ISSUE 6 | VOLUME 1
JULY/AUGUST 2020 2020 IS THE YEAR OF CLEAR VISION FOR PHYSICIANS AND PATIENTS ALIKE
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PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS
Cover art by Dr. Ekta Shah
F R O M T H E P U B LIS H ER
PHOTO CREDIT ALIC IA ROSELLI
Summer Sunflower Soliloquy SOME RANDOM THOUGHTS FROM THE PUBLISHER
I
Wri t t en by Dr. Ma rl ene W ü st- S mi t h
usually am never at a loss for words...I have so much to say and write that the editors have to put my pieces on the chopping block to whittle my thoughts into a cohesive readable article that makes sense to someone who doesn’t know me. But of late I have felt trapped, stuck, blocked. I blame the pandemic “new normal” for often not knowing what day it is, what month we are in, what time it is...and I sometimes find myself yearning for the routine that I used to resent. Overnight our vocabulary became peppered with new phrases, a new language. I hate it. Lockdown. Social distance. Isolate. Stay safe. Quarantine. Be safe. Contact trace. Maintain a 6 foot distance. Don’t shake hands. Don’t hug. Mask. Homeschool. Zoom meet. FaceTime. Use hand sanitizer. Work from home. Wash your hands. Don’t work from home if you are essential. Wear PPE. Reuse PPE because there’s a shortage. Sign up for vaccine trials. Donate plasma. Take Zinc, C, D. Don’t take elderberry. Be careful with ibuprofen. Beware the cytokine storm. Take hydroxychloroquine early if exposed. It’s a game changer. Take HCQ as prophylaxis. Drink tonic water. Take azithromycin. Use 2 | J U LY / AU G U S T 2 020
doxycycline. Don’t use a nebulizer. Look at drugs which are zinc ionophores. Consider ivermectin. Give budesonide via nebulizer. Don’t hoard meds. Ask for remdesivir. Stay home. Consider ECMO. Don’t take HCQ. Beware of drugs that prolong the qT interval. See your doctor via telemedicine. Get tested. Expect immunity passports. Get swabbed by scheduling a parking lot visit. Don’t go to the ER. Be wary of the happy hypoxemic patient. Put on CPAP. Place in prone position. Avoid intubation. Flatten the curve. Don’t be a mask-hole. The unrelenting, monotonous routine and lexicon that COVID19 has cast upon our collective world has clearly left an indelible impression and is taking its toll. My solution? Forget it is happening. Live in the present. Take time to enjoy the scenery, the family time, the board game, the puzzle. Make pretend COVID19 doesn’t exist. I hunt like a scavenger through social media to find new material, new art, new points of view and I choose things that bring me joy and inner peace. This month I chose sunflowers. Sunflowers bloom during the summer and often last into the fall. For many
parts of the country, they represent the end of summer, the change in seasons. It felt à propos to adorn the covers of this late summer issue of Physician Outlook with the beautiful photography of physician artist Dr. Ekta Shah. Dr. Shah has been an avid PO fan from the start, and has introduced me to the larger world of physician artistry I did not know existed. She is a member of a group called “Feral Physician Artists” and feral they are. The Merriam-Webster dictionary offers some very provocative synonyms for the word “feral,” and they are all fitting -their work is savage, unbroken, undomesticated, untamed, wild. The sunflowers that grace this month’s covers are beautiful. Forget that we are in the midst of a pandemic. Be still. Be with yourself. Become one with nature. Take that mask off (even if just for a little while). Take time to smell the fragrant flowers, and change your outlook. Enjoy the beauty imparted by the happy, bright, tall yellow sunflowers before the dark winter is once again upon us. 1 Dr. Marlene Wüst-Smith Publisher
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Table Of Contents
FROM T HE PU B LI SHER
Summer Sunflower Soliloquy By Dr. Marlene Wüst-Smith/p.2 VI PP SPOT LI G HT
Black Men In White Coats By JR Hill/ p.6 B A B B LI N G S
The Sekhmet Writing Project 3/12 By Dr. Megan Babb/ p.8 N EW N EWS
Unemployment Paralysis By Pamela Ferman/ p.12 T I ME FOR YOU
Stand on My Shoulders, Sisters By Dr. Robyn Alley-Hay/ p.14 A DVOC AC Y I N AC T I ON
It Starts With Us By Dr. Errin Weisman/p.20 The Comeback Kid By Dr. Robert Campbell/p.22 OFFI C E SPAC E
Design Thinking Vs. Ground Hog Day By Nathan Eckel/p.24 IN TELLI G EN C E ON T HE MOVE
It’s All Up In The Air By Ayushi Chugh, M.D./p.27 T HE LA ST WORD
COVID-19 And The Political Pandemic By Craig M. Wax DO./p.28
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V IP P S P OT LIG H T
Black Men In White Coats Wri t t en by JR Hill
By the Numbers For nearly 40 years, the number of black men applying to medical schools has decreased according to the AAMC report Altering the Course, Black Males in Medicine. Despite the efforts put forth by medical schools across the country to increase diversity, this demographic comprises about 2% of all practicing physicians today. When Dr. Dale Okoradudu realized this shocking statistic he wanted to do something to change this grim outcome. That is why he created Black Men in White Coats, an online mentoring program that seeks to increase the number of black men in the field of medicine through exposure, inspiration and mentoring. Changing the Narrative Black Men in White Coats currently partners with several medical 6 | J U LY / AU G U S T 2 020
schools across the country to produce short documentary videos of black physicians in their respective fields to bring awareness to this issue that not only affects the black male population, but also the nation as a whole. “This is for every child that feels marginalized,” Dr. Okordudu said. Many black children believe they can’t achieve certain things or become anyone they want to become, most don’t truly believe that being a lawyer or a doctor is even in their reach and Black Men in White Coats seeks to teach these men that it is possible! The field of medicine needs to be a diverse group of physicians to serve the diverse group of patients. Additionally, Black Men in White Coats organizes youth summits across the country. By working closely with medical schools, high schools, and physicians to provide informative and inspirational sessions and mentorship
to our youth who may be interested in healthcare as a profession. You can check out their upcoming events at www.blackmeninwhitecoats.org/summit/ In addition to Black Men in White Coats, Dr. Okordudu also created the Diverse Medicine Recruitment Center, a free online community where pre-med
Dr. Dale Okoradudu
A SC LEP IA N DREA MER C REDIT P HYSIC IA N A RTIST DR DA N IE L OKORODU DU
THE BLACK WOMAN’S HEALTH DIRECTORY
D
r. Sharan Abdul-Rahman is a board certified OB/ GYN and founder of Today's Woman, a unique boutique gynecological practice in Philadelphia, Pennsylvania. Dr. Rahman offers state-of-the-art care with old-fashioned compassion and courtesy. She practices with a focus on health and wellness, not medicine. She advocates preventive care, education and uses the latest technology to better women’s lives. Her specialties include care to women in midlife and menopause. In addition to earning her MD from Yale School of Medicine, Dr. Rahman holds an MBA from the University of Pittsburgh. She began her clinical experience as an OB/GYN with the National Health Service Corps providing care in physician shortage areas. She’s also volunteered in a variety of clinical settings both in the United States and third world countries. Dr. Rahman is a proponent of the philosophy that overall female well-being includes mental, physical and sexual health.
“Nobody is self-made, everyone has someone who has helped them”
Dr. Dale Okoradudu
students from diverse backgrounds can connect with medical school recruiters. The purpose is to provide recruitment opportunities for students. There are many qualified students who never get the chance to pursue their dream of being a medical doctor simply because they did not know that there was a medical school out there looking for a student just like them while at the same time, the medical school never knew the student existed. Diverse Medicine Recruitment Center solves this problem by providing 24/7 online recruitment not limited by time, money, or location. You can check them out at www. diversemedicine.com. 1
In late June of 2020 she launched a directory to help eliminate healthcare disparities. It is a directory called TheBlackWomansHealthDirectory...and no it doesn’t exclude black men, it’s just highlighting, shining the light on black women. She invites all black doctors--male and female--to list their profile @ theblackwomanshealthdirectory.com. The directory includes the physician’s phone number, website address, which insurances are accepted and their specialty/areas of expertise. 1
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B A B B LIN G S
T h r e e | T w e lv e: T h e P e rsist e
The Sekhmet Writing Project 3/12 THE PERSISTENT ONES Wri t t en by D r. M ega n B a bb
T
he other day while working in the quiet space of my bedroom, I heard a repetitive (and quite distractive) sound coming from my youngest daughter’s room. It was rhythmical. Thump. Five seconds later... thump. Five seconds more, thump. Over and over it continued. As I moved down the hall to get a better listen, I heard another sound to this rhythm. Oomph… Thump. “What was I hearing?” I asked myself. I drew closer. Then a third sound. Oomph… Thump… Exasperate. Over and over again. When I turned the corner I found my five year-old daughter in her room, repeatedly jumping off a small tea table chair while reaching high in the air (though falling drastically short of the mark each time) for a 8 | J U LY / AU G U S T 2 020
stuffy that laid perfectly draped across the ceiling fan above her. With each Oomph a display of effort. With each Thump an experience of failure. With each Exasperation a sign of resilience. When I saw the picture in its totality I recognized what I was hearing: I was listening to the sounds of my daughter’s persistence. About ten minutes earlier, my oldest son (her twin brother) flung a soft, grey penguin stuffy into the air and it lodged on the ceiling fan. After many failed attempts at retrieving this stuffy, there my daughter stood, frozen, with her hands on her thighs and waist bent at the hips, patiently waiting until another idea popped in her head. She stood up, proceeded to move the chair back to its home, walked towards the
wall, reached for the switch and turned on the fan; there she patiently waited for the fan to create enough momentum to fling the penguin back to ground level. She then picked it up and handed the stuffy to its owner, her younger brother (my three-year-old son) who sat
Uché Blackstock MD
st e nt O n e s
on the other side of her bed, waiting for his favorite stuffy to be rescued. To him, this stuffy is everything. To her, it is just a plush penguin. But that didn’t matter. What mattered was her fortitude and persistence in solving what my three-year-old saw as an impossible problem. But my daughter knew that if she kept trying, she would find a solution. In healthcare, for women and individuals of color, equity in the workplace can be found in predicaments similar to my son’s penguin: stuck in places low enough to see, yet high enough to be just out of arm’s reach and seemingly impossible to retrieve. Though very rarely discussed, there is a reason for this perception. Looming in the past of America’s healthcare system lies a
deep and dark history full of forgotten racial and misogynistic transgressions. Many that have left the male and white dominated space of healthcare void of equitable opportunities for people of color and women. Often times these inequities are minimized, blown off, viewed as nothing more than minute problems easily remedied by annual Diversity in the Workplace training sessions. Furthermore, the inequities are justified by those in power through the use of gas-lighting. Instead of recognizing these transgressions to belong to inherent systemic issues, they are often viewed as isolated events. This act is intentional so that patterns of behavior can be more easily safeguarded. Though this would make change in a large system seem impossible, every now and then, along comes a certain type of individual, like my daughter, who refuses to give up and instead tackles problems with persistence. Those who see the switch on the wall. Those who recognize that even the smallest shift in momentum can have profound positive effects. Those who just might be able to find a way for equity to fall into the arm’s reach of those who deserve it. Enter The Founding Physician Women of Equity Quotient: Drs. Uché Blackstock, Esther Choo and Jane Van Dis. Healthcare has an incredibly checkered past filled with unjust transgressions. Included in this is the unauthorized use of deceased enslaved Black individuals for the education of anatomy to physicians and medical students in the eighteenth and nineteenth centuries. In fact most recently in 2013, the bones belonging to an enslaved Black man named Fortunate, were finally given a proper burial in Waterbury CT. They were previously taken without consent by the white physician who owned him so he may teach anatomy to others. Only after TWO- HUNDRED and SIXTY years following this man’s
Jane Van Dis, MD
death was he finally laid to rest. My God not even after death would the white race grant freedom to those enslaved. Forced into servitude postmortem, Fortunate was left to serve the white race and the privilege the white race saw fit. Our history also includes unethical studies on minority races. There are many well documented scientific investigations where specific diseases were not only forced into a minority host but then it’s known treatment was purposefully withheld so scientists (and in many cases physicians) could observe the progression of that disease in the human body. In some cases this even meant allowing a disease to lead to the host’s death. In addition to this, documentation exists of pervasive and inhumane treatment towards women as well. This was commonly the case so that surgical and non-surgical procedures could be developed and then perfected (even procedures for ailments as common as pregnancy). These were often at the detriment to the female, causing immense pain and causing chronic effects such as infertility. It is also important to note that many of those individuals used for such studies were Black enslaved women. The opinion that women are less-than can even be seen today. It’s been over three-hundred years since the birth of medicine in the United States and still the ownership of a woman’s body and her autonomy to make individual reproductive decisions is largely dictated by white males. WWW.PHYSICIANO U T LOOK . C OM | 9
Dr. Esther Choo, MD, MPH
To date, nearly 45% of Black individuals working within the healthcare system have experienced some form of racial bias. In addition to this, over 65% of women have had a similar experience with gender bias. How is it that the greatest healthcare system in the world is failing it’s workers? Is it because if the system as a whole acknowledged such data, it would require an outward recognition that the foundation of America’s medical system was built upon racism and misogyny? As a nation, we rely heavily on data collection and educated interpretation to aid in healthcare advancements. Especially those pertaining to how social determinants of health affect individual disease states on the human body as well as how their associated therapeutic interventions do as well. Why is it then that these same processes are not used to objectively observe social flaws such as racism and misogyny within the system itself? What better way to advance science and strengthen its arguments than to elicit the help of none other than science itself. Since the healthcare system is historically resistant to introspection, the only conclusion I can draw to the lack of effort in the collection of such data (in both large medical and hospital systems) is the result of willful ignorance. In other words, if it is simply not collected, the system can proceed as if it does not exist, allowing the status quo to remain intact. This is where Equity Quotient and the persistence of its founders, will single handedly change the inner struc1 0 | J U LY / AU G U S T 2020
ture of the American healthcare system, indefinitely. EQ is a physician-led company which strives to help healthcare organizations and academic institutions create equity for all its associated members. The foundation of its work is driven by data collection, the discussion of members’ unique experiences with bias and qualitative measures to identify the pervasiveness of both racial and gender inequalities existing in that specific system. Because healthcare was founded on racial and gender biases centuries ago, they have been given ample space and time to flourish. And because these biases are so deeply embedded in it, it has become nearly impossible to identify the extent of their reach without the aid of objective, quantitative and qualitative measures. Equity Quotient, like so many other American businesses, was born out of need. In the wake of the #MeToo and the #BlackLivesMatter movements exist palpable energy necessitating the urgency for introspection and change within our healthcare system. Because equity is so scarce, there is a need to dismantle and rebuild the only system we have ever known. The change will be uncomfortable. The change will demand that the voices of those oppressed and marginalized be heard. Our hope is that, this time, it will be everlasting. Equity Quotient and the persistence of Drs. Blackstock, Choo, and Van Dis are the difference. If you are a physician or member of the healthcare community, or are a professor or member of an academic institution who has experienced either gender or racial biases, I urge you to reach out to your leadership team to consider the use of Equity Quotient’s services. 1 Be sure to follow Dr. Megan Babb on Instagram (@mbabb1522) and Twitter (@MeganBabb1522) Bios Dr. Esther Choo, MD, MPH Associate Professor, Emergency Medicine Dr. Choo is a nationally recognized expert in gender bias in medicine, lecturing frequently on this topic and writing on discrimination and women’s careers for both the popular press and the scientific community. She is a funded researcher and brings
significant experience in quantitative and qualitative research methods and analysis. She has served as President of the Academy of Women in Academic Emergency Medicine and a Senior Advisory Board member for FeminEM.org. Jane Van Dis, MD Ob Hospitalist Group, Usc-Keck Verdugo Hills Hospital Dr. Van Dis is an expert in gender equity in the workplace. She established the Working Group on Gender in the Physician Workplace, a national network which amasses data on gender-based disparities in healthcare and solutions to these disparities. She is currently Medical Adviser to three technology-based women’s health start-up companies, as well as Co-Founder of OB Best Practice. She is currently volunteer clinical faculty at USC Keck SOM; works at Verdugo Hills Hospital, and serves on the USC Gender Equity in Medicine Advisory Council. She speaks nationally on gender equity in medicine. Uché Blackstock, MD Founder & CEO, Advancing Health Equity Dr. Uché Blackstock is the Founder and CEO of Advancing Health Equity, which partners with healthcare organizations to address the critical factors contributing to health inequity, through talks, educational trainings and consulting services. She is a former Associate Professor in the Department of Emergency Medicine and the former Faculty Director for Recruitment, Retention and Inclusion in the Office of Diversity Affairs at NYU School of Medicine. She left NYU School of Medicine in December 2019 after almost 10 years on faculty to focus on her company. Dr. Blackstock received both her undergraduate and medical degrees from Harvard University.
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N EW N EW S
Unemployment Paralysis
U
Wri t t en by Pa mel a F erma n
ncertainty about anything can bring on fear, lack of motivation, and anxiety. But what if that uncertainty was directly related to your ability to pay your bills, feed your family, or provide other basic essentials? You might want to just crawl under your blanket until it all goes away. Unemployment can be paralyzing, but it doesn’t need to be and you can’t afford it to be. Jumping into the job market can already be a terrifying experience. The whole process lends itself to you being “judged.” It all starts with your resume, right? So let’s break it apart from an employer’s standpoint – starting with the top. Your name. Just by looking at your name, employers are making assumptions. Male or female, race, ethnicity, cultural background…the list can go on. Moving down on your document, we can 1 2 | J U LY / AU G U S T 2020
continue to determine your age, where you live (is that a good area or not?), and your college experience. How do you match up to other applicants based on where you went to school and the grades you received? See what I mean? I’ve only read the first 1/8 of your resume and I’ve already made judgements about your race, gender, age and intelligence. Now here is the thing. It can be good judgements or bad. It all depends on the person. Currently the unemployment rate is over 11%, but many sources believe that due to inconsistencies with the survey, it is actually much higher. Last month, as the rate was near 15%, an article in Forbes came out called “Don’t Be Fooled By Official Unemployment Rate of 14.7% The Real Figure Is Even Higher” due to the way that the questions were asked.
The fact is that we are not really seeing the light at the end of the unemployment tunnel, and, quite honestly, if more states start to pull back again on re-opening due to another surge – we may not see that improvement for a very long time. But my message to you isn’t about that. The job application experience is not changing, and maybe the number of opportunities out there seem dismal, but I’m here to urge you to see that regardless – you are not helping yourself by hiding under that blanket. We can live for the excuse because it’s easy. It allows us to avoid judgement or engaging in an uncertain time commitment. Why apply when I’m NEVER going to get the job? Should I even bother reaching out for a job when I’m sure there are many other people out there that are more qualified?
Of course there are people who are more qualified or times in which you will be overlooked for an opportunity, but you will ALWAYS be unemployed if you do nothing. I’ve been in career services for over 9 years now. I’ve seen what really works and I’d like to share with you the most effective ways to apply and put yourself out there in the job market. 1 – Check Your Attitude It always starts with your attitude. If you jump in with a negative attitude, expect a negative response. Right now, we should all be eating humble pie. Grateful for a job if we still have one, humbled for any opportunity or connection we can make. At one point you may have expected a particular type of job or salary – but now we should be okay with that looking a little different. There is always time to move up, and that job may lead to other connections or provide a safety net of finances while you continue to look for another position. We can always learn something. 2 – Be Politely Aggressive Spending hours each day on your computer completing online applications is one way to send someone spinning into misery. It’s just not effective. You are spending close to an hour importing your data into a company system that will run an algorithm to see if you check the boxes to meet the key word search. Cross your fingers and hope you make the yes pile against the other 1000 applicants. It’s a passive form of an application where you are hiding behind a screen and not showing the company who you really are as a person. I coined the term “politely aggressive” to explain that when you are in the job search, being aggressive is taking action (or ownership) in combination with that attitude part I mentioned before. Online systems give you no ownership of your outcome. You are filling out a form. Look at it like this. You see a job on LinkedIn. It looks like something you would be interested in, and you notice
that there is an easy application system where all you have to do is click and your resume and data gets imported into their system and you officially apply. So you go for it. Click, click, type, type – done. On to the next job right? Wrong. Go back to that job. Click on the company. Who do you know that works there? Ah shoot, no one. Okay – on to the next one. Wait. No. Don’t give up. Be aggressive. Look at who works there in the area that you are applying. It looks like this one contact went to my alma mater. Another one is a first connection with my uncle. I don’t know them personally – I’m sure they won’t be able to help me. You won’t know unless you ask. Call your uncle. Send a message and make a connection. The few moments it takes to put yourself out there and politely ask for help and recommendations from successful professionals can potentially change the trajectory of your career. Go around the electronic system and take control of your destiny. This same idea applies when you send an email, text or make a phone call to someone who you want to make a connection with. Not just with LinkedIn. How do I know this works? I’ve heard it time and time again…. I met this great person at a wedding that said I should call them about a position that may be opening up… I sent an email to a friend of a friend and asked to set up a time to chat about the company she works for – she offered to send over my resume to HR! Or in my case.. I requested a meeting from the current Dean of Students and VP of Student Affairs at the University of Pittsburgh at Bradford, PA while I was just a low-level intern, and after a 5 minute conversation where I asked him for his advice in my job search process, connected me to a VP of Student Affairs that he mentored
over at St. Bonaventure. St. Bonaventure happened to be getting ready to create the “next generation” career center to better prepare students with professional development programming. Those 5 minutes changed my life. What if I was too afraid to ask? (Thank you, Dr. James Evans!) This brings me to my final thought. 3 – Get out of the box In this time where it feels like everything is completely upside down and that nothing in this world is the same, stop trying to think that the job search process would be the same either. Yes, we all need to make money. Get a job to make money – but if that doesn’t make you happy – work on developing your skill set at the same time to make you more marketable for other opportunities in the future. Learn another language, volunteer (yes, you can even do this remotely through dosomething.org) or take a free online course. This also comes into play when we think about our misconceptions of people. Take me for example. If you read my title, you would obviously see that I have connections in higher education, career and student development. These are things that you are assuming about me. What you may not realize is that I also have a great deal of connections within the medical field due to my work with Physician Outlook. You don’t know who other people know. So talk to everyone. Share what you are passionate about – what you hope to achieve with your career – humbly ask for advice or recommendations. Closing : Where to go from here My heart is saddened by the levels of stress and anxiety that unemployment has placed upon the lives of so many individuals. It’s a real thing. My hope is that these recommendations will provide a way to rethink the job search process and express to you how you can stand apart from your resume – because you are much more than words on a paper. Make them see it. 1 WWW.PHYSICIANOU T LOOK . C OM | 13
TIM E F O R YO U
Stand on My Shoulders, Sisters IS THIS TALE FAMILIAR TO YOU AS A FEMALE PHYSICIAN?
A
Wri t t en by Dr. Ro by n A l l ey-H a y
fter worrying and worrying, not knowing what to do with all that worry, I caused myself double suffering by making myself wrong and inf licting various types of self-punishment for falling short of perfection. Only now, when I look back twenty years, can I see, really, how brave and determined I had to be to: First, get into medical school; second, do a residency in a competitive specialty; third, survive said residency; fourth, I had four children during my education and training, and lastly, not lose my mind a whole lot earlier than I eventually did! I now appreciate how resilient I had to be to get out of bed every morning to take more unpleasantness and soul crushing aggressions. In fact, I would really, really like an apology for the mistreatment from several male professors and attendings. I still have words (in my imagination) with my residency director and he passed away 1 4 | J U LY / AU G U S T 2020
several years ago! I would like him to understand: It wasn’t his fault per se that he was ignorant of inequity from the comfort of his maleness. We (as in colloquial “we”) have all learned how blind we can be to inequities that exist as we judge from relative safety and comfort. Once noticed, there is a responsibility to apologize and make it right, and then use that privilege for the highest good. Damn you, Dr. Patriarch Program Director, you’ll never be able to realize your ignorance, apologize, or work to effect change, or make it up to me for the career lost to burnout (and very nearly suicide). You might actually need what I have learned from the experience of being female in a patriarchal, hierarchical male world; learn what I know as a woman, and let me educate you on my scholastic expertise in topics of being human. You might want to learn higher level communication skills and be facile at positive relat-
ing and bring awareness to the dynamic of power differentials. A tsunami is on the horizon – a tsunami of empowered women in medicine. Why do women in medicine STILL have to worry so much? It seems like there is so far to go! I sometimes forget how rapid change has occurred at significant times in history. Birth control pills were only legalized for married women in 1965 and it took an act of the Supreme Court to make contraception legal for unmarried women in 1972. 1972! Thank goodness I was not born ten years earlier! That was not that long ago. It follows that women were criminals for having sex outside of procreation. Unbelievable. (Don’t get me started on the continued fight for women’s reproductive rights!) I can see now that I took those rights for granted and forgot how hard fought those rights were. We stand on the shoulders of women who fought, protested, boycotted (including their marital bed), and spoke out to
power – male power. The men making all the decisions for a weaker sex. A Little History To understand from where we have come, a review of feminism provides context. Feminism is commonly referred to as occurring in “waves” in scholastic circles. They are said to be like diffuse, small perturbations of the water that coalesce into swells, and finally break into our collective consciousness. The first recorded wave in America started in the 19th century. (There have been feminists for thousands of years. In general, women have never considered themselves property.) The first American wave was focused on the right to vote. This, of course, resulted in the vote for white women in 1920. Women of color did not have representation and thereby full citizenship, until The Voting Rights Act of 1965. The second wave was in the 1960s-70s. Defining supreme court
and legislative action gave women the right to contraception, privacy, and equal rights although the Equal Rights Amendment is still not ratified by the necessary 38 states. The second wave of feminism focused on equality of citizenship rights, employment, birth control, and defining marital rape legally. Shirley Chisolm became the first African American woman in Congress (1968) and the first woman and African American to seek the nomination for president. Abortion was legalized. The third wave began in the 1990’s and sought to redefine the portrayal of gender, gender roles, beauty, sexuality, and womanhood. New feminist icons were sexy and unapologetic. Sexual morals shifted. There was significant movement in the LGBT movement. The fourth wave began around 2012 with renewed interest in feminism and focused on justice for women, condemnation of sexual harassment, and violence against women. It started with empowerment in the community with use of the internet. Focus was on intersectionality of gender, race, class, sexuality, and physicial appearance that were two sides of the same coin, discrimination and privilege. It has continued with the “me too” movement, and reexamination of societal misogyny as the old balance of power is challenged. Wait, wait. WAIT! What happened in the late 80s-2012, between the 2nd and 3th waves? Where were we during this time?? Where was I? Well, as a woman physician, I was one of the millions of women who were determined to make it “in a man’s world;” to infiltrate traditionally male careers. This path was not easy! The struggle was real. Those that came before me made “I can do anything,” and “do it all” (common phrases of the times) possible. There is actually a perfume commercial jingle in the 1970’s that I swear put feminism in reverse. Imagine a tall and thin beautiful woman, dressed in a slinky white long dress and holding a frying pan, singing and
moving suggestively, “I can bring home the bacon, fry it up in a pan, and never, never let you forget you’re a man. You’re a woman...” At Story Within A Story Let me tell you a story within a story. You say the phrase “old white guys” to me, and I can picture at least a dozen male academic attendings that I tangled with. From the surgeon that insisted I wear a scrub dress and panty hose (I did NOT and walked), to the attending that refused to call me by my name because, “I don’t believe in hyphenating names, Dr. Hay.” (I went to the Dean of the medical school on this one and was told to “pick another rotation if you object.”) I tangled with my neurosurgery attending and the dean (again) when I was pregnant with my second pregnancy. Working 5 am to 10 or 11 o’clock at night, throwing up in snow banks and every bathroom in the hospital, I could not physically continue such hours. The neurosurgeon, “Dr. Patriarch” was not flexible and neither was the dean. “Dr. Patriarch” Dean of the medical school told me I would have to sit out a whole year. There was no other way. I lost that baby at 1617 weeks and because I missed four weeks of the student surgical rotation, I couldn’t go back that year. There was no accommodation. This was just my second year of medical school!! Someday I’ll write all of my stories – so I can help women physicians and their male counterparts recognize the misogyny and abuse by these Patriarchal doctors who had and still have the power. “Dr. Patriarchs” had the power completely over my time, my reproductive life and ultimately, my health and the health of my pregnancies. They had all that and my career in their hands. You get the gist. Could I have advocated for myself more? I don’t think so. I am one powerful bitch to be able to have a career as a doctor at all. Please! Stand on my shoulders for the next generations of women in medicine. 1 WWW.PHYSICIANOU T LOOK . C OM | 15
Dr. Alley-Hay is an international women’s empowerment coach, author, speaker, educator, and longtime feminist committed to helping women master their inner power and vision. She is bringing feminism and
Dr. Alley-Hay is to anmedicine, international women’s empowerment coach, speaker, educator, and longtime Dr. Alley-Hay is an international empowerment coach,author, author, speaker, educator, longtime humanism seeking towomen’s change the culture of medicine. Her experience includes and 25 years in feminist committed to helping women master their inner power and is bringing bringingfeminism feminism and feminist committed women master their inner power andvision. vision. She She is and clinical medicine as to anhelping Ob/Gyn and over 10 years of life coaching. humanism to medicine, seeking to change culture medicine.Her Her experience experience includes years in in humanism to medicine, seeking to change thethe culture of of medicine. includes25 25 years clinical as an Ob/Gyn and over 10allies years of coaching. What is medicine feminism medicine? “Women and alife collective, committed to feminist principles and clinical medicine as anin Ob/Gyn and over 10 years ofas life coaching. working for the highest good, for all people, in a healthcare system that works for everyone.” What is feminism in medicine? “Women and allies as a collective, committed to feminist principles and
What is feminism in medicine? “Women and allies as a collective, committed to feminist principles and working for the highest good, for all people, in a healthcare system that works for everyone.”
working for the highest good, for all people, in a healthcare system that works for everyone.”
“I’m committed to empowering all women to master their inner power and vision. I am especially passionate about “I’m committed to empowering all women to master their
“I’m committed to empowering all women toto master their bringing the feminine and feminist energy medicine.”
inner power and vision. I am especially passionate about
inner bringing power and vision. I am passionate about D Rto . Amedicine.” LLEY -HAY the feminine andespecially feminist energy bringing the feminine and feminist energy to medicine.”
DR. ALLEY-HAY
DR. ALLEY-HAY
When you work individually or in a course setting, you will:
Identify your life and career purpose and discover what fulfillment and satisfaction look like to you When you work individually or in a course setting, you will:
Remove obstacles, limiting beliefs, past trauma, self-sabotaging behaviors, and energy blocks from your
When you work individually or in a course setting, you will:
Identify life and career purpose and discover what fulfillment and satisfaction look like to you life and your leadership Remove limiting beliefs, past trauma,and self-sabotaging behaviors, and blocks from your Develop obstacles, your communication skills for freedom ease in having your ideal lifeenergy realized
life and leadership Identify your life and career purpose discover what fulfillment satisfaction look like to you Open new paradigms and developand a path of action that takes you and to your calling Develop your communication skills fortrauma, freedom and ease in having your idealand life energy realizedblocks from your Empower yourself to reach your highest self! Remove obstacles, limiting beliefs, past self-sabotaging behaviors, Open new paradigms and develop a path of action that takes you to your calling life and leadership Empower yourself to reach your highest self!
Develop your communication skills for freedom and ease in having your ideal life realized Open new paradigms and develop a path of action that takes you to your calling If you’re ready to feel badass, purposeful, and in control, please join her for a discovery session
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PHOTO CREDIT TO DR. HETVI JOSHI
- Dr. Marlene Wüst-Smith
CREDIT TO DAUG HT ER OF DR. HETV I JOS HI
ne of my favorite places to visit on social media is the Feral Physician Artist group, where I discover all of the hidden talents of my professional colleagues. One artist in particular, Dr. Hetvi Joshi (who amazingly just discovered her talent for painting 3 years ago) is a prolific and talented artist who has a young daughter. She often post paintings that her little girl creates on her own while she is at work. I love how much this little girl admires and emulates her mother. I am in awe of the talent that this six year old has, and am touched by the love and adoration these two have for each other.
PHOTO CREDIT TO DR. HETVI JOS HI
O
Publisher’s Note
PHOTO CREDI T TO DR. HETV I JOSH I
CREDIT TO DAUG HT ER OF DR. HETV I JOS HI
PHOTO CREDIT TO DR. MICHELLE JORDAN
ADVO C AC Y IN AC TIO N
It Starts With Us
M
Wri t t en by Dr. Erri n Wei sma n
ost parents would get stars in their eyes if their 8-year-old told them he wants to be a doctor when he grows up. Even though the Hippocratic Oath has been around for 2,500 years, being a physician is still seen as a noble profession. After all, doctors are scholars, leaders and healers. What’s not to love? But when my son first turned to me and said he wants to be like mommy, I felt a knot in my stomach. The image that came to mind wasn’t a white coat and stethoscope, it was medicine chewing up and spitting out my kind, loving child. I’d gone through all of it, and I wouldn’t wish it on my worst enemy, much less my oldest kid. So I did what any good millennial mom would do. Instead of saying no, nuh huh, you aren’t gonna do that, I squeaked out a “Oh yeah, are you sure?” 2 0 | J U LY / AU G U S T 2020
I’m not in the business of telling my kids they can’t be whatever they want, especially because I was still figuring out my career well into my adulthood. And they’ve got my genes, so telling them a flat out no is just an invitation for them to prove me wrong. Before you call me dramatic, I know that kids change their minds all the time. My son still has a lot of growing up to do and no one is going to hold him to this path (thank goodness). But just in case he, or any of my three kids, decide to pursue medicine, I have got to ask the medical community a favor. Let’s be better. Let’s make healthcare an awesome place to work. Let’s stop accepting crappy workloads and doctor guilt. Let’s help our colleagues grow. Let’s start taking care of ourselves the way we take care of everyone else.
When I started off on my journey out of burnout, it was mostly about me. I needed to get out or else I wasn’t going to survive. Then it became about the people around me. Colleagues, residents, other professionals that were struggling the same way I did. I still want to pull people up and out of dead ends. Community is everything. But now I’m realizing it’s about something even bigger. It’s about imagining a future where physician wellness is so prioritized that doctors aren’t burning out at astoundingly high rates. It’s about creating a culture that allows doctors to thrive from the moment they start med school. It’s about getting in touch with everything that made us want to be physicians in the first place and making sure that when our kids say they want to be doctors, we can turn around and proudly tell them, “That’s great, me too.” 1
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P HOTO C RE DIT OF DR. ROBE RT C A M P BE LL
ADVO C AC Y IN AC TIO N
The Comeback Kid GROWING UP UNTOUCHABLE Wri t t en by D r. Ro bert C a mpbel l
M
y name is Dr. Robert Campbell and I am a Physiatrist currently leading the largest pain care practice in Wyoming. In the coming months, I hope to share my struggles that led me down the dark road of addiction to both opioids and alcohol. I will also share my journey to recovery and the important life lessons I have learned along the way. I am excited to open up about my life, the decisions I made, the consequences I suffered, and the storm brewing inside my head during my darkest moments in the hopes of shedding some light on this sensitive and prevalent issue. But first, let’s start with my upbringing and the early influences that led me down the path of medicine and shaped my ideas of who I was. 2 2 | J U LY / AU G U S T 2020
Family Life In A Small Town My parents and extended family are from a suburb of Pittsburgh, Pennsylvania. I was born outside of Philadelphia and around the age of one or two, moved to a small, rural town in north central PA called Coudersport. “Coudy” was an amazing place to be raised and in my eyes, I felt that we were always the “All American” family. I grew up with two younger sisters and my loving parents who have been married for 40 years. My mother was a schoolteacher and my father is a practicing Audiologist. We had a nice house with a picket fence and a dog. I spent my summers as a young kid at the swimming pool with all my friends, played baseball in the evenings with our local league, and spent time with my family.
I did not really have a care in the world, life was pretty great. The Road To A Physician My strongest influence that drove me into medicine was my father. I was always touched by the way our community loved him, not only his patients, but family members of patients, it was deeply profound. I wanted to BE that person. The guy that was loved and liked by everyone but also had garnered respect. The guy that was invited to everything, that everyone wanted to be around. Not to mention being a doctor is an honorable profession and the money is good. So why not, right? It was not until I made it into medical school, graduated, and then started residency that I realized I had a much
A recovering physician addict recalls his hard fall from grace stronger, unconscious pull towards this field for all the right reasons. More about that later.
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From Med School To Medical Director I graduated from high school in 1999, and went on to play varsity baseball and major in Biology at Westminster College in New Wilmington, PA. I attended medical school at Ross University, which was a year-round, slightly expedited program. I graduated medical school at the age of 27 and was accepted into the Internal Medicine Internship at Allegheny Hospital in Pittsburgh, Pennsylvania, as well as a Physical Medicine and Rehabilitation residency at the University of Pittsburgh Medical Center thereafter. In 2012, I moved myself and my girlfriend at the time to the small mountain town of Lander, Wyoming to accept a position as the Medical Director of the inpatient rehabilitation floor at the local hospital. I also started my own private outpatient practice simultaneously. The Fall From Grace The culmination of how I was raised, my own infallible ego, personal relationship struggles, and the addition of a new baby proved to be more than I could handle. These factors, compounded with the stressors of the “good old boys club,” office managers and physician providers “dumping” their unwanted, uncared-for chronic pain management patients into my lap culminated into the perfect storm that led me down the path of addiction and a hard fall from grace. In my wildest dreams, coming from the perfect family this was not even on my radar screen as something that would ever or could ever happen to me. I was untouchable. Join me in the next issue to learn more about my journey. 1
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P HOTO C RE DIT OF IN GRA M IM AGE S
O F F IC E S PAC E
Design Thinking Vs. Ground Hog Day
D
Wri t t en by N a t ha n Ec k el
esign thinking isn’t just a hip buzzword. It’s a critical skill that you can utilize quickly and effectively to gain the margin you absolutely need in a post-COVID world. As part of mental health month this past May I watched a documentary and listened to the stories of many medical students, residents, fellows and attending physicians featured in that documentary. Such storytelling films provide an enormous tool to share and influence others. Especially when produced by a skilled Emmy nominated filmmaker like Robyn Symon. Patients and physicians alike need these tools to share and create emotional engagement for others. The good news is that you don’t have to be a filmmaker to use this tool. Design thinking will give you new opportunities to reinvent and reimagine your work and your life. At its core, design thinking simply takes a step back, observes the bigger picture, and asks “is this the best way to do this?” Just like the reframing tool from last month, you 2 4 | J U LY / AU G U S T 2020
can discover new tools to allow physicians and patients to build healthy lifestyles. These tools allow physicians to be the trusted advisor instead of a cog within assembly line medicine. Here’s where design comes in -Last month we talked about the interactions of medicine and patients. As a designer I have to wonder how well the physician’s limited time is being invested in patients. Remember the film Groundhog Day? I fear many physicians’ lives look increasingly like Groundhog Day -spending so much time repeating similar information to different faces. If this hasn’t happened to you, it might explain why your colleagues are so grumpy sometimes -just like Bill Murray’s character. When I ask physicians about this, I find many can give me at least a Top 3 very quickly. Most physicians would have a Top 3 list within seconds. Your Top Three... Repetitive conversations Annoying conversations
Draining conversations Pandora’s Box conversations, Policies We Didn’t Create (But Have To Legally Follow Anyway) conversations. Do those conversations ever take their toll on you? Your time? Your energy? Your spirit? If you’re a few years or more into your career and feel less than ecstatic to be a physician, could this be a small part of the reason why? We both know that you can’t control everything - but I’d suggest that you might just be able to change this one part of your day. If you choose to see your role differently, you might be able to reframe your role and your persona in your practice. How do you do this? You simply answer those questions - for the last time. If there were a way to answer every question, while staying positive, and staying out of many if not all negative interactions, would you be willing to think openly and objectively about it? Because this solution is out of the box. It’s NOT for everyone. But it might just be for you. Of course patients expect physi-
cians to do the same thing over and over. But what if this could change? What if more physicians stepped outside of tradition, and took a design view instead? Remember the 90s? The very early days of the internet? Those early websites quickly learned to adapt to all the repetitive questions they were being asked. This resulted in the FAQ. You’re a highly trained professional, and I understand why so many of your colleagues simply repeat the same answers with different patients. However the FAQ quickly became a standard way for organizations to save a lot of time on their websites. And now in the age of tele-Health, where patients are starting to get used to virtual connections, the time has never been easier for forward thinking physicians to empower their patients. There are enormous ramifications beyond just saving some time. Here are just a few you could consider:
LIVE. LIFE. FULL.
1. Save Time & Energy especially on draining conversations 2. Train Your Patient patients want to partner with you on their health and many are eager for a more active role in their health - if you empower them. Tip - Adult learners need to know the why and not just the what. 3. Build Authority many patients are asking Doctor Google simply because they don’t have access to their primary physician’s insights. Building a library of short spoken or written content that patients can access on-demand suddenly puts you on the same league as any celebrity doctor - with the added benefit that patients know they can see you regularly -unlike the talking head on TV. So many physicians have already made this shift to on-demand content. And I’m not even suggesting you become a blogger or podcaster. Simply doing your Top 3 frequently asked questions will help you enjoy these benefits. Will you take the leap? What three conversations would you most like to eliminate if you could? 1
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MEDICINE IS
OUR AND
T AK I N G
WWW.PHYSICIANOUTLOOK.COM
HOUSE, WE
I T
ARE
B A C K !
IN TELLI G EN C E ON T HE MOVE
It’s All Up In The Air Writte n b y A y us hi C hug h, M. D.
Life vs Livelihood Medicine vs Economy, Heart or the Mind ....Never an easy decision Madding Crowd vs Sound of Silence, Fireworks vs FireSk ies, Faces or Facades, Nothing is ever in Black or W hite, Oh Decisions, decisions... Frontlines vs Last Lines, To Admit...or Not? W hich is safer? A nd for W hom? Ethics vs Academics, Not an easy decision... Save a life, but who’s f irst? W ho Saved W hom? Masks vs Vents, Breath of Fresh A ir vs High Flow Ox ygen, Virus vs Ignorance, any Panacea out there? Of Dilemmas and more,
PHOTO CREDI T OF PHYSICIAN ARTI ST AYUSHI CHUGH
Only One thing isn’t for Us to decide, Inha le vs ....Exha le.. Breath in, or, well...Breath Out? For it’s a ll ‘Up in the A ir’! With Life, come decisions, Without Life?...what remains? Records broken, of the wrong k ind, Tough Decisions. Indeed. In W hose Hands? Hands that are throwing up in Despair! For it’s just ‘A ll up in the A ir. 1
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T H E LA S T WO RD
COVID-19 And The Political Pandemic Wri t t en by C ra i g M . Wa x D O
M
Welcome To The Last Word
y goal for this column is to present various physician perspectives on issues that we encounter every day. You may agree, you may disagree, or you may seek more information. The unlimited freedom to share ideas, compliments, and criticisms are the sole path to improving physician conditions and individualized patient care. As I did in two decades of articles in MEDICAL ECONOMICS journal, my goal is to get physicians to think, speak up, and act in the interest of themselves, the medical profession and patients. I hope you find this column insightful, eye-opening, and stimulating, in every sense of the words. I look forward to sharing information, receiving your feedback and thoughts, and the road to results. Best Health! Craig M. Wax DO 2 8 | J U LY / AU G U S T 2020
2
020 was “the year of the political pandemic.” If COVID-19 coronavirus wasn’t a bad enough worldwide pandemic, it ignited a political pandemic that absolutely destroyed our response to COVID-19, all our defenses, our civil rights, and our livelihoods, putting our very country’s existence at risk. How could this happen? The Democrats blame the president for the “wishy washy” academic approach of Dr. Anthony Fauci. Don’t wear a mask. Wear an N95 mask. Wear any mask. No real research to support masks for well people, but only a century of medical surgical dogma. The Republicans blame the state governors for citizen lockdowns and mandating COVID19 infected patients be sent across their states to nursing homes and long-term care facilities, against CDC guidelines and facility objections. Both policies resulted in needless deaths and citizen
loss of rights, freedom and liberty. The media presented a very biased and political view, depending on which you were tuned into. MSNBC, CNN, and ABC/NBC/CBS network media suggested that the president’s rallies were responsible for the spread of the virus. Fox News and Conservative Media suggested that “black lives matter,” and the accompanying destruction of property, violence, and looting was a far bigger problem for the spread of the virus. Perhaps worst of all, potential treatments and preventative strategies were politicized, and even “outlawed,“ in many states. Since 2005 with the SARS virus, Dr. Fauci and our government published that Chloroquine(CQ)/hydroxychloroquine(HCQ) are effective “as a treatment and an immunization.’’ Since COVID-19 coronavirus is closely related to SARS, it would make sense and logically follow that it should be
PHOTO CREDIT OF INGRAM IMAGES
Never before had governors made executive orders that restricted physician practice
tried if the patient and physician are comfortable. But, as unluck would have it, on physician urging (mine included) our president spoke positively of hydroxychloroquine and the political games began. Various Democratic governors banned the use of HCQ without a positive test, reportedly to prevent shortages of the drug for other uses. Nasal swab testing was not an accurate way to determine positivity if the patient was recently infected. This prevented the treatment from being most effective. Never before had governors made executive orders that restricted physician practice and patient options for treatment. Rushed research began at multiple institutions but most seemed like a set up for planned failure. Some was conducted in comorbid dying patients at the VA. Other studies didn’t include zinc, and still others, like The Lancet, couldn’t produce the
data. Making matters worse, the media played up a story of a man ingesting fish tank cleaner which contained CQ potentially and distantly, “on the reported advice of the president,” which was not the case. Congress was as polarized as ever. Conservative and Republican thought leaders tended to minimize the spread and effects of the virus, while liberal and Democrat thought leaders tended to magnify the spread and effects of the virus. Politically speaking, it was in the best interest of Republicans to minimize fear and damage estimates so as not to harm the president’s reelection campaign. Democrats, and most of the media tended to maximize fear and damage estimates so as to potentially harm the president’s reelection campaign. Unfortunately, this left most people in a “lockdown panic syndrome,“ feeling either polarized and apoplectic, or utterly bewil-
dered, not knowing what to believe. There was even a wide split of physicians on the topic as well. Academic physicians, administrators and government “experts” favored “shut down,“ and avoidance of the virus by all parties for indefinite time. Schools and “nonessential“ work places would be closed and schooling and business was to be done over the Internet. It was initially for two weeks, “to flatten the curve,“ but has been more than four months thus far with an unstated and unclear endpoint. They also called for masking and distancing everyone, whether sick or well, by gorvernors’ executive orders as if they were law. Independent private practice physicians tended to favor “open,“ policies where healthy youth at low risk would be exposed to gain herd immunity, while only the sick or elderly at high risk would be masked or distanced. Schools would be open, and work places would be open and operating at the owner‘s discretion. The politicization and utter ruination of physician autonomy, patient freedom of choice, and the scientific method is unacceptable and is costly in both lives and livelihoods. No matter which view you favor, all views must be available, entertained, and given due consideration. There is certainly more than ample room for all fights, brainstorming, trials, and patient unique choices. Physicians in the United States and all over the world should be vocal and take action to not only limit the extent of this damage caused by politicians and media, but prevent future outbreaks of a political pandemic. Politicians and people resort to personal attacks when they are out of ammunition and good ideas. Stick to your guns. Freedom of speech where all ideas are heard and debated is the best concept to find and act on the best ideas. 1 WWW.PHYSICIANOU T LOOK . C OM | 29
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Publisher: Dr. Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Assisting Editor: JR Hill VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Social Media Interns: Priscilla Contreras and Letitia Bottino Contributing Authors Dr. Marlene Wust-Smith, JR Hill, Dr. Megan Babb, Pamela Ferman, Dr. Robyn Alley-Hay, Dr. Errin Weisman, Dr. Robert Campbell, Nathan Eckel, Dr. Ayushi Chugh, Dr. Craig Wax. Original Artwork: Dr. Ekta Shah, Dr. Daniel Okoradudu, Dr. Robyn Alley-Hay, Dr. Hetvi Joshi and her daughter, Dr. Michelle Jordan, Dr. Robert Campbell, Dr. Ayushi Chugh Published By “Physician Outlook Publishing” Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues. The views expressed herein are those of the authors and/or those interviewed and might not reflect the official policy of the magazine. Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@ physicianoutlook.com “Physician Outlook is a registered trademark” Cover art by Dr. Etka Shah
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