President’s Message

Posted on May 1, 2020 in President's Message | 0 comments

It looks like the curve has flattened in the Bay Area. Our worst fears that our emergency departments and ICU’s were going to be swamped, thankfully, did not come to pass.

So what now?

As we begin the process of trying to figure out how to open up again, as a state, as well as a hospital, we are left facing new challenges. It is clear that our hospital volumes have diminished substantially during the last few months, but it is equally unclear whether or how we can regain the volume loss. The effects of this pandemic and the associated economic toll are just beginning. Many of our outpatient based practices have seen a significant decline in visits, and only some larger practices have instituted telehealth capabilities. Some of us have had to make difficult decisions to furlough non-essential staff.

As much as we as healthcare providers have worried about how we can safely provide care to our patients, both COVID and non-COVID, our patients have felt that same concern.

This story in the SF chronicle, which features interviews from Dr. Junaid Khan and Dr. Ronn Berrol, summarizes the fears of our patients accessing our medical systems and hospitals.

https://www.sfchronicle.com/bayarea/article/A-shelter-in-place-side-effect-Bay-Area-people-15219842.php#photo-19328615

We are carefully planning how we can address the non-COVID health care needs of our patients, as established disease processes are agnostic to this new kid on the block. It is vital that we do this, not only to adequately safeguard our community, but to maintain financial viability of the hospital. For this, we are asking for your help. Please circulate the below information to your patients and to your staff.

How We’re Managing Non-COVID-19 Care

At Sutter, your health is our main priority. We understand you might have concerns about going to an emergency room or to see your doctor if you don’t have COVID-19 (coronavirus) symptoms. That’s why we want to let you know that if you need any type of care, we’re here for you.

If you have a medical problem, please contact your doctor.
We may be able to schedule a video visit, or you may need to come in to be seen by your provider. If you visit a care center, be reassured that we’re actively isolating anyone with COVID-19 symptoms. All patients are screened before entering the building. It’s important not to delay seeking treatment when you need it.

Our emergency and urgent care facilities are open and ready to provide care.
We’ve taken several steps to make sure you’re safe when you come to our doctors’ offices, emergency departments and urgent care facilities:

  1. Mandatory Masking – All patients and visitors must be masked while in any of our care sites, with specific exceptions.
  2. Isolation – Anyone with COVID-19 symptoms is isolated from waiting areas, patient rooms, entrances and any space that the general population uses.
  3. Cleaning – Our teams are performing extra cleaning and disinfecting in all spaces.
  4. Employee Screening – We’ve instituted mandatory employee temperature screenings before each shift.

You can find out more about the steps we’ve taken to prepare for COVID-19 and answers to frequently asked questions on our website.

If you or someone you know is experiencing an emergency such as a heart attack or stroke, it’s essential to seek care immediately by calling 911 or going to the nearest emergency room.

Thank you for trusting us with your care, and for the support and gratitude you’ve shared for our clinicians on the front lines. Together, we’re #SutterStrong.

SEND TO A FRIEND

I want to thank you all for your resilience. The medicine that we practice now is drastically different than three months ago, and it is incumbent upon us to determine how, as a medical staff, we can envision the shape and direction of healthcare going forward at ABSMC. I am continually impressed with the level of engagement and volunteerism that our medical staff has demonstrated during this crisis.

We rely on our hospital administrative partners: Ursi Boynton, CME, Denise Navelier, CNE, Patty Pilgrim, CFO, to channel that vision, and I want to thank them for the incredible work that they have done to get our hospital ready, to train staff, to procure critical PPE. We welcome David Clark, our new CEO, who has done an amazing job in the last year as our interim CEO, as he helps to lead ABSMC in the challenging times ahead.

Sutter Community Connect

Posted on May 1, 2020 in Announcements | 0 comments

How Can We Live and Practice and this New (Awful) Normal? With Attention to Connection!

Posted on May 1, 2020 in Wellness Committee | 0 comments

Well, I think we have all had that huge sigh of relief that Summit didn’t turn into Brooklyn’s Elmhurst Hospital west, but now here we are with this new awful normal: masks, gloves, social distancing, fewer patients and still plenty of COVID -induced anxiety to go around.

We may not be acutely afraid that we are going to die, but prolonged low (medium?) level stress is toxic.  What is not immediately apparent is that we are not just stressed, but we are losing much of what fuel so and builds resilience at work.  We can’t touch or even get near our great teammates.  We can’t see each other’s face.  Much of what keeps us going happens at an unconscious level: we see a smile we smile, we reach out and grab a patient’s hand and we feel our compassion flow. There is a virtuous cycle, a positive feedback loop where our sensations and proc-social emotions activate and amplify themselves.  The masks, the gloves, the distance, the anxiety all interfere with these and leave our work feeling just not the same.

To prevent the worry about infection, the financial stress, the frustration about political leadership from taking us on a downward spiral, we need to jumpstart positive spirals.  Since much of the external stimuli is missing we need to consciously think about using what we do have – and maybe even in a little exaggerated way.  We need to use:

  • Touch (with gloves, as we can) to convey connection
  • Body language that adds emphasis to our message and our
    emotions that may go above and beyond what we are used to
  • Tone of voice that enhances our words
  • Talk that emphasizes the big stuff, such as love, fear, connection and community when we talk to each other and our patients.


A poorly appreciated silver lining of disasters is that is frees us from our private never-ending stressors and give us a common goal that is only met through acting together.  We have a great culture here at Summit.  If we pay attention to what connects us to our patients and each other, we can come out of this craziness with a stronger more resilient medical center.

Lief Hass, MD – Wellness Committee Chair

A shelter-in-place side effect: Bay Area people are afraid to go to the hospital

Posted on May 1, 2020 in Uncategorized | 0 comments

Hany Metwally sat at home for four days with chest pains, too tired to move from his easy chair. He already had a stent in his chest for a heart condition and knew he should see a doctor, but his fear of exposure to the coronavirus was greater than his fear of an oncoming heart attack. https://www.sfchronicle.com/bayarea/article/A-shelter-in-place-side-effect-Bay-Area-people-15219842.php#photo-19328615

ABSMC Ashby & Summit EPIC Support and On-Campus Hours

Posted on May 1, 2020 in Uncategorized | 0 comments

While the physician liaisons are continuing to work primarily remotely, we have scheduled office hours for any necessary in-person EPIC support or to assist providers enrolling applications on their cell phones. We have been asked not to go to critical care areas, but we are able to meet you in our offices, the doctor’s cafeteria, physician’s lounge, or other non-critical care areas.

For remote support, we have Skype and Bomgar software which enables us to connect to your computer, whether you are on campus, at your office, or at your home.

Patty Fitzgibbons, EHR Physician Liaison, Summit Campus
Phone: 510-325-9618, Fitzgip@Sutterhealth.org
Monday through Friday, 6:00 AM – 2:30 PM (variable based upon training schedules and meetings)
Onsite hours: Monday and Wednesday 10:00 AM – 2:00 PM

Shala Thomas, EHR Physician Liaison, Ashby and Herrick Campuses
Phone: 510-495-5254, ThomasS5@Sutterhealth.org
Monday through Friday 7:00 AM – 3:30 PM (variable based upon training schedules and meetings)
Onsite hours, Ashby: Thursday 10:00 AM – 2:00 PM
Onsite hours, Herrick: Tuesday 10:00 AM – 2:00 PM

Stay well.

Patty and Shala

Sudden Stroke Trend Seen In Younger COVID-19 Patients

Posted on May 1, 2020 in Uncategorized | 0 comments

https://kcbsradio.radio.com/articles/sudden-stroke-seen-in-younger-covid-19-patients

Doctors are noticing disturbing trends among some younger patients infected with the novel coronavirus, one if which is a sudden stroke.

“When this pandemic started, we noticed that there is an increased incidence of COVID-19 positive patients presenting with a stroke,” Thomas Jefferson University Hospital’s Dr. Pascal Jabbour said.

Dr. Jabbour told KCBS Radio that about 40% of stroke patients who came to the hospital for treatment between March 20 and April 10 had contracted the novel coronavirus.

What is even more concerning is the age range of some people with COVID-19 who have strokes.

“We’ve seen really young patients that usually don’t have strokes presenting with strokes,” Dr. Jabbour said. “Those patients are young with no risk factors.”

Dr. Jabbour has written a paper on the connection, currently under review.

Doctors are experimenting with various treatments, thinking of giving blood thinners to some COVID-19 patients as a preventative method.

Dr. Jabbour said doctors are also seeing some patients waiting to seek treatment for stroke symptoms, especially if they don’t know they have COVID-19 because they are afraid to go to the hospital right now. Other physicians are seeing the same trend, including Dr. Junaid Khan with Alta Bates Summit Medical Center in Oakland.

He said there has been a significant decrease in the number of patients with serious ailments who come into his ER for treatment.

“The patients that are coming are coming in later,” Dr. Khan said. “They have been ignoring their symptoms. And when we ask them why, they were really afraid of coming to the hospital because they were afraid they were going to get COVID-19.”

Dr. Khan added that hospitals are taking precautions to treat people who need to be seen safely.

“Everyone that comes into the hospital is provided a mask,” Dr. Khan said. “All the staff is wearing a mask. We have proper isolation techniques. So, if they’re having these symptoms of a stroke, time lost is brain lost.”

Both doctors said there is a very small window of time to treat strokes and anyone experiencing symptoms should seek treatment immediately.

New Physicians Memo

Posted on May 1, 2020 in Announcements | 0 comments

S U M M I T   M E D I C A L   S T A F F   O F F I C E

M E M O R A N D U M

DATE:           April 15, 2020

TO:                 Distribution List

FROM:           Leanna Hudson
Medical Staff Services

The following new physicians have been granted privileges. To review privilege list please go to the Intranet: Department/Medical Staff/ Summit/ Physician Privileges. Please contact the Medical Staff office if you have any question.

Sajoy P. Varghese, MD
Virtual Medical Staff LLC
2655 Northwinds Pkwy
Alpharetta, GA  30009-2280
(877) 732-7089
Psychiatry

President’s Message

Posted on Apr 2, 2020 in President's Message, Uncategorized | 0 comments

Dear Colleagues,

We are at the forefront of a monumental challenge in the fight against COVID-19. This global pandemic has ripped apart the norms by which we practice medicine, threatens to sicken us as we care for those affected, and will undoubtedly alter forever the nature of our social fabric.

It is with that understanding that I feel ever more committed to my community – my neighbors, my colleagues, and my patients. Every day I go to work, I reassure myself that my training and experience have prepared me for this. Our senior administrative leaders have been working tirelessly with our physicians to plan and execute a strategy for dealing with the pandemic. We are expanding our clinical footprint, re-purposing existing spaces, flexing staff to meet the demands.

Is it enough?

Reading and watching the news is profoundly sobering. New York has a growth and death curve for the disease that surpasses the tragedy occurring in Italy and Spain. Is California only a week or two behind? Did the shelter in place order enacted by our counties and our state do enough to “flatten the curve” locally?  There are more questions than answers.

Let me acknowledge all the fears and anxieties that you face, because I have them too. I worry about getting sick, and exposing my family to disease. I worry about my colleagues who are older and with medical conditions that put them at greater risk. These are my friends. My greatest comfort and expectation is knowing that in these extraordinary times, we physicians will act extraordinarily.  Already I have received pledges of support from physicians in the community, physicians returning to bolster the ranks, and offers from other specialties to fill in wherever they are needed.

 We must also be mindful to care for ourselves in all of this. Get some sleep. Go for a run. Read your kid a story. Catch up on Game of Thrones. Get in touch with friends through FaceTime. In such difficult times, it is often the little things that will get us by.

If those little things are not enough, our EAP for physicians is going live on April 1. This is a resource that can help you with free counseling, referrals for pet care/child care etc.

Call 800-477-2258 or email eap@sutterhealth.org

You can also reach out to peer support @ peeroutreachabsmc@gmail.com

Attached is also a list of resources from the Palo Alto Medical Foundation, some of them dealing specifically with coronavirus.

Well-Being Checklist

Posted on Apr 2, 2020 in Uncategorized, Wellness Committee | 0 comments

We are all struggling to deal with this unprecedented outbreak.  I wanted to share with you a Well-Being Checklist  I created with the guidance of colleagues at Berkeley’s Greater Good Science Center and a longer reflection on how we might deal with this stressful time.

1. When in doubt take few deep breaths and slow down
2. Appreciate our teamwork
3. Find beauty in those we care for
4. Let your compassion flow 
5. Look for the gifts that life offers
6. Take stock of the people in your life and check in on them often
7. Hug those you can
8. Get outside and smell the roses
9. Move your body and get some sleep

Stress, Anxiety and Well-Being in the Time of Covid-19

1. Let’s keep the existential threat in perspective.  Let’s go to the big question that crosses all of our minds.  Am I going to die? We are use to the idea of pathogens surrounding us, but this threat is on a different level and rising death tolls and worried families makes it feels a lot worse.  Doctors describe feeling “radioactive” and are making up their wills. It is important to look at the data and not the news stories of deaths without a denominator or circumstances of the infections (no PPE) . First of all, we are now taking universal precautions – all masks all the time now. If we take a high number of 10% healthcare worker infection rate ( it was much lower in Hong Kong without universal precautions) and a high death rate from infection of 5%, the chances of dying from COVID-19 is 1/200.  If the numbers are 5% infection rate and 2% mortality, the chances of dying from it is 1/1000.  If I got on the bus to Cache Creek knowing my chances of winning was 199/200, I would feel pretty good about it.  Something to keep in mind when your brain, like my mine, starts spinning out of control in moments of worry. 

1. Anxious, Stressed? Of course, we have good reason to be! Anxiety can have this negative connotation of repetitive thought patterns and wasted energy, but when we have to process an unprecedented event and ever-changing data, anxiety is an appropriate response.  There is a lot we need to learn and there is new information daily!  It takes time absorb it and then process it.  However, we can slip from productive processing to unproductive ruminating pretty easily. Self awareness can help us see the addictive nature of the computer and social media. When this happens, it is time to change the channel and utilize our social support systems to move our thoughts away from the news.  We also need think about mindfulness and other self-care tools.

3. The answer?  It starts with the breath.  The best way to quiet our minds through the breath. A single deep breath will decrease sympathetic tone.  And if you take a few, focusing on the breathing as you do so, you can begin to calm the mind as well as the body.  This is basis for most mindfulness practices.  Research has shown that those who do even brief but regular breathing meditation get back to a calmer nervous system faster after a stressor than those who don’t.  Part of this is just learning to pay attention to our bodies and thus notice and let go of the tensions that build up.  

It is inevitable while working these days to have a mind racing with ruminations about lack of PPE and insufficient testing and worries about what is next.  For me sometimes this happens to the point that I am not paying as much attention to what is actually happening right now, right in front of me.  And that is how errors with doffing and donning happen.  Even just a single deep breath helps! Practice makes it better; I have found that my 5 minutes of meditation most days – a  practice of being in the present moment – allows me, at least for a moment, to stop the fretting and see more clearly what I need to do right now. With a sense of calm, I then carry on. 

4. “Never waste a good crisis!” I am not sure who said this first, but crises can lead to change.  For many of us, well-being practices have gone from feeling like a luxury we don’t have time for to anecessity.  So take this opportunity to start a practice which will benefit you a lifetime.

For those interested in a breathing or meditation practice.The headspace meditation app https://www.headspace.com/ is free to physicians for the rest of the year.  I like  https://insighttimer.com/ and it is always free.

There are other easier well-being practices like gratitude, connecting with friends and looking for the wonder and beauty in our lives. There are many easy tools to develop these types of practices at the Greater Good Science In Action site https://ggia.berkeley.edu/.  

5. Gratitude in the time of COVID.

People who study gratitude talk about the idea of hedonic adaptation – you get use to stuff going well so you take it for granted.  Well, nothing like a pandemic to make you realize how good things have been. Now I am saying thank you to those who grow the food, make the toilet paper, pick up the trash and make it so the internet and lights go on every time I push the button.  I am sure we all are taking stock of the important relationships in our lives and in so doing, feeling gratitude for them as they grow.  And at work, we all appreciate the support we give one another and the incredible leadership we have.  So be sure to deliberately count your blessings everyday!  We do “three good things” at the dinner table to share good things that have happened.

6. “A Paradise Built in Hell”. 

In her fantastic book, San Francisco based writer Rebecca Solnit describes how disasters often allow people to be their best selves: to act with generosity, and selflessness, to make community, to find courage, and to act with purpose that can elude them in the day to day when we are lost in the routine and more focused on ourselves. If we take a break from the grim statistics on Twitter, we can find much of this inspiring behavior on social media:

Here is a card passed out to  help neighbors in need

Here, People singing with their neighbors in Spain:

Some of the love is directed toward healthcare providers like the people of Madrid cheering for healthcare workers:

The tension at work can make it hard to see, but we can see the heroic work of everyone at the med center – from the nurses who continue to provide the gentle loving touches our patients need, to EVS who is diligently killing the bad guys, to the leadership teams that has expanded the med center’s capacity and changed workflows practically overnight! 

7. The Science of Happiness: Concern for others ->Meaning ->  Purpose-> Service-> Happiness.  We all need time on the beach with a margarita (or a corona?!) in our hand, but the research compiled by my colleagues at the Greater Good at Berkeley come up with a  surprising at is in line with religious traditions: concern for others is the key to a meaningful life and a sense of overall happiness with one’s life.  The research suggests that finding meaning and acting with purpose are the keys to happiness. We intuitively know it having chosen this work, but we often fail to appreciate it. Now is time to take this in: We are dedicated to serving the most vulnerable members of our community.  We save lives everyday. 

Despite our concerns, we understand we are privileged to be part of the solution to this crisis. Taking care of our community is what we do.    We open our hearts to strangers and treat them like family. We live with purpose.  Keeping that in mind may be the best thing we can do for ourselves in the time of COVID. Now is a time to feel pride in our work and to live life with a real sense of meaning.  

If we take care of each other and learn to take better care of ourselves, we can will find deep satisfaction in our work and our lives even as we confront this pandemic. 

Happiness = love+ fun+meaning and purpose!

8.  Famous last words: Fear of things getting out of control has rightfully driving much of the anxiety.  Thankfully, the infection curve remains relatively flat and we have only a week until of social distancing should kick in. We appear to be ahead of the curve in terms of preparation in the East Bay.  We have learned from the mistakes of others and  we have had valuable time to prepare.  Everyone from the state, local government, big Sutter and especially our local leadership has done an amazing job. We need more PPE, clarification of new work-flows, more capacity, more vents, a palliative/ fever unit and guidelines for palliating those at extreme risk –  all of which are happening now.  With these steps in place, our great team of hospitalists will be safe along with the rest of the med center staff.  Importantly, our community will get the care it deserves, too. Of course, we are not there yet, but I think we can have a certain degree of confidence that we will be pretty well prepared when things inevitably heat up.  

Thanks for being great teammates and all you do for our community!
Leif Hass, MD

Sutter Health Community Connect

Posted on Apr 2, 2020 in Uncategorized | 0 comments