"Celebrating Diversity in Medicine" Cover Art Created by Dr. Marlene Wust-Smith by Physician Outlook Magazine

ISSUE 5 | VOLUME 1

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Cover art by Dr. Marlene Wüst-Smith

IN HONOR OF MENTAL HEALTH MONTH F R O M T H E P U B LIS H ER

VIRTUAL SCREENINGS & PANEL DISCUSSIONS EVERY SUNDAY IN MAY REGISTER AT www.DoNoHarmFilm.com The Publisher’s 10th – Transforming Medical Culture Response 17th - COVID19: Preventing Vicarious Trauma & PTSD TO THE ISSUE OF SYSTEMIC RACISM AND THE BLACK LIVES MATTER MOVEMENT, JUNE 2020

24th- Unionizing & Physician Independence 31st – Fighting Back: Legislation, Lawsuits & More Wri t t en by Dr. Ma rl ene W ü st- S mi t h

THE FILM: Ahisgroundbreaking filmportive about the hidden epidemic of issue of Physician Outlook group “Dads Married to Docget involved and “dough something” to an suicide and burnout. Doctors take anmale oath to do harm but is dedicated to persons of tors” where members of allno shades show support for the Black Lives Matand colors unitetrapped over their common ter movement. taking theircolor, own particularly lives at anblack alarming rate, in a toxic health Dr. Natalie Newman physicians, makelives up onlyat 5%risk of as bond as fathers to physicians.they blesses us with her gift of the written stem that putswho their well as married the patients serve.

the doctors in the United States.

Dr. Megan Babb continues her

word in her piece “Take A Knee,” and

We do not know what it feels like

Sekhmet series by shining light on

Dr. Poonam Bhatia shares her poetry

We need to listen more and talk

color who simultaneously aspire and

In my article titled “Confessions

to walk infilm. your shoes. three remarkable women physicians of art,to inspired by current events. "Excellent Just the right balance of compassion butand call action.”

less to understand your perspective. inspire all who they encounter. a (recovering) Color Coward” I de"That was an amazing experience! What a great wayofto connect This is what it takes to become “Color Dr. Sarah Rowan’s bravery inspired scribe how it took seeing my nephews with a larger community.” Brave.” a website and Instagram page that feamature into young, black men that In this month’s issue of Physician

tures breathtaking works of art inspired

made me become less of a coward.

Outlook, Dr.film Lulu (aka “the so Momawomen of color on the front lines. We multiple are more alike times, than we are difis a wonderful -- on manyby levels. I was moved to tears trician”) spells out Commandments #DoughSomething movement ferent. We are all humans. It’s time we and it reminded me15 of the whole The range of emotions from residency and med will help parents teach their chilwas started by pastry chefs and cookie all started behaving that way. 1 school that that I have stuffed and repressed for decades. I'm so glad I attended dren about racism. artists outside of medicine; Dr. Shruti Dr. Marlene Wüst-Smith the event, and so glad for the panel afterwards.” Curtis Webster describes how and Desai tells the tale of the crafty kitchPublisher

why he started the wonderfully sup-

en doctors who themselves decided to

vate screenings email us at www.DoNoHarmFilm.com 2 | J U N E / J U LY 2 0 2 0

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Table Of Contents F ROM THE PUBLI SHE R

The Publisher’s Response By Dr. Marlene Wüst-Smith / p.2 V I PP SPOTLI G HT

Dads Married To Doctors By Curtis Webster, Jr./ p.6 Women Of Color On The Frontlines By JR Hill/ p.8 Mistaken Identity By Dr. Poonam Bhatia/ p.9 BA BBLI NG S

The Sekhmet Writing Project 2/12 By Dr. Megan Babb/ p.10 NE W NE W S

How to Teach Your Children About Racism By Dr. Uchenna Umeh/ p.14 False Equivalence By Parvez Dara, MD, MBA and Craig M. Wax, DO/ p.18 Restoring American Communities Safely By Joe Annotti/ p.20 TI M E F OR YOU

Green Eggs and Ham Chickens? By J Ross aka John Roselli/ p.22 #DoughSomething Together By Dr. Shruti Desai/ p.24 A DVOC AC Y I N AC TI ON

Take A Knee By Dr. Natalie Newman/p.28 Dirty Knees By Alicia Roselli/p.29 The Comeback Kid By JR Hill/p.30 Collateral Damage Due To Covid-19 By Estine Wells/p.32 OF F I C E SPAC E

Direct Primary Care By Dr. Kimberly Corba/p.34 Additional Healthcare Benefits By Dr. Aakanksha Asija/p.36 My Doqter By Shilesh Iyer, M.D., Founder myDoqter/p.38 Design Thinking By Nathan Eckel/p.42 INTE LLI G E NC E ON THE M OV E

Confessions Of A (Recovering) Color Coward By Dr. Marlene Wust-Smith/p.44 I Can’t Breathe By Dr. Poonam Bhatia/p.47 2020 #ColorBrave Summer By Dr. Marlene Wust-Smith/p.48 WWW.PHYSICIANO U T LOOK . C OM | 5

V IP P S P OT LIG H T

Dads Married To Doctors Wri t t en by Curt i s Webst er, Jr.

“If we’re going to date and get married, I want to make sure you understand that I’m GOING to become a doctor, and I need you to be on board with that.”

y name is Curtis Webster Jr and I’m a Dad Married to Doctor (DMD). My wife, Emergency Medicine Physician, Dr. Allison Webster, knew from the age of 6 watching Dr. Huxtable on TV that she wanted to practice medicine. When we met, day one at UNC Chapel Hill and started dating 6 months later, she made sure I was aware of her goal… and I’m glad she did. Now 15 years of marriage and 3 amazing daughters later, I realize how I had NO CLUE what I was agreeing to. There have been some amazing ups and downs during our medical marriage. There were times I felt very isolated and alone with very few I could turn to that would truly understand the DMD lifestyle. While the US statistic for women in medical schools is just now reaching 50.5% my wife’s class was already half 6 | J U N E / J U LY 2 0 2 0

If you’d like to learn more about the Dads Married to Doctors organization, please visit our website, www.dadsmarriedtodoctors.com.

female in 2005. By her graduation in 2010, there were several physician families, but the support group that was created for them catered to the medical students. During our entire married lives, I have worked (in and out of the home) while serving as the primary caregiver to our children alongside an amazing wife who herself has also worked (more than a full time schedule in residency) and also gone out of her way to be involved in the lives of our children. After finishing residency, we completed our 4th move in 9 years, welcomed our third daughter, and added a new and very exciting zero to the end of Allison’s salary. At that same time, we also upgraded our car to accommodate three kids, built a new home, and oh yeah, we were immediately hit with six figures of student loan and credit card debt that had been piling up.

With all these changes and new experiences that neither of us felt prepared to handle, we both were looking for an outlet. We both were looking for support. Allison found it in a newly established group of Physician Moms. I searched and looked and asked around, but could not find a community for me. December 27, 2014, right after we celebrated Christmas and started looking toward our goals for the new year, I decided to create what I had always been looking for, and Dads Married to Doctors was born. Now with over 4,000 members throughout our global community, we have a MISSION to strengthen the physician family by empowering and educating one another to become better dads and husbands. A support system of men committed to helping one another bridge the gap between fatherhood, marriage and manhood.

Through our private Facebook group, https://www.facebook. com/groups/dadsmarriedtodoctors/, and our website, www. dadsmarriedtodoctors.com, we provide curated content and resources to our members such as: • Community posts and interactive conversations • Blog articles from DMD members and guests • Virtual Discussion Forums and Guest speaker events • Regular local meetups/events in several cities (now held virtually) • Book Club and educational led discussion • Yearly DMD Retreats • DMD Spotlight Podcast • DMD Gives Back, our charitable fundraising initiative that’s donated $10,000 to date. DMD member SB said, “I am so grateful for DMD. I was really struggling internally before joining and now I’m much more confident in my role as a husband, a father, a man, and a DMD! We’re here to support each other. DMD4LIFE!” Serving as the primary caregiver for our families and supporting our busy physician spouses is a very unique role. For many men, this role reversal, according to our societal norms, creates a lot of additional stress. Along with our spouses, we all have the normal worries of life such as finances, providing for aging parents, raising kids, maintaining or improving our own health, work, household responsibilities and more. DMD lifestyle is all about us doing life together and learning from each other to create a better life and lifestyle for our families and communities. I have seen in our 5+ years of doing life together that strong personal connections are one of the main ways physician spouses can not only survive a medical marriage, but thrive in a medical marriage. Life is better, when we do life together! 1

Curtis is a dad to three divas and has been married to his ER Doc wife, Allison, since 2005. Life is busy, but life is good! He enjoys bourbon, poker and meeting new friends, which is what led him to create the group, Dads Married to Doctors. His mantra is “Life is BETTER, when we do life TOGETHER!” WWW.PHYSICIANO U T LOOK . C OM | 7

C RE DIT A RTIST DR SA RA H ROWA N

V IP P S P OT LIG H T

Women Of Color On The Frontlines

Wri t t en by JR H i l l

r. Sarah Rowan is an Infectious Disease Specialist in Denver who recently created Women of Color on the Frontlines, a visual depiction of physicians who have been front and center of the COVID epidemic. What started out as a simple plea in a Facebook group has exploded into a movement that has generated so much interest they now have a website, Facebook page, and Instagram account, and her inspirations will soon be featured in a virtual exhibit in Denver. Describing the events that led to her idea Rowan states, “When I saw the New Yorker cover with the female physician in full PPE video chatting with her family from work as her husband put their kids to bed, I was so touched. I felt like my role as a physician mother was validated and honored”. But as a female physician, Rowan believed that art, media, 8 | J U N E / J U LY 2 0 2 0

and news outlets were not honoring or recognizing women of color in medicine. This project started as a simple request to a physician moms’ Facebook group for photos of women of color that could be used for portraits. The response was more than she had hoped for. More than 150 women shared photos of themselves on the frontlines, most wearing the personal protective equipment they wear every day to protect themselves and others. “I put out a call out to my artist friends to see if anyone else wanted to do some portraits. Several signed up right away, and many recruited their artist friends, who recruited their friends, and so on.” The artwork displayed on their website has been created by fellow doctors, a CPA, a librarian, and even professional artists! “These creative souls are using their talents to recognize the amazing service these doctors provide.”

When asked where she thinks this crusade will take Women of Color on the Frontlines Rowan hopes the will inspire donations to non- profit organizations working in this area, specifically those linked to supporting healthcare workers and encouraging people of color to go into medicine. As a physician who is also an artist, Rowan hopes to continue capturing the unsung heroes that continue to give of themselves tirelessly everyday to fight the spread of COVID-19. You can find more information on Women of Color on The Frontlines on their Facebook page or check out their website at https://www.wocfrontlines. com/ 1 You can find more information on Women of Color on The Frontlines on their Facebook page or check out their website at https://www.wocfrontlines. com/

VI PP SPOT LI G HT

Mistaken Identity Writte n b y D r. Poonam B hatia

You mistook My love for dependence My kindness for ignorance My restraint for innocence My silence for helplessness My need for peace and harmony for my weakness My second, third, fourth chances you mistook for my naiveté My supplicant nature for insecurity You saw the turbulent waves and missed the vast stillness below You scoffed at the tears and missed that it nourished the seed you buried oh so long ago You saw the fury of the tornado and missed the calm before the storm That weak, dumb, insecure woman you toyed with, was but a figment of your misogynist imagination! The reality is that I am a strong, benevolent woman full of grace and compassion! Kind, selfless, forgiving, powerful and generous.......and yet You raped You plundered You pillaged You drained You ravaged

I said NO MORE This game of mistaken identity, I refuse to play it anymore! No more dimming of my light No more playing small and hiding in plain sight No more denying what is my right No more interfering with my flight For now I know who I am I stand resplendent in my own might .... 1

MISTAKEN I DENTITY CRED IT ARTIST DR. POONAM B HATIA

You took and took and took until it was too late, You crossed the line, you wrote your fate

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B A B B LIN G S

T w o | T w e lv e: T h e L ig ht B r

The Sekhmet Writing Project 2/12 THE LIGHT BRINGERS Wri t t en by D r. M ega n B a bb

hey move through the earth as if similar to you and I but that is part of the disguise. During the day, their light pervades, ultimately blending with the rays of the sun. But when the sun goes down and the world becomes dark this is when their shine is sublime. Throughout healthcare, spaces of darkness exist that hide profane elements of inequality and injustices for minority patients. The danger they possess is through their contribution to the already present socio-economic gaps existing in America today. By widening their margins, social determinants of health have emerged and have unequivocally added to the health disparities seen in our healthcare system. While these elements thrive in the 1 0 | J U N E / J U LY 2 0 2 0

darkness, light has finally shone upon them. If we were to trace the rays of such brightness to its source, we would find it comes from those who hide in plain sight. While all Light Bringers expose what hides in the darkness, the methods in which they achieve this are unique to each Light Bringer themself. Dr. Joan Bianca Roberts It was nearly ten years ago the first time I met Dr. Roberts. She was a resident physician and I was in my last year of medical school. Her journey to becoming a physician started at a young age. Growing up South Sacramento, California, she thrived in academia. Her love for the sciences and community involvement

ultimately earned her an undergraduate seat at the University of California San Diego where she would go on to study biochemistry. Though unsure what she would choose for a career, she was encouraged by a mentor to pursue a higher degree in the practice of medicine.

Dr. Joan Bianca Roberts

B ri n g e rs

This led to a primary care shadowing opportunity in La Jolla, California that ultimately would change everything for her. “As a Black child growing up, I thought everyone was destined to develop high blood pressure and type two diabetes. I was under the assumption that these particular disease states were absolute with aging. However, when I shadowed a primary care physician in a predominately white upper-class area of San Diego, I learned this not to be the case. It was here when I learned that a patient’s environment and their access to affordable and appropriate health care contributed greatly to the risk of disease development. This was my point of realization. I wanted to be a conduit of health information for

my patients as well as the access my community desperately needed to live a healthier life.” Dr. Roberts was accepted into the University of California San Francisco’s Medical School in 2006 where she embarked on a five year track program-PRIME, that aims to provide future physicians with the tools needed to give medical care and support to the underserved communities of America. The light that Dr. Roberts brings to the practice of medicine originates from her unique ability to provide unbiased and unrestricted care to patients who are often marginalized by the practice of medicine. This gives birth to a massive wave of positive energy strong enough to cause mass disruption of the highly clung-to status quo of America’s healthcare system. In just five short years of practice Dr. Roberts has become the division chair of family medicine where she practices. It is in this arena she not only leads by example for her fellow colleagues but she leads change towards inclusivity. She provides light to her patients and unselfishly to her colleagues as well. This allows them to acknowledge their own biases both in gender and in race, ultimately helping them become better physicians for their patients and better champions of health for their communities. I have had the honor and opportunity to work with Dr. Roberts for five years now and just as she was the first time I met her, she continues to be the reason darkness is losing its space in healthcare. It is a privilege to know her. Her advice to help empower women: As women, it is not good enough to only recognize in one another our potential to achieve greatness. We also need to help one another achieve greatness by recognizing those who take their names out of the hat for positions of leadership due to insecurities stemming from outdated and patriarchal norms. If we support one another, the norms will be challenged. When the norms are challenged change is possible.

Dr. Lori Bryant

Enter Dr. Lori Bryant In 2019 Dr. Lori Bryant was the recipient of The Viking of Distinction Award given by her alma mater, Omaha North High School in Omaha, Nebraska. This award is meant to honor graduates who have achieved outstanding success in their chosen careers. They are individuals who have demonstrated a willingness to provide mentorship to younger generations, helping to inspire and expose children to different career opportunities at a young age. It is no wonder the sentiment of this award felt by Dr. Bryant, considering the woman behind her aspirations to become a physician (thirty years prior), was in attendance watching as she received this distinguished award. Dr. Bryant grew up in Omaha, Nebraska born to a mother and father who believed that collectivism should come before individualism. When she and I spoke for this piece she said, “As a child, I would react differently than most children when face to face with sadness. There always was (and still remains) in me, a strong desire to remove it in others. I learned at such a young age that to help better another is also to better the individual” Both her parents were strong advocates for equality and through their work with both the Boys Club and the local Community Center, they taught Dr. Bryant the value of giving to those in need. She described fondly the regular weekends, afternoons and holidays she and her family spent helping those at the Community Center. From these experiences she further maturized her innate ability to empathize with others. WWW.PHYSICIANOU T LOOK . C OM | 11

Her advice to help empower women: Be proud of your story, own your story and be willing to share your story so that other females can be inspired to become our future leaders.

Dr. Ayana Jordan

As a pediatrician now, it is evident that ultimately this would become the foundation of success her career in medicine was built on. The light that Dr. Bryant brings to the practice of medicine originates exclusively from her overwhelming ability to empathize with others both alike and not. Not only does she serve as a mentor for many young Black women, but she consistently serves as a mentor for ALL female physicians in medicine. The foundation supporting America’s healthcare system, intentionally or not, gives way to racism and healthcare disparities amongst minority populations. For those physicians who practice medicine void of such populations, it is very easy to remain blind to those disparities existing outside their bubble. However, Dr. Bryant has an incredibly rich way of teaching her colleagues about the racial disparities existing in healthcare and does so in a way that allows a safe place for vulnerability and humility to lead the learning process. Her words are as refreshing as a breath of fresh air. To be a female physician in medicine is challenging, however being a Black female physician in medicine is even greater a challenge. Yet using her empathy as a driving force, Dr. Bryant pushes beyond the existing barriers in medicine by encouraging others to recognize the pervasive biases that leave our minority patients and colleagues vulnerable. In the three years I have personally known her, I can say with complete certainty, to know Dr. Bryant is to be a better human being. 1 2 | J U N E / J U LY 2 0 2 0

Enter Dr. Ayana Jordan As a child growing up in America, Dr. Ayana Jordan credits her inspiration to become a physician from none other than television icon, Dr. Cliff Huxtable. “To believe you can be something requires an objective visual. Seeing a Black individual in the role of physician, created a space for me to see myself similarly. In other words, though only a child at the time, I could visualize myself as a physician. It was nothing short of inspiring.” Dr. Ayana grew up with dual parent educators who helped foster a love for the sciences. After obtaining her undergraduate degree from Hampton University, she found herself stuck somewhere between two roads. One road led to a PhD. The other, towards an MD. When she landed a coveted internship with the NIH (National Institute of Health) working with talented researchers in Immunotherapy, she realized that though a bold decision, she would forgo choosing one passion over the other and instead enroll in the dual MD/PhD program at Albert Einstein College of Medicine. “When I first moved to New York, I lived in the Bronx and prior to this, never knew that poverty existed in America like it did here. It was evident, culturally informed care was lacking for minority patients and many suffered from mental illness without adequate options for treatment. They deserved better. When I did my first clerkship in psychiatry, I knew I had found my home.” She would go on to shock herself by applying for one of the few highly coveted psychiatric residency positions at Yale University. “When I matched, I had no idea what I was getting myself into,” she said. “Ironically, it had everything to do with the illusive white ivory towers.” The structural advantages favoring the white race along with embedded racial biases within American academia are

both widespread. In fact, the academic success of White students was built on a foundation supported by white privilege. This model of education in our country ensures the success of future white generations by providing more than adequate academic tools necessary for them to succeed in white-prodimanate areas. However simultaneously, with intent or not, this model also creates a disparagement towards the minority populations that it fails to recognize, thus favoring white interests above others, weakening nearby minority communities and further widening the racial divide. The light that Dr. Jordan brings to healthcare is embodied by her willingness to challenge the racial biases existing in university academics. Academia in America is a machine with nearly impenetrable walls, yet she has done just that. Her ability to enter into the White Ivory Towers of Yale University and unapologetically rearrange the system is nothing short of inspiring. Cultural brokering is an exhaustive endeavor for any minority to embark upon. It is apparent Dr. Jordan’s light originates from her unbridled strength, her unwavering ambition, and her ferocious tenacity to dismantle a system that has long prevented Black individuals and women from entering into the fold. To know Dr. Jordan is to be at the center of inclusivity where exclusivity is nowhere to be found. Her advice to help empower women: You can’t be what you can’t see. Stay connected so that you can help a new generation of women see themselves in the woman you have become. Find inspiration from sisterhood, navigate sexist spaces, and do it all knowing you never have to do it alone. To empower women, is to do just that, empower women. This edition is dedicated to all my Black female colleagues who have suffered more than I will ever know. Thank you for your patience, allowing individuals like myself the opportunity to listen, to learn, to change. 1 #BlackLivesMatter

K ERRY WASHINGTON

STE V EN PASQUA LE

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N EW N EW S

15 COMMANDMENTS ON

How to Teach Your Children About Racism Wri t t en by D r. U c henna U meh

s parents, we are in the driver’s seat. As if the quarantine and lockdown were not stressful enough, due to the recent happenings mainly here in the United States, we have now come face to face with the reality of our poor, no, sorry state of race relations. Even if you don’t live in the US, you are still required to do what is right by your kids in regard to teaching them about racial biases, prejudice, and systemic racism when necessary. Do you know that racism and prejudice are mostly rooted in fear? Fear that comes from a lack of understanding? Yes. Ignorance leads to fear, fear leads people to draw the wrong conclusions, and soon those conclusions become their truth. And then they are ruled by a con1 4 | J U N E / J U LY 2 0 2 0

cept based on falsehoods like all Black men are a threat, before you know it, it becomes a system and a “way” of doing things and that’s when the cookie crumbles. Yeah, I know, having that conversation about race is one that some people have neither ever had, nor want to have (but obviously need to), while others find themselves having the conversation nearly every day in their lives. Well, it has to start, and the time is now. Things must begin to change. The world is actually witnessing just how dangerous being “color blind, or color neutral” can be. An issue Blacks have dealt with for years. You see, what happened to George Floyd, can literally only happen in Amerikkka, oops, my bad, America. For over

400 years Blacks in America have continued to work more than twice as hard to be recognized half as much. The dehumanization must stop! And those who are silent now, MUST examine their why. Some much-needed soul-searching must be on everyone’s to-do list…now! Sadly, our children are caught in the cross-fire. The other day I asked the following question on my Facebook page: What would happen if we put 10 children in a room for 10 minutes? The answers were interesting. The kids will start playing with each other right away. But if you performed the same experiment with grown-ups, they will either say nothing, or team up according to some categories, preconceptions, and even misconceptions about each other.

P HOTO C RE DIT OF IN GRA M IM AGE S

So, inspired by a Facebook post that a friend of mine tagged me on, I decided to write to you today, with my thoughts on how parents should approach the elephant in the room: The talk about race, with their young’uns. Enjoy! 1/ Thou shalt first become comfortable with having uncomfortable conversations with thyself, before ever trying to have them with any other person. Yes, at this point in our earthly lives, we must as a matter of urgency get into that space of vulnerability and face our fears and insecurities. Dig deep to figure out why we are uncomfortable and get past that point with intention and focus.

2/ Thou shalt educate thyself properly, and gather all the facts that thou might need, and yet not have, before embarking on any such discussions with thy children. Children are smart, they will see through your charade. They are already learning about it or hearing about it, so you might as well be their guide. I know that talking about race can be sensitive, and yes, even a bit messy, but the other option is not an option, so just buckle up and do it.

mans are social beings, we love to eat during celebrations. So, when next you go to visit your Nigerian friend perhaps (wink wink), ask about fufu ati efo riro, jollof rice with “shikin”, fried plantains (dodo), isiewu (goat head delicacy), ofensala (fish pepper soup), or nkwobi (cow foot delicacy) to name a few. These are seriously tasty mouth-watering meals that you can only learn about by having an open mind. Take it from me, they are all #delish!

3/ Thou shalt ensure that thy abode is racist-free. Remember, information can be conveyed by thoughts, words or deeds, and thy kids will absorb them all from thee. Yes, you might be racist, your words might be racist, or your actions might be racist and you might not even be aware of it, but your kids will, and then it might be too late for them to unlearn the bad lessons.

7/ Thou shalt listen to music and learn dance moves from other cultures…yes, thou must! I told you to have an open mind. While I wouldn’t necessarily ask you to learn the acrobatic nkpokiti, or break-dancing, it is certainly time to expand from your line dancing days to something else that is fun and exposes a whole new world to you. Your kids will love the moves, the melody, and the novelty, and they can brag about their new skills to their friends. This could also be a form of a bonding exercise for y’all.

4/ Thou shalt first find out from thy kids what they already know about racism (if age applicable) before proceeding with the teaching. A simple question and answer session will suffice. There is no point in building a house upon a faulty foundation. First, dig up the old one, find out what the kids know, reteach them the correct information, and then proceed with teaching them new things. 5/ Thou shalt expose thy kids to other cultures, by visiting their museums, their churches, or attending civic events organized by them. There is no better way to get immersed in African American, Jewish, Native American, or Hispanic history than by visiting their museums, civic centers, places of worship, or one of the many events these cultural communities often hold in a city near you. The time is now! Summer is here, so, put on your masks and get going!

8/ Thou shalt encourage thy kids to make friends with, and visit homes of kids of other races, and have them visit your home in return. Get to know their parents, and learn a thing or two about their history and upbringing. Extend a hand of friendship. Offer to take their kids to a game, pick them up from school or even buy them dinner. Get out of your comfort zone a bit. Live just a little bit, you might even like it.

6/ Thou shalt endeavor to cook, order-in, or learn about foods of other ethnicities. This is a must! HuWWW.PHYSICIANOU T LOOK . C OM | 15

10/ Thou shalt police thyself, thy relatives, and thy kids with purpose, intention, and mindfulness. Yes, you must ensure that you are not perpetuating intolerance, hate, or prejudice in any way. You know your family members who are racist. Everyone does. You must be bold, take action, and police them. Speak up. We are tired of being tired of being tired. You must have “the talk” with your family and friends. And if they choose to be silent, I suggest you re-evaluate your relationship with them. 11/ Thou shalt endeavor to learn a foreign language, preferably a language in Africa. Thou shalt also teach said language to thy kids. Yes, spread your wings, fly far away to the land of communication and understanding. To the land of open-mindedness and love. Because learning a new language will help you understand, and when you understand there will be no fear, and when there is no fear, there is no racism. 12/ Thou shalt visit the predominantly Black part of the city or town thou lives in…with thy kids in tow. Get to see what life is like over there. You might begin to gain a bit of empathy, compassion, understanding, and maybe even respect. Your daughters want to date our sons, and that’s a fact. You might as well get to know where she will be hanging out, and get ready to have soul food at the wedding 1 6 | J U N E / J U LY 2 0 2 0

PHOTO C REDIT OF IN GRA M IMAGES

9/ Thou must become acutely aware of the microaggression some things you do or say can cause to people of other races. Like calling me the nurse or “miss” when my name tag clearly says MD or asking me where I went to medical school, or wondering how my English is so good, or not trying at all to pronounce my name after I have told you how to say it…more than once! And do try to let your guard down when I am in the room. I don’t bite. Oh, and… STOP touching my hair, this is not Ripley’s Believe it Or Not!

13/ Thou shalt teach thy child to recognize bullying behavior and speak up when other kids are being bullied, especially on account of their race. Bullying is a catalyst for suicide, and it is a serious problem in our schools (stay tuned for my next book out in a few weeks, it tackles bullying headon). Teach them to find the kids who are ostracised and sit with them on the school bus, at the cafeteria, or play with them at recess. That will go a long way towards ending the current epidemic of youth suicide. 14/ Thou shalt not make a mockery or joke about any person who is different from you on account of their race, and neither should your kids. Yes, don’t discuss their skin tone, their kinky hair, their body type or any other physical attribute that pertains to their race, except in a good light. Or if they let you. I don’t really care much for people touching my hair to know what it “feels like,” that’s actually an intrusion. 15/ Thou shalt ensure that all the above are adhered to, and from time to time, check in with your kids to assess for progress. Yes, you must also continue to work on yourself

and on your family members like Karen, Becky, Amy, Stephanie, Derek, Gregory, and Travis. There is much work to be done. Policing the police is not enough, we must also police ourselves, our thought processes, and mindsets lest we remain imprisoned by them. “The only way, to really talk about race and racism, is by activating a growth mindset.” ~Amber Colemen-Mortely I say “The only way to talk about it, is to freakin’ talk about it!” 1 A former Lieutenant Colonel and commander in the US Air Force, Uchenna L. Umeh, MD is a mom, pediatrician, global speaker on youth suicide, bestselling author, and youth suicide activist. She is Nigerian-born, and the CEO of Teen Alive, and Dr. Lulu’s Youth Health Center, both dedicated to serving high risk teens and suicide prevention. No stranger to suicidal ideations herself, Dr. Umeh started speaking publicly about suicide prevention in 2016 after losing physician colleagues and a patient to suicide. Her mission is to end youth suicide globally through her work with at-risk youth, parents and communities. Dr. Umeh is a regular on media outlets, freelance-writer, podcaster (Suicide Pages with Dr. Lulu), blogger (Words by Black Butterfly) and parent coach, and was recently selected to speak at a TEDx event. She has been recognized by the Texas Medical Association, Association of Nigerian Physicians in the Americas (ANPA), “Nigerians in the Diaspora Commission”, and the Texas State House of Representatives.

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T h e L a s t Wo r d The La st Wo rd

False Equivalence GOVERNMENT LOCKDOWN VS CORONAVIRUS

Wri t t en by Pa r ve z D a ra , M D, M B A a nd C ra i g M . Wa x , D O

here is a powerful force in humans that drives their destinies. This force asserts itself in the form of Liberty. In the Declaration of Independence, the statement “Life, Liberty and the Pursuit of Happiness,” is the most powerful. The absence of subjugation to power and the right to act, speak, or think as one wants, are the tenets of what makes us all Americans. When these basic rights are threatened, the ire of freedom loving people is raised. The current COVID-19 pandemic seems to have roiled the tranquil waters. In this chaos many a voice seems to invoke falsehoods and render them as truths. There is a false equivalency between disparate ideas that rule the minds of the policy makers attempting to rule the minds of the citizens. Let us look at the last few months and gather reality from this recent past. 1 8 | J U N E / J U LY 2 0 2 0

As the pandemic broke across the Pacific and Atlantic shores simultaneously there was a sense of urgency and panic. The urgency was fueled by some very poor models that were based on hypotheticals that failed to materialize. Large quantities of beds were made available and larger numbers of ventilators were built. Most of the beds remained empty and ventilators are being diverted to other countries. Yet, the virus continues to move through the United State from both coasts into the middle taking thousands of lives in its wake. The tally of the infections and deaths has become the daily mantra of the experts. In fact, some seem to thrive in reporting such numbers, and take delight in the fact that the worst is seemingly yet to come. Even in the face of a slow and steady decline, these experts continue to feed the beast of

public fear. Caught in the trap are politicians that have a lesser sense of what is real. The louder the drumbeat, the more deference is paid to the experts. Policies are made to counter this beast of an epidemic. No one seems to pause and reflect for a moment as to what is at stake with each policy or mandate they conjure. No one! One such policy is the “lockdown” of private commerce in its many forms. Closure of hotels, airlines, shops and even short distance travel is frowned upon. So much so, that drones have been utilized by police precincts to command and control citizen movements through virtual means. In West Texas, the police SWAT team was summoned to close down a bar. The loudest voices seem to be repeating the phrase, “We must flatten the curve.” By that they imply, “Social distancing,” from

one another and, “shelter at home,” the spread of the virus will be contained, and the healthcare system will not be overburdened. Meanwhile dubious policies take flight; Prisoners are released while law abiding citizens are imprisoned for walking with their children. But within this “shelter in place” and other such terms, is a sinister mechanism that has raised its ugly head and seems to hover over us as the Sword of Damocles. The thinking goes that if private businesses are opened too soon, then we will have many hundreds of thousands of more deaths. That specter shakes the core of any human being. But time is passing, and more and more information is being revealed. The virus seems to not like living under sunlight and moist air. Yet even armed with this knowledge, the powerful governing forces have shut down parks and beach-

es, albeit a few have been reluctantly opened due to pressure from citizen protests. Small businesses still are forced to remain closed. Among small businesses, physician office closures are having a deleterious effect on medical care of the infirmed and ailing fellow citizens. There are estimates of over 6,000 early deaths among cancer patients alone, with 80,000 missed diagnoses of cancer. Other specialties are also seeing fewer patients with heart disease, diabetes, lung disease and kidney disease. All these patients have been furloughed from healthcare due to fears of hospitalization and close contact with others for fear of contracting COVID-19. How many people will die from such an action? The number will most certainly exceed deaths from COVID-19. False equivalency exists between the control of the virus and the shelter in place concept. Although shelter in place may have “flattened the curve,” it still remains in dispute given the data from Sweden, certain states, and other parts of the world, where shelter in place was not undertaken by government force. The essence of this virus suggests that it will find “parity” with its surroundings and eventually die off. “Parity” here means herd immunity. Scientists have since the beginning said that it will take infection of 70% or more of the population for the virus to finally die off. But some epidemiologists have models that suggest only 25-30% of infected population shuts the virus down. Further evidence suggests that between 40% to as much as 65% of the deaths were from nursing home patients. In fact, the Swedish Health Minister stated that the increased deaths in Sweden were from poor infection control in nursing homes. The incomprehensibility of some enforced policies of moving patients with COVID-19 into the nursing homes in New York, New Jersey and California are counterfactual to scientific reality. Governors’ policies directly increased morbidity and loss of life. It would therefore be prudent to allow the country to open for business and people

over 65 years of age with co-morbidities might continue “physical distancing,” as a preventative measure against the virus. The younger population meanwhile can begin the process of normal living with recommended good hygiene standards. The herd will get itself immunized and the virus will become a distant memory, and limit further economic, emotional and health damage caused by the capricious government lockdown. While Aristotle suggested that desire can be subjugated to reason and Plato stated that all desire must be postponed for a higher ideal, the current ideal threatens the economic welfare of everyday workers in every country, as the economic collapse continues from these unbridled restrictions. Socrates meanwhile argued, “that happiness and personal growth were a major purpose of life, and a central goal of education.” If that is true, and it is, then the current actions by some governors are a direct assault on individual human liberty and freedom to pursue happiness. It is therefore imperative that governors exerting undue force of their incomprehensible logic should undo their dictates and open the civil activities of daily life, so that for the time being those 18 to 60 years of age can work and provide for their families. Government subsidies cannot sustain life as has been evidenced throughout history. The United States Constitution states, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” As the New Hampshire flag and automobile license moniker states, “Live Free or Die.” Let us throw off the chains of government lockdown and assume our rightful individual rights and responsibilities. We must demand our freedom to continue to live under that banner of liberty. 1 “The Last Word” WWW.PHYSICIANOU T LOOK . C OM | 19

P HOTO C RE DIT OF IN GRA M IM AGE S

N EW N EW S

Restoring American Communities Safely Wri t t en by Jo e A nno t t i

group of physicians, medical professionals, and public health officials is behind a new movement promoting the safe re-opening of American communities. The Restore American Communities Safely coalition’s mission is to communicate critically important information about Covid-19 based on fact-based science to the public and to public policymakers. Coalition members hope to support the enactment of well-reasoned measures to re-open American society, overcome the damaging public health consequences of prolonged lockdowns, and establish practices that help society live with the virus while the search for effective treatments and a vaccine continues. 2 0 | J U N E / J U LY 2 0 2 0

The coalition consists of over 30 medical professionals from across the country and its members are actively recruiting their colleagues to join the organization. Member physicians have written articles and guest editorials for local newspapers and social media outlets, and have been interviewed by print, digital, and broadcast media in their areas. Coalition members believe that Covid-19 presents a medical and public health challenge that can only be overcome by analyzing all the facts about the disease – information that increases on an almost daily basis. Public health and public policy decisions must then be based on the scientific data, not pan-

ic-driven horror stories that spur fear and irrational behavior that threaten to collapse our economy and society. “We need everyone to know and tell the truth about the virus’s effect,” said Dr. Marion Mass, Senior Advisor to the coalition. “Covid-19 poses a danger to the elderly and medically compromised. For others who are infected, Covid-19 can be nasty and persistent but not life-threatening. For many more who are asymptomatic, it is barely a nuisance.” Moreover, new data from around the world is improving how we treat patients, improving the recovery rate and reducing the need for extreme and sometimes debilitating procedures such as the use of ventilators.

According to the coalition, the economic crisis is a “side effect” – partially of our own making – of the medical challenge. “As testing increases and society re-opens we are almost certain to have more confirmed infections,” said Dr. Mass. “But these will not necessarily translate into a situation where the healthcare system is overwhelmed. Tragically, until an effective treatment and vaccine are developed, we will lose more Americans to this disease. But by protecting the most vulnerable and practicing common sense social distancing and personal hygiene we can dramatically reduce the spread and mortality rates of the disease.” The coalition emphasizes that the physical and mental health of our nation is at stake: people’s livelihoods and the education of our children should not become collateral damage because of fear-fueled policy that compounds the casualties of Covid-19. Damage to public health as unemployment, lost health care benefits, postponement of medical procedures, and rising levels of depression and hopelessness will inevitably lead to an increase in disease and death, particularly among younger Americans. Coalition members believe that Covid-19 should be viewed -- and treated -- as a big threat to a small percentage of our population and a small threat to the overwhelming majority. The fallout of a lengthy shutdown will be devastating to the mental and physical health and future of our nation. “If we can summon the courage and imagination,” said Dr. Mass, “the U.S. has the opportunity to reduce the risk of death from Covid-19 for the most vulnerable, while at the same time allowing most of society to return to their livelihoods and lives. 1 Joseph Annotti is an independent management consultant who helps businesses and not-for-profit organizations develop and implement effective strategic plans that ensure all organizational activities are fully aligned with the vision and mission.

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TIM E F O R YO U

Green Eggs and Ham X Chickens?

Wri t t en by J Ro s s a k a J o hn Ro sel l i

ovel coronavirus, officially known as COVID-19, was declared a global pandemic. Originating in bats in the city of Wuhan, China, the virus attacks the lungs, causing fevers, coughing, and shortness of breath. However, as the virus has also been found to lodge in the small intestine, other symptoms including nausea, vomiting, and diarrhea have also been reported. But let’s not worry about that because we are here to talk about the gastro-friendly BIG GREEN EGG (BGE). The BGE is a kamado-style oven for pizzas, BBQ or smoking meats and cheeses. Its ceramic design lends itself to a consistent grilling or smoking temperature by design. You can cook a leg of lamb with rosemary and potatoes or have spatchcocked chickens with baby back ribs. It even has a special pizza stone insert to make wood-fired pizzas in your own backyard! We, being my wife and I, didn’t pay a cent for our new BGE. We were gifted this beautiful piece of ceramic culinary cooking delight. How, you might ask? Well, as the story goes, let’s call him Jim, burned himself so badly on the initial lighting that he nearly went to the hospital, which also meant he would never use 2 2 | J U N E / J U LY 2 0 2 0

it again. (Note that when used properly the BGE is in fact quite safe.) His wife, lets call her Marlene, my wife’s cousin, was spending more time at our lake house than I was because of her travels… yes, even with the COVID-19 restrictions, as she is a doctor. Marlene asked her husband to bring the BGE to our house. Like we needed another useless POS taking up space in our garage. I called Jim, AKA Jersey, and told him to bring that POS BGE and get your wife, AKA Maddog’s mom, out of here by the weekend. Jim proceeded to make his way to our house on a Wednesday to set up the BGE on our back patio. He taught me the nuances of just lighting the grill, and how to avoid burning my face off during cooking. Our first meal was two Spatchcocked chickens. Spatchcocked chickens are birds that have their backbone taken out and splayed. These chickens are never turned and cook bone side down. My wife, lets call her Tits, marinated them. One was a Bobby Flay recipe with lots of garlic, lemon and thyme, and the other a delectable NYS Fair Cornell University recipe, Marlene’s alma mater. Both birds were about five pounds each and cooked at 350 degrees for an hour. Effortless on the BGE. The meal was finished with

red beans and rice and cucumber tomato salad. One of the most delectable meals we have had in a long time. Maddog, aka Marlene and Jim’s daughter, has already selected recipes for her next visit to the lake. I think next on the menu might just be that keg of lamb. Oops, might have had one too many beers, but you get the gist…grilling with this ceramic beauty is effortless. Grill On, with good spirits, family and friends. And the BGE. 1

PADPCA is a non-profit organization of Independent Direct Primary Care physicians in Pennsylvania.

WE ARE GRATEFUL RECIPIENTS OF OUR STATE MEDICAL SOCIETY’S 1ST ANNUAL PRACTICE INNOVATION GRANT. Thank you PAMED Society! As the model grows rapidly across the country, PADPCA is informing and educating the public, medical schools, residencies, physicians, and employer groups in PA about our transformative model of healthcare delivery. DPC = Transparency + Affordability + Access + Attention + Patients + Physicians–the Middlemen

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TIM E F O R YO U

#DoughSomething Together Wri t t en by D r. S hru t i D esa i

“Art is not what you see, but what you make others see.” - Edgar Degas

n June 9, 2020, athlete Jay Urich created a sign that said “matter is the minimum” for a peaceful protest. He and fellow athlete friend, Darien Rencher, held it up at separate protests, showing solidarity between black and white teammates. At the same time, something was happening in quiet and boisterous kitchens alike. It happened in different parts of the country and world, as bakers showed a similar unity for their colleagues. It happened to lift up black voices, speak against racial inequality and showcase art and baking in a way that the world was not used to. It was a celebration of black voices, and also the acknowledgement of a silent system that has entangled itself 2 4 | J U N E / J U LY 2 0 2 0

in this country’s roots from the days of the first slaves through now. For Malek Binns (@frostedbymalekbinns on Instagram), who is an avid baker and published author of a cookbook, the Black Lives Matter Bakers Collab was created “to bring peace and unity during the tragic events happening in the U.S.” Malek speaks about wanting to create an opportunity for others to come together as one to showcase two things we have passion for, justice and baking.” Meanwhile Dr. Priscilla Sarmiento Gupana(@sarmiesistersweets), a celebrated cookie artist, advocate and pediatrician, had planned a similar Dough Something cookie collaboration. Her mission was to amplify

black voices and raise awareness about organizations supporting Black, Indigenous and People of Color (BIPOC). Her goal was to have cookie artists and their followers “do something tangible to benefit those affected” by contributing to such organizations and raising money. Once she became aware of Malek’s collaboration, it was the perfect time to share the mic with a fellow cookier from the black community in order to “further boost the community and amplify voices like his.” They advertised for each other, worked together, much in the way that cookie artists do, celebrating and elevating each other. In the process, they brought hundreds of bakers from different backgrounds together to fund-

P HOTO C RE DIT OF DR. JE SSIC A SO

P HOTO C REDIT OF DR. JU LIA A N U RA S

To see more amazing #DoughSomething physician-created works of edible art follow Physician Outlook on social media

raise for organizations supporting the BIPOC community and to raise their voices about the struggles of black people. Matter was the minimum to know that black lives are beloved. Candice Weaver, a black mother, lifestyle medicine expert, author, and artist, started cookie making to honor her grandmother, who was a baker in Yonkers, NY. She created a moving piece showing the tears of black mothers who will not hold their children again, the same children that cried out for them. The collaboration served as a platform to stand with other black women and allies in the fight for justice for black lives. To uplift and advocate for her community. To remind people that

matter is the minimum and that black lives are worthy. For me, the collaboration was recognition that the words of black people through history speak to their perseverance, but also their struggle. So many lives have been lost, so many freedoms taken, so many trails with dead ends and so many black people exhausted. Still, despite the injustices faced by Rosa Parks, Malcolm X, Martin Luther King, Jr and Ruby Bridges, there was a singular belief between them that giving up was not an option; blazing a trail was necessary; freedom and peace were not separate roads; and that right would always be possible. As I painted Trayvon Martin’s face and wrote the

names of black lives lost on my cookies, I was reminded of the need for systemic change. Juxtaposing this with the words of freedom fighters who never gave up reminded me that we cannot stop learning, unlearning, and pushing for right. The DoughSomething and BLMBakerCollabs allowed art to speak where words were unable to explain. There is much that needs to change in the United States, from equal justice, to access to healthcare, to disenfranchisement. We will need black voices to be heard and understood for this to happen. At this point, matter is the minimum. Black lives are beloved; black lives are worthy; black lives are needed. 1 WWW.PHYSICIANOU T LOOK . C OM | 25

Art Credit to Women of Color on the Front Lines (Dr. Sarah Rowan) Wocfrontlines.com

“ THE

TIME IS ALWAYS RIGHT

TOWHAT DOIS

Right

”

ADVO C AC Y IN AC TIO N

Take A Knee

Wri t t en by Dr. N a t a l i e N ewma n

n September 1, 2016, Colin Kaepernick, quarterback for the San Francisco Forty-Niners, knelt during the playing of the Star Spangled Banner to protest police brutality and racism. Approximately two weeks prior to this event, he had sat during the national anthem; however, after speaking to Nate Boyer, a former NFL player and retired Army Green Beret, he decided that to be more respectful to former and current military members, he would kneel. He was vilified for his actions by many in society who believed he was being disrespectful to the flag, the military, police officers and the United States in general. I understood exactly what he meant when he took a knee. Martin Luther King, Jr. took a knee during the Civil Rights Movement to pray--in peaceful protest. Colin K. took a knee, also in peaceful protest, because he believed it to be disrespectful to the symbolism of the flag to stand when Black people did not have equal justice in America. As an American and a veteran of the United States Army, I supported his right to kneel. 2 8 | J U N E / J U LY 2 0 2 0

The American flag has stood and withstood the test of time. During slavery, it stood. During multiple wars, it stood. During Jim Crow, it stood. During the internment of Japanese Americans, it stood. During the slaughter of the indigenous people of America, it stood. During the Civil Rights Movement, it stood. And it still stands, representing Life, Liberty and the Pursuit of Happiness. And when we witnessed the murder of George Floyd at the hand of law enforcement officers, that flag still stood, waiting for us to honor its significance. And today, those protesting social injustice and racism kneel, just as Colin K. did 4 years ago. How can we say we honor the flag and all it represents, yet ignore the brutal inequities that exist and continue to exist in our society? Are we not, in fact, disgracing its meaning? There is no pride when innocent Black people are being murdered in the streets, shot in their homes or beaten like dogs by individuals purporting to represent law and order. And these same offenders hold their

hands over their hearts and pledge allegiance to the flag. And the republic for which it stands. One nation, under God, indivisible, with liberty and justice for all. Is this not the worst example of hypocrisy? When one kneels with one’s head bowed and eyes lowered, it is to honor. It is a submissive position. It is the greatest sign of respect because it demonstrates humbleness, and at times, shame. We are not yet worthy to stand and face that flag until the injustices are righted and all men and women are treated as equal. Then, and only then, can we stand with our heads held high, our eyes upward and our backs straight, proud to have given that banner that waves in the land of the free and home of the brave, its due respect. Trust me, it will still be standing. As it always has. Patiently waiting for us to adhere to our promise that all men are created equal. 1 Natalie Newman, MD Former major, U.S. Army

A DVOC AC Y I N AC T I ON

Dirty Knees Writte n b y A licia Ros e lli

justice, Tim kneeled for moral injustice.

for this month’s issue, my husband

Colin was voted most disliked player in

showed me a post he found on FB: “Re-

the NFL. Tim is well known and re-

member that time when a black man peace-

spected for his signature move known as

fully protested by kneeling during a song

Tebowing. Colin received death threats

and people lost their fucking minds? Now

and acquired distasteful monikers. Tim is

those same people are in my replies saying

invited to speak at churches, schools and

“I’d listen to the Minneapolis protesters if

conferences.

they were peaceful.” Fuck all the way off, they tried it your way!” It seems for some, there is no winning.

Could it be that America values a white knee over a knee of color? If that is the case, it’s time that ALL the white knees around here got a little

I loved Dr. Newman’s article Take a

dirty, ALL kneeled in solidarity against

Knee. When I saw the FB post, it got me

racism and other social injustices affect-

wondering, are there other examples of in-

ing our great country. We are starting to

fluential people “taking a knee” for what

see some amazing examples from those

they believe in? And if so, what was the

with the power to influence our nation’s

public response? Were they villainized like

beliefs and attitudes - the athletes and bak-

Colin K.? Or were they embraced with

ers highlighted in Dr. Desai’s piece, Dr.

open arms?

Rowan’s Women of Color on the Front-

Enter Tim Tebow. While coming

lines project, and the emotional show of

from very different family and socio-eco-

support from the Nascar drivers and crew

nomic backgrounds, their shared values

as they ALL pushed Bubba Wallace’s car

are uncanny - both devout Christians,

to the starting line.

generous philanthropists and activists for

What if each and every one of us rec-

important causes, to name a few. Colin

ognized our power to influence? It’s there

kneeled in peaceful protest for social in-

- all we need to do is get a little dirty. 1

PHOTO CREDI T OF INGRAM IMAGES

s I was finishing the last of the edits

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ADVO C AC Y IN AC TIO N

The Comeback Kid HOW ONE DOCTOR CONQUERED ADDICTION

Wri t t en by JR Hill

he stigma of drug addiction still exists today, and, in some communities, it is often hard to ignore. Some people believe addiction is a lack of will-power, money, privilege, or education but the harsh reality is, it is a disease that does not discriminate. You cannot escape it based on your age, race, gender, or profession, it is an insidious disorder that can destroy lives and rip families apart. Relapse rates are estimated to run as high as 60 percent, even after treatment. For many who do remain sober, it can be a constant struggle. For some, this disease may creep up 3 0 | J U N E / J U LY 2 0 2 0

without warning and like a tornado, it strips away everything in its path. Physiatrist Dr. Robert Campbell knows exactly what I am talking about. After med school he quickly rose to the top of his game in 2012 when he became the Medical Director of an inpatient rehabilitation floor specializing in acute spinal cord injuries, stroke, Traumatic Brain Injuries, neurological diseases and post-surgical care. He believed he was infallible and could do anything he wanted and have anything he desired. “Honestly, (if you follow football) I was like Johnny Manziel coming out of res-

idency. I thought I was untouchable, I could talk my way out of anything, I was in control of everything. Man was I wrong!” The pressures of job, family and life can force us to make decisions we never expected or intended. We all behave differently under pressure but there is a breaking point. For Dr. Campbell, the perfect storm of a difficult relationship and taxing job caused him to spin out of control. “I was miserable, my girlfriend at that time hated it here in Wyoming. We just had our baby. I did not like my job and I was getting all chronic pain

P HOTO C REDIT OF DR. ROBE RT C A M P BE LL

patients pushed onto me while being the director of the rehab unit. I started drinking a lot on my own time but then started taking pain pills all the time (right during the whole opioid epidemic). It got to the point where I couldn’t be without them, so I reported myself to the medical board.” For the next several months he participated in both inpatient and outpatient treatment and had to forfeit his medical license. When asked about inpatient rehab Dr Campbell said, “Oh man, it was crazy. First, I had instant respect from everyone from staff to other patients

“The Comeback is always stronger than the Setback” which I thought was super strange, just because of my professional status.” He went on, “I was legit unemployed for almost three years, but I kept being faithful to myself and put the work in.” After four and a half years of sobriety Dr. Campbell is back to practicing medicine with a fulfilling career in pain management. While his struggle with prescription drugs is behind him, he admits that abstaining from alcohol was and still is a difficult decision he makes every day. “It changed my entire life for better and worse. I would probably be dead by now if it did not work out how it did. I think I’m the only person in my rehab “unit” that didn’t relapse and one of few of doctors here who haven’t relapsed.” Many of us have big dreams and goals about the kind of career we want and the legacy we want to leave behind. I remember finishing my master’s degree in Social Work thinking that I was equipped to help others who struggled with addiction because I had a family member that went through rehab for substance abuse. I had worked in both adult detox and adolescent drug and alcohol during my early career so I’ve seen what this disease can do to a person and their family. When hearing about Dr, Campbell’s struggle with addiction I felt his story needed to be told because it reminds us that doctors are human and make mistakes. It’s his continued faith, courage and humility that has not only made him a better man and a better father but also a better physician. In the coming months you will get to know Dr. Campbell and hear more about his road to recovery with his new column called “The Comeback Kid.” He hopes his story will inspire, encourage and at times even entertain us by demonstrating that with grace, forgiveness and some hard work you can make it back on top. 1

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ADVO C AC Y IN AC TIO N

Collateral Damage Due To Covid-19 AND HOSPITALS CULTURE OF FEAR

Wri t t en by Est i ne Wel l s

he catastrophic effects on those stricken with COVID-19, their loved ones, and our frontline warriors are devastating and almost unbearable. However, non-COVID-19 patients have had their rights usurped. Hospital protocols are rife with undesirable tactics marginalizing quality care while limiting physician input and physician oversight. Administrators prioritize profits over patient care. Staff is threatened with retaliation if they voice opposing viewpoints.

Of significant importance is the ability for patients to advocate for themselves or have someone advocate for them, ensuring that information is properly communicated, received, evaluated, and understood. Violating rights has become prevalent as a result of untenable practices implemented during the current pandemic. Following, please review several rights being breached. There are many examples of nonCOVID-19 patients being victimized by

• Receive care in a safe setting free from any form of abuse, harassment, and neglect. • Receive kind, respectful, safe, quality care delivered by skilled staff. • Receive efficient and quality care with high professional standards that are continually maintained and reviewed. • Receive information in a way that you understand. This includes interpretation and translation, free of charge, in the language you prefer for talking about your health care. This also includes providing you with needed help if you have vision, speech, hearing, or cognitive impairments. • Designate a support person, if needed, to act on your behalf to assert and protect your patient rights. You have the right to: • Receive information about your current health, care, outcomes, recovery, ongoing health care needs, and future health. • Participate in the care that you receive in the hospital. • Receive instructions on follow-up care and participate in decisions about your plan of care after you are out of the hospital. 3 2 | J U N E / J U LY 2 0 2 0

unreasonable protocols. Patient W spiked a fever while receiving chemotherapy, and was admitted to the hospital. Put immediately on a COVID-19 floor until tested, the immunosuppressed patient was further compromised. Testing negative, patient W was then transferred to a non-COVID-19 floor posing additional risks to others. Patient X was to have follow-up scans and labs in April, 2020, for her six month post cancer treatment. The tests were denied because of modifications made to accommodate COVID-19 patients, resulting in a delay of care. Upon insistence and demands from the patient, the scans and labs were done in mid-June 2020. The tests showed the cancer had spread. On-time scans could have been pertinent in early intervention and more favorable outcomes. It is beyond negligent. Patient Y required radiation to the eye which involved mapping, designing, and implementing a plan for delivery of the radiation. A visit to New York City during the initial phase of the pandemic

P HOTO C RE DIT OF IN GRA M IM AGE S

added stress and uncertainty. Helped by a wonderful radiation oncology Fellow, the frustration was assuaged, and the visit took place. Most remarkable was the lack of protective gear worn by staff. Physicians were told, by management, not to wear masks in the hallways because of the negative perception it would create. During the course of the radiation therapy, Patient Y did not have the usual in-person weekly appointment. A phone call the first week was followed by a virtual visit the second week. As agreed by the physician, it was less than optimal. Just another example of management making protocol judgments. Patient Z was urgently admitted to the hospital for a non-COVID-19 related issue. Placed in a room with no visitors allowed caused an immediate escalation of the fear and concern felt by the patient. Having no one to advocate in person, and the staff less than forthcoming with regard to information and transparency, further hindered the care received. Patient Z authorized and

vehemently insisted that his/her advocates be privy to all records, communication, and attending physician visits to help facilitate informed decisions with regard to care options, choices, and recommendations. These rights were violated. Eventually, FaceTime visits brought some clarity. However, these visits were fraught with confusion and fragmented facts. At one point, a hospitalist told the patient to get off the phone. The physician on the phone had been called by Patient Z and was listening while remaining silent. Other attempts to garner necessary information were thwarted by a nurse manager and a hospital employed patient advocate/navigator. Worst of all, discharge instructions and follow-up recommendations were scant, leaving the patient to fend for himself/herself. The examples are rampant, it is a systemic problem. Basic rights are being violated. Physicians, not management, need to determine protocols. It is unconscionable. 1

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Direct Primary Care Wri t t en by Dr. K i mberl y C o rba

A new beginning An innovative model of medical care is expanding across the country and it is changing the delivery of healthcare. It is called Direct Primary Care (DPC). DPC practices are redefining patient-centric, value-based medical care. While these adjectives are “buzz words” for insurance-based healthcare entities, there is a refreshing application of the same adjectives to personalized patient care delivered by DPC physicians who do not participate with insurers. DPC redefines and reapplies medical care for patients and physicians. A periodic medical service fee, such as a monthly subscription (think Netflix or Costco), pays for a comprehensive list of medical services. Patients get to “binge” on their healthcare! Specialists are jumping on-board too in which case the model is called direct care or direct medical care. Our country has not seen this kind of innovation in the healthcare arena for decades which makes this choice for patients and physicians a breath of fresh air. 3 4 | J U N E / J U LY 2 0 2 0

The impetus The DPC model was born for many reasons; two of the needs are crucial. The first were the needs of patients, who found themselves in the middle of a severely broken, expensive, and inefficient healthcare system. DPC reacted and developed ways to improve access, attention, and affordability. The second need was the physicians’ desire to restore sanctity to the patient-physician relationship. Removing the roadblocks, such as administrative red tape of middlemen, helps patients and physicians meet each others’ needs for a better healthcare experience. Patients and doctors enjoy benefits from the DPC model; patients have more time with their doctor, experience affordable care while doctors spend more time with their patients, and provide improved access. This win-win scenario which preserves the patient-physician relationship results in improved health outcomes. DPC is a cost-effective option for patients’ basic primary care needs. Front-line primary care should never be cost-prohibitive for patients.

Accessible • DPC offices actually answer their phones! And if you leave a message during office hours, they get right back to you. • Same day/next day appointment for acute issues, non-acute issues within a week. • Unrestricted number of office visits. • Unrestricted amounts of telemedicine-talk, video, text - these services are included with the periodic medical service fee. • DPC patients have their doctor’s email address and cell phone number for direct access after regular office hours. • Urgent Care and ER visits, hospitalizations, readmissions, specialty visits are reduced for DPC patients. Attentive DPC physicians never want to tell their patients, “sorry we don’t have enough time to address all of your issues today [in your 7-10 minute visit]. You have to schedule another appointment to discuss some of those issues.”

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This can be a waste of your time AND cost another co-pay while adding to deductible expenses. Patients are scheduled for prolonged appointments, averaging between 30-60 minutes (sometimes longer if needed). DPC physicians coordinate care with specialists and help patients navigate the existing complicated and expensive medical system. Affordable This is a word we don’t hear often when talking about health care in the US. But DPC is changing that - paradigm shift! Prices are 100% transparent and always discussed with patients. Direct Care offices negotiate wholesale costs for laboratory testing, radiology services, and most offices dispense generic medications at near wholesale prices directly from the office to the patient. Direct to consumer discounted pricing drives down the cost of ancillary medical services.

DPC leaves no one behind Pre-existing conditions are not an issue with the vast majority of DPC patients unless their condition falls outside the physician’s scope of training. DPC compliments all insurance plans through either access, affordability, or attentiveness. Health care received in a DPC practice benefits the well-insured (Medicare and Medicaid patients are paying out of pocket to be part of a DPC practice), the under-insured (high deductible patients love discounted cash prices), the uninsured (DPC helps navigate the system, often finding cash prices for medical services needed outside of primary care), health sharing plans, Short Term Limited Duration Plans, employer self-funded plans (DPC saves employers quite a bit of money), Association Health Plans, Indemnity Plans, etc. There are no racial, socioeconomic, cultural, or religious barriers in DPC practices. Pandemic Performance Telemedicine is a regular part of the workday for a DPC practice, so there was no major adjustment during the COVID-19 quarantine. There is no extra cost for telemedicine to patients of DPC practices - it is a value-add that is included with the periodic medical service fee! The lack of onerous administrative layers and suits dictating how to practice medicine allows DPC offices to be flexible and adjust to all situations while following guidelines, especially the global emergency of a pandemic. DPC offices were able to triage, test, and treat COVID-19 patients and didn’t skip a beat when ensuring their patients’ nonCOVID-19 acute and chronic health conditions received attention. Economic Recovery As the economy grapples with how it will respond and recover from the pandemic shutdown, independent DPCs are well-positioned to help individuals, families, employers, employees ensure they have access to primary care. Many

companies may either be unable to afford health benefits for employees or will need to reduce health benefits. Whichever the case may be, DPC will help to keep the costs low for the care their offices can provide to employees in these situations. DPC will be ready to do its part to help get our country’s economy strong again. HSAs For All Every single American should have access to the tax benefits of an HSA this ability should NOT be tied to certain health plans. Such continued policy is economically and financially detrimental. The uninsured should be able to make a tax-free contribution to a savings account for health care expenses. Any regulatory or legislative policy that limits access to HSAs for people with HDHP, must be directly addressed, repaired, or dumped. This is not the time for restrictive federal policy from the Treasury or Congress, which would promulgate who can have an HSA account and who cannot. If folks cannot make a tax-free payroll contribution to their HSA because they have Medicaid or Medicare, then pre-paid vouchers for a certain amount should be distributed to allow these beneficiaries to shop for their health care services, some of which could be with a DPC practice. Exponential Growth 29 states have passed legislation or have some form of state guidance in support of consumers of DPC and protection for this free market model (as of now 7 more states have proposed legislation). There are 49 states with Direct Primary Care practices. Since 2014, there has been an 800% rate of growth for DPC across the US. Summary DPC patients get an incredible amount of service for a fraction of the cost when billing insurance. Just add water…and watch it grow…affordably, accessibly, attentively for ALL patients. 1 WWW.PHYSICIANOU T LOOK . C OM | 35

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Additional Healthcare Benefits Wri t t en by Dr. A a k a nk sha A si j a

s the coronavirus pandemic rages on, healthcare workers around the world make tremendous sacrifices to continue caring for their patients. They live apart from their family and quietly draft their wills. They are fearful not only for their own lives but also for the lives of their children and spouses. They continue to work fearlessly, day in and day out, taking care of patients with COVID-19. When efforts to treat fail, they are there to offer support and company during the last few moments of these patients as they die alone, away from family. Health care workers at the frontline are under tremendous strain physically and psychologically, as they take on additional roles of caregiving, beyond what they had reckoned just a few months back. 3 6 | J U N E / J U LY 2 0 2 0

Not surprisingly, healthcare workers are getting sick and dying of COVID-19 at an alarming pace. At the time of this writing, statistics from the CDC indicate that more than 9200 medical professionals in the United States have been infected with COVID-19. Globally, more than 100 doctors and nurses have died from COVID-19. As the pandemic progresses and fractures our healthcare systems, these numbers are bound to increase. Due to the nature of their job, physicians and nurses spend a lot of time in close contact with patients. They are therefore at risk of catching COVID-19, despite using correct PPE. PPE or personal protective equipment provides protection but only if used consistently and correctly, with the

right fit. On many occasions, their usage itself can act as a hindrance to the care being provided. Furthermore, as we learn more about COVID-19 presenting in an atypical manner, aside from the typical fever and f lu like symptoms, there is a danger that diagnosis may be delayed and result in inadvertent exposure of our healthcare professionals. Under these circumstances, it is crucial that healthcare workers and their dependents be provided special benefits. Grocery workers and other essential workers are currently being provided a temporary increase in wages as a way to ensure they continue working but also to recognize their work. This should apply to healthcare workers as well. Another alternative would be to

provide them tax credits or lower their tax bracket for the year. In addition, dependents of healthcare workers who die from COVID-19 should be provided death benefits. In the military, a death gratuity is routinely given to survivors of those who die while on active duty. Dependents of firefighters and law enforcement officials who die in the line of duty are eligible for various programs that provide death and educational benefits. Congress must take action to extend such provisions to our frontline healthcare workers including resident physicians, fellows, nurses, paramedics, nurse practitioners and physicians. Many healthcare workers may be the sole breadwinners of the family and having this protection may provide them some comfort as they at-

tend their calling and care for patients with COVID-19. The other provision that should be provided to our young medical and nursing students is student loan forgiveness. The average medical student in the country graduates with a debt of about $200,000. Private student loans, unlike federal loans, do not get discharged after death. Furthermore, in the current scenario, medical students are graduating early and being deployed in the battlefield right away to fight COVID-19. Given the age bracket they are in, these medical and nursing staff may be getting married and/or having young children at the same time. If they do contract the disease or worse yet, die from it, the least we can do is to guarantee that their educational loans

Dependents of healthcare workers who die from COVID-19 should be provided death benefits. will be forgiven and their dependents provided for. Despite the current economic losses, this funding is justified given the risks our medical professionals are taking every day to protect the fabric of our society. The current pandemic is being called a war. Appropriately remunerating our frontline workers for their work above and beyond their call of duty as well as honoring our fallen heroes through provision of death benefits is of crucial importance. 1 WWW.PHYSICIANOU T LOOK . C OM | 37

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My Doqter Wri t t en by Sh i l esh Iy er, M . D. , F ou nder my D o qt er

hey say Medicine was like a House. The House had many rooms, some general and some highly specialized. There were libraries. There were research rooms. There were interactive areas where patients and family could be seen. There were quiet rooms where patients could rest and recover. There was a Doctor’s Lounge where physicians could eat, rest, and recuperate. There was even a well-structured boot camp area where young students and doctors could prepare and transform themselves to enter the House. It was challenging and daunting, but the challenge was worth it for the House was a mansion full of wonders, health, and healing. 3 8 | J U N E / J U LY 2 0 2 0

Doctors came and went in and out of the House, but the House stood strong - an independent institution in its own right. The House took care of all who entered - doctors, nurses, assistants, and even administrators. Everyone had a role to play and they did their part. It was not just a House, but also a complex orchestration and a vibrant symphony. We all remember that moment we would commit to enter that House. For some, we were wide-eyed children and knew it was our destiny. For others, it may have been a certain life experience that opened their eyes to the mission. Still others shift careers later in life looking for a more meaningful way to contribute. Whatever the story, we all had

that moment of resolve and grit to make that commitment and travel the hard road. We would face its challenges and travails and its ups and downs. But we were committed to entering the House and we would do whatever it took. That House is now in shambles and we need to rebuild. But how? And who should do it? And with what? To answer these questions requires us as physicians to look back to where we came from and look within to harness our power to move forward. How do we rebuild? Physicians face a daunting task to be sure, but we needn’t fear for while the House is weak, its foundation remains strong. If we return to

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When the House was strong, it flourished under and because of physician leadership. With what do we rebuild? Perhaps the biggest challenge for the physician community is to identify the new building blocks of the House. Today’s bricks and mortar are new. They consist of technology, media, and data. We must rebuild with these building blocks on a foundation of our profession’s core values. There is an epic battle between conservatism and progress, but we as physicians intimately know the importance of balance. We now must conserve and guard the timeless values of our profession as we march and progress into the new digital age. We face many challenges to be sure, but they fall into two buckets: 1. Erosion of physician autonomy and financial independence. 2. Societal suspicion and disrespect for the expertise and knowledge of our House of Medicine.

this foundation, we will find solid ground on which to build. The foundation was laid down by centuries of physician leaders that came before us. We know the names - Hippocrates, Avicenna, Maimonides, Osler, and Halstead are just a few. The foundation they laid down consisted not of the specific science of the day, but the tenets of commitment to science and knowledge combined with the compassion to heal and serve. The foundations upon which we are to build are the values of our profession, those values that we are called to serve: “do no harm,” service, compassion, assimilation of humanity’s ocean of medical knowledge, and non-avarice. Those values live on today. The legacy has been

transmitted from generation to generation and they live through us in the very oaths we take. Who should rebuild? It is those individuals who have committed themselves to the values of the House of Medicine who should lead the rebuild. When the House was strong, it flourished under and because of physician leadership. Only physicians are committed to the House’s core values, for it is only they who take the oaths to serve patients first. We must remember there are no others sworn to this cause. It’s time to dust ourselves off and look in the mirror. There you will see the physician builder leading Medicine into the new millennium.

To rebuild our House, we need to invoke our strength, clarity, and hope. On December 10, 2015, myDoqter was born. The idea started among a small group of friends. There was one simple aim: to restore the sanctity of the patient-doctor relationship. As the concept transformed itself from imagination to life, we have been joined and supported by many physician friends along the way. Friendship is the connection that enables us to create more than we could create as individuals alone. It is this spirit of friendship, collegiality, collaboration, and synergy that will carry us forward. The core values of myDoqter can be summed up by the AEIOU’s. They are simple, yet deeply profound: • Physician Autonomy to practice • Empowerment of the patient – doctor relationship WWW.PHYSICIANOU T LOOK . C OM | 39

• Independence (financial and otherwise) of physicians and Medicine • Physician Oversight of Medicine • Public re-education about YOU and our House Together we can rebuild our House based on the values we hold dear. Our blueprint for the House has two wings: 1. PR: Public Re-Education: Through our profile feature, physicians can promote their expertise as doctors educated in the medical school paradigm. We are a network of America’s Real Doctors. We will re-educate America on our credentials, our training, our expertise, and how to find us. We aim to accomplish this through: • Establishing a Network of physician-led practices • Creating robust physician profiles with photos, video and your credentials that highlight your expertise and skills • Peer reviews to reform the review process and make current unprofessional online review sites obsolete • Graphic depictions of years of physician education by specialty • myDoqter content featuring your books, media appearances, and publications to show we are the experts of Medicine 2. VR: Virtual Resources: As physicians we must build and provide technology tools for ourselves if they are to be intelligently designed to meet our needs and be cost effective and affordable. Today’s office-based technology tools are exceedingly costly, clunky, and burdensome because they were not designed by physicians. The myDoqter platform provides all your front office functionality including online scheduling, reputation management, contact-free payments, and more - all with physician and patient’s needs and input in mind. Through building our own technology and data libraries, we can maintain physician autonomy and create new financial resources to go back to 4 0 | J U N E / J U LY 2 0 2 0

the physician community and patient care. We must also be committed to maintaining medical data and sensitive patient information under physician purview so it can be used for advancing science and patient care rather than merely for financial gain. Many physicians are seasoned investors and are familiar with the concept or ROI, or return on investment. As a group, we need to create sources of ROI for individual physicians and the profession as a whole lest we be weak and dis-empowered in the future. Weak physicians, weak science, and weak Medicine leads to weak health and wellbeing, weak people, and weak societies. Hence, physicians and medicine are known as pillars of society. For physicians, while financial ROI is important, the true ROI of years of sacrifice is living a value-driven life and contributing to the world. It is time for us to seriously ask what happened to that true ROI as we live lives mired in anxiety, frustration, and insecurity. Together, we need to restore the practical ROI to run our practices, but we need to also restore the true ROI and guide the profession and the legacy of Medicine as a whole. Many of us committed to our profession at a young age because there was a dream. We were inspired to follow in the footsteps of those giants who came be-

fore us to rise and serve. But now the dream is dying. So many physicians say they would advise the young to pursue a career in Medicine only with great caution, as they feel burned out, financially burdened, belittled, and demoralized. But we cannot let the dream die. We need doctors to raise the ideal, care for the suffering, and we need the best among us to preserve, teach, and advance humanity’s most precious body of knowledge. Amidst the turbulence of modern life, people are searching high and low for “truth and authenticity.” We must recall the tenets and values of our dear Medicine, for they are aspects of Truth. As physicians, we come from all colors and stripes from all over the world, but there is an underlying unity driven by our desire to strive for the highest human ideals. Despite our superficial differences, we speak one common language of science and healing. We must work together, to provide ourselves hope and restore balance, service, compassion, and the intellectual rigor of Medicine. We each can contribute to our dear House that is now in shambles. It is up to us for we are the true physicians of the new millennium building the future of health and medicine; only we can keep the dream alive. 1

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O F F IC E S PAC E

Design Thinking

THE PHYSICIAN’S ETHICAL ADVANTAGE (PART 1) Wri t t en by N a t ha n Ec k el

“Most people are about as happy as they make up their minds to be.” - Abraham Lincoln

he other day my physician wife was concerned about her upcoming clinic. What had been fun earlier in her career - interacting with patients - had become something she no longer anticipated. Can you relate? My guess is that you went into medicine for the purpose of serving, helping, and healing others. You paid an enormous price for the opportunity. In the process you could have been negatively impacted too. You signed up for arguably the most difficult job there is to do. And as a result you work with people in all kinds of situations, environments, and mindsets. Many people aren’t always eager to have the hard conversations. 4 2 | J U N E / J U LY 2 0 2 0

The saying goes, “hurt people, hurt people.” Pushback, anger, accusation, gaslighting, lose-lose outcomes are likely a significant part of your day. So you might just understand - or even share - a growing apprehension toward patients - especially the “special” cases. I certainly do. As a sustainability designer married to medicine I have the opportunity to think below the surface. Since I don’t have patients to see, emergencies to solve, or insurance minutia to process, I am able to focus on the “Important but not Urgent” quadrant. So I exploit this luxury of thinking longer term and more systematically - and sustainably in the hopes of being as helpful as I can possibly be.

Steven Covey talked about this 30 years ago in The 7 Habits of Highly Effective People. He drew a matrix containing “Urgent” and “Important” axes. Then warned us about the very quadrant where so much of pre-COVID medicine occurs - the urgent category. In the ongoing debate about “suits vs. scrubs,” I am concerned that so many “scrubs” are no longer in control of their activities. They are largely stripped of the self-governing ability to make these important decisions, and defaulting to a constant state of reactivity instead of proactivity. This is the very reason why design thinking for physicians is vital. It can be an extremely empowering habit - especially during weekend walks or even your commute if your mind wanders.

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Remember the special case patient that you might or might not be eager to see? What if you took just a couple weekend minutes to envision the big picture? You might discover something unexpected - you might observe that what you thought was the problem is not the actual thing impacting you. And you could uncover new options and solutions. My question to my spouse - and perhaps to you - is whether it is the actual patient that is draining? Or is it the future anticipation of treating a difficult patient? Or the unpredictability of the patient? The loss of control and whatever could happen after that? Put another way, is the issue the patient interaction, or is it the habit of looking ahead to a negative story - a

story many of us will unintentionally build and believe over time? Is it possible that the apprehension is actually from projecting that negative expectation into the future? Is it strange to imagine that this could sap the enthusiasm we used to have? Can our unchecked minds spiral into unhelpful places and actually become a self-fulfilling event? Well I don’t want that for you - or my wife. And I’m not going to suggest that you simply paint a happy picture to project into the future. But would you simply identify this thought pattern instead? Would you remind yourself that there’s a huge difference between your future situation versus an emotionally-driven mental scenario? Because we

will live with the result, real or imagined, positive or otherwise. It sounds idealistic but the reality is we can be as happy as we choose to be. “When we change the way we look at things, the things we look at change.” Could Wayne Dyer’s quote be an invitation to design-thinking, beyond positive thinking? I don’t want to just leave you with that idea - if you’ll allow me, I’d like to provide actual design-based tools and prototypes for your consideration. I’d like to help busy physicians like you to gain the additional margin you’ll need to flourish in a post-COVID world. I’ ll be providing practical tools for you in part 2. 1 WWW.PHYSICIANOU T LOOK . C OM | 43

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

Confessions Of A (Recovering) Color Coward Wri t t en by D r. Ma rl ene Wu st- S mi t h

hat do George Floyd, “American Son” (a Netflix movie and Broadway play starring Kerry Washington), and my two biracial nephews have in common? More than you could ever imagine. As a first generation American, the daughter of Hispanic immigrants who did not speak English until the age of 5, I thought I knew what racism felt like. Looking back over the years I have perceived discrimination from time to time. When I was younger it was because of my family; their broken English, the color of their skin, how loudly they spoke Spanish, or how they were dressed. As I got older, I imagined it was because I myself was speaking Spanish, because of 4 4 | J U N E / J U LY 2 0 2 0

my crazy hair, or maybe it was the deep summer tan or the size of my butt. As the song goes, “baby’s got back.” I have always thought of it as a blessing (but maybe it has been a curse) that I have a “Teflon” personality and can let negative energy “slide off” of me, instead of letting it ruin my day or affect my persona. I have instead chosen to consciously take advantage of concessions offered to me on the basis of my race and heritage and make sweet lemonade out of the occasional lemons lobbed my way. Instead of dwelling on my “different”-ness or seeking or thriving on racial ostracism, I chose to celebrate the benefits afforded to me because I WAS

different. Yes, I have that “glass half full” personality. I always figured it was the same for my black friends and colleagues. They, TOO, could choose the same glass half full attitude. When it comes to racism, I’ve often felt “in between” black and white. The reality is, I have no idea what it feels like to grow up black, to be black, or be judged based on the history of my ancestors. I have no idea how hard it is to be a black physician or a black patient. I have made the wrong assumptions. I have not been as good a friend to those of color as I could have been. I have not been a good listener, wanting to “fix” or explain, instead of being accepting. I have wanted to impart my own value set

without a clear understanding of what it is like to be black. Worst of all, I had been a color coward, silently watching, rationalizing. My knees - squeaky clean.

house to go out with two black friends. The play, set entirely in the waiting room of a police station in south Florida, was riveting. I was on the edge of my seat the entire time. I had just seen my nephews for Christmas a few weeks prior to attending the show and their transition to manhood had shocked me, as I hadn’t seen them in a while. Jamal WAS my nephews. I left that play and immediately bought my sister and her family 4 seats before the show closed. They never speak about race. They have never had “the talk” with the boys about what it is like to be a black young man in America. This was an opportunity to talk to my sister about racism because we hadn’t had any discussion since she was a teenager and started dating her now husband who is black. Having difficult/sensitive conversations in an office setting is something I am trained to do. Why hadn’t I initiated or facilitated these important conversations earlier with my sister, brother-inlaw, and my nephews? I have doled out pediatric advice about everything else throughout the years. Why had I waited so long? Seemingly overnight they had turned into grown men and now they were in danger like Jamal from “American Son.” Worse yet,and they were blind to the danger. They had no idea what kind of darkness and evil lurks out in the world for them. They have been brought up to think that life is fair. To believe that law enforcement is trained to be just.

The Road To Recovery My journey towards “color bravery,” a term I first heard from Dr. Niran Al Agba, started serendipitously last year when I was invited to attend a short-running award-winning Broadway play in NYC by a friend who was producing the show. It was called “American Son.” It starred the very talented black actress Kerry Washington (who co-produced the show along with my friend) as the mother of Jamal, a teenage boy of mixed race who goes missing when he leaves his

Fast Forward To Spring Given the global state of affairs, I thought things could not get any worse - a worldwide pandemic that is causing unprecedented loss of life, an impending sense of doom and panic, a nationwide quarantine, and a global economic collapse. But things did get worse. The day I saw a Minneapolis police officer snuff out the life of George Floyd was entirely a new low point in my life. In my mind’s eye I could not help but see the faces of my two handsome, biracial

nephews underneath that crushing knee. I am forever traumatized by hearing this man whimpering for his mama, saying “I can’t breathe” before he took his last breath. While I had been affected emotionally in the past over the senseless murders of black people at the hands of law enforcement, I subconsciously chose to be a color coward. I would see the names on the news or on my social media feed... Michael Brown, Eric Garner, Philando Castille, Breonna Taylor. Choosing to not implicitly trust the mainstream rhetoric that is passed off as news, I would do a quick internet search to get a little more personally researched background on the circumstances surrounding each of these deaths. Ultimately, however, I would go about my day, my business. l did not let these deaths affect me in any significant way. I shrugged them off as a sorry “c’est la vie” sign of the times. “They” should have been more careful. “They” had a criminal history or were taking drugs. “They” had made poor choices in picking friends. “They” were in the wrong place at the wrong time. That word “they” sticks out like a sore thumb for me. It is a descriptor that reeks of racism, that emphasizes the “not same-ness.” I feel ashamed at my lack of true empathy in the past. It turns out that “they” could be my nephews, who in the past few years have transformed from little boys into young black men. “They” are what started giving me pause, waking me up, making me change and feel and worry in ways that I have chosen not to for most of my adult life. Time For The Talk (Ok, Text, They Are Teenagers Afterall) My nephews have been raised in an upper middle-class neighborhood outside of New York City. My sister has always been very strict with the boys who are both exemplary students and excellent athletes. They use their manners. WWW.PHYSICIANOU T LOOK . C OM | 45

My younger nephew is lighter skinned than the older one, and identified as “Dominican” and “not” black at one time. He has a temper, and a mouth, and as he gets older, he is the one that worries me. Teenagers can be mouthy. They can be fresh. They can back talk. They are human. They can make mistakes. But suddenly, my color cowardice slapped me in the face. My nephews CANNOT AFFORD to behave like ‘normal teenagers.’ Such behavior at the wrong time, in the wrong place, could cost them their lives. I sent them as a family to“American Son” hoping it would spark some difficult conversations. They all loved going to see the play on Broadway, but much to my chagrin, not a word was spoken afterwards as a family about how to stay safe. They loved the ending, one that terrified me and robbed me of sleep for weeks afterwards, and still haunts me to this day. So, in the wake of the George Floyd murder, and the Amaud Arbery shooting, I decided to do something that makes ME uncomfortable. I needed to find out what they knew, what they thought about racism. What they perceived their own risk to be as young black men. I had to continue forward on my journey towards color bravery. I initiated the “conversation” by asking what each of them knew about Ahmaud Arbery, as both boys are ath4 6 | J U N E / J U LY 2 0 2 0

letes. They go for runs, alone, through their neighborhood to stay in shape. (I have no doubt that my sister would follow them from afar in her car if there were ever a shooting in their neighborhood like the one that killed Arbery.) It was reassuring to learn that both boys feel very loved and protected in their lives, and do not perceive racism from their peers, teachers, or their community in general. My younger nephew (who is almost 15) knows way more about world events than his brother gives him credit for, although his “news source” is Instagram, not Twitter. The lessons that I personally learned from breaking the color barrier with my nephews: We adults need to reach out regularly to our young to initiate these difficult conversations. I need to do this more and come out of my comfort zone. The importance of a good well-rounded education cannot be overstated. It scared me to hear both boys tell me that their primary source of information are “apps” that were not intended nor designed to be primary unbiased “news” sources. These are sites where individuals come to express their opinions. On Twitter this information is expressed via 140-character sound bytes or “SMS”s (short message service). On Instagram the “news” is delivered via pictures and short videos. When I was

young, we watched the news together after dinner, and we regularly heard our parents discuss what they read in the newspaper as a family. This sparked conversation between the adults which shaped the way we children saw the world. It was reassuring to hear that my older nephew was engaging his parents in discussions about what he was seeing on Twitter (riots, protests, and Trump). It worried me that my younger nephew did not seem to be engaged in these conversations. Instagram is primarily a video and photo-sharing app. Their choices of preferred social media match their personalities to a “T.” My older nephew loves to read, debate, and have deep intellectual conversations. His brother is very bright but prefers playing video games, relaxing, and learning passively. Relying on social media feeds for information has the one big advantage that the news is coming from influencers that “speak” to the subscriber, and not from polarized biased media outlets. As a pediatrician, however, I worry that adolescents may not always choose wisely in who their role models are, and I am also concerned that nefarious forces could be purposefully manipulating algorithms to brainwash our youth in one direction or another. Balance is key, and family values must necessarily play a role to help our youth thrive and shine. Land of the Free, Home of the #ColorBrave I am sorry it has taken me so long to recognize my inner coward, and appreciate your patience when I stumble on the path towards bravery. For me, having these difficult conversations is a tiny step in the right direction. As we approach the 4th of July holiday, there are American flags proudly displayed in great numbers across our towns, decorating every flagpole, porch and lawn. I am filled with hope that we can become what those flags represent - the land of the free, and the home of the color-brave. With this hope, I can breathe - a little. 1

IN T ELLI G EN C E ON T HE MOVE

I Can’t Breathe Writte n b y D r. Poonam B hatia

I can’t breathe I heard this familiar chant from outside of myself today Hallucination or a reality Is it my pain that is echoed in your keening A universal reckoning The refrain getting louder It will be silenced no more For years my brain screamed into the silence For years my body was trapped in this agonizing pain You kept me quiet and unseen Suffocating me and shutting down my throat That knee hard and unforgiving Ripping out this bleeding heart A gnarly hand reaching to grab and twist my innards Searing hot pain as my limbs are torn apart A stifled cry A quivering sigh I heard this familiar chant from outside of myself today Am I hallucinating or is it reality Is my pain really echoed in your keening A universal reckoning Its refrain getting louder that will be silenced no more

Willed by the Divine Without any say not mine nor yours I am being breathed Lovingly gently Moment by moment Until my purpose fulfilled And until I can’t I breathe..... 1

PHOTO CREDI T OF INGRAM IMAGES

But for now, right at this moment Air still flows in and out of me I. Am. Alive

WWW.PHYSICIANOU T LOOK . C OM | 47

PHOTO CREDIT OF INGRAM IMAGES

2020 #ColorBrave Summer FAMILY OUTDOOR MOVIE THEATER RECOMMENDATIONS Wri t t en by D r. Ma rl ene Wu st- S mi t h

aving unexpected time together as a family will go down in history as COVID19’s legacy. We have had our young adult offspring home from college attending “Zoom University,” our high school students expressing boredom from being cooped up in the usual sanctuary-like privacy of their bedrooms, our fur-babies wondering why their day-time nap routines are all messed up, and our littlest ones spending unprecedented time in the kitchen helping to prepare food for themselves and other siblings...all while parents try to attend to all of their work and home obligations. Meanwhile, grandparents have been stuck in their own homes, afraid of becoming ill with coronavirus, but suffering the depressing effects of having to socially isolate themselves from their families. Now that it’s summer, we encourage physician and non-physician families alike to take advantage of everything that the great outdoors has to offer...in your own backyard!! Easy-to-use, quality affordable projectors and bluetooth sound systems let 4 8 | J U N E / J U LY 2 0 2 0

you stream movies right from your phone or laptop onto the ‘big screen’ of your choice. At our house we use a ‘vintage’ (ie, no longer available) inflatable Mickey Mouse screen, but you don’t have to get fancy--you can project on to the side of your house or even onto a sheet hung up between two tree branches! We encourage you to set up a tradition of “Movie Nights” where everyone turns in their personal electronics and you make memories by watching movies together as a family. If you have enough space AND if the weather permits, set up a makeshift outdoor viewing space where grandparents, neighbors and a few friends could join you (keep groups under 20). Set up chairs/blankets appropriately distanced from one another (especially important for those from different households). Make things fun by providing outside guests with decorated masks for them to wear at your ‘concession stand’... we want you to pass the popcorn and the candy, not the COVID crud! Following are some recommendations for movies that will inspire families to learn about history, diversity, dispari-

ties, amazing accomplishments, the arts and the future. The Princess and the Frog Set in New Orleans, The Princess and the Frog (2009, 97 minutes) tells the story of Tiana who finds true love when she kisses an enchanted frog. Tiana is a hardworking, resourceful young lady who is a great role model for girls. In marked contrast to most Disney princess stories, Tiana does not need a man to rescue her. There are some scary scenes for the youngest. The Lion King Trilogy The Lion King (1994), The Lion King 1 ½ (2004), The Lion King (2019) Lion King is Disney’s most famous animated musical is a beautiful story of

the importance of family, responsibility, hope and love. Lion King 1 ½ is a light-hearted funny “inter” -quel that has lots of bathroom humor that both the children and adults (especially dads) seem to love. The 2019 Lion King film remake is so realistic that it’s easy to forget that the characters are computer-generated “lion doubles.” Prepare for some violent, scary and sad scenes (stampeding wildebeests, Scar’s plot to kill his brother Mufasa), but the soundtrack and values imparted make up for any tears. For some teachable moments that reinforce the importance of black actors, be sure to showcase the voices of the actors in both films (in the original film, only a third of the actors were actors of color: Niketa Calame-Harris as the voice of young Nala, Whoopi Goldberg as the voice of Shenzi, Robert Guillame as the voice of Rafiki, James Earl Jones, as Mufasa and Madge Sinclair as Serabi. In 2019, the cast of 20 is overwhelmingly of African descent and includes Chiwetel Ejiofor as Scar, John Kani as Rafiki, Alfre Woodard as Sarabi, JD McCrary as young Simba, Shahadi Wright Joseph as young Nala, Penny Johnson Jerald as Sarafina, Keegan-Michael Key as Kamari, Eric Andre as Azizi, Florence Ksumba as Shenzi, Chance the Rapper as Bush Baby, Phil La Marr as Impala, J Lee as Hyena, Donald Glover as Simba and Beyoncé as Nala. It is culturally important for a movie set in the Pride Lands of Kenya and Tanzania to use actors of appropriate heritage. The Boy Who Harnessed the Wind The Boy Who Harnessed the Wind (2019) tells the true story of a young teenage boy from a small village in Africa, who creates a device that prevents farm land from getting ruined after flooding.

would restore the land and save grain crops after repeated flooding ruined their grain fields. The movie sparks curiosity, reminds viewers of the importance to be courageous, have integrity and persevere. K ERRY WASHINGTON

STE V EN PASQUA LE

American Son American Son is a Netflix original movie adaptation of the play by the same name which stars the very talented wonderful original Broadway cast. Written by Christopher Demos-Brown, American Son tells the story of the interactions between an estranged biracial couple (played by Kerry Washington and Steven Pasquale) who reunite in a Florida police station on a very stormy night when their teenage son unexpectedly does not return home. Also starring are a rookie police officer (Jeremy Jordan) and an older lieutenant (Eugene Lee). It is most appropriate for mature tweens and teens to watch along with their parents. Queen of Katwe The Queen of Katwe (released 2016) tells the true story of a Ugandan homeless girl from the slums who becomes a chess champion. It is an entertaining drama best for tween girls (younger children may become upset by some of the scenes and characters). The movie exemplifies the importance of teamwork and perseverance, as well as demonstrating the values of integrity, empathy and humility.

Hidden Figures Hidden Figures is based on the true story of 3 women of color who were brilliant mathematicians. They worked at NASA at the Langley Research Center in the 1950s and 1960s and were integral in helping to launch the manned spaceflight program. Despite living and working in a very racist and segregated Virginia, these three women (who were engineers and literal “computers”) thrived and persevered. They are excellent role models for children of ALL ages and races, but of immense importance to young black girls, who can catch a glimpse of themselves in the early scenes of the movie. The film does a great job portraying the racial tensions of the Civil Rights era (segregated schools, libraries, bathrooms). Selma “Selma” follows the events leading up to the civil rights march organized by Martin Luther King Jr. and his Southern Christian Leadership Conference to campaign for voters’ rights.Set in 1965, this movie is best suited for children (tweens/teens) and adults with good attention spans, and tolerance for “old” movies. The movie explains how each group in the march campaigned for different issues that discriminated against blacks in the segregated South. There are many disturbing scenes of race-based violence, even against non-violent protesters. Some protestors are killed, including innocent children who are blown up in a church. Selma is a powerful, educational drama that parents are encouraged to watch with their mature tweens and teens after the little ones have gone to sleep. 1

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P H OTO C RE DIT OF DR. JE SSIC A SO

"Celebrating Diversity in Medicine" Cover Art Created by Dr. Marlene Wust-Smith

Articles inside

"Take A Knee" Written by Dr. Natalie Newman