President’s Message

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

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