"Physicians On The Front Lines" Cover Art created by Dr. Marlene Wust-Smith

ISSUE 2 | VOLUME 1

MARCH/APRIL 2020 2020 IS THE YEAR OF CLEAR VISION FOR PHYSICIANS AND PATIENTS ALIKE

HOPE

WWW.PHYSICIANOUTLOOK.COM PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS

Cover art by Dr. Marlene Wust-Smith

What A Time To Launch A Magazine Writte n b y D r. Marle ne Wus t- Sm ith, M. D.

2

020 wa s supposed to be

to turn to. This magazine start-

the year of clear vision, of

ed out as a hobby for me--a place

clarity, of laser-sharp focus.

to express my new-found voice as

COV ID-19 has made ever ything

a physician advocate, a vehicle to

blurry, fogg y and has blind-sided

help physicians combat burn-out,

us all.

a forum to connect directly with

The news is changing by the

patients and with other physicians.

minute, and we at Physician Outlook

What started as a “side-gig” of sorts

found ourselves deferring articles we

has now become a platform of na-

had planned for this issue to replace

tional importance as coronavirus

them with content that is more rel-

throws Physician Outlook into the

evant to the current crisis. March

limelight.

2020 marks the 5th anniversary of

Physician Outlook is a labor of

National Physicians Week (March

love and my goal is not to drown

25-31), and this issue’s origina l

out other voices, but to instead

theme was to celebrate our fellow

unite those voices with a tool for ed-

doctors who have dedicated their

ucation, a conduit of introduction,

lives to the practice of medicine.

a place of peace, unity and collab-

Instead, we find ourselves in the

oration. A publication where the

midst of a worldwide novel corona-

right and the left can meet to take

virus pandemic, and it is more im-

us back to inclusive physician-led,

portant than ever to have a reliable

team-based care. A place where red

source for physicians and patients

and blue can become purple. 1

2 | M A R C H / A P R I L 2 020

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, …”

C h a r l e s D i c k e n s , A Ta l e o f Tw o C i t i e s .

Dr. Marlene Wüst-Smith Publisher

PHOTO COU RTESY OF IN GRA M IMAGES

FROM T HE PU B LI SHER

MA RC H | A PRI L 2020

Table Of Contents F R O M T H E P UB L ISH E R

What A Time To Launch A Magazine

By Dr. Marlene Wust-Smith / p.2 V IP P SP OT LIG H T

Meet The MD Behind The Curtain Of KevinMD.com

By Paula H. Cookson LCSW, freelance writer /p.4 Finding Hope In The Face Of Panic

By JR Hill /p.7 Those Simulations

By Dr. Nana Dadzie Ghansah /p.8 NE W NE WS

There Are Not Enough Nurses To Care For The Coronavirus Pandemic

By Susan Shannon, RN /p.10 Mother-Daughter Duo Celebrate A Unique Match Day On March 20th

By Dr. Jasmine Kudji /p.12 You Are What You Eat?

By Dr. Rupali Chadha /p.14 A DVO CAC Y IN AC T IO N

Physician Moms Group: An Online Network Of Support

By Kaylie Dudelson /p.16 The Scarlet C

By Dr. Marlene J. Wust-Smith /p.18 My Colleagues Are Nervous. My Patients Are Crying.

And Yet, We Are Here.

By Dr. Ashley Sumrall /p.24 Medicine Is A Profession Health Care Is A Business

By Dr. Mercy Hylton /p.26 O F F IC E SPACE

Dr. Head Coach - My Day “Off ”

By Dr. Mary Tipton /p.28 More Doctors Implementing Telemedicine

By Dr. Saya Nagori /p.31 T IM E F O R YO U

5 Tips For How To Master Self Love

By Grace Huang /p.32 Chow Time - (Dr.) Tina’s Tepsi

By Alicia Roselli /p.35 Documentaries - Physician Outlook Staff Picks

By Pamela Ferman/p.37 I NT E LL IG E NCE O N T H E M OV E

An Introduction To “Physician Heal Thyself: A Doctor’s Journey From Medicine To Miracles”

By Dr. Seema Khaneja /p.38 Hostage

By Dr. Fatima G Wilder /p.41 WWW.PHYSICIANO U T LOOK . C OM | 3

V IP P S P OT LIG H T

Meet The MD Behind The Curtain Of KevinMD.com

“AN INTERVIEW WITH DR. KEVIN PHO P H Y S I C I A N , A D V O C AT E AND MENTOR EXTRAORDINAIRE” Wr i tte n b y Pa u l a H. C o o k so n L CSW, freel a nce w ri t er

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r. Kevin Pho didn’t start his medical career with a plan to be an advocate and mentor to other physicians. After completing his education in Boston, he took a position in New Hampshire as an internal medicine practitioner and has been there ever since. Dr. Pho is passionate about patient care. He shares that he was compelled to enter medicine for a variety of reasons, but one of the significant reasons was “to give patients a voice; to help the most vulnerable people with a system that is often so difficult to navigate.” Dr. Pho finds meaning and purpose in helping patients learn about their health options so that they can make the best decisions for their own wellness.

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Now, eighteen years later, he remains at his practice 3.5 days per week and has another passion to which he dedicates 20-25 hours of his time on a weekly basis, KevinMD.com. Dr. Pho is kind of a big deal. He is a doctor, an advocate for patients and fellow medical providers, and an influential public figure who understands the impact of policy and procedure on all aspects of the medical profession and health outcomes; he is, in short, a healthcare celebrity. This explains the nervous energy Dr. Wust-Smith and I both held as we prepared for the interview with this insightful physician.

So, how does a physician transform into a public speaker, advocate, coach and mentor? Dr. Pho explains that his

journey on this alternative path began in 2004. He had written an article about the recall of the drug Vioxx in an effort to help educate patients about the risks of the medicine and why it was being taken off pharmacy shelves.

Dr. Pho immediately heard follow up from his patients about the article, and it offered him a lightbulb-moment about patient care in this evolving, increasingly computer-driven world. Dr. Pho decided to start his own blog called KevinMD.com in order to help bridge the gap between patient care and physician knowledge and information. At that time, few doctors had online blogs, and he began to see the value of having this venue as an additional way to connect with patients.

Dr. Pho is kind of a big deal. He is a doctor, an advocate for patients and fellow medical providers, and an influential public figure who understands the impact of policy and procedure on all aspects of the medical profession and health outcomes

D r. P ho ex p l a i n s t h a t h i s j o u r ne y o n t h i s a l t e r na t i ve p a t h began in 2004.

Since 2004, KevinMD.com has continued to grow. The website now includes (and encourages) any medical provider to write in to discuss the challenges of being in healthcare. The site serves as a useful educational service for patients and a valuable place for medical providers to communicate about concerns, needs and inspiration in the field. Dr. Pho aptly states, “Burnout is a hidden epidemic; the public has a preconceived notion about doctors having a life of extravagance.” Dr. Pho adds that it’s time for physicians to “pull back the curtain” and be more open about the challenges, and advocate for change within our systems that will benefit patients and medical providers alike.

Dr. Pho observed the need for this public discourse on his website due to the shifting nature of healthcare which is causing physicians to leave medicine earlier than ever before. Dr. Wust-Smith adds, “the system is driving us out…it’s not the work.” Dr. Wust-Smith and Dr. Pho have both observed the mass frustration within their fields of medicine. Challenges with non-user-friendly Electronic Medical Records, increasing demands on physician time and a growing focus on productivity have created a perfect storm for physician burnout, and the problem is wide-spread. Dr. Pho has grave concerns about the impact on the medical profession, as does Dr. Wust-Smith, who states, “we need to save medicine from going down this path…and work collaborative-

ly. People need good, affordable healthcare.” She adds that physician burnout “has unintended consequences; we want everyone to be able to obtain care.” Dr. Wust-Smith feels that it is “important for doctors to feel supported and to have a safe place to express themselves and learn about self-care.” When people have expressed concern about the openness of KevinMD.com, Dr. Pho has advised that people using the site, or any other online forum, should use what he calls the “billboard” rule and treat all posts as if they will be read by anyone and everyone, since “everything is public” and searchable online. Dr. Pho notes that if doctors are concerned about sharing their stories or experiences on his website, they should seek clearance from their employer first.

He adds that hospitals may actually want their doctors to share on public forums to increase visibility for the practice and for the hospital itself. All posts are HIPAA compliant and no information is shared that can be traced back to a particular patient, and this safety net is a compelling reason so many doctors flock to KevinMD.com and willingly share their stories and challenges.

Dr. Pho emphasized that there are “many pressures that lead to burnout in the field of medicine.” The risk of such widespread burnout can result in fewer people entering the field of medicine and those who are already in practice leaving prematurely. Dr. Pho states that his site, WWW.PHYSICIANO U T LOOK . C OM | 5

KevinMD.com “shares the human side of doctors; it lets people know what it is like to be a physician. Patients are sometimes surprised at the difficulties physicians face…patients need to know; they have a vested interest in doctors not burning out.” Dr. Pho offers doctors the following advice regarding burnout, “Something’s got to give... With a focus on quality and the number of procedures, there is only so much volume doctors can deal with.

The time with patients needs to be better valued, and this may mean seeing fewer patients.”

Dr. Pho, in his public speaking and physician advocate role, tries to help other doctors see the need for three crucial aspects of their online presence, “to counter mis-information, to define their own reputation and to have a voice.” He adds that doctors aren’t trained to market themselves and advocate for policy change, yet that is what the field is demanding through these increasingly business-driven expectations and the online world in which we live. Doctors enter the field of medicine because they are passionate about providing healthcare and making a difference. Now more than ever before, a great deal of false information is easy to access. Dr. Pho offers the example of 6 | M A R C H / A P R I L 2 020

anti-vaccine campaigns that have grown online over the past decade. “Eight out of ten patients research symptoms online and on Facebook… mis-information is out there; pseudo-practitioners pushing treatments that are not valid.” The dangers of this misinformation are significant. Dr. Pho advises physicians and medical providers to “be online and point people toward accurate treatments.” He adds that the internet is a “free, powerful tool to educate patients properly.”

“The upcoming presidential election has high-stakes and will have a drastic impact on healthcare,” he states. Dr. Pho feels strongly that doctors need to be involved in speaking up about policy decisions and advocating for their healthcare values. He further states that it “doesn’t matter which party” one is voting with, but to make decisions based on sound healthcare policies that help people access affordable, quality care. “We need our voices heard. Now is the time for physicians to have their voices heard and use the tools that are available. If we’re not part of that change, the healthcare decisions will be made by people who don’t have the expertise.” Dr. Pho adds that without physician input on healthcare reform, more doctors will burn out and there will be fewer providers to treat the healthcare needs of the public. “Patients will be impacted; there will be more uninsured people, the cost of healthcare will rise and high deductibles will prevent access to care. What good is it to have doctors when people are unable to get in to see someone?” Dr. Pho states that there is a tendency to get bogged down by “how to solve” many of these issues, when in reality there are “multiple ways to solve the issues.” Dr. Pho feels that the ultimate goal is for everyone to have coverage and for doctors to be an integral part of the healthcare policy making decisions that impact all of us.

For more information about Dr. Kevin Pho and his future speaking engagements, visit KevinMD.com and subscribe to his blog, which explores relevant healthcare topics and offers valuable advice to doctors and patients alike. 1

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V IP P S P OT LIG HT

Finding Hope In The Face Of Panic ONE WOMAN’S RECOVERY FROM THE C O RO N AV I RU S Wri t t en by JR H i l l

T

he world events in the last month have led to some never-seenbefore federal, state and local restrictions placed on all Americans as a result of the coronavirus or COVID-19.

Schools, churches, restaurants and other public places of gathering have closed; sporting events, music festivals, tradeshows, and vacations have been canceled and most of the US workforce is now working from home as we are all observing a form of self-quarantine in an effort to eradicate the spread of this novel virus that so far has claimed over 200 US deaths and affected more than 15,000 people (CDC, March 22 update).

While news outlets and social media are full of fear and panic, one woman who has contracted and recovered from this

virus has a message for all of us and has shared her story hoping to “give people a little bit of hope” during these uncertain times.

The CDC’s first confirmed case of the coronavirus occurred near Seattle, Washington, not too far from where 37- year-old Seattle resident Elizabeth Schneider attended a small house party with friends on the night of February 22nd. She described what happened next to Agence France-Presse (AFP) and now encourages people not to panic, in fact, she wants to offer a bit of hope. Schneider, a marketing manager with a doctorate in bioengineering, began to feel ill during work 3 days after the party. She described her symptoms to include headache, nausea, and body aches with a fever

that reached 103 degrees Fahrenheit later that night when she began to “shiver uncontrollably” and experienced “tingling in [her] extremities”. She recounted that without the characteristic symptoms of COVID-19 that includes cough or difficulty breathing, she wasn’t tested for COVID-19. However, when several others from the party also fell ill, with similar symptoms around the same time, their doctors believed they all had the flu and weren’t tested for coronavirus. Tests provided all came back negative for the flu. However, things just didn’t sit well with Schneider who learned about an organization that had testing kits available so she enrolled at the Seattle Flu Study, and was issued a test for the virus which later confirmed she was positive. By the time she was given her results she already felt better. Local health authorities urged her to stay home for at least seven days after the onset of symptoms which she noted were all treated with over-thecounter meds, some rest and fluids.

While US health authorities say 80% of the cases have been mild, symptoms may include: cough, fever, shortness of breath or difficulty breathing. In severe cases, pneumonia can develop.

Symptoms may appear anywhere from 2 days to 2 weeks after being exposed.

The best way to prevent the spread of the virus is to keep a safe distance from one another and avoid being around those who are actively coughing or sneezing.

Other considerations are a persons’ age and prior health status which may affect recovery times and severity, resulting in our elderly population and those who have recently been sick or have a compromised immune system as a high risk for contracting the virus.

“The message is don’t panic,” Schneider told AFP. “Obviously, it’s not something to be completely nonchalant about, because there are a lot of people who are elderly or have underlying health conditions,” she said. “If you are healthy, if you are younger, if you take good care of yourself when you’re sick, you will recover, I believe. And I’m living proof of that.” 1 WWW.PHYSICIANO U T LOOK . C OM | 7

P HOTO COU RTE SY OF IN GRA M IM AGE S

V IP P S P OT LIG H T

Those Simulations Wri t t en by Dr. N a n a D a dzi e G ha nsa h

There is a German saying that goes, “An enemy that is surprised is already half-defeated.”

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cting separately in 2019, two groups in the US ran simulations of an important event — a novel respiratory virus that broke out and caused a pandemic.

Both simulations revealed glaring deficiencies in the US’ preparations for such an unfortunate event.

The first simulation was run in Washington DC and titled “ Crimson Contagion”. It was organized by the Department of Health and Human Services (HHS) and led by former Air Force physician Robert Kadlec, an expert in biodefense. The program was started under the Obama administration after the 2014 Ebola outbreak. The staff at HHS kept it going under the Trump administration.

Last year’s simulation was run with dozens of states and federal agencies, charitable groups, insurance companies, and major hospitals.

The exercise imagined a “pandemic flu” that originated in China, infect8 | M A R C H / A P R I L 2 020

ed 35 tourists who visited China and spread globally after these tourists returned to their respective home countries. The disease broke out in the US after the son of the infected tourist, who had a cough and body aches, attended a concert in Chicago and infected others.

The simulation ran from January to August of 2019 and in the process revealed several worrisome problems — problems that we are seeing play out even now: insufficient hospital space and medical supplies, as well as confusion between federal agencies and between states and the federal government. The organizers also discovered that the US did not have the means to quickly manufacture medical equipment, supplies or medicines, like antiviral medications, needles, syringes, N95 respirators, and ventilators.

Whether anyone in the White House saw or even read the results of the simulation is unknown.

The second simulation was run by Johns Hopkins University’s Center for Health Security in collaboration with the World Economic Forum and the Gates Foundation in New York City in October 2019. It was titled “Event 201” and was led by Eric Toner, an internist and emergency physician, who is also a senior scientist at the Hopkin’s School of Public Health. Participants were a group of policymakers, business leaders, and health officials. This simulation was partly driven by not only the possible loss of life but also by economic studies that show that pandemics could cause an average annual economic loss of 0.7% of global GDP — or $570 billion.

Event 201 simulated a coronavirus, modeled after SARS, that caused a condition called Coronavirus Acute Pulmonary Syndrome (CAPS). The virus was named the CAPS virus. It spilled over from bats into pigs on a Brazillian farm. The farmhands who worked on the farm got infected and

Even This Too Writte n b y D r. N ana D ad zie G hans ah

Let go of the fear, That envelopes your day.

Don’t let panic steer, The joy in your being away.

Then as sure as night becomes day, Even this too shall pass.

The invisible haunts the land, The unseen stalks all souls.

A scourge has taken command, Filling our essence with holes.

Yet as sure as the seasons change, Even this too shall pass.

Ten thousand shall fall in the east, Twenty thousand even in the west.

It’s roar like a crowned beast, Does our very day and night arrest.

Yet as sure as the stars in the sky shine, Even this too shall pass.

Thus we are asked to hold on, Look beyond today’s plight; Help each other towards the dawn, Assist one another in the fight.

For as sure as the sun rises each morn, Even this too shall pass.

So shout it on the mountaintop, Echo it in every dale and valley.

Sing at every airport and bus-stop, In every hamlet, city, and alley.

Then we must hold on tightly to hope, For even this too shall pass. 1 © Nana Dadzie Ghansah, March 2020 WWW.PHYSICIANO U T LOOK . C OM | 9

IMAGE COURTESY OF DR. DANA CORRIEL

somehow got it into some of the South American megacities. It exploded from there on and spread to Portugal and then to the US and China and then worldwide. Without a vaccine or an effective treatment, it ended up killing 65 million people. The simulation ran until a vaccine was found or until so many people were infected that a herd immunity developed over a period of 18 months.

As it was noted in one of the reports on the exercise: “The pandemic crippled trade and travel, and sent the global economy into a free fall. Social media was rampant with rumors and misinformation, governments were collapsing, and citizens were revolting.”

The verdict after the exercise was that the US as well as the rest of the world was not really ready for a pandemic. On January 17, 2020, the Johns Hopkins Center for Health Security, World Economic Forum, and Gates Foundation released a paper with 7 recommendations on how to prepare and deal with a possible pandemic in the near future. By then, the COVID-19 outbreak was already underway in Wuhan China. Their recommendation can be found on Johns Hopkins Center for Health Security Center News.

In hindsight, these two simulation exercises had results that should have caught the attention of our leaders but unfortunately, that was not the case and now we find ourselves unprepared and in the grips of a pandemic.

There is a German saying that goes, “An enemy that is surprised is already half-defeated.”

As we flounder around trying to get control of this COVID-19 outbreak, we as a nation look like the unprepared enemy that was surprised. We overlooked all the warnings and early signs and now, here we are. I guess if one turns a blind eye to all the warnings, signs and simulations, one can then boldly and rightfully say, “Nobody knew there would be a pandemic or epidemic of this proportion. Nobody has ever seen anything like this before.” 1

N EW N EWS

There Are Not Enough Nurses T O C A R E F O R T H E C O RO N AV I RU S PA N D E M I C

PHOTO COURTESY OF INGRAM IMAGES

Wri t t en by S u sa n S ha nno n, RN

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t’s a cliché but the horse is out of the barn. There is no doubt that coronavirus is widespread in the United States and the situation is getting worse. No one — not the government, not hospitals — are addressing the elephant in the room.

There are not enough nurses to care for a worsening coronavirus outbreak in the U.S. With decreased reimbursement, hospitals run a tight ship. Hospitals don’t even staff for full capacity. They staff for their average census throughout the year. When there is a surge, they count on nurses to work extra: overtime. Many offer bonuses in this 1 0 | M A R C H / A P R I L 20 20

situation. For example, in the ER I worked in, there is a program called the capacity alert. When they are desperate, they put out a page to nurses. If you come in, you receive double pay. There was rarely a day that one of these pages didn’t go out. I doubt nurses will come in extra during the peak of this crisis.

The same capacity alert system exists in the ICU. Few people in this country realize the complexity of nurses’ jobs these days. Nurses literally hold patients’ lives in their hands. An example of this is the advent of ECMO (extracorporeal membrane oxygenation).

ECMO has become commonplace in larger hospitals. Due to its complexi-

ty, the standard of care is a two nurse assignment. Consider the fact that every coronavirus patient in an ICU will probably require ventilation and management of multiple drips.

I anticipate the majority of patients in a hospital will be coronavirus patients. Priorities in hospitals will be reordered. Critical care beds will be increased. Some nursing stations will be closed and nurses reassigned. You really can’t reassign medical/surgical nurses to ER or ICUs. If this gets as bad as anticipated, other facilities outside hospitals will be set up to care for patients.

This is where we get to the bottom line: Who will care for all of these patients? There are not enough nurses in the workforce to staff this situation.

How about the military? Will they step in? Probably. The problem is most nurses in the military staff military hospitals.

How about the reserves? The problem is most nurses in the reserves have civilian jobs. There is something called the Medical Reserve Corps, a volunteer organization that sends health care personnel to help in a disaster. I venture to guess most of these nurses are already employed elsewhere.

So where do we get the nurses?

Retired nurses? It’s a possibility. In Italy, there was a plan to try and recall retired nurses and doctors. They may be the only way to increase staffing numbers.

It is estimated there are 200,000 nurses in the country right now. Nurses will become sick and therefore unavailable. I do not hear any plan to address staffing shortages in this situation. It puzzles me. It is at the very core of the pandemic. It will determine life and death. Why is it not being talked about?

Why are doctors not anticipating this?

It is a devastating mistake. I can assure you nurses are thinking about this and they are scared to death. 1 Susan Shannon is a retired nurse who blogs at madness: tales of a retired emergency room nurse. Source: KevinMD.com; March 15, 2020

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N EW N EW S

MotherDaughter Duo Celebrate A U N I Q U E M AT C H D AY ON MARCH 20TH Wri t t en by D r. Ja smi ne Ku dj i

An inspiring story of an incredible daughter and mother who graduated from the same medical school together and on Match Day 3/20/20 ALSO matched at the same institution.

“Successful mothers are not the ones who have never struggled. They are the ones that never give up despite the struggles.”

-Sharon Jaynes y name is Jasmine Kudji. I am a 4th-year medical student attending LSU School of Medicine in New Orleans, Louisiana.

Like thousands of graduating medical students across the country, on Friday, March 20th I found out that I matched into the program of my dreams. I was extremely excited to find out that I would soon begin my medical career

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as a General Surgery resident at LSU in New Orleans. However, what made my Match Day experience especially unique was the fact that I got to share it with my mother, Cynthia Kudji, who also discovered that she matched at LSU as well, in a Family Medicine program. As a result, we are the first mother-daughter duo to not only attend medical school at the same time but also to match together at the same institution!

My mother is the most inspiring person in my life, and she is one of the only reasons I was able to make it to where I

am today. She was born in Ghana, West Africa and is a second-generation college graduate. At the age of 23, during her senior year of college at Tulane University, she became pregnant with me and had to put her dreams of attending medical school on hold. She had no source of income and was forced to raise her daughter on her own. As a result, she began working as a Nursing Assistant and soon became a Registered Nurse. Many years later she then became a Nurse Practitioner as well as a faculty member at the LSU School of Nursing in New Orleans.

All the while, she was also raising me to become the doctor that she had always dreamt of becoming. I remember countless days and nights of my mother working back-to-back 12 hour shifts so that she could afford to send me to the best and most expensive high schools in New Orleans, Isidore Newman School.

She pushed me to become the best student that I could be. As a result, I graduated with multiple college acceptances and as a National Achievement Scholar for receiving one of the highest SAT scores among minority students not only at my school but in the nation. I went on to receive my bachelor’s degree from LSU then to attend LSU School of Medicine. As I embarked on my academic career, my mom, at the age of 41 applied to medical schools around the world and eventually got accepted to The University of Health and Sciences on the island of St. Kitts and Nevis in the Caribbean.

Afraid and apprehensive about whether or not she was smart enough to compete with students half her age in a foreign country, she moved to the island and lived there for 3 years pursuing a career in medicine. This was by far the hardest thing she had ever done. There were countless nights where she’d call me crying, daring herself to quit. At times she struggled to find acceptance among her peers being the oldest in her class by over 20 years. It seemed impossible for her to remember concepts that she learned over two decades ago in college, but still she persisted.

My mom has encouraged me to be everything that I’ve ever wanted to become, and I am forever indebted to her for not only molding me into the woman I am today but also for being a shining example of perseverance and strength. She is truly a virtuous woman in every sense. My hope in sharing our story is not only to inspire people both young and old to pursue their dreams but also to honor my mom and provide her with the praise that she deserves for truly showing that age is just a number and that with faith all things are possible! 1 WWW.PHYSICIANOU T LOOK . C OM | 13

N EW N EWS

You Are What You Eat? Wri t t en by Dr. Ru pa l i C ha dha

Editor’s Note: New research reveals even tighter bonds between gut health and overall health - body AND mind.

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ver heard the expression, you are what you eat? More and more we are finding that what we consume affects our brains, not just our bodies. Many physicians have started educating their patients on the dangers of the Standard American Diet (SAD) and heavily processed foods. In this endless merry-go-round of what is considered healthy, fat has been demonized and lately carbs and sugar. But is the picture much more complex? Could it be that

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it’s not completely what we eat, but what the billions of bacteria in our gut “let” us eat?

Gut microbiomes have become a hot topic lately. From actual scientific research to health adjacent businesses marketing probiotics, from everything to anxiety to erectile dysfunction. But the actual science is exciting and something to explore in healing our brains!

For a long time many of us psychiatric physicians have seen a mind-

brain-gut connection. When we get excited or nervous we have “butterflies in our stomach.” Many gag when disgusted or have a bathroom run when anxious. The most common side effects when starting SSRIs (Selective Serotonin Reuptake Inhibitors, a class of antidepressants) are gastrointestinal (nausea, vomiting, diarrhea). It is true that the gastrointestinal tract has more neurons and serotonin receptors than our actual brain. This is why the

ing probiotic foods would make the problem worse until it is known what is causing the decreased gut motility and SIBO. Subclinical hypothyroidism and other hormonal issues are often the culprit and it is good to have a team of doctors on the case. Diet wise, a simple diet is introduced with easy to digest pureed fruit and cooked vegetables.

Each week or so one may advance the diet and see how the gut responds.

Besides eating plants, one can adhere to a whole food and unprocessed diet as much as possible for good results in mood. A study last year in Molecular Psychiatry found an observational link in those who avoided a pro-inflammatory diet and their mood.

Another recent study looked at an “antidepressant food score” and spinach scored the highest, with plant antidepressant foods scoring much higher on their scale than animal antidepressant foods. The score was calculated by looking at 12 nutrients which met the level of “evidence criteria” and were considered “antidepressant nutrients.”

These were folate, iron, long chain omega-3 fatty acids (EPA, DHA), magnesium, potassium, selenium, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin C, and zinc.

As the picture evolves, we will see more clearly how mood and food and our host gut microbiome are intertwined. Until then, it is probably best to eat the rainbow, listen to your body and stay tuned. 1 References: Valles-Colomer, M., Falony, G., Darzi, Y. et al.

The neuroactive potential of the human gut microbiota in quality of life and depression. Nat Microbiol 4, 623–632 (2019).

Mol Psychiatry. 2019; 24(7): 965–986. Published online 2018 Sep 26. doi: 10.1038/ s41380-018-0237-8 PMCID: PMC6755986 PMID: 30254236

PHOTO COURTESY OF INGRAM I MAG ES

gastrointestinal tract is often called the second brain. How are the second brain and the brain connected? The hypothesis is through the vagus nerve, but the story is still unfolding.

The whole picture may be even more intricate and beautiful, a symphony of interplaying neurotransmitters and our resident gut bacteria and what we eat. A study in Belgium found that people with Major Depressive Disorder were consistently missing two strains of gut bacteria, Coprococcus and Dialister. Of course it is unknown if the missing gut bacteria caused the plummet in mood or if they are the effect of depression, but the finding was interesting and consistent in the study (the findings of the missing gut bacteria were replicated in Belgians and again in a Dutch population). Coprococcus was found to have a pathway linked to dopamine production, a key neurotransmitter linked to mood. In Switzerland, there is a trial underway to use FMT (fecal microbiota transplants) to see if depression can be reversed.

Commercially, there are several companies that will perform FMT for a fee for anything from autism, to Parkinson’s to SIBO (small intestine bacterial overgrowth). Even though the science to prove the efficacy is in its infancy, you can easily get a stranger’s microbiome with a few clicks on the internet.

What about what we eat? Well since we have different bacteria, we can “tolerate” different foods. Being a plant-based physician myself, I do believe that eating a variety of plants (even if you do eat meat, fish, eggs and dairy) is a great way to increase the biodiversity of your gut bacteria. Plants are great prebiotics and feed the bacteria we have, and fermented plant products are great probiotics. The exception is if one has bacterial overgrowth in the small bowel where there are not supposed to be much bacteria (SIBO), in which case the gut moves too slowly and the overgrowth occurs. Add-

World J Psychiatry. 2018 Sep 20; 8(3): 97– 104. Published online 2018 Sep 20. doi: 10.5498/wjp.v8.i3.97 PMCID: PMC6147775 PMID: 30254980 WWW.PHYSICIANOU T LOOK . C OM | 15

ADVO C AC Y IN AC TIO N

Physician Moms Group AN ONLINE NETWORK OF SUPPORT Wri t t en by Ka y l i e D u del so n

H

ala Sabry D.O., M.B.A, is a full-time Emergency Medicine physician and mother of five young children. She is also the founder of a Facebook support group called “Physician Moms Group” or PMG for short. This grassroots support group is the first of its kind to provide physicians, that are also moms, the network that helps them overcome their real world problems.

PMG presently has 71,000 members and has just held their first annual family convention in San Antonio, Texas.

But PMG wasn’t always a large group of thousands of followers. It began as a group of 20 of Sabry’s friends, from whom she wanted to get advice. At this point, with already 3 children all under eighteen months, she sat down and thought, “Well, I still have all these school loans and my investment of working has not paid off.” She was snubbed for a promo1 6 | M A R C H / A P R I L 20 20

tion that she knew she deserved and was next in line for. But when she asked why she did not receive it, Sabry was told by her boss “you didn’t do anything wrong, but you just became a mom. Don’t you want to be a mom?” She said, “but the message I heard was, ‘You’re only going to be a good mom, like you can’t be a good doctor. You chose your path’.”

This caught her off guard. “I felt like I was given an ultimatum. My ultimatum was, you’re either a doctor or you’re a mom. You can’t do half of each. And you can’t do anything else. So, I wanted to quit medicine because I felt like I had to.”

This was the question that caused her to turn to Facebook to see if there was anyone that had similar experiences, but none of the mom groups that she found were niche enough. She stated, “So I made this group all in one night. I texted a friend and said, ‘Hey I’m going to make

this group.’ I’m going to put out my first question. It’s a very vulnerable moment for me because I’m very much admitting that I don’t know how to handle anything right now, and all I want you to do is support me.” She was hoping for a train of support on her one question, not thinking about any further questions.

Yet, the support that she desperately desired grew. The impact of the group made her realize the necessity of support groups, especially for women in the medical field. The women in PMG began to create close bonds with one another as they discussed topics such as the guilt they feel when they spend more time with patients rather than their own children. She recounts how some of her online friends became real life friends. She said, “these friends, some of whom I had not met at the time, had reached out and made a lot of effort to support me in real

PHOTO COURTESY OF KAYLIE DUDELSON

life. And so those types of friendships are really strong.”

On the PMG Facebook group, all points of discussion are welcomed. The women opened up about difficult times in their lives as well as discussed subjects that are normally avoided, like politics.

The government is changing healthcare and other regulations that affect physicians and patients alike. Sabry describes the physician’s job to include educating and to be educated on such topics because it can help the physician understand the patient. She explains “part of our role as physicians is to teach our patients. We’re teachers first. If we can’t even understand the situations that our patients are in, how can we adequately serve them?”

These types of discussions in the group help create growth and allow people to understand different arguments.

Having several difficult discussions

plaguing like minded individuals, who are going through the same challenges, was the reason why they needed a conference. They decided to actually meet in person in order to see and meet the people who they have had various difficult conversations with and have supported for years. She elaborated and said, “While you can be really mad about something online, maybe you form a relationship with that person in real life and you realize that there’s a certain amount of grace, humility, forgiveness, patience, tolerance, all these things that we learn in social structure to have.”

The first annual PMG convention was held February 14-16 at La Cantera Resort and Spa in San Antonio, Texas.

The theme of the convention was: “It’s a Family Affair.” “I don’t want anyone to ever feel like they have to choose their family or their career. Ever. And I feel that this conference really speaks to that.”

Sabry stated. It allowed the moms who were at the conference to listen to various distinguished speakers and connect with one another on a personal level while leaving their kids in a daycare-esque group called the Kid’s Track, which was run by PMG. The Kid’s Track is, “Not only child care, but they’re actually learning. And they’re learning from members of our community. They’re learning how to suture, they’re learning how to splint, they’re learning basic life support, first aid, [and] they’re doing yoga in there right now,” Sabry explained. With the Kid’s Track, the moms could have their fun, knowing that their children were in good hands, learning, and enjoying themselves as well. After the success of their first annual conference, PMG is already planning their next convention, which will be held next year in Kiawah Island, South Carolina, where the theme will be to “Bridge Communities” to host other online communities who have yet to have regular in-person meetings.

Sabry feels that the success of the PMG conference should be shared and the connection to other online communities is one way to unite physicians in today’s healthcare landscape.

They expect to be able to continue helping women build a network and spread necessary information to other women in the medical profession. Ultimately, Sabry wants to specifically spread three important messages since she now has a voice in the community. The first is, “Do no harm” which is an oath all doctors take. Sabry believes, “By not listening to each other about medical needs and social needs in society, we [physicians] are doing more harm.” The second point is, “See one, do one, teach one.” By this she means that starting from training days, physicians are observing and learning, and to solidify the knowledge, they teach it to another person. She connects this with support systems, and how groups allow people to keep learning from others.

Finally, the third point is that “the physician community is very fragile, there are a lot of issues that are facing us, whether it is with policy with the government changing healthcare, whether it is legislation on physicians that is leading to burnout like in lawsuit cases and in liability, or the concerns that we have about physicians being the lead of the health team and making sure that true in depth pathophysiology of patient care is the primary care of clinical medicine.” Since the system is overwhelmed, there are fewer individuals graduating medical school and less getting into residency. She continued, “[the medical society is] really doing a disservice because the physicians should be the lead of heath teams because they know the most medicine. It’s not that they know just enough to get by, they know it. And we need to be able to continuously train physicians to be the leads of these healthcare teams. We owe it to our professions, we owe it to our patients, and I wouldn’t want anything less than that for my children. .” With these closing statements, Sabry clearly expressed her passion for the community while revealing why she believes an open network of different voices is necessary in the medical community.

PMG is steadily growing and is allowing physicians who are also moms to have an outlet to express themselves while receiving support from others.1 WWW.PHYSICIANOU T LOOK . C OM | 17

ADVO C AC Y IN AC TIO N

The Scarlet “C” THE CORONA C H RO N I C LE S, PA RT 1 Wri t t en by Dr. Ma r l e ne J. Wu st- S mi t h

W

riter’s block had been plaguing me. I knew I wanted to write about the worldwide coronavirus pandemic for the March 2020 issue of Physician Outlook magazine but I did not know where to begin, what to pen that wouldn’t become obsolete within minutes of writing it. Never in my lifetime, nor in my 3 decades as a practicing physician, has medical information changed so rapidly. Because Physician Outlook is both an online AND a print magazine I did not want to write something that would become “old news” by the time the magazine hit the presses.

Little did I know that my family and I would be making “front-page news” because of COVID-19, and that I would have a first-person story to recount. An experience that nearly turned my daughter and I into modern-day Hes1 8 | M A R C H / A P R I L 20 20

ter Prynnes. One in which I uncharacteristically made unwise choices (both as a mom and a physician), and one which has somewhat defiled the ethical, evidence-based way I have practiced medicine throughout my career.

I gave my blessing to my daughter to board an international flight to London, England on March 7, 2020, at a time when I knew that the World Health Organization (WHO) and Center for Disease Control (CDC) were recommending the now all too familiar 2020 verb called “social distancing.” I knew that the situation with this virus had escalated and it was running rampant through Northern Italy. The UK had closed its borders to China early on in the epidemic, and was one of the countries that was reporting the fewest cases. More and more cases were being reported in the United States.

I really thought of this like influenza,

which had already caused more than 30000 deaths in the US when we first heard about coronavirus, but the media wasn’t hyping that up.

The risk of traveling to the UK seemed one that was worth taking. In fact, I was pretty sure that I myself had already been exposed to coronavirus on U.S. soil at the end of January and in early February when I treated a student that had spent her winter break in southern China who returned to campus with a fever and cough days after landing in the US (more about that later, but the CDC refused to test because of the lack of travel to the Hubei province). My personal hypothesis is that this student (who continued to cough for weeks) likely passed it on to several others on campus.

I had a cluster of student patients with influenza-like illnesses who had negative flu swabs (it is important to note, how-

PHOTO COURTESY OF DR. SAIRA RAHMAN

My husband and I had some very blunt discussions with our daughter prior to the trip about the risk she was taking.

ever, that my hypothesis may indeed be incorrect, as to date there have been NO identified positive cases by that county).

With the benefit of hindsight, I know that I did not make the right decision to sanction and bless my daughter’s trip to London for her spring break with her college girlfriends. On March 20, 2020 she earned the dubious honor of being the first patient in our small rural county to be diagnosed with the dreaded novel coronavirus known as SARS-CoV2 which causes the COVID-19 disease.

My husband and I had some very blunt discussions with our daughter prior to the trip about the risk she was taking. A group of 4 friends was supposed to travel together to the UK, but at the last minute one of the girls canceled, deciding that the risk of being exposed was too great. That friend’s decision to opt out did not make us back down. Look-

ing back at my reasoning, the only explanation must be that I selfishly wanted our daughter to “live life” and enjoy her spring break in a country that I have never ventured to. I knew there was a risk of her getting sick but I guess it didn’t seem “real” at the time. My brain would switch into the completely opposite mode... I’m embarrassed to admit this, but part of the reason I think I was OK with her going was because I sensed deep down inside that the world and freedom as we knew it was coming to a screeching halt. We were in the throes of “End of Days” and she deserved to experience one “last” normal life experience and a bit of fun before Armageddon was upon us.

It is too soon to tell, but it certainly feels that my sense of foreboding is not off the mark. We are currently days away from a probable mandate to “shelter in place” nation-wide as the horror that has

happened in other countries is upon us now. The U.S. intensive care units are getting filled with sick patients, and in some hospitals care is not even being offered to octogenarians because there are not enough resources. Worse yet, my fellow physician colleagues (and nurses, respiratory therapists and other front line healthcare workers) are in harm’s way because there is not enough Personal Protective Equipment (PPE) to keep them from getting showered with patients’ virus-laden secretions. Exposure of the middleman problem - Mafia-like Group Purchasing Organizations (GPOs) and Pharmaceutical Benefit Managers (PBMs) that control the U.S. healthcare system’s supply chain - is one of the main reasons that I founded Physician Outlook. People need to understand that U.S. healthcare is so expensive and shortages so abundant because they are ENGINEERED to be this way. We need to join together as a nation to repeal the perverse Safe Harbor protections that help to perpetuate the current equipment and drug supply predicaments we are currently in. I read in horror today that an anesthesiologist had to intubate patients with a plastic bag over his head because his hospital is out of face shields. Overnight we have become worse than the socialized country of Venezuela! This is the stuff of bad Hollywood horror movies.

This shouldn’t be happening in the most developed country in the world.

It was not until my daughter was in the throes of violent coughing spells and became hypoxemic on her 2nd day home from London that I stopped to question how irresponsible I had been. Trips can wait. Fun can be had in the future, even if that fun has to be fabricated in a new WWW.PHYSICIANOU T LOOK . C OM | 19

PHOTO COURTESY OF DR. M ARLENE J. WUST- SM ITH

post COVID-19 world. Is it truly more important to “live in the moment” than to protect the public good? She was upset with me, but on her first night home I completely forbid her from even having casual contact with her boyfriend, who she was dying to see. I had to put it in crude terms: if you see him, and his grandmother or grandfather end up in the ICU or dying, that is not going to be on YOUR or MY conscience. She thought I was overreacting that her minor illness was just from jet lag or lack of sleep. My daughter then realized the potential of being positive for Covid-19 and how she would never want to spread the virus to the community she knows and loves.

I can make myself feel somewhat better by remembering that “we make our decisions based on the best information we have at the moment.” At the time she left for England, the risk did not feel that great. Probably the only great decision I have made in the past few weeks was to completely opt out of all interactions with the outside world. As soon as she got home I gave her a great big hug, relieved that she was back in my arms. But the second I heard “the cough” (one that I 2 0 | M A R C H / A P R I L 20 20

feel I have been hearing in my student patients for the past few months on campus) I quarantined her.

Intellectually I knew there were risks inherent to traveling in the midst of a worldwide pandemic. Emotionally I was more afraid of her getting furloughed away from us indefinitely in a foreign country as the virus spread and borders closed.

As a physician, I knew better. I am held to a higher standard than most people. The community looks to me for leadership and advice. I was starting to counsel others to socially distance (but not all, interestingly...I told a dear friend to go ahead and take her chronically ill son to Disney at the same time that my daughter went to London, and they were one of the last people to visit before the parks closed). Her family was adamantly opposed, and were probably upset with me for going against every bit of advice that they had gotten from others. They had a blast at Disney, and they have come home and been in strict isolation. So far so good, no one has gotten sick. That mom and I both discussed prior to the trip that if his grandmother were to contract the virus from him she would not survive it. It was a calculated risk we were both willing to take for our children so that they could experience joy and make memories, even if it was an irresponsible thing to do.

I have behaved similarly in the past when I have had patients with cancer...I once sent a young girl with a recurrent metastatic Wilms tumor to a germ-laden dangerous water park with her family days before she was to re-start chemotherapy and have surgery. I knew she would be at higher risk for contracting infections but I didn’t care, I wanted her to enjoy her last little bit of fun before “the end,” even if it meant that her chances of survival were lessened because it compromised her immune system.

The hardest part of my daughter’s illness for me, however, was not her gut-wrenching cough or fever. I am a doctor, I know how to heal and care for the physical symptoms. I made sure she

got started on albuterol to open up her lungs. She was taking acetaminophen instead of ibuprofen. She was not taking any elderberry products. She started Zinc 50mg, Vitamin C and I made sure she got enough Vitamin D. I had her check her pulse oximetry and temperature on a regular basis. I made regular calls to her pediatrician and to the Department of Health. I even made the difficult decision to start her on a medication that is not normally given to anyone unless they are going on safari and need to prevent malaria. I had heard about hydroxychloroquine way back in February, and I myself had uncharacteristically taken a 400mg dose as prophylaxis upon the advice of one of my “tin-foil hat wearing” alarmist physician friends (he had recommended early on that every physician take a loading dose and start a weekly pill “just in case this thing kept going viral.”)

The dichotomy of my life at the time was not lost upon me. On the one hand, I had let my daughter go galavanting around the world at the same time that I was worried about needing to take a potential “antidote” for the poisonous virus that was slowly creeping into daily life.

The social implications of being the brunt of rumors and having to experience the ugliness that being “the first” with a feared disease brought upon my daughter in our small rural, one-horse town was almost worse than her cough. I was powerless to stop it. Because we live in a small town where everyone knew that she and her best friend/college roommate had gone overseas together, she became the unwitting central player of a perverse version of the “telephone game” (also ironically also known as “Chinese Whispers”).

In the traditional children’s game, the first player comes up with a message which is whispered into the ear of a second player, who then whispers it to a third player, and so on. In the game version, the last player usually repeats a hilarious version of the initial message. The original message was the standard Pennsylvania Department of Health report (without any identifying information) that our county had its first COVID19 case, but it didn’t take

https://www.endeavornews.com/articles/pottercounty-covid-19-victim-shares-story-advice/

Editor’s Note: Potter County’s first case of COVID-19 was diagnosed late last week. The victim, who had recently returned from London, England, has shared her story. It follows.

I

am sure some of you have heard that I have tested positive for Covid-19.

As far as we can piece together, this is the timeline.

The first appearance of my symptoms occurred only two days after being outside of the country in London, England. At the time of my trip, there were more cases in the United States than in the United Kingdom, so I decided to go and continue to experience new things and new places.

So, that being said, I could have contracted the virus in the U.S. up to two weeks prior to my trip abroad. Nobody knows, and there is no way for anyone to know.

Upon returning from my trip on March 14, my mother (who is a physician) immediately put me into a quarantine inside my own home. At this point, I only had a dry cough and very mild cold symptoms that I took as a side effect of jet lag.

I thought it was an overreaction, but I abided anyway, because I am not an ignorant human being and knew it was the right thing to do. I have not left my house since I returned on March 14 and have not been in contact with anyone else since I returned to Coudersport.

PHOTO CO URTESY O F M M S

long before the whispered rumors started flying in person and on social media.

Errors accumulated, and many friends were getting back to us, reporting what people were gossiping about. In one telling, I was implicated as being contagious and “spreading corona through the local hospital’s newborn nursery” (when in reality I haven’t worked at our local hospital since June of 2018). My daughter was reportedly sighted out shortly after her return from London playing basketball (when she hasn’t played the game since having an ACL repair many years ago after hurting her knee), nor had she left the house. In one particularly hilarious version one of us reportedly was “caught” spitting at the McDonald’s drive-through cashier.

The ostracization she felt from the whispered rumors, the many cars driving slowly by our house on our usually desolate road, the meanness that so many before her have experienced when they were diagnosed with stigmatizing diseases was so upsetting to her that until she finally made the difficult decision to “out herself” publicly.

She posted the following on her social media account, and it has gone “viral,” with >1000 shares, likes and comments. Not exactly the way to become a modern day “ influencer.” It brought joy to my heart that the majority of the comments and re-shares are overwhelmingly positive and supportive, and we are feeling blessed that we are part of this very tight-knit loving community. My husband and I both tested negative (the fact that the three of us were tested when others are being denied testing has been another source of hate mail and gossip, and unkind comments).

It will be a while before any of us leave the confines of our home, because we want to make sure that there is no doubt in ANYONE’s mind that we are not responsible for the illness and death that is surely to soon infect our little town. 1

This virus has made me feel like death, but I am on the mend. I would never wish this upon anyone and would never want to risk spreading it to anyone else.

The frightening aspect of this pandemic is that the coronavirus (Covid-19) can appear as a multitude of symptoms or no symptoms at all.

Many could be carriers and not even know it.

Honestly, none of this was anyone’s business to know that I tested positive, as it is my patient privacy. As a 19-year-old girl, it is tough living in a small town where it feels like everyone is against you. They never ask how you are and always just spread rumors, similar to the exponential growth of the virus.

So as well as flattening the curve of the rumors, I would also like everyone to do his or her part in flattening the curve of the virus. Please stay home.

I am not the only one who comes and goes to Potter County. I love my community, and I would never want to put anyone at risk. I just want everyone to stay safe and remain healthy.

As far as for myself, I plan on staying in my house until I am fully recovered and healthy. 1 WWW.PHYSICIANOU T LOOK . C OM | 21

Help us prevent the spread of COVID by socially distancing. campaign created by Drs. Hala Sabry-Elnaggar & Dana Corriel

O F F IC E S PAC E

My Colleagues Are Nervous M Y PAT I E N T S A R E C R Y I N G .

A N D Y E T, W E A R E H E R E .

D

o you remember when you were a bright-eyed pre-med student, head bowed at the computer, typing your personal statement? Type, type … backspace, backspace … type.

You didn’t want to use the phrase “to help people” in your statement as your reason for wanting to be a physician. Maybe you said something like me. I mentioned how there were no doctors in my family, and I wanted to be the first. I mentioned that I wanted my life and work to be meaningful. I shared experiences from working as a nurses’ aide for a local pediatrics group.

When I didn’t get in the first time (or second), I kept at it. I just “knew” I was destined to become a physician. Why did I really want to do it? It’s hard to put into words, aside from saying that it was a calling. Years later, I still feel that way.

I feel blessed to practice medicine daily.

Over the last few years, I’ve watched as we have disparaged medicine. For all of her glory and wisdom, our society has devalued her. We, physicians, have talked behind her back, called her names, and even abandoned her. We have bullied her, 2 4 | M A R C H / A P R I L 20 20

PHOTO COURTESY OF DR. CHETN A SIN GH

Wri t t en by D r. A shl ey S u mr all

or watched others bully her … standing off to the side, leaving her undefended.

And then a pandemic happens.

Li Wenliang, the whistleblower, makes the ultimate sacrifice as he dies from COVID-19 after caring for affected patients.

News from Italy reveals that 1 of 5 cases of COVID-19 is a health care worker.

Two emergency physicians (in New Jersey and Washington) are hospitalized in critical condition with COVID-19.

My colleagues are nervous. My patients are crying.

And yet, we are here.

Every physician I know has stepped up to help. Retired physicians are returning to care for patients and educate our teams. Outpatient physicians are re-learning pulmonary and critical care. Administrative physicians are donning scrubs and swabbing patients for COVID-19 in makeshift clinics tucked inside tents.

Physicians are talking and tweeting in ways that I haven’t seen in years. As terrible as this pandemic is, it has fueled an excitement for medicine again. There

is a fire in our collective belly to learn more and help as many as we can. We are gobbling up recommendations from our brothers and sisters in Italy and China.

We are reading journal articles and passing them around to colleagues. We are rediscovering ways to reduce the incidence of disease via public health measures. We are volunteering to cover for each other.

We are crying with each other. Our walls are down, and we are humanizing medicine again.

At my alma mater, the University of Mississippi Medical Center, medical students felt helpless as their clinical rotations were closed. They rallied and put together a list of students interested in helping others without being in the hospital or clinic. They are providing babysitting, shopping, and home services for those health care workers on the front lines.

Meanwhile, a quick Twitter search will reveal helpful therapies for COVID-19. Instead of “claiming research credit,” physicians are sharing novel ideas about helpful strategies broadly. A clinical trial for a potential vaccination has opened in the U.S. in record time. I have read about hydroxychloroquine, tocilizumab, and remdesivir as potential palliative strategies. Physicians have shared data on ventilator settings, ECMO, and even sample CT scans of affected patients. In my local physician moms’ group on social media, we have shared helpful daily updates to over 700 local physicians. In Charlotte, we are raising funds to help our patients with cancer who are affected by COVID-19. Physicians from various hospital systems are working together for the common good of our communities … the way medicine should be.

May we all emerge on the other side of this pandemic with a renewed enthusiasm for medicine. I am watching, as she welcomes us back with open arms. Perhaps we will all continue to fall in love with her all over again. 1 Ashley Sumrall is an oncologist and can be reached on Twitter @AshleySumrallMD. Source: KevinMD.com

MEDICINE IS

OUR AND

TA KIN G

HOUSE, WE

IT

ARE

BA C K!

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ADVO C AC Y IN AC TIO N

Medicine Is A Profession H E A LT H C A R E I S A BUSINESS

D

Wri t t en by D r. M erc y H y l t o n

oes anyone really want health care for all? I promise this is not a political rant.

Americans, of any political persuasion, should not be misled by the implications of health care for all: It does not mean medical care for all. Providing a card stating you have health insurance is only a nominal solution, provided by politicians, who are looking for a superficial fix. Our problems are more complex than such a bandage can heal.

I use the terms “health care” and “sick care” interchangeably because our current system seems to have little to do with health.

Physicians are trained in medical schools, not health care schools. A person in need of healing is referred to as a “patient” in medicine. In health care, this person is a “consumer,” “customer,” or “client.”

Medical care starts with the patient-physician relationship. Health care 2 6 | M A R C H / A P R I L 20 20

is the wedge that drives itself between the patient and physician: an amalgam of entities including third-party payers, hospital administration, corporate business, legislators, and bureaucrats.

During the seven-plus years in medical school and residency, physicians are trained in the incredible breadth and depth of human disease, but there is scarce opportunity to teach “health care” education.

Most physicians complete their training without gaining the practical skills to maneuver in the industrial “sick care” complex, how to advocate for our patients, nor how to fight those entities exploiting physicians’ service and sacrifices for their own gain.

Physicians strive for a balance between the intellectually challenging science of medicine and the humane art of healing. Health care creates “providers,” who are encouraged to mindlessly follow algorithms and are trained in maximiz-

ing reimbursement via “jumping through all the hoops.”

Health care has commoditized physicians’ work. Some physicians of past and current generations have been complicit in creating this system, which is now sucking the joy (and sometimes, quite literally, the life) out of physicians and patients. The rest of us are complicit by our participation: keeping it humming and growing by not disrupting or even questioning it.

Health care has commoditized patients’ health and lives. The metamorphosis into “health care” began when Americans ceded the financial responsibility for their medical care (via participating in employer-sponsored health insurance).

Most Americans have not known any other system during their adult lives.

And with handing over the financial reigns, patients (myself included) gave up our autonomy. Before you complain that your deductibles and copayments

P HOTO COU RTE SY OF DR. SA IRA RA H M A N

are evidence of your financial responsibility, please realize that those amount to chump change in this system. Those expenses were created merely to disincentivize patients from spending the insurance companies’ money.

And so here we are. As a whole, our entire population, including physicians, is physically, mentally, and emotionally unwell.

Our population health outcomes are the worst among developed countries, despite health care being the biggest business in the U.S. Physicians have the highest suicide rate of all professionals, are suffering “burn out” and “moral injury” at epidemic rates, and it seems most are looking for exit plans despite our severe physician shortage.

Almost half of every federal government dollar goes toward health care spending. Employee health insurance costs are a huge (and rising) expense for employers. Out of pocket health care

expenses are increasing for insured employees faster than their incomes, despite stable utilization.

Our “sick care” system is bloated beyond reason, but physicians’ salaries account for <8 percent of health care expenditures.

For every one physician in the U.S. health industry, there are 16 non-physicians, of whom six are clinical workers (nurses, allied health professionals, aides, care coordinators, etc.), and ten are purely administrative or management staff.

The purpose of those 10 “sick care” industry jobs is to administer and manage the 7 of 17 of us who do patient-care.

Those ten non-patient-care jobs exist due to burdensome government regulations and the intentional complexity created by insurance companies, which profit when they can deny patients’ access to care or deny reimbursement for care.

Ironically, I continue to work in health care so that I can afford to provide health care insurance for my family, in case of catastrophic need. But, my goal for my family is to stay out of the “sick care” system as much as reasonably possible, because I know that this system swallows up patients, too. It is a system that feeds and benefits from our human frailties and anxieties, both as patients and as physicians.

As an emergency medicine physician, I am well aware of the unfairness, randomness, and frequency of serious illness and death. I am grateful to the generous people who donate their remains for the education of first-year medical students learning human anatomy. I may donate my body to science, but I will not donate my body to an ignoble “sick care” system.

Many physicians I know do not want their bodies nor their families’ emotional or financial well-being abused by the sick care system if death is inevitably close.

Think about this. The very people who are cogs in the sick care machine are the most hesitant to want that type of care for themselves. 1 Mercy Hylton is a pediatric emergency physician.

Source: KevinMD.com; March 18, 2020

I do not wish health care for all, but, rather good health for all. My advice as a physician?

•

Be physically and mentally active.

• Maintain a healthy weight.

• Turn off the screens.

• Read books, join a book club.

• Call a friend.

• Listen to or create music.

• Meditate or pray.

• Write an annoying blog.

• Get involved in your community, and enjoy your family to ward off depression.

• Volunteer.

• Adopt a shelter animal.

• Adopt a child.

• Wear your seatbelts.

• Do not smoke, drink to excess, nor use recreational drugs.

• Get annual check-ups, cancer screenings, and immunizations.

• Avoid toxic relationships.

• Consider paying out of pocket for care from a direct primary care (DPC) physician or price-transparent surgeons.

• When you do need to access the “sick care” system, demand a physician; do not settle for anyone who has acquiesced to be a “provider.”

• Practice mindfulness, kindness, and gratitude.

• Have reasonable expectations of medicine and health care.

• Take ultimate responsibility for your health.

• Live your best life every day. Tomorrow is promised to no one.

These are this doctor’s orders.

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O F F IC E S PAC E

Dr. Head Coach MY DAY “OFF ” Wri t t en by D r. M a ry T i pt o n

I

t was just a couple of days after Christmas when I arrived at the office late afternoon to drop off a stack of work and pick up another stack. As I walked into my tiny backroom office a nurse practitioner who works a few days a week for us said, “Oh, what are you doing here on your day off? I thought you had the whole week off? Must be nice.” I slowed to a stop, adjusting the white coat I was wearing because I had just come from the hospital, and gripped my stack of superbills a bit tighter. “It is a day off clinic for me but…. “ My voice trails off but then I decided to say, “Yes, it’s been great to have some more time with my family this week than usual.”

2 8 | M A R C H / A P R I L 20 20

Any further conversation is halted by the home health nurse calling me back.

I pick up my huge stack of superbills waiting for me to review before year end - a task that will take up most all the family time left this year - and wave goodbye to the nurse practitioner.

I am a primary care physician and owner of my busy private practice with a couple physician partners. Our aims are patient centric. The medical center is open every day of the year for both urgent and scheduled care visits, serving patients of all ages. We employ physicians, nurse practitioners and physician assistants. Our team includes other very important members: medical assistants, x-ray technicians, phleboto-

mists, schedulers, triage nurses, office manager and a small army of staff to manage all the third party payor demands and billing. Every member has a job and every job is important. I count on the front desk to greet patients warmly, check them in promptly and get them to the team of clinicians.

I rely on my lab staff to process blood and urine samples.

A physician, and especially a physician practice owner, leads the team.

But since we all know it’s the practice of medicine and every encounter brings new challenges, my job is most analogous to the head coach. In football, the head coach manages all the assistant coaches and players. The coach

A physician, and especially a physician practice owner, leads the team. But since we all know it’s the practice of medicine and every encounter brings new challenges, my job is most analogous to the head coach.

is an expert at developing and training athletes. The coach chooses coordinators for the team that are good at their specialty, offensive or defensive. Sometimes the coach needs a sub specialist, like a kicker to secure a field goal. If the coordinator’s offensive plays do not work against the opponent, the game will be lost and it’s the head coach that takes the heat.

The head coach of a football team gets some of the credit for winning a game, but most of the blame for losing.

That is the definition of job stress right there. The coach is always thinking about the team, watching videos of recruits, analyzing plays and researching the other teams. Even on days “off”

and in the off season the coach is hard at work. The 32 hours of clinic visits printed on the office schedule (the game time), is less than half of the actual time the doctor head coach has her heart and head in the game.

On that day “off” from the clinic after Christmas, my pager woke me up at 6 am. Two more babies were born the night before, making the total four at two hospitals. Three of the four had complications so my physician assistant could not help me round that day. I texted her that I would take care of all the newborns and headed off to the hospital. One baby was small and struggling with low blood sugars and feeding difficulties. Another required several

hours of help breathing after birth and needed supplemental oxygen. As I tried to leave one hospital I ran into one of the many nurses who come to see me as a patient, along with her whole family. Thirty minutes later I had heard all about her husband’s declining health, the grandson she was worried about, and my most common complaint…. I can’t get an appointment with you until the end of the month. “Are you taking a long vacation?” I empathize with her frustrations and explain that I do work full time and I will have someone contact her to work her in sooner.

On my way to the next hospital I got a text from a nurse for my patient who was just discharged from the ICU on Christmas day. She has a new diagnosis of colon cancer and an adult son with spina bifida at home. I called the nurse and we discussed her new ostomy and how to help the son. As I pulled into the hospital parking lot a notification from my clinic facebook page pings my phone. There is a negative review left online by a patient who had to wait over an hour to be seen. I make a note to look that up later to see how it can best be addressed. Maintaining a favorable online presence is very important to a private practice.

At the next hospital I inform a mother taking suboxone that contrary to her impression from the OB, her baby was at risk for opioid withdrawal and would need to stay for a minimum WWW.PHYSICIANOU T LOOK . C OM | 29

As head coach I am always playing the long game. It’s not a “clock in and out” job. It’s not shift work, it’s a calling. of 3 days for observation. She was devastated. Because I didn’t have to get to the clinic, I was able to sit down and process that grief with her. Forty minutes later she dried her tears and felt comfortable with the plan which shocked her an hour ago. While logged into the hospital system I set up some follow up appointments for the babies being discharged. I see urgent messages from staff and patients via the portal so I quickly answer ten of those. In the hospital inbox there is a message from a rheumatologist. As a coach I train my clinicians to recognize the atypical and ask for help when they need it. After he asked me to look at a “weird rash” I identified Gottron’s papules characteristic of dermatomyositis. Since an appointment with rheumatology is a three month wait, I coordinate plays and call in favors to other coaches who trust my experience. In this case the rheumatologist gave the patient a sooner appointment and me some advice on additional tests and treatments to take care of her in the meantime.

No time for lunch, but I grab a granola bar while I head to the office. I promised the supervisor for the medical assistants I would train two of our staff that day how to download and direct messages from all the hospital systems to our EMR system. In private practice we see all insurances and go to all hospital systems. Thus, our team works with a handful of EMR systems, none of which communicate with each other.

Two hours later, after many interruptions from the pager, the hospital and other staff, we finished that training.

I then accompany my office manager while she terminates a medical assistant whose careless mistakes have put 3 0 | M A R C H / A P R I L 20 20

patients at risk. Despite the many positive contributions from this employee over the years, she has to go. When my patient develops septic shock from an e coli bladder infection because the lab staff forgot to check their alerts, it’s my name that will be “in the newspaper”, not the linebacker who missed the tackle.

My day “off” is only half over. I haven’t seen any of my children or my husband all day. I am still wearing my workout clothes, but never made it to the gym as I had hoped. On my way back to my desk my administrator stops me to tell me that another physician assistant called in sick. She begs me to work for a few hours to absorb some of the many urgent care patients piling up. The other clinician working that day is new and needs extra time to see patients. Since I am an experienced coach I can analyze plays and come up with strategy twice as fast. The office manager quickly puts 10 patients on my schedule for a two hour period, which is as many as the other clinician will see all shift. I also discuss a contract issue with the office manager about a physician we are recruiting. We have been short staffed for months and it’s wearing on us all. Finally, I text my husband to tell him that I will not be home as I had planned. I hope to make it home by dinner, which he will make for our family.

This brings me to the point at which I walk to my desk and the nurse practitioner asks me if I’ve been enjoying all my time “off” for the holidays.

As head coach I am always playing the long game. It’s not a “clock in and out” job. It’s not shift work, it’s a calling. I spend late nights pondering my patients and partners. I spend hours educating staff and reviewing “plays” from the less experienced team members. I review and sign off on charts and catch many mistakes before they cause a problem.

I scope out new recruits and make the tough decisions to get rid of anyone who may prevent us from winning the game. Winning, in this case, means

providing timely, patient-centered care based on best practices. Winning is helping our patients navigate this complex and unwieldy healthcare system. Winning is making sure the critical game-deciding plays are executed perfectly. After all, a lesser trained clinician can throw an algorithm based cocktail at every cough that walks in and be right most of the time. But it takes an experienced head coach to find the cough that is a pulmonary embolism or the rash that is dermatomyositis. That play matters. It’s a life or death, win or lose outcome for that one person. Someday that one person may be you, or your loved one.

All our loved ones deserve physician-led team based care. If the defensive coordinator suddenly decides he can win a football game all by himself, the offensive game will suffer and the special teams will be off target. We can not win for our patients without a head coach, and those patients deserve to have a physician head coach... the standard of care! 1

O F F IC E S PAC E

More Doctors IMPLEMENTING TELEMEDICINE

PHOTO COURTESY OF INGRAM IMAGES

Wri t t en by D r. S a y a N a go ri

T

he growth of telemedicine in the last five years has been astounding. With the continual addition of Medicare codes for coverage of virtual health services, the adoption of telehealth is growing year over year. In fact, presently, some form of telemedicine is covered by Medicaid in all 50 states. In addition to this, private payer coverage for telemedicine is also growing with reimbursement in some states paralleling that of in person services. Telemedicine has taken on many shapes and forms, from urgent care delivery that is operated by companies like Teladoc to remote patient monitoring, chronic care management as well as basic prescription renewals.

In addition to expanding reimbursement coverage, doctors everyday are realizing that patient use of telemedicine is inevitable. Doctors who shy away from telemedicine, may find

themselves left behind as patients may growingly choose convenient over cumbersome options when it comes to care.

Given that patients use digital solutions in all aspects of their life - from banking to retail - healthcare is no different.

Salesforce reported data that surveyed millennials which showed that 60% of them support the use of telehealth to eliminate in-person health visits. Telemedicine is no longer an innovative fad, it’s a necessity for most physicians to incorporate in order to meet patient demands.

Luckily for physicians, the trend towards telemedicine and digital health implementation will prove to benefit doctors and patients alike. With rates of physician burnout on the rise, digital health provides physicians with more freedom in how they choose to practice medicine. Data shows that almost ⅓ of physicians are burned out and many of them report that more control over

It’s no longer an innovative fad.

Telemedicine is now mainstream and a key part of the strategy in the fight against COVID-19. scheduling and increase in work life balance would increase work satisfaction. While some physicians fear that telemedicine and digital solutions like artificial intelligence could “take their job”, the fact is that the American Association of Medical Colleges reported in 2018 that they anticipated a physician shortage of 120,000 by 2030. In fact, without digital health solutions, the demand would far outweigh the supply.

Implementation of telemedicine into outpatient based practices can be done in a stepwise fashion. Resources for implementation can be found at MedicineAndTech.com, a physician community focused on innovative efforts as well as telemedicine education.

Telemedicine integration into current physician practices can be overwhelming for physicians who have been in practice for several years, but integrating in small stages not only allows for a cost effective process but also one that is mindful of reimbursement fluctuations by CMS and private payers. Early physician adopters of telemedicine are the doctors who will see the most benefit from this from both the standpoint of patient satisfaction and personal satisfaction. 1 Dr. Nagori is the Founding Physician for the telemedicine platform SimpleHealth.com. She also teaches physicians and healthcare entrepreneurs how to build out digital health initiatives, telemedicine practices, as well as advises for several healthcare start ups. She is also the conference chair for the Medicine Innovation & Entrepreneurship Conference (www.MedicineAndTech. com) and the course creator for Getting Started in Telemedicine: Masterclass for US Physicians (InnovateHealth.Teachable.com).

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TIM E F O R YO U

5 Tips For How To Master Self Love Wr i tte n by G ra c e H u a ng

I

n a culture where we’re taught to conform and receive massive amounts of conditioning and programming, self love is a concept that seems elusive to many of us. Although self love is rapidly gaining traction, exactly how to put this into practice can still feel like a dog chasing his tail.

For this reason, I’ve put together a practical guide of things to focus on in order to master self love, and to help you continue on your journey to fulfillment and wellness.

1. Love Yourself Without Ifs, Ands, Or Buts To love yourself unconditionally means that no matter what we are or aren’t doing, how we are feeling, we love ourselves nonetheless. That is to 3 2 | M A R C H / A P R I L 20 20

say, the love we hold for ourselves is not contingent upon any requirement, achievement, emotional state - or lack thereof.

So whether or not you do well in school, meet that work deadline, fight with your friends and partner, sink into depression, are unproductive, eat healthfully - you accept these aspects of yourself as part of the current truth of yourself. We accept and love these parts without expecting them to change.

The radical concept here is we love ourselves simply for existing.

This is so far from what we are taught very early on in childhood.

Most of us grew up in households run by the reward-punishment dynamic.

With this kind of upbringing, we subconsciously learn that we are loved for

being a certain way or doing specific things.

Subconsciously as children, we then reject, disown, or suppress the parts of ourselves that do not fit this narrative in order to receive the love from our families that we so desperately need.

When we learn that parts of us are unacceptable, it can be hard to reintegrate them into our whole selves, especially when we feel that there is something innately wrong with these parts of us. The nature of love in the vast majority of relationships on Earth today are conditional and transactional, whether those relationships are familial, platonic, or romantic.

Conditional love means - I love you for the parts of you I deem acceptable.

LOVE BY JULIANA COUTINHO IS LICENSED UNDER CC BY 2.0

brought about a plethora of questions like, well what if I don’t even like, let alone love, certain parts of me?

I came to the realization I was now in a transactional love relationship with myself - one that mirrored the parent-child relationship I had. I would love myself, but only when I was doing something that I perceived as “good”.

At first the concept of loving and accepting myself during my lows was incredibly foreign. It felt odd, narcissistic, and even wrong. It was only when I understood that I needed unconditional love most during these times that I became (and am still becoming) more comfortable with this practice.

Transactional love means - I love you for what I receive from you in return.

Conversely, unconditional love is just that - love without any preexisting conditions, terms, or exceptions.

Unconditional love says - I love you in your entirety, no matter what.

While remaining in a state of unconditional love 24/7 is not usually possible (we are human after all), we can approach this as a practice we commit to working on. As with any practice, the more we consciously work on it, the more we will begin to see progress. We find that it becomes easier to tap into the state of true love.

Many of us are incredibly resistant to this idea, I know I certainly was earlier on in my journey. Love myself?

For simply being? No matter what? This

2. Take Time To Recharge When we get beaten down by life and are feeling exhausted and overwhelmed, we must understand that we must prioritize our mental-emotional health. Allow yourself the time to take care of yourself in any way that feels good to you. This can be taking that nap, vegging out in front of Netflix, going for a walk, or anything that works for you.

A lot of us, myself included, have a difficult time allowing ourselves to rest.

The fear here is that - if I don’t do XYZ, then I’m not worthwhile, I’m not doing anything productive, I’m feeling sorry for myself. As we discussed earlier, this is due to the nature of conditional and transactional love.

Maybe it looks a bit different for you, but the fact remains that our resistance to caring for ourselves is due to a fear of what happens when we take the time to do put our needs first and the false belief that we do not deserve it.

What I want to help you understand is that taking time to care for yourself, even if it is to do absolutely nothing, is in fact, doing something.

When we are cared for and after rebalancing our energetic state, we will be much better at doing whatever it is we need to do. So in this way, taking this time for yourself is actually helping you to be your best self!

I want to clarify that taking a rest should not be tied to the expectation that it will make us be more of something or less of something. Such as, if I allow myself to rest, it is because I want to be more productive the next day or I want to be less emotional afterwards.

Rather, we can approach our recharge time as I am resting because I am important and I deserve to feel good.

Whatever comes from that will come.

If I recharge and am more productive the next day, this is a happy byproduct of my self care, not the expectation or condition.

3. Do Some Kind Of Daily Maintenance When we take time to connect with ourselves each day, we are showing ourselves that we matter and are worth our time. In dedicating a certain chunk of time to solely you every single day, you are deepening your relationship with you and thus, your self love, understanding, and acceptance.

What kind of daily practice you pick is up to you! To get you started, here’s a few things I cycle through in my daily self care routines.

Writing three pages freehand stream of consciousness in the morning, meditation, practicing yoga, consuming positive educational content to help me learn more about myself, practicing tarot to become more in touch with my intuition, mantra chanting, pranayama (breath work), writing poetry, going for walks and talking to myself through a recording device.

These are all things you can try if they resonate with you - just to name a few. Choose a form of daily self connection that speaks to you! Whatever allows you to deepen your connection with yourself works. If you’re a dabbler with many interests as I am, feel free to change it up by having several practices you can use and oscillate between these on a day-to-day basis.

It doesn’t matter so much what we choose to do, but to remember why we are doing it (hint: it starts with self, ends WWW.PHYSICIANOU T LOOK . C OM | 33

4. Pay Attention To Your Internal Dialogue We do this so we can observe our self talk. How are you speaking with yourself? Are you judging yourself harshly and criticizing yourself constantly? Are you putting yourself down and beating yourself up for things? Or are you letting yourself know that your worth and love for yourself is dependent only on your existence?

As with most things, the development of our self talk begins in, you guessed it, childhood! The way in which our parents speak to us becomes our self talk. I want to reiterate here that this is NOT a blame thing. Blaming only brings us down to the state of powerlessness and draws us into the victim mentality.

When we choose to examine these things from a place of acceptance and understanding rather than trying to figure out who’s fault it is, we are able to create lasting change, if that is what we desire. We acknowledge that yes, how I was treated in my childhood is not my responsibility, but at the same time, I am the way I am now because I have chosen to be.

Consciously or subconsciously, we have chosen to perpetuate our current relationships with ourselves and thereby, our self talk. If the thought of your decisions being ruled by subconscious mechanisms you are not aware of brings about a sickening feeling as it did for me, know that this is why we first start with simple observation.

We are making ourselves aware of what we previously were not. This is a crucial first step on the road to change.

One of the things we can do in abstaining from judgment as we observe our thought processes is to not identify with the thoughts that arise. We detach 3 4 | M A R C H / A P R I L 20 20

from thoughts by recognizing that we are not the thoughts themselves - we are the ones who are observing the thoughts.

5. Treat Yourself As You Would Treat Your Child Self Whenever you are in doubt about how to show yourself love or need to make a decision, I want you to visualize your child self. For some, visualization does not come as easily which is perfectly okay! Instead, you can scrounge up an old childhood photo and keep that on hand.

Consider asking yourself the following questions. What does this child version of you need? What would make this child feel loved unconditionally? Which decision is in alignment with the wellbeing of this child?

If you are tuned in to your child self (we all have one inside us), we can directly ask this part of ourselves. At first, this can feel odd and the response we get may be quiet, unclear, or even nonexistent depending upon the extent to which we have repressed our child selves. The more we practice this exercise and look inward for answers, the louder and more resonant this voice will be.

Allow your inner child to guide you.

Spending time in meditation with this part regularly can really help to accelerate your connection.

When I spend time with my child self and ask her what she needs to feel loved in this moment, the answer varies depending on the situational context.

Some days she may want to be comforted, she may need a nap and a break from working, or she may need some alone time. Other days she may need to let loose, play, and have fun!

There is no wrong answer here, my friends.

If what your inner child needs is not something tangible, such as to be understood or to be told everything will be okay, you can practice a visualization exercise in which you as your adult self gives your child self what he or she needs.

If it is something more tangible such as taking a break or going to the beach, get a move on and let it happen!

ART OF HEALING BY HARTWIG HKD IS LICENSED UNDER CC BY ND 2.0

with love). When we are more centered, fulfilled, and grounded, we find that it radiates out into every aspect of our lives. When our internal environment is in alignment, our external environment mirrors this back to us.

Your child self is not typically concerned with work, bills, and all the other responsibilities we face in our adult lives.

This is why tuning in to this part is so impactful for understanding how to love ourselves.

Friendly Reminders This journey will look and feel different for everyone. What works for me may not necessarily help another! As always, take what resonates, and leave the rest. Get as creative and playful with it as you can. When we adopt a curious mindset rather than a punitive one, the process becomes a whole lot easier because we have removed the internal pressure.

As with all things relating to progress and change, try to remember that the reward is not in the destination, but in the journey itself. Some days will come easier than others. We can adopt the mantra - I am worthwhile. I am unconditionally loved. I am deserving of happiness. I am meant to be here.

Happy discovering my loves! Be gentle with yourselves and have faith. 1 What is your favorite practice of self love?

Share your experiences with me in the comments section below! Want to talk more about how to develop your own self love practice? Contact me

by DMing me on Instagram @lotuscoaching13 or shooting me an email at lotuscoaching13@ gmail.com.

T I ME F O R YO U

(Dr.) Tina’s Tepsi Wr i tte n b y A l i ci a Ro sel l i

A

s you may have learned from last month’s issue, I’ve acquired a taste for middle eastern dishes. It’s the combination of spices, ingredients and preparation technique that make the “dish”. In honor of National Physician’s Week, this month’s issue highlights a recipe courtesy of Dr. Tina Tarazi and her sisters Tamara and Tara, the three T’s behind the website Three Teas Kitchen.

Doctor by day, food blogger by night… or wait… is it the other way around?

The recipe I chose to feature is called Tina’s Tepsi. I’ll admit I was a bit intimidated by both the time commitment (it was a workday mind you) as well as the main spice, which I had never heard of and didn’t have on hand. But I was determined - on the website Tina described this dish as her favorite, the ultimate comfort food. I was able to find the ingredients at our little lake-side grocery really it’s a clean and simple list - all but the bahar. Strike 1. Next came the typical phone call to my neighbor across the street who is my “go to” when I’m stuck in the kitchen. No bahar in their pantry either. Strike 2. Last resort - the online search for substitutions. Success! There were various suggestions out there, including https://threeteaskitchen.com/ baharat/. Based on what I had at my disposal, I used equal parts paprika, cumin and cinnamon. For the ground meat, I used turkey.

The outcome was wonderful. The prep time ended up being quite short, the recipe easy to follow. The aroma in my kitchen was mouth-watering, and all enjoyed the dish. I will definitely make this again - next time with real bahar. 1

Prep time: 1 Hour Cooktime: 1 hr 20 mins Total Time: 2 hrs 20 mins Ingredients: 2 lbs ground meat (85/15) 2 eggplants 2 peppers, any variety of colors work 1 large onion 6 ounces tomato paste (1 small can) 3 cups water 3 cloves of garlic, minced olive oil 3 tbsp bahar ~1 tbsp salt 2 large tomatoes

Directions: • Preheat over to 450F. • Mix meat, 2½ Tbsp. bahar and ½ Tbsp. salt in a bowl with your hands.

Shape meat into an oval, football like shape.

• Prep all the vegetables. Chop peppers into rings, and then large pieces once you reach the seed cavity. Chop onion into rings and tomatoes into large slices.

• Line 2 sheet pans with foil, grease (slightly generously) with oil.

• Peel eggplant and cut lengthwise into 1/4 inch strips. These strips should be slightly thick, as this will help with removal of eggplant from sheet pan and with rolling meat into the strips later. Place eggplant strips on greased pan and brush each strip lightly with oil and then sprinkle with salt.

• Bake eggplant for about 20 minutes, until strips are lightly golden.

• While the eggplant cooks, cook meat patties. Heat a pan to mediumhigh heat and drizzle a little of olive oil on the bottom. Once the oil glistens, place meat patties in and cook until lightly browned on all sides. Avoid overcrowding your pan, and cook in batches. Place meat patties on a paper towel lined plate once done to drain off excess oil.

• Once eggplant is removed from the oven, reduce oven temperature to 400F. Once the eggplant is slightly cooled, take an eggplant strip, place a meat patty on one edge and roll until the patty is fully rolled up by the eggplant (see pic).

• To make the sauce, combine tomato paste, water, 1½ tsp. salt, ½ Tbsp. bahar and garlic into a bowl and whisk until combined.

• Pour half the sauce onto the bottom of a large baking pyrex or casserole dish. Place meat/eggplant rolls into pan. On top of each roll, place first a tomato, then onion, then pepper. It's ok if they do not all sit evenly.

• Cover pan with foil. Bake for 60 minutes covered, then 15 minutes uncovered, then 5 minutes on high broil. Enjoy!

Reach Three Teas Kitchen on Instagram @ThreeTeasKitchen Source for recipe: www.threeteaskitchen.com WWW.PHYSICIANOU T LOOK . C OM | 35

AHIMSA

D R. DE SI G NED , K ID AP P RO VED SAFE, ECO-FRIENDLY AND FUN!

WWW.AHIMSAHOME.COM 3 6 | M A R C H / A P R I L 20 20

T I ME FOR YOU

Documentaries

P H Y S I C I A N O U T L O O K S TA F F P I C K S Writte n b y Pam e la Fe rm an

The Pharmacist

In 1999, after losing his son in a drug-related shooting and frustrated with the lack of response from police, a small town pharmacist – Dan Schneider – embarks on a pursuit to find and bring his son’s killer to justice. But months later, the ripple effects of his son’s addiction and tragic death would find him again when a troubling number of young, seemingly healthy people begin visiting Dan’s pharmacy with high dose prescriptions for OxyContin. Feeling a crisis long before the opioid epidemic had gained nationwide attention, Dan stakes a mission: Save the lives of other sons and daughters within his community. Then take the fight to Big Pharma itself.

Miss Americana

This revealing and insightful documentary about the career of mega superstar Taylor Swift, is a short but fascinating understanding of many of the struggles brought on through the pressures of fame. First released at the 2020 Sundance film festival, Miss Americana is part interview, part flashback clips – that hit the media by storm when Taylor reveals for the first time publically her battle with an eating disorder and the scrutiny of her political views. While being increasingly obsessed with being the “good girl” or shamed in front of her peers from Kanye West, Swift lays out the psychological work that was done to overcome the need of approval and admiration from others.

RECOMMENDATION FOR THE WHOLE FAMILY – SHOW YOUR KIDS A NEW PERSPECTIVE OF THE WORLD.

Minimalism: A Documentary About the Important Things

Imagine a life with less. The authors of two best-selling books on minimalism, Joshua Fields Millburn and Ryan Nicodemus, take viewers on a road trip across America that reveals the core ideas behind minimalism and challenges the traditional “American Dream” and “Keeping Up with the Joneses.” Millburn and Nicodemus are friends from college who lived the corporate rat race only to find that it never really brought them happiness. Though their paychecks grew, the void in their lives remained the same. Each had their own personal breaking point that moved them away from the consumer lifestyle. The film explores the ways that many different types of people are attempting to live simpler, more meaningful lives, and what really defines success.

Three Identical Strangers

David Kellman, Bobby Shafran and Eddy Galland believed they each had a normal childhood until the age of 19 when it was discovered by sure happenstance that they were identical triplets separated at birth. Hitting the 1980’s media by storm, everyone loved to talk about the similarities between the boys that were raised in very different households. However, as the interviews tick on – piece by piece the viewer is lead down a grim and disturbing path to unveil the story of what lead to the children’s separation. Torn between one of the most basic questions of psychology – what will win, nature or nurture?

WWW.PHYSICIANOU T LOOK . C OM | 37

I NT E L L I GE NC E O N TH E M OV E

An Introduction To “Physician Heal Thyself: A DOCTOR’S JOURNEY FROM MEDICINE TO MIRACLES” Wri t t en by Dr. S eema K ha nej a

W

hen I entered an accelerated medical program right out of high school, I was just 17 years old. I felt this burning desire to marry the science of biomedicine with the spirit of true service. Medicine was a calling that I had to answer. There was simply no other choice.

Did you feel this way too when you chose to become a doctor? Do you still feel this passion for medicine today that you felt as a young medical student? Or perhaps now, many years or even decades later, do you feel disillusioned, perhaps disenfranchised, and maybe even 3 8 | M A R C H / A P R I L 20 20

disgusted with the state of medical practice? With the rise in physician burnout and many physicians choosing to leave medicine all together, many of us might be questioning our initial choice to become a doctor.

This brings me to my very first book which I recently self-published, Physician, Heal Thyself: A Doctor’s Journey from Medicine to Miracles (A mindful approach to healing based on teachings of A Course in Miracles.)

Physician, Heal Thyself is my exploration of the bridge between Western medicine and spirituality from my

vantage point as a traditionally trained medical doctor. Drawing from my personal and clinical experiences along with scientific research, I share a clear explanation of the basic principles of A Course in Miracles, long regarded a classic among modern spiritual teachings.

My book also offers simple, expansive, and effective tools for healing.

Here’s how my book begins: “During the summer following my high school junior year, almost a year before I would enter an accelerated medical school program, I experienced a profound

mystical experience while visiting my native India. It was what Abraham Maslow would have referred to as a peak experience, when time stands still and all barriers between me and other simply dissolve.

In that moment, I experienced a sense of completeness and wholeness in which nothing was lacking and there was no need for me to do anything.

When I returned to the States, I found myself immersed in the maze of medical school applications, SATs, and college essays. Wherever I turned, the voices I heard all seemed to demand that to survive in this world, I needed to make something of myself. Being just as I was—well, that simply was not enough!

Eventually I yielded to this worldly pressure and enrolled in medical school.

Yet something about this path never seemed right. I had so many questions that were not being answered in my medical school training: What is healing? How can we support healing? What are the obstacles to healing? What is the role of a doctor in healing? What is my purpose in becoming a doctor?” 1 My friend, Dr. Marlene WustSmith, who asked me to write this article, felt inspired to start Physician Outlook because she feels a strong desire to create a safe space where we can each find our answers to these questions. I believe at some level all of us as physicians seek to answer such questions using the framework that resonates most for us. We might feel drawn to lobby for changes in the sociopolitical aspects influencing access to health care. Or we believe strongly that fundamental shifts are required in medical student education, associated costs, student loans, and debt. Perhaps we are adamant that cutting medical expenses at the risk of delivering substandard health care simply cannot be a viable option.

Through my book, Physician, Heal Thyself: A Doctor’s Journey from Medicine to Miracles, I share the answers I have discovered. But my book is not about sweeping health care reforms or external ways to dramatically change anything about our health care landscape. Rather,

my book is a clear, systematic roadmap for the inward journey that I believe we are all being called to take so that the broken health care system that we try so desperately to fix with all sort of BandAid approaches can be healed - but from the inside out. I wrote my book because I felt inspired to share this profound message with all those who feel ready for a radically new way to see themselves, their patients, and their role in medicine and healing.

The ancient Chinese philosopher and writer, Lao Tzu, wisely shared the following: “If there is to be peace in the world, There must be peace in the nations.

If there is to be peace in the nations, There must be peace in the cities.

If there is to be peace in the cities, There must be peace between neighbors.

If there is to be peace between neighbors, There must be peace in the home.

If there is to be peace in the home, There must be peace in the heart.” 2 Before we can heal our health-care system, we need to turn inwards and heal ourselves. Not just our bodies but also our minds and hearts – specifically, our perception of ourselves, and the world around us which includes hospitals, patients, pharmaceutical companies, health care administrators, nurses, and all other health care practitioners. If we are to heal, we must first experience peace of mind and inner happiness on a consistent basis- not just when we take off time to vacation in Bermuda or some other distant tourist spot.

In my book, I share how as a young medical student I intuitively knew that healing lay beyond the body. Yet all I seemed to learn during medical school was just about the body! I recall how whatever joy, love, and wonder I felt for healing faded away as I listened daily to lectures about organs, tissues, cellular processes, and biochemical pathways, and the body’s deterioration, disease, dying, and eventual death.

“I felt like I was living two lives. As a medical student and later resident, I was

being trained to constantly look outside to figure out which patient factors needed to be manipulated, such as diet, medications, surgery, and exercise, to achieve optimal health. Yet deep within, whenever I was outside of the confines of medicine, I felt a desire to simply let go of all need to control anything and just give myself over to a life devoted to meditation, prayer, and spiritual exploration.

To resolve this conflict, I began to study many different complementary and alternative health modalities. I discovered that most of these healing systems spoke more to the inner psychosocial and spiritual aspects of healing. Often when I should have been studying for exams during medical school, I began to hang out at the selfhelp and alternative healing sections of my local bookstores and library. Voraciously I read books by Deepak Chopra, MD, Bernie Siegel, MD, Louise Hay, Edward Bach, MD, Shakti Gawain, and others.

I attended their workshops and seminars and tried to share this with my medical school friends—most of whom thought I was crazy! I even traveled to India and Nepal, so I could explore yoga and meditation as well as Ayurveda. All these experiences helped me to nurture my vision of a more expansive healing system that viewed each of us as much more than a WWW.PHYSICIANOU T LOOK . C OM | 39

PHOTO COU RTESY OF IN GRA M IMAGES

soup of biochemical reactions and neurological pathways.” 3 Eventually, after graduating from the Mount Sinai School of Medicine in NYC and completing my pediatric residency at NY Hospital-Cornell Medical Center, I felt inspired to create an integrative medical practice where I worked with children and adults facing complex medical and mental health issues.

I shared homeopathy, yoga, meditation, Ayurveda, and Reiki with them. I found that in cases where the traditional medical model failed to help, many responded favorably to these alternative modalities.

However, I would not fully understand what true healing was until I found myself unexpectedly spiraling into a state of deep sadness following a falling out with a dear friend. At the same time, I was facing a personal illness that eventually resulted in chronic pain. Despite all my training in traditional and alternative medicine therapies, nothing seemed to heal my pain. I felt helpless and powerless. It was during this time that I found myself reaching for a book titled A Course in Miracles (ACIM).

I was already somewhat familiar with ACIM from my regular forays into the healing and spirituality sections of my neighborhood bookstores as a young medical student. However, while the words of ACIM were comforting, the 4 0 | M A R C H / A P R I L 20 20

book felt remote to my life. But now, in the midst of emotional and physical pain, the Course felt like my most trusted friend and advisor.

“Like soft moonlight that soothes as it shines, the Course drew me out of my depression and taught me about the healing power of forgiveness. As I devoted myself to practicing the teachings of the Course and joining with other Course students and teachers, the light I had been constantly shining on my physical discomfort and emotional turmoil turned inward to the source of my pain, which lay in my perceptions, inside my mind.

I became more interested in discovering what was blocking my peace and joy from within, instead of constantly searching outside for relief in the form of some temporary Band-Aid. Instead of changing what I saw, I committed to change how I was seeing. Gradually, my physical pain disappeared, and this truly was a miracle. Yet I realized that this physical shift was simply a reflection of the deep healing inside my mind, and this was the true miracle.” 4 When I healed from my pain, I realized with complete certainty that the most powerful source of healing lies within our own minds- in our perception, awareness, and attitude. This profound understanding impelled me to create Coaching for Inner Peace - a

simple, elegant, inclusive, and expansive approach to healing that I was searching for ever since I was a young medical student. I am so excited to share this with you all in my very first book!

Coaching for Inner Peace is rooted in science, specifically in cutting edge research in quantum physics, the stress response, the placebo effect, and neuroplasticity. I also draw from the teachings of world spiritual traditions with the aim to share simple yet profound tools and practices for healing; these include mindfulness, prayer, meditation, chanting, listening to the still small voice within our hearts, choosing love over fear, forgiveness, gratitude, being clear about our purpose, connecting with our desire for healing and peace, and joining with our mighty companions.

My goal is that we experience consistent joy and peace, which I firmly believe is our birthright. It is from this space that all healing emanates. I invite you to open to an inward journey to inner peace and stable joy while you negotiate whatever challenge you face.

Perhaps you can share this approach with your patients, and this can grow to include your family and community.

Maybe this will be something that expands to include our larger society along with our health care system.

But for now, the most important task you can do is to heal yourself.

Amazingly, this is the most profound gift you can give to others as well.

Physician, Heal Thyself: A Doctor’s Journey from Medicine to Miracles is available on Amazon in both paperback and Kindle editions. If you want to learn more about me and my work, please visit coachingforinnerpeace.com 1 Sources: 1. Khaneja, Seema. Physician, Heal Thyself: A Doctor’s Journey from Medicine to Miracles (A mindful approach to healing based on teachings of A Course in Miracles) 2. Lao-Tzu https://www.goodreads.com/ quotes/125184-if-there-is-to-be-peace-in-theworld-there 3. Khaneja, Seema. Physician, Heal Thyself 4. Ibid.

IN TELLI G EN C E ON T HE MOVE

Hostage Wri t te n b y D r. F a t i ma G Wild e r

Today you held me hostage.

Two hours of my life. Stranded. Stuck.

I couldn’t do anything more than lay, still, staring.

At you.

Examining your perfect eyelashes. Listening to the mouselike whimpers that escaped from your being every few minutes. Breathing in your sweet breath as our noses sat one inch away from each other. Feeling your warm chunky palm stroke my cheek every now and then. As if to remind me that even in your sleep you wanted me close.

In my head, I ran through the list of things I was supposed to be doing. How my “vacation” was being sucked up with everything but what I needed to get done.

As I lay there, almost cramping from laying so still for fear of waking you, it became clear...

When I am in my next 6 hour case. When I yet again have to miss bath time and bedtime. When I can’t be there to snuggle you the next time you are sick. I will think back on these two hours that you gifted me. And thank you silently for holding me captive. 1 WWW.PHYSICIANOU T LOOK . C OM | 41

Fit, t e G

iery F , e Fierc

ous! l u b Fa and

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EXC LUS IVE AT WWW. PH YSI CI AN O UT L OO K . C O M

there is a "secret" message on the inside!

E MAI L H E LL O@ PHY S I CI AN OUT LO O K . C O M FOR AN OR DE R

4 2 | M A R C H / A P R I L 20 20

WHAT IS PRACTICING PHYSICIANS OF AMERICA?

A nonpartisan community of physicians who work cooperatively to communicate the voice of the working physician Into the future of the profession of medicine.

BECAUSE,

Unlock the future of healthcare.

RESTORING THE RIGHTS OF PHYSICIANS AND THEIR PATIENTS.

VISIT

HPEC.IO

TODAY!

WE BELIEVE IN PATIENT SAFETY AND PHYSICIAN AUTONOMY. WE BELIEVE THAT PATIENTS DESERVE THEIR OWN PHYSICIAN. WE BELIEVE IN THE SANCTITY OF THE PATIENT-PHYSICIAN RELATIONSHIP. We have published in National newspapers, been your voice in the halls of Washington DC and state government, and led the fight against MOC

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Mindful Marathon Coaching You to Love the Run mindful-marathon.com

Publisher: Dr. Marlene J. Wust-Smith, MD Editor in Chief: Alicia Roselli VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Social Media Intern: Priscilla Contreras Contributing Authors Paula H. Cookson LCSW, freelance writer, JR Hill, Dr. Nana Dadzie Ghansah, Susan Shannon, Dr. Jasmine Kudji., Kaylie Dudelson, Dr. Mercy Hylton, Dr. Mary Tipton, Dr. Saya Nagori, Grace Huang, Pamela Ferman, Dr. Seema Khaneja, Dr. Fatima G Wilder, Dr. Ashley Sumrall. Original Artwork: Dr. Dana Corriel, Dr. Saira Rahman, Dr. Chetna Singh Published By “Physician Outlook Publishing” Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues.

The views expressed herein are those of the authors and/or those interviewed and might not reflect the official policy of the magazine. Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@physicianoutlook.com “Physician Outlook is a registered trademark” WWW.PHYSICIANOU T LOOK . C OM | 43

A PPE Prayer Wri t t en by A nony m ous

Lord, as I put on my eye protection, I pray that You open my eyes to see Your precious face in each patient I care for.

As I put on my mask, I ask that Your words are on my tongue, to speak Your wisdom and comfort.

As I put on my gown, please wrap Your arms around me and give me strength to strengthen others.

As I put on my gloves, I ask that You steady my hands to do Your work.

As I remove my protective equipment, I implore You to remove any traces of my selfishness and pride.

And when I wash my hands, please wash away my fears and doubts.

Protect me, Lord, so that I may protect others. Grant me courage; I am here to do Your will. 1