President’s Message

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

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

President’s Message

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

I hadn’t seen a doctor in years.

Some of it, probably most of it, was my fault of course. I had procrastinated and tried to reassure myself with thoughts that I was exercising pretty regularly, eating pretty well. Heck, probably too well. I thought, “I’m a doctor, I’ll know when there is something wrong.”

Then there was the pandemic and transition to virtual visits. The switching of primary care doctors due to changes in health insurance and contracted providers. My wife kept on pestering me, “When are you going to make a doctor’s appointment?” I relented, got onto MyHealthOnline (MHO), and made an appointment with my assigned PCP.

I was anxious the night before my appointment. What would be uncovered after several years of shameless neglect? I went into the clinic, breezed through the obligatory COVID screening, and was routed into the exam room. The medical assistant greeted me and promptly said, “We need to get your weight and height”. A sense of dread came over me as my pants had gotten quite a bit tighter around the waistline in the past year, and I reluctantly faced the music.

I was the heaviest I had ever been. Call it the COVID 20. My height had shrunk by half an inch. My blood pressure was high. The rest of the exam proceeded uneventfully, but then came the expected recommendations from my doctor regarding lifestyle modification. Easier said than done. Throughout the day, scattered blood test results filtered back through alerts on MHO. My vitamin D was low. My cholesterol was higher than I wanted it to be. My hemoglobin A1C was borderline. My uric acid was high.

Clearly, things had to change. Internally, I signed a commitment to change contract, and set about the next few days to right the ship. I refrained from eating too much food at night (difficult with ER shift schedule). I moderated my carb consumption. I went out for several runs in the next few days, but every time I got on the scale, I was mortified by the task before me.

I had a clinical day off midweek, and though it was raining and gloomy, I overcame inertia and got out on my bike. You have to take the opportunities when they come. I was thoroughly soaked and quite cold, but invigorated by being outdoors. Then the clouds parted, if only just briefly.

Call it coincidence, divine providence, or the physical diffraction of light. It was beautiful.

2021 hopes to be better than 2020, but only if we make it so. Self care is vital.  Make time to take care of yourself, and if you haven’t seen your doctor recently, make an appointment!

Verbal order signage

On the business side of things, our verbal order signage compliance has lagged considerably after gains in 2019.

Please remember to sign your Verbal/Telephone Orders. Our Medical Staff Rules and Regulations state that Verbal and Telephone Orders must be signed within 48 hours.

Right now, we are well below the 90% mark and at risk for citation by regulatory agencies (i.e. JCAHO). Please do your part and sign your orders ASAP.

Please see attached for order signage within Haiku!

Additional tips:

1. Hardwire signing your Verbal/Telephone Orders. Make signing deficiencies the first and last thing you do daily.

2. Sign ALL Verbal/Telephone orders including Discontinued and Canceled orders.

3. Work with your group to sign orders for each other. Inform your team when going off service and ask that your orders be signed.  Patty Fitzgibbons will work with you and your group to make it easy to sign each other’s verbal orders.

4. Inform Health Information Management when going on vacation so deficiencies can be placed on hold while you are out.

In order to place a hold on any potential medical record deficiencies, you have 3 options:

1. Call the local HIM/Medical Records Department, Chart Completion Team at Summit:  510-869-6545, option 2 (Summit Campus only).

2. Call or email the S3 physician line (Summit and/or Alta Bates Campus) 855-398-1641, Option 1, or email S3Chart CompletionTeam@Sutterhealth.org.

3. Call or email the HIM Manager (Summit and/or Alta Bates Campus) Summit:  510-869-8741, or Email Stinnal@sutterhealth.org.

Cosigning Verbal Orders – Setting Email Reminders

Verbal Order Email Reminder

Providers are able to receive email reminders when there are verbal orders in their In Baskets.  This requires a modification to the In Basket Settings.

1.  Click on In Basket from the main menu in EPIC.

2.  Click on Settings

3.  Click on Reminder Email

4.  Click the box to the left of “Subscribe with email address and,

     in the field to the right, type your email address

5.  Enter the Message Type “Verbal Order Cosign”

6.  Enter the Outstanding Days to the right of the Message Type

If there is a workflow issue we can assist with, please contact Patty Fitzgibbons, Physician Liaison, at 510-869-8339 (office) or 510-325-9618 (cell) or by email fitzp@sutterhealth.org.

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

President’s Message

Posted on Jan 4, 2021 in President's Message | 0 comments

Who would have thought that getting a shot would be such an emotionally charged event? As the Pfizer and Moderna vaccine began to be deployed nationwide, social media and news sites erupted with images of the first recipients receiving their inoculations.

ABSMC rolled out its first wave of vaccinations for health care workers two weeks ago, and it has been extremely successful (aside from the initial hiccups with myEHS). All active medical staff members are eligible to receive the vaccine in this first round, and affiliate and courtesy staff will be offered the vaccine later.

I never thought that I would have wanted to have my picture taken for a shot, but others clearly felt the same. Elation, relief, anxiety – all of those emotions bundled into one brief moment.

I applaud all of you for stepping up to get vaccinated. This is the first step of real recovery from the pandemic. You are protecting yourself, your patients, and your families in this process. As I looked at the initial data from the Pfizer vaccine, I was struck by one particular graph.
Red is placebo, and blue is the vaccine, and that’s only after the first dose.

We have to be mindful however, that our eagerness to be vaccinated does not translate wholly to other health care workers and patients. Vaccine hesitancy is a real issue, particularly among communities of color, who have justifiable reasons to distrust medicine in the U.S. We must play our part to convince those around us that the vaccine is first safe, and that it is also efficacious.  Tell your stories, in person, online, and whatever avenues you have to promote mass vaccination.  This is how we get back to normal.

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

President’s Message

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

Thanksgiving just passed, and even though I was working, somehow the holiday was actually quite pleasant.  Several patients said to me, “thank you for being here” – something that I don’t commonly hear, and that small gratitude made me feel much better about the day. I was even able to share some laughs with a particularly upbeat patient who was on her way to the OR.

We’ve all sacrificed a lot this year. These holidays have traditionally been times when we have gotten together with friends and family, shared a meal and stories, and generally reveled in good times. But this year pleads with us not to do that, or certainly not in as carefree a fashion as previous years.

There is a path forward. The promise of an efficacious vaccine is not on the horizon, it’s just around the corner. We have 3 potentially viable vaccines from Pfizer, Moderna, and Oxford/AstraZeneca currently undergoing review process from FDA for emergency use authorization. Sutter has invested in ultra cold storage in anticipation of the distribution of the vaccines. And yet, the nation is experiencing its largest surge yet, with nearly 200,000 new cases reported daily. Most counties in California have gone back to more restrictive measures and even stay at home orders. This past holiday has seen a tremendous amount of travel that threatens to bring that surge back to our doorsteps. We are certainly seeing signs of a steady rise in cases across the Sutter system in the last few weeks.

So I ask of you to be patient, minimize non-essential travel, refrain from getting together with extended family, and continue to adhere to sound public health advice. We are so close, and while the recovery won’t be immediate once the vaccine is deployed, this is our only way to get back to a semblance of more normal living.

Thank you for all the work you have done throughout the year, and thank you for the sacrifices you’ve made. I am proud to be part of the Summit family. Please, let’s us all be safe through this holiday season, and I look forward to us all getting together in person soon.

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

President’s Message

Posted on Nov 3, 2020 in President's Message | 0 comments

This month I would like to try something different.

We are a big medical center with a lot of doctors, and some members of the medical staff I just don’t regularly encounter through my clinical practice as an emergency physician. I’m sure that some of you feel similarly in your daily practice, and as such, I am starting an interview series: “An evening with one of your Summit Medical Staff.”

I would like to start this series with a colleague that to this date I have only met through meetings, but who continually impresses me with the deftness of his comments and his appreciation of the intricacies of other specialties. Not to mention that he is the hippest dressed doctor at Summit!

Sebastian Sasu, MD, chair of Pathology.

Me: “Thanks for giving me some time this evening Sebastian. I know you have a busy schedule, so I appreciate you allowing me to intrude.

SS: Any time for you, Jeff.

Me: So I wanted to do this so that we can learn a little more about you. What made you choose to be a pathologist? We used to have a running joke in my med school that pathologists like dead people…

SS: So, this is going to sound really weird, but the reason I chose pathology is because I like to have the last say. (laughter ensues) We used to go to these multispecialty conferences, the internal medicine doctor would stand up and present the case, and they would tell us all about the patient and how he came in, and then they would say that they got all these radiology studies done, and then he would turn to the radiologist, who would stand up and say “oh, we did these studies and we found this really weird mass, and then we did a biopsy of it.” And then everybody would turn to the pathologist and ask, “what did this patient have?” There is definitely a satisfaction to figuring out what is going on.

Me: If you were not a doctor, what would you be?

SS: A journalist. I’ve always wanted to be a journalist. I’ve always wanted to travel to these fantastic places and cover amazing stories. That sense of get up and go and adventure has always been very enticing.

Me: I know you spent some time practicing in LA. Let’s get down to brass tax, are you an LA or NY guy, or has the Bay area stolen your heart?

SS: That’s a hard answer. I spent some time on the east coast, in Boston, and when I was there, I was a Boston guy, then when I moved to LA, I was still a Boston guy living in LA. But then I spent so much time in LA that I ended up being an LA guy. And then my wife pried me away from that, kicking and screaming, and moved us to the Bay Area. And you know, it was a process, people talk about the difference between Southern California and Northern California, and it’s there. The thing I liked about LA, and what I miss about it, is that there’s a lot more ritz, than there is in the Bay Area.

Me: What’s the rest of the pathology department like? Are they as cool as you? I envision you all sitting around drinking absinthe… or maybe that’s toxicology folks.

SS: Probably not, but about half of the department is as cool if not cooler than I am. You know I’ve been encouraging everybody to be more interactive and show their face more, but believe it or not, we have a lot of clinicians, different specialties come by the pathology department and interact with us. Medicine has changed a lot, in the last 5-10 years. It used to be that certain clinicians that we interact with quite a lot would be in our office everyday looking with us at slides, getting to understand the subtleties of when we make a diagnosis. Like what the gray zones are, what the comfort level was at making a diagnosis.

Me: Can anything gross you out, or are you immune to that sort of thing?

SS: Oh man, nothing can gross me out.

Me: What was your most recent ASMR (Autonomous Sensory Meridian Response – a sort of pleasant paresthesia that goes down the spine) moment?

SS: My what? I don’t know what that is. (explanation above ensues). Nope. (refuses to answer)

Me: Describe to me your perfect evening.

SS: Weekday or weekend? It’s different. Ok – weekday, come home, have a nice dinner with my family, have a nice glass of wine, read my book. Weekend – go out for a drink or dinner, catch a band, and have some good cocktails.

Me: What’s the last book you’ve read? Or what are you reading now?

SS: I am reading a fantasy book, believe it or not. It’s called the Black Song by Anthony Ryan, one of my favorite fantasy writers.

Me: You seem to enjoy the finer pleasures. Cosmopolitan, Martini, Manhattan, or none of the above?

SS: None of the above. I’m actually a custom cocktail kinda guy. I don’t do a lot of the traditional ones. The only traditional ones I do are margaritas and mai-tai’s. But I do a bunch of custom cocktails. My wife does gin and tonics, so I modify her gin and tonics quite a bit, an example would be a dark and stormy with muddled mint. It’s halfway between a dark and stormy and a mojito.

Me: How has the pandemic affected you? Not just at work, but personally?

SS: Both positive and negative. So positive, it’s brought me closer to my family. So we’re spending a lot more time together, and it’s been a lot of fun. Negatively, it’s been the lack of a routine exercise regimen.

Me: Second to you, who’s the coolest person in the medical center to sit down and have a drink with?

SS: There’s actually quite a few people that I would love to do that with. You’re trying to pin me down to one person. That’s a tough thing. Shlomo Leibowich.

Me: PC, Apple, or Linux?

SS: Apple anyday. Anyday and twice on Sunday.

Me: Thanks for giving me almost, gosh, 30 minutes of your time tonight. I hope this was fun for you. It was for me.

SS: And pretty honest answers that are not censored. For whatever that’s worth. I hope I’m not going to be in big trouble.

The above was edited for content and time.

A few reminders for this month.

The physician engagement survey is live and running for the next 3 weeks. A raffle for Apple Airpods goes to one winner from each campus each week. Please fill out the survey (was sent to your email last week) and give honest feedback to the medical center!

Open notes is now live, which means that notes and results for your patients are viewable by the patient in My Health Online in real time. Please be aware of how you are documenting!

The rest of the country is experiencing a significant surge in coronavirus cases but we are currently holding steady in ABSMC and the bay area. We are expecting a fall surge to be imminent. Please continue to practice appropriate social distancing, wear masks, and avoid large social gatherings, especially as the holidays approach.

Stay safe and be well!

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