President’s Message

President’s Message

Posted on Oct 1, 2021 in President's Message | 0 comments

First of all, I want to say thank you. The past few months have been pretty rough, with short staffing at ABSMC coinciding with the recent surge in COVID cases. Thanks for complying with the California healthcare worker vaccine mandate: to keep ourselves, our families, and our patients safe. And lastly, thanks for participating in the most recent physician engagement survey. Your responses are critical to making a better working environment at Summit.

A bit of good news: COVID cases across the system are finally on the decline. The graph below illustrates the daily case count over time within the Sutter geographic footprint.

Flu cases during the pandemic have been thankfully sparse, but as we are approaching the winter months, it is vital that we also get vaccinated for influenza to help avoid a twindemic of COVID and flu. Below is the schedule for the flu/TB clinics for the East Bay.

The CDC is currently also recommending a COVID booster (for those who received the Pfizer series) for age greater than 65 and those who work or live in high risk settings. That would include most of us, but it has not yet been yet determined that a booster is necessary for those that received the Moderna or J&J vaccine.  The news came unfortunately a bit late to incorporate Pfizer boosters to the flu/TB clinic schedule, so I encourage you to get your shot through your primary physician or your local pharmacy, or through https://myturn.ca.gov/

We continue to highlight the importance of wellness and mental health during these difficult times. Please see below for a list of resources.

EPIC refuel is coming soon – November 6. This is a major revision to EPIC that will bring the EHR more to a native state and make future upgrades less time consuming.

The Best of Epic:

Upgrades and Enhancements coming November 6th!

Secure Chat: fully integrated text messaging

  • Securely share patient information and images
  • Expanded to ALL Epic users on the desktop
  • Bonus: Physicians and Advanced Practice Clinicians can also use their mobile devices!
  • Facilitate team communications

Care Everywhere Image Exchange

  • Send and receive images with other Epic health systems
  • Phase 1: Outgoing images include clinical photographs, consents, POLST forms, and other items in the media tab
  • Incoming images include all of the above PLUS reference quality radiographs and ECG’s from other organizations that choose to send them

Efficiency and Usability Tools Including…

  • Personalization: Customizable SmartSets, Consolidated My Tools menu, modifiable Chart Review reports and Navigators
  • Efficiency: Improved patient search across the system, exempting orders from reconciliation, note template speed buttons, enhanced pre-charting
  • Enhanced Communications management function

As we approach the release date we will send out additional details about the new tools, but wanted to give you a sneak peek at what’s coming

Lastly, I wanted to share a letter from Barbara Kivowitz, a patient family advisor. Her words and thoughts capture a lot of the emotions we have been feeling recently.

President’s Message

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

I felt a pit in my stomach that weighed a ton. I had just gotten out of a code, a cardiac arrest that had sadly not survived. He was a relatively young man, and had a sudden and dramatic collapse, with not too many comorbidities. In short, his demise was quite unexpected. We had done everything possible, but that day was just not meant to be.

A short while later, my charge nurse notified me that his family had arrived and were waiting to hear news. Of course, I was encumbered, mired in the details of my other patients, but I knew that talking to the family was going to be the most important thing I did that day.

I had Stevie, the chaplain, as backup for some emotional support – not just for the family, but for me as well. When delivering bad news, you can never know how a family will react. Most of the time, it’s just sadness, but sometimes, it’s anger that can be misdirected at physicians and nurses.

As I walked toward a private room where the family was waiting, my brain had to switch gears. While working, I tend to be pretty analytic, almost a bit too calculating and cold in allowing logic to dominate my decision making. Though cognitive neuroscientists have dispelled the myth of a strict right/left brain divide, there are some useful distinctions between the two halves that interact. Take for example Broca’s area, the portion on the parietal lobe that encodes speech/language: the left side typically analyzes the content of the language, while the right side interprets the prosody and emotional content of speech.

I sat down with the deceased patient’s wife and his brother. Behind masks, our eyes met, and I could see that she was still hopeful. As I delivered the bad news, I could tell that she needed to hold my hand. She grasped very tightly on my every word. And as I tried to be analytical, I knew that that was not what she needed. She needed more, that human connection of grief. I hugged her as she sobbed. She thanked me for all I had done.

When I left that room, the pit I had in my stomach was gone. Perhaps it was a sense of relief on my part that the ominous task was complete, but I think that it was actually that I was able to help a family get some closure.

These are the challenges we face everyday, as we get lost in the minutiae of medical data. Our patients expect a translation of data into something more relatable, more personal. This is not only in times of bad news, but with equivocal and good news as well.  

On the business side of things, I hope you all have read the emails from the system, the medical staff, and our chief medical executive, Dr. Boynton.

Below is additional information to help us be compliant with the public health order recently instituted.

Vaccinated (at a Sutter hospital Dec 2020 – Mar 2021)

We should have your vaccination records. No further action is required.

Vaccinated (not at a Sutter hospital via myEHS)

If you are already fully vaccinated but did so in an outpatient setting or a non-Sutter hospital you should have received an email requesting you to submit your information. If you have not already done so, please use the following link to provide your vaccination information:  http://covid19.sutterhealth.org/VaccinationProof/external

Not vaccinated

If you are not yet vaccinated, then by Sept 30, 2021 you will need to submit either/or:

  1. Valid proof of vaccination: http://covid19.sutterhealth.org/VaccinationProof/external
  2. Valid religious or medical exemption via the following links:

http://covid19.sutterhealth.org/ReligiousExemption/external

http://covid19.sutterhealth.org/MedicalExemption/external

In addition, you will need to provide negative test results semi-weekly starting August 23, 2021 in order to continue treating patients in the hospital setting. Please use this link to submit your test results: http://covid19testresult.sutterhealth.org/external

  • Recommendations on testing frequency and timing can be found in CDPH guidance for acute care hospitals and all other clinical environments.
  • Clinicians do not need to submit proof of their test results. The state only requires they report the result of the test. However, it is recommended they retain proof of each test.

If you plan to be fully vaccinated, you will be exempt from the bi-weekly testing requirement two weeks after receiving either a single-dose COVID vaccine or the second dose of a two-dose vaccine and no further action will be required.

Please contact Leanna Hudson (Manager, ABSMC Medical Staff Services) if you have any questions or need assistance with your submission.

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

President’s Message

Posted on Aug 5, 2021 in President's Message | 0 comments

I was enjoying a blissfully peaceful day at the San Diego Zoo with the family. The sun was out, there was a nice breeze, and I had no mask on. Sure, we were outdoors, and the CDC had relaxed mask recommendations for the vaccinated indoors. But this was still a new thing to me, to be in public without a mask on. In fact, this was the first time that I had strayed from the Bay Area since the start of the pandemic, and it was liberating.  Vaccination rates in the state, while not approaching the magic 70-75% hurdle, were quite good in most counties. Overall disease incidence was still quite low.

Abroad however, reports came from Indonesia of a massive surge. Israel was reporting breakthrough infections among the vaccinated. The UK was in the midst of another wave.  News of the highly infectious delta variant became widespread, and I was cautiously hopeful that we would be able to resist this locally.  But as a global pandemic is indeed global, so were we to soon feel its effects.

Upon my return to work, I came to know that we were not going to be spared the latest COVID surge. CDC reports indicated that the delta variant, a more highly infectious strain, and one that seemingly caused more severe disease, was responsible for 80% of new infections in the US. We were once again wearing full PPE, N95’s and eye protection all day, PAPR’s were whirring constantly, and the arsenal of weapons we had to combat the virus were once again deployed. Moreover, as more data came out, we learned that even the fully vaccinated were not exempt from falling ill, though the severity of disease was lessened, the risk of hospitalization and death was substantially mitigated.

In some ways, we are better prepared for this. We know much more about COVID than at the outset, and we have better data on the efficacy of treatment regimens. Dexamethasone, remdesivir, casirivimab/imdevimab, tocilizumab, baricitinib: These tongue twisting names had become part of our daily lexicon and were dutifully employed on the sickest of patients.  But to hear a patient asking for the vaccine when they have already contracted the disease and to have to respond with “we can’t give it to you now, but when (or if) you get better, you should get it in a few months,” – is heart-rending.

In some ways, we are in a worse state. Our hospital is struggling financially, morale is low, there are constant staffing shortages (the causes of which are multifactorial) and patient volume is high. Most recently we are hearing about nationwide shortages of tocilizumab and baricitinib.

I am so thankful of the time that I had to see my dad in San Diego and have some (mostly) carefree moments, but I realize that now is not the time to let our guard down, for the enemy at the gates has returned with increased vigor and strength.

We will get through this, and the vigilance at work has to be met with equal seriousness outside of work. We know that even while fully immunized, we can be infected and transmit disease to others.  There are still vulnerable populations that either have not been vaccinated or cannot receive the vaccine. My kids, about to start school in person in two weeks, are not eligible for the vaccine yet.  So we are not out of the woods yet. Please, mask up when indoors and around large groups of others outdoors.

I can understand the frustration of taking care of patients who have not been vaccinated, but we have the golden opportunity to make a difference. Your patients trust your medical advice, and they are far more likely to be influenced by your counsel than a celebrity or a PSA. Take the time to understand the barriers and the causes of reluctance and address those with an open mind. Vaccination is not the only path forward, but the alternative is going to result in far more deaths, and far more difficult end of life decisions.

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

President’s Message

Posted on Jul 1, 2021 in President's Message | 0 comments

There is a phenomenon well described in the social science literature called the “U-curve.” It illustrates the nadir of job satisfaction that occurs in one’s mid career, say in one’s 40s-50’s. To the layman, it is the proverbial mid-life crisis. Previously, it was though that one’s happiness and wellbeing was generally on a downward slope as age progresses, all things being equal. However, that appears not to be the case. Data sets of approximately 500,000 individuals in the U.S. and Europe clearly identify a low point in self and job satisfaction in one’s 40’s, with a constant and steady rise thereafter.

Coincidentally, I find myself in just such an age bracket at the midpoint of my career. My early years as a physician were filled with fears of ineptitude, fears of making mistakes, but curiously tinged with the optimism that anything was possible.  As I aged, my skills and knowledge progressed, but they were countered by accumulated disappointments and regret. As such, I found myself in the inevitable burnout. I’ll admit that on the physician satisfaction surveys over the past few years, I have responded affirmatively to the burnout questions. How much of this was due to the actual work though, or was it part of a greater social experience?

As it turns out, I am not alone. This experience has been replicated across all income levels and career types in over 50 developed countries (notable differences exist in developing countries, though the exact reasons are not entirely clear). Just by being “successful” does not ward off this particular phenomenon. Whether you’re the CEO or you’re housekeeping, you are susceptible.

So what can we do about it? The first is to acknowledge and normalize it. The second is to focus on the things that we have control over, namely the personal relationships we have around us. The third is to express gratitude – to yourself and others, every day. Lastly, stop comparing yourself to others. Fear of missing out is a powerful fear, but it tends to highlight differences and magnify discontent.

As physicians and allied health professionals, we have taken a long road to get where we are. It is not an easy journey, and to get to this point requires an unusual combination of perseverance, intellect, and character. This is not to say that we are better than those in other professions, but just that we should recognize all the hard work and accomplishment that has gotten us this far. Pat yourself on the back. And it’s ok to feel burned out or dissatisfied. It will get better.

https://hbr.org/2015/04/why-so-many-of-us-experience-a-midlife-crisis

https://www.theatlantic.com/magazine/archive/2014/12/the-real-roots-of-midlife-crisis/382235/

https://www.inc.com/jeff-haden/scientists-just-discovered-mid-life-crisis-peaks-at-age-47-heres-how-to-minimize-effect-of-happiness-curve.html

Jeff Chen MD, MPH, FACEP
Chief of Staff, ABSMC Summit Campus
chenje@sutterhealth.org
jchen@bayem.org

President’s Message

Posted on Jun 1, 2021 in President's Message | 0 comments

Last month was AAPI heritage month, and I had the opportunity to participate on a systemwide forum, sponsored by the Sutter Multicultural inclusion and Diversity Group, as a panelist to discuss the experience of Asians in today’s troubling climate of rising hate crimes and violence. It was widely well received, and a similar forum was replicated locally, sponsored by the ABSMC Diversity and Inclusion Council. I appreciate all who were able to attend. Some tough questions were asked and not easily answered, but a dialogue was started, and there is intrinsic value to that. I will try to keep you updated on future forums regarding diversity and inclusion.

Here is the link to the recorded event, but it does need to be opened within the Sutter network due to privacy concerns.

https://bcove.video/3uuki71

On the COVID front, things are feeling eerily more normal. We are testing less thanks to less symptomatic patients, and given the vaccination rate, we have been able to avoid unnecessary screening tests on admission or pre-operatively. We even have hit a new low of cases in the hospital since the beginning of the pandemic! Thanks to Dr. Boynton for her regular updates.

I have been thankful to be able ride my bike outdoors and not wear a mask! I anticipate however that we will be wearing masks in the hospital for the foreseeable future.

We soon may be able to have indoor meetings, but we are waiting on SHEMS guidance based on local health department and CDC guidelines.

In Alameda County, nearly 64% of eligible residents have received at least one dose of vaccine!

This is taken from the CA COVID 19 page.

More information is available from:

https://covid19.ca.gov/vaccination-progress-data/

You can look up vaccination rates by zip code on this website as well.

California is projected to open up on June 15, with restrictions lifted on most indoor gatherings aside from mega-events.

If you’re vaccinated, you will be eligible for the Vaccine Lottery – 10 winners of $1.5 million, 30 winners of $50,000!

Vaccine hesitancy however is still real within certain communities and people of color. Please take the time to ask your patients if they have been vaccinated, and if not, what barriers exist to their receiving the vaccine.

Lastly, please update your Sutter Profile.

As a member of the medical staff, you should have a Sutter online MD profile. Some of you might not. Some of yours might be out of date. In 2020, physician profiles on sutterhealth.org were viewed > 17 million times. Please take a moment to review and update your profile with a current photo and campus information to make sure any info being posted is accurate. Thanks.

Step 1: Review your profile =  https://www.sutterhealth.org/find-doctor

Step 2: Update your profile = https://feedback.sutterhealth.org/f/141134/2f80/. Complete sections. Scroll to the bottom and hit “submit”

Once you submit this form, they will update it within 1-2 weeks. If you have any questions or need assistance with your online profile, please email physicianprofile@sutterhealth.org.

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

President’s Message

Posted on May 3, 2021 in President's Message | 0 comments

In the canopied forests of the Democratic Republic of Congo lives a rather unusual species of primate, the bonobos. Though by outward appearance resembling chimpanzees, albeit slightly smaller, the bonobo is a distinctly different species.  What is curious about them is not so much their physiology or genetics – they share almost 99% of the human genome – but rather in their social structure, and how they might serve to reflect the more enlightened aspects of human society.

Bonobos are unique in that their society is primarily matriarchal; a female is universally the leader of the group. As a result, infanticide is unheard of, and warring with rival groups similarly rare. And perhaps more importantly, bonobos are renown for being willing to share scarce resources such as food, and even more willing to be gracious to strangers than those within their immediate family. Chimpanzees on the other hand live in a male dominated society, are beset by frequent warring between clans, and when individual chimpanzees are presented with a scarce resource, they will usually keep it to themselves.

This translates into communication skills as well. Bonobos typically resolve conflict through mediation, and often sexual behaviors, while chimpanzees resort to physical fighting. As a result, bonobos are quite good at reading social cues. In an experiment in which a tasty treat was hidden underneath one of several cups, chimpanzees consistently chose at random which cup may be hiding the treat, while bonobos looked at the human to see if there were visual or gestural cues that would hint at the true location of the treat.

How does this relate to us, and specifically in medicine?

On the best days, we are bonobos. We cooperate towards a common goal. We are nice to strangers and can display both empathy and sympathy. When we are faced with conflict, we try to resolve issues without anger and physical confrontation. We can display incredible acts of heroism in kindness. As Michael Jackson so eloquently expressed to Paul McCartney in “The Girl is Mine” – “Paul, I think I told you, I’m a lover, not a fighter.”

Margaret Chiu, the leader of the ABSMC Gender Equity Taskforce, has the following thoughts:

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, the 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. 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. 

Next week is Nurses Week, May 6-May 12.

Here is an opportunity to show your nurses appreciation through a focused recognition app!

For iOS users:
https://apps.apple.com/us/app/sutter-focused-recognition/id1489387015?form=MY01SV&OCID=MY01SV

For Android users:
https://play.google.com/store/apps/details?id=org.sutterhealth.recognition

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