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This is the Wellbeing column. Why talk about Race? Because our wellbeing is necessarily tied to the wellbeing of our community.

Posted on Jul 7, 2020 in Uncategorized | 0 comments

Systematic Racism and Healthcare Disparities:

Lessons from the Black Lives Matter Movement as We Reckon with Healthcare Disparities.

In the wake of the recent widespread protests over police killings, San Francisco is discussing creating a new service of community responders who would be unarmed and properly trained to deal with issues the police should not be involved with, like homelessness, addiction and other non-violence problems.  People are demanding that we defund an expensive institution that is ill-suited to do much of what it does. We are now beginning to see some civic leadership proposing different solutions that reflect the demands of the people.

Many people across the nation are learning that being “not a racist” is not enough; we need to be actively “anti-racist” if we are to end racism that is weaved to into the fabric of our society.   For health care workers that means not just protesting and voting but taking a hard look in our own backyard.  I for one have become numb at times to the way we operate in a dysfunctional healthcare system that has albeit weak but important analogies to the criminal justice system. 

While distinct from criminal justice issues, health disparities are an important manifestation of and continued driver of systemic racism.  We all know how pervasive health inequities are and we see the end result of them daily as increased morbidity – in the African American community in particular. At ABSMC, probably a quarter of what we do should have never reached our doors and sadly, our solutions don’t get to the root of the problem. I treat an opioid dependent person and discharge them back to their tent and needles.  I offer no real program for our patients with COPD who still smoke. My diabetes patients are discharged back to shop at the dollar store for food since they are impoverished. Much of the follow-up care for those in the “safety net”, though provided by smart, dedicated people is shamefully underfunded. When I acknowledge that I have become complicit with this dysfunctional status quo- while receiving societal respect and a good salary – I am at moments ashamed. 

At the same time, I am truly proud of the work we do at ABSMC.  Beyond the excellent, compassionate care we provide, we now have an in-house diabetic education program, case managers funded by us in the ED and our FCHCs.  There is an asthma initiative in the ED and nascent inpatient addiction service now, too. We are working on a vegan diet our kidney patients who are disproportionally underserved. To target high users, we have the STAR program.  Wow, bold and inspiring work; thanks to Steve Lockhart, Meggie Woods, Michelle Tang, Manj Gunawardane, John Mouratoff, Sutter Enterprise, local physician and executive leadership and the many others of us involved in spearheading these efforts.

Yet, we have so much more work to do. Seeing the police officer kneeling on George Floyd’s neck caused anguish for many reasons: loss of life, cruelty, seeing the results of societal racism and dysfunction. To grieve publicly as a number of us did at our kneel-in acknowledged the pain and was moving but also inspiring.  Those of us there have a renewed clarity of our values as a medical center and sense of purpose. We must admit that the expensive and failed healthcare system is both a symptom and a source of societal problems.

 I have been around long enough to remember the slogan of the HIV movement: Silence=Death.  The same holds true today. True, we are all working so hard and the answers often lay beyond our skills set, but inaction is not a moral option.  What do we do? First, we need to acknowledge that inaction makes us complicit. Next, get educated about our own implicit biases.  Admitting them doesn’t make us a bad people.  It simply acknowledges we are human.  Then, we need to loudly advocate (and likely pay more taxes) for programs that lead to primary prevention for the problems we make a living off of. How to do that?  We all have to figure that out.  I have communicated with the president of my specialty organization, Society of Hospital Medicine, and asked them to advocate for programs that put dollars into primary prevention perhaps at the expense of hospital care. I have similarly messaged the CMA. I have written to Steve Lockhart, Sutter’s point person on health disparities asking how we can help him in his work.  As an institution, we need to be aware of how we are tracking the med center’s activities that are tied health disparities and follow the trends so we can better advocate for services.  Services here at the med center, in the broader medical safety net and more generally as anti-poverty programs for our community. I would suggest a quarterly report to the MEC about our institutional efforts that is then sent out to all medical staff.

And I am now asking our med center and my hospitalist leadership and YOU to think about ideas – maybe using a different toolkit – to address our community’s most vexing social and health problems.

Living with purpose and being anti-racist means acknowledging racism imbedded in our society and healthcare’s role in it.  It also means working toward solutions. So, what should happen? And what should we be doing?  Let’s talk! 

Empathy in the age of misinformation: An open letter to healthcare and science professionals

Posted on Jun 1, 2020 in Uncategorized | 0 comments

Dr. Yenting Chen is a board certified emergency medicine physician practicing at the Alta Bates Summit Medical Center emergency departments in Berkeley and Oakland, California. In this opinion piece, he discusses the importance of empathy when tackling misinformation during the COVID-19 pandemic.

Recently, many of my peers in the healthcare and science professions have found themselves on a new, unexpected frontline in the war against COVID-19: the battle against widespread medical science misinformation on social media. 

It is important for us to engage empathetically if we choose to enter into this discussion, even though this is particularly challenging for those of us who have spent our entire careers adhering to the standards of evidence-based medicine. https://www.medicalnewstoday.com/articles/empathy-in-the-age-of-misinformation-an-open-letter-to-healthcare-and-science-professionals

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.

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.