rest of our family was over a year ago. That’s been hard.

The silver lining is that Peter got to stay at home, and we were spending more time together.

My brother in law got COVID, and was hospitalized, but in the end, he was fine. It hit close to home.

Me: How do you get your dopamine fix during the pandemic?

Joann: Running. The biggest thing is getting outside for exercise.

Me: What’s your perfect evening?

Joann: No admissions!

Me: How about at home? Or anywhere, assuming a nonpandemic world.

Joann: Traveling. I would be on a beach, just relaxing..

Me: Do you have any superpowers?

Joann: Other than being able to stay up?

Me: Are you a caffeine junkie?

Joann: No, I drink decaf.

Me: That IS a superpower.

Me: Last question, what do you think of all this anti-Asian hate going on?

Joann: You know, I look back in the past. Just looking at our family, moving from Hawaii to Massachusetts, it’s a big change. There was always a sense of being outsiders. I know that my mom had a lot of… not quite abuse, but people didn’t respect her because of her accent and who she was. It trickled down to us where they didn’t want to teach us the language (Tagalog) so we could assimilate. We felt that, we had that everywhere.  We moved a lot because we were in the military, and it felt like we just needed to suck it up.

We were surrounded by the unfamiliar and were taught to ignore it or let it slide by. But now, it’s not supposed to be normal.  I’m glad that people are standing up and it’s coming out. Hopefully it will bring a change.

Me: Thanks Joann, I think I’ve taken enough of your alone time today. You’ve been very gracious.

Joann: I hope you have a nice rest of your weekend.

And with that, I drank my coffee in preparation for my overnight shift, appreciative of what doctors like Dr. Dominguez have to do on a regular basis.

If you see her in the halls as you are coming in to get breakfast, recognize and thank her for the hard work that she has done for us over these past eight years, and wish her a safe drive home to see her son Ben and her husband Peter!

DOCTOR’S DAY CELEBRATION:

Please stop by the medical staff office to pick up these exceptionally fetching hoodies, hopefully in the size that you have specified, and show off your ABSMC pride. Thanks to the medical staff and administration!

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

Patience Experience

Posted on Apr 6, 2021 in Uncategorized | 0 comments

Those moments when we first meet a patient, give them important news and send them home are times that can create the most meaning for us.  For our patients, they build trust and provide a sense of groundedness and hope.

The doctor patient relationship is scared; let’s approach these important moments with the patient with the appropriate respect.

These moments are important for the institution.  Our patients’ thoughts about our encounters with them are the outward face of our institution.  It effects our reputation and our bottom line. 

Here is what our patients will be asked:

During your hospital stay, how often did your doctor:

  1. Treat with courtesy and respect?
  2. Listen carefully to you?
  3. Explain things in a way you could understand?

Patient encounters that reinforce our sense of purpose and help our patients answer those questions with an enthusiastic “always” don’t have to take longer.  It only takes presence of mind and an open heart!  And remember this is a practice we can all continually work on to improve upon

  • The ABSMC Patient Experience Team –

At ABSMC We Live a Life of Purpose!

Posted on Apr 6, 2021 in Wellness Committee | 0 comments

Walking toward our Covid unit at 7:30 on a Saturday morning, I passed a very ill patient being urgently transported on a gurney.  With an RT bagging and couple of all PPE’d-up nurses   pushing, this frantic caravan moved the patient towards the ICU.  When I arrived at the nursing stations a moment later, the team there had just figured out the staffing for the day. “Linda and Marina, thanks so much for staying over and working a double” called out Tola the charge, “And Claire, thanks for staying over to help with that Rapid Response call.” Even the nurses who just arrived already look tired with their glasses steamed up and their shoulders hanging low.

They turned and got to work as I stood still taking it in. These exhausted nurses were getting at it because there was work to be done.

“I wish you all could see it with my eyes.” I said, “You are all amazing and you might not even realize it.  Well, I have to tell you.  Our community thanks you.  The medical Staff thanks you.  Your nursing colleagues thank you.”

“As thanks, let me offer you this.  Something so obvious we tend to forget it around here.  You live a life of purpose! You believe in taking care of the elderly, the sick, the disenfranchised.  You believe that people take care of people, because that is what human beings do, because that is how we build a just and beautiful society. You sweat and hustle and breathe all day through N-95s because that is what a nurse has to do to serve in the pandemic. Looks like we need better staffing and you could all probably use a cup of coffee, but I offer you this because you should have great pride in what you do!  Tell your friends and family that you live a life of purpose.”

A little embarrassed by my preachiness, I then shut up. But I felt compelled to tell them. It is true and it is something we all need to hold in mind as we grind through this awful pandemic. I tried to slink away but the team was energized now. “You are right; we don’t think about it and people don’t often remind us of it either. Thank you so much!”  Phones came out and we did socially distanced selfies.

I had been feeling crispy myself the week before when I got a text from my friend Ray. Ray is a wonderful human being and a person whose life is inseparable from his faith.   Every couple of weeks, I get a text from him.  On that morning the text said, “Have a great day on purpose!”  I had heard that playful pun-like phrase before, but going to work, to work caring for some of the sickest and most vulnerable people in the east bay, it didn’t feel trite that morning; it felt profound.   My purpose was my path to make a potentially tough day a work into a “great day”.

That night, I started doing a little reading about purpose and got even more fired up!  Dacher Keltner who co-teaches UC Berkeley’s class on happiness says, “a sense of purpose is possibly the best predicter of a life well lived.”  Developing a sense of purpose is one of the keys to happiness.  Nothing predicts performance and satisfaction at work as much as having a sense of purpose.  An entire industry has developed to help people find a sense of purpose at work. Why had I lost sight of this sense of purpose in my work?

Turns out that perhaps I had started to fall into common trap. I started to equate wellbeing with thoughts about one’s self. While working on ourselves is necessary, it could be a life time before I get myself “dialed” just right. It seems those community focused, hardworking ideals that got me into medicine in the first place, ideals that seem naïve at times now, are fact right.  Our years of study and training to earn the right to care for the most vulnerable in our community is something to be very proud of and should be a driver of our wellbeing.

Purpose is energizing and motivating.  Purpose won’t empty your inbox or get the OR to run on time, but it can put gas in our tanks, and we all need that from time to time.

Perhaps the purpose in our work is so omnipresent we lose touch of it.  Perhaps it is the relentless emotional content of the work or the irritating administrative tasks that blind us to it as well. Perhaps there is an important sense of humility, too.

Yet we can hold these notions in our minds and hearts at the same time: Ours is a life of service and purpose.  We accept the responsibility with humility and a tender heart. As an institution we should have a sense of full-chested pride.  And with each other, we should remind each other of our purpose.  When we have those late-night phone calls, those tough conversations with patients and those grueling days we need that pride in our purpose to turn our sacrifices into a great day.  Thank you for living a life of purpose and all you do to serve our community!

Leif R. Hass, MD
Summit Wellness Chair

Sutter Community Connect

Posted on Apr 6, 2021 in Uncategorized | 0 comments

New Physicians Memo

Posted on Apr 6, 2021 in New Physicians | 0 comments

President’s Message

Posted on Mar 2, 2021 in President's Message | 0 comments

My ears perked up when I heard a code being called overhead in the ED. As I rushed to the nurse’s station, I was informed that a man was being wheeled back from the waiting room. “GSW” – gunshot wound for the uninitiated, was all that needed to be said. As the middle aged Asian male was rushed to a resuscitation bay on a stretcher, I could see that he was unresponsive and had an obvious penetrating wound to the head. I concentrated on the task at hand, performed my ABC’s of trauma resuscitation and stabilized him as best I could, so that he could be transferred subsequently to Highland Hospital for further treatment. During the resuscitation, I noticed his son, arms crossed, looking scared and worried.

“What happened?” I asked. He was a store owner and had stepped outside of his store, only to be senselessly shot.  My hopes for his survival given the grave nature of his injury were quite dim. It seems that minding one’s own business is one of the most dangerous things you can do these days.

I thought about this a lot later, and I was struck with a sense of anger and injustice. Since the start of the pandemic, there has been a dramatic rise in anti-Asian anger and violence, oftentimes to the most vulnerable – i.e. elderly. One only need to look at the shocking videos and reports that have surfaced as of late on traditional and social media to see what is going on. Whether this is fueled by simmering racist perceptions of the Asian community that truthfully, have always persisted in America, or the callous words and shaming by the past administration to characterize this pandemic as the “kung flu” and “China virus”, or by misplaced frustrations that make the Asian community a convenient target, I don’t know. Perhaps all of the above?  In times of crisis, we are always looking for someone to blame, and the “other”-ing of different racial and ethnic groups rationalizes the hate as justified.

The Bay Area, which has always prided itself on its inclusivity and diversity, has nonetheless had a dark history as it pertains to the Chinese American community. Thousands came as cheap labor to complete the transcontinental railroad, but were subsequently denied the opportunity to build their future in what they had then perceived as their new home, with the passage of the Chinese Exclusion Act of 1882. This forbade Chinese immigrants from settling in this country. It was only through the eventual repeal of this act in 1943 by the Magnuson Act, which allowed a paltry 105 Chinese immigrants per year, and then the subsequent abolishment of the National Origins Formula in 1965, that my family and I were allowed to immigrate here from Taiwan in 1978.

We have seen nationally that anti-Asian hate crimes are on the rise – up 150 percent nationwide. In the Bay Area, 708 events have been reported since the pandemic started. Asians have been typically reticent to report, so this is likely an underestimate. I myself have not been immune to racial aspersions during the pandemic, even behind my white coat, mask and protective eyewear. Thankfully, none have escalated to violence.

A considerable number of Asian American physicians are part of this medical staff, and it is time that we acknowledge what is occurring within our local community and support them, and to help dispel the myths not just where we practice, but where we live and interact.   As I have previously highlighted the unjust and disproportionate impact that COVID has had (and continues to have) on our black and brown communities, so to do I ask that we all take some time to understand the impact it has had on the Asian community.

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus

Patient Experience at ABSMC

Posted on Mar 2, 2021 in Announcements | 0 comments

Patient Experience at ABSMC

Gaunt and disheveled, Ms. R looked emotionally and physically exhausted.  She had been somehow managing to live in her car with severe lupus arthritis. Then she developed a high fever and could not get her wheelchair in and out of the vehicle so she drove herself to the ED. I saw her the next morning.  Sitting at the bedside, I said, “Ms. R, you must have been really suffering these last few days and frightened, too.”  Then taking her hands I said, “You can take a deep breath and relax now.  You are in the caring hands of the beautiful people at Alta Bates Summit.  We will care for you like family: we will clean you, comfort you and provide expert medical care – all with a whole lotta Love!  You can rest easy now; my friend, you are in good hands.”

“God bless you, doctor!” she said with tears rolling down her face.  My eyes were damp and my body almost pulsed with meaning as I left the room.  Trying to see the world from her perspective, I felt I had started to meet her needs.  Judging, by the way I felt, I must have done something good for me as well.

It is a little different for each of us, but we know it when great patient experience happens.  It is the goal of the ABSMC MD Communication Task Force to help us have more of these moments.

This is the first of the ABSMC newsletter posts from the Patient Experience – MD Communication Task Force. We are reaching out to the medical staff because patient experience is important for some many reasons:

  • A good experience promotes healing and adherence
  • Our patients stories are the best way to spread the word about the good work we do
  • Patient Experience data can affect the medical center’s bottom line in several ways
  • Connecting with patients deeply and witnessing their great experiences with the our processes and our staff are crucial for our own wellbeing

In the coming months we will share our data on patient experience and offer tips for you to improve your wellbeing, while also improving the patient’s wellbeing.  We look forward to sharing this with you and inspiring your engagement in the process.

Thanks and look forward to sharing more soon!

Leif Hass, Ursi Boynton and ABSMC Patient Experience MD Communication Task Force

Single-dose Radiation Therapy for Breast Cancer removes treatment barriers for underserved Black Women

Posted on Mar 2, 2021 in Uncategorized | 0 comments

March is Women’s History Month and February was Black History Month.  Single-dose radiation therapy for early stage breast cancer removes treatment barriers for underserved black women.  Black women experience longer breast cancer treatment times and may have less access to essential radiation technology, according to a recent study published in the journal Cancer on 11/15/2020.  The wider adoption of TARGIT-IORT (Intra Operative Radiation Therapy) addresses racial disparities and reduces compliance issues.  ABSMC has one of the leading IORT programs in the USA and has published.

The traditional approach to treating stage one or two breast cancer is tumor removal surgery followed by three to six weeks of daily External Beam Radiation Therapy (EBRT). Missing multiple daily treatments, having an unplanned break in treatment, or not completing the treatment course can result in a higher incidence of breast cancer recurrence and decreased long-term survival.

Transportation challenges, lack of childcare assistance, and inability to take time off work to attend radiotherapy appointments are just some of the obstacles noted across several underserved patient groups, including black women.  The arduous EBRT model is no longer necessary for many early-stage breast cancer cases. By not offering more tenable options, women risk falling through the cracks due to poor compliance. Targeted intraoperative radiotherapy can remove many of these barriers.  It provides women with the ability to complete all their necessary treatment with less interruption to their daily schedules.

TARGIT Intraoperative Radiation Therapy (TARGIT-IORT) is a single dose of targeted radiation delivered from inside the breast during surgery immediately following the removal of the tumor while the patient remains asleep. The 20-year TARGIT-A international clinical trial compared TARGIT-IORT to EBRT, and long-term data consistently demonstrated no difference in local and distant breast cancer control, breast preservation or breast cancer mortality.

The Cancer study, which assessed nearly 3,000 women enrolled in the Carolina Breast Cancer Study Phase III, found that nearly one third of all Black women have a “prolonged treatment duration” (>56 days) for EBRT, while just over a fifth of White women were in that same group. These findings are consistent with several other studies, which show that compared to white women, black women are diagnosed with breast cancer at a lower rate and at more advanced stages; receive post-surgical radiation therapy less frequently; report greater breast cancer-related financial impact; and suffer higher overall mortality.

Targeted intraoperative radiation eliminates the no-win scenario of a patient choosing between going to work and going to treatment; deciding between childcare and cancer care; or opting for mastectomy over saving her breast.  Single-dose treatment can ensure that a woman, regardless of her racial background, experiences less interruption to her daily schedule and gets back to her work and to her family sooner.

The Cancer study also looked at women across different socioeconomic strata and found that lower-income patients encountered more barriers to completing post-surgical EBRT in the time prescribed than women of higher incomes. However, within both of those income groups, black women still experienced longer treatment durations than white women.

ABSMC has been offering Intra Operative Radiation Therapy (IORT) for early stage breast cancer since 2011.  We have treated >400 patients with excellent results. 

Women with early breast cancer were eligible if they were:

1)  aged 45 years or older, 
2)  had a diagnosis of a unifocal invasive ductal carcinoma, and 
3)  suitable for wide local excision with a cancer that was ≤3.5 cm in size on imaging. 

With long term follow-up, no statistically significant difference was found between immediate TARGIT-IORT and EBRT for the following outcomes: 

local recurrence-free survival (P=0.28), 
invasive local recurrence-free survival (P=0.70), 
mastectomy-free survival (P=0.74), 
distant disease free survival (P=0.30), 
overall survival (P=0.13), and 
breast cancer mortality (P=0.54). 

Mortality from other causes was significantly LOWER (P=0.005) in the TARGIT-IORT arm.

Benefits of TARGIT-IORT during lumpectomy for early stage invasive ductal breast cancer:

less travel, thus less cost,
less pain, 
better quality of life, 
cosmetically superior
fewer non-breast cancer deaths
less risky during the CV pandemic since most patients do not need to come in every day for weeks for external radiation

and IORT bridges the health care disparity gap for women of color.

TARGIT-IORT should be offered when planning breast cancer surgery, especially in these CV-19 pandemic times.  The patient gets all her radiation during her lumpectomy with less risk.

To learn more about this treatment and the TARGIT-A trial, please visit the consumer education website www.targetbreastcancer.org.

Respectfully,

Valery Uhl, MD
Radiation Oncology, IORT Specialist at ABSMC
President, TARGIT Collaborative Group (TCG)
Cell/Text (510) 421-7808

Raising Stroke Awareness during Black History Month

Posted on Mar 2, 2021 in Uncategorized | 0 comments

https://newsplus.sutterhealth.org/blog/2021/02/19/raising-stroke-awareness-during-black-history-month/