"A Cupful of Gratitude" Cover Art by Dr. Nigam Sedhai by Physician Outlook Magazine

ISSUE 7 | VOLUME 1

AUGUST/SEPTEMBER 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 Physician Artist Dr. Nigam Sedhai

CREDIT PHYSIC IA N A RTIST A N A PAU L A VELEZ, MD, FAC P

F R O M T H E P U B LIS H ER

Hotel COVID-fornia

Wri t t en by Dr. Ma rl ene W ü st- S mi t h

y first semester at Saint Bonaventure University, in the fall of 2019, was filled with what I expected: students with sore throats, coughs, rashes, UTI’s, STI’s and some headaches/abdominal pain and anxiety. This fall, in the midst of a global pandemic, life couldn’t be more surreal at the Center for Student Wellness, where I am the sole physician and Medical Director for our small campus in rural, upstate NY. If someone had told me a year ago that making beds and stocking rooms with linens, towels, toilet paper and snacks would be part of my job duties as a physician in 2020, I would have laughed them right out of the room. Our university is one of a handful of institutions of higher learning that made the bold decision to welcome ALL of our students back to campus, into their small two-per-room residential dormitories, for in-class instruction. Our students are wearing masks, socially distancing, and were required to submit negative COVID-19 PCR tests within 14 days of arriving on campus. I am beyond proud of these young men and women. They are so happy to be at school, eager to learn, and behaving like responsible young adults. They are demonstrating the sort of 2 | AU G U S T / S E P T E M BE R 2 020

resilience rarely seen in “Generation Z.” Pandemic-associated adversity has been character-building for a group of young adults who have been raised to think they are invincible. They are demonstrating true humility and grace and have shifted their focus from self to community. Another pleasant unexpected consequence of this pandemic. This year we’ve had to prepare not only for “routine” types of visits, we also needed a plan to detect and hopefully contain COVID-19, knowing full well that even the most benign cough, sniffle, upset stomach or fever has to be considered COVID-19 until proven otherwise. We made it through an entire week of classes without ANY positives (which is amazing because Western NY is currently considered a “hot spot” due to an outbreak at an Erie County processing plant). Housekeeping duties became part of our “opening plan” when we decided to renovate the wing down the hall to create a makeshift infirmary for sick and positive students. We prepared our empty rooms for any potential “SUI’s” (Students Under Investigation) for COVID-19. We have been hosting students from hot spots and international locations who were unable to quarantine in New York for 14

days prior to arrival on campus, and it has been good “dry run” practice for me in Hospitality Management as we await students to start presenting with symptoms. I am reminded of an oldie but goodie, the song Hotel California, by the Eagles. Except in my head it goes like this Welcome to the Hotel COVID-fornia Such a lovely place (such a lovely place) Such a lovely face Plenty of room at the Hotel COVID-fornia Any time of year (any time of year) You can find it here This semester I am ready, and every day that goes by that we are able to allow in-person education is a blessing. We hope to make it through until the Thanksgiving holiday, but will be pleasantly surprised and blessed if we make it another week. Governor Cuomo orders require a 2 week suspension of in-person classes if 5% of the student population or 100 test positive. One day at a time. 1 Dr. Marlene Wüst-Smith Publisher

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Table Of Contents

AUG U ST | SE PT E M B ER 2 0 2 0

FROM T HE PU B LI SHER

Hotel COVID-fornia By Dr. Marlene Wüst-Smith/p.2 Artist: Dr. Ana Paula Velez VI PP SPOT LI G HT

Gratitude With An Attitude By Jaime Schwarz and Adi Segal/ p.6 Mental Marathon By Anonymous/ p.8 B A B B LI N G S

The Sekhmet Writing Project 4/12 By Dr. Megan Babb/ p.12 A DVOC AC Y I N AC T I ON

Drug Prices: The Unmasked Truth Behind Legal Kickbacks By Alicia Roselli/ p.14 The Comeback Kid: A Big Fish With A Big Head By Dr. Bobby Campbell/ p.16 OFFI C E SPAC E

Give Amazing Presentations By Dr. Brent Lacey/ p.18 Trust Toolbox - Inbound Phone Triage By Nathan Eckel/ p.21 T I ME FOR YOU

From Fat To Fit By JR Hill/ p.22 IN TELLI G EN C E ON T HE MOVE

An Ethereal Rant By Dr. Chris Caramia/ p.24 Artist: Dr. Douna Montazer

Dictum By Dr. Jean Robey/ p.27 Artist: Dr. Nancy Prendergast T HE LA ST WORD

Lessons Learned By Craig M. Wax DO./p.28 Artist: Dr. Akop Jack Seksenyam

Front Cover: Dr. Nigam Sedham Back Cover: Juliet Moore, daughter of Dr. M. Christina Lee WWW.PHYSICIANO U T LOOK . C OM | 5

V IP P S P OT LIG H T

Gratitude With Attitude

A JOINT LOVE LETTER FROM PHYSICIAN OUTLOOK AND SENDTHANKSNOW Wri t t en by J a i m e Sc h w arz a nd A di S ega l

Dr. Wust-Smith writes: When I founded Physician Outlook, my vision for the magazine and website was to partner with advertisers and sponsors that were completely different from those one typically finds in “medical magazines,” journals and other publications whose primary target audience are physicians and laypersons seeking medical information. I didn’t want us to find ourselves beholden to Big Pharma, Big Hospitals, Big Insurance or any of the many middlemen who control these entities and have, to a great extent, ruined the practice of medicine for many physicians and patients. We are strategically choosing to partner with physician-owned businesses, grass-roots advocacy groups, 6 | AU G U S T / S E P T E M BE R 2 020

state and county medical societies and also with non-medical commercial entities whose mission and core values align with ours. We were extremely fortunate to meet the founders of SendThanksNow, who have developed a unique and wonderful platform where the language spoken is “GRATITUDE,” and where transactions occur in the currency of “HEARTS” which can be passed on to others or redeemed via PayPal/Venmo for whatever would help them get through and enjoy a “feel good” moment from a thankful person. Jaime Schwarz and Adi Segal write: It took all of two seconds to realize their gratitude network would be a

wonderful extension of the stories we were telling, empowering our readers to connect and thank the healthcare professionals we highlight every month personally and directly. When Dr. Wust-Smith (Publisher) and Pam Ferman (Executive VP of Marketing) reached out to us, being a startup of only a few weeks old, we were just grateful they had heard of us! Of course, when they started sharing their goals to report the deeper, human side of the people we all rely on at our worst moments, we knew how lucky we had just become to find a partner in them. Although we started as an internal gratitude platform for hospital and nursing home administration, this pandemic we happened to launch in the middle of has given us the opportunity

daughter, Lucy (who was stillborn at 36 weeks), and 3 days later her husband Joe died of unusual complications from Hepatitis A. She is raising her son London with the help of her family, as her job requires for her to work for grueling week-long stretches at a time. She goes through an elaborate “decontamination” process upon arrival home, and has to avoid direct exposure with her loved ones in order to keep them healthy. Losing both her daughter and husband are unimaginable tragedies for anyone to endure; but instead of being resentful, angry or despondent, Dr. Easley shows us all by example what it is like to be full of mercy and grace. She has touched so many with her words and her story, and has shown us all by example what resilience looks like. She is blessed to be surrounded by a tribe of fiercely loyal and thankful friends, family, and colleagues. We hope to grow that tribe through our new partnership. With Gratitude, The entire teams of Physicians Outlook and SendThanksNow 1

to tap into a world of pent up gratitude. Although we want to make sure everyone is able to thank anyone essential to them through SendThanksNow, we were founded in Healthcare and come from clinical, health tech and health marketing backgrounds. We can’t wait to help people discover more about the essential workers on our platform through Physician Outlook and empower readers to connect so easily with the very people they are reading about. Through our Hearts currency (100 Hearts = $1), we can not only make sure text, emojis, pictures, and even video are passed on to essential workers, but a gesture of gratitude they can use to help them cope a little more easily with their stressful lives. We look forward to working very closely with

Physician Outlook to showcase as many of these amazing people as possible for both readers and STN users (who hopefully, more and more, become the same people:) Our First Feature Together: The first physician we are featuring together is Dr. Leslie Easley. Dr. Easley is an Internal Medicine physician who works full-time as a hospitalist for the Abrazo Medical Group in Phoenix, Arizona. She is truly on the front lines of the pandemic, and frequently posts daily inspirational musings and reflections about working in a hot spot city/state during COVID-19. In August of 2019, after a healthy and uneventful almost full-term pregnancy she tragically lost both her WWW.PHYSICIANO U T LOOK . C OM | 7

PHOTO CRE DIT OF INGRAM IMAGES

V IP P S P OT LIG H T

Mental Marathon Wri t t en by A no ny mo u s

marathon begins months before the participant ever pins on his or her bib. The preparation is lengthy, tiresome, and trying, but half the battle is convincing oneself that crossing the finish line is worth all the sweat, tears, and strains. Running a marathon is a completely mental game. Mental, a simple adjective that bears more weight for my family than the appearance of this six-letter word. Mental, never separated from mental health: it has metamorphosed from an adjective into a disease, a state of 8 | AU G U S T / S E P T E M BE R 2 020

being. Mental health is a battle; my brother’s secretly began months before the pivotal starting point of his race as he unknowingly prepared to run the marathon of a lifetime. Leading up to that day, there were signs. Of course, there were signs, there are always signs. As he trained and trained to become a high school graduate and transition into adulthood, the voices started. Alone in his room or driving his car the voices accompanied him in the back seat. They became his worst enemy, an inhibitory training partner,

sabotaging all his hard work. Like a strong head wind, the voices were there, but invisible to the rest of us. Slowly, breaking down the brother I adored and admired. There were days of tempo runs: quick bursts of sadness and anger. There were days of slow runs: draining, depressing, with no end in sight. A silent killer, his emotions and thoughts began to control his mind. His methodical presence began to fade into the background as his preparation for the upcoming monumental change began to consume our family’s lives.

Then race day arrived. High school graduation day: A time of celebration, happiness, anticipation, and change. As the countdown begins, the runners line up at the starting line. The gun fires. Let the marathon begin. The beginning of a race is always chaotic. Every runner struggles to find his or her pace as each stride is met with the resistance of an overcrowded path ahead. The first major challenge is separating the excitement of the race from the reality. Although one may have excessive energy now, 26.2 miles is a journey, not a sprint. At first, my brother struggled with this separation. “Is what I am feeling just a ‘funk,’ am I depressed, or maybe just anxious to leave home and start college in a foreign place?” Slowly, the harsh reality began to settle in. “These voices are real. My suicidal thoughts are scary. This is not the person I am.” With spectators lining the stage my brother put on a happy face, but once the crowds faded he began unraveling before our family’s eyes. In the calm setting of our home, the breakdown began. At mile three there was an aid station and my brother thankfully stopped for help. So soon into the race confusion set in and the entire racecourse was altered, as the calculated distance appeared to lengthen in time. The next week, originally filled with celebrations and graduation parties, turned into white walls, visiting hours, fears, and tears... more and more tears. Most people have never run a marathon. Most people have never been in a psychiatric ward. Envision endless crisp white walls, with no inspiring generic quotations or picturesque destination getaways, no fake plants, or attempts to ease the anxiety of the patients in this unnerving setting. Walking into the psychiatric ward on that sunny June day, my family’s entire world turned to darkness. As the clouds shuffled in overhead, the race began to unravel. The next two weeks were a state of dehydrated delirium. This cannot be happening at mile three, not before the

race even truly began. Sitting in the parking lot of the hospital, my mother and I sobbed, praying that by a slight miracle this was a false start. There are always rules and regulations a participant has to follow before any race begins. No baby strollers or iPods, no trail shoes or bare feet. Entering into the psychiatric ward, the rules were not so simple. All shoe laces removed, all edges of papers or pictures rounded, no pants with drawstrings. Need to go to the bathroom? Leave the door open and a nurse will wait outside. Instantly my brother turned into an experiment. Combinations of medicines, with all other variables controlled, observations were taken and data was collected - all in the hopes of continuing the race. Unfortunately this pit stop lasted two weeks. Two weeks of sleepless nights, constant worry, and unmasked fear. As my brother’s body started to regain nourishment and his dehydrated delirium started to subside, daily visits home were incorporated into our family’s new agonizing “routine.” Finally the doctors released his discharge papers and my brother was able to continue on with the marathon. The next couple of miles were slow with every stride more cautious than the next. Quickly, our family came to the realization that this 26.2-mile endeavor had now become a family affair as we fluctuated between spectating and running alongside him. Our family learned to move with hidden reluctance avoiding any breakdowns, but the breakdowns were unavoidable. Every aid station gave our family false hope. With every two miles gained, another mile would be lost as together we would slowly slug backwards, re-tracking and re-running the now familiar course. As a marathon spectator your only job is to encourage runners passing by that every painful stride is worth crossing the finish line. As muscles cramp, your digestive system breaks down, and chaffing appears in unimaginable places, runners need every smiling face, every cow-

“These voices are real. My suicidal thoughts are scary. This is not the person I am.” bell, and every cheer. As his number one spectators, our “mom and daughter” morning coffee talks turned into a two-way therapy session. A way to re-energize each other mentally and find the strength to continue to cheer, mile after mile. The human body is not designed for this kind of abuse nor is the human mind. As spectators watch runners move into the second half of the race, they question why would someone run 26.2 miles? The anguish on runners’ faces reflects the deterioration of their bodies and minds. Marathon runners will tell spectators that at this pivotal point, one begins to play head games filled with calculations, rationalizations, bargains, and rewards. For most runners, this is where one’s mental will steps in to salvage the race. My brother’s lack of preparation for the marathon left his mental muscle weak midway through the race. The next couple miles of the race stretched on for months. Months filled with false hopes, sadness, frustration, and cruel disappointments. Slowly, the remainders of my brother’s original college dream began to unravel. Posters decorating his room were torn down; his university-labeled clothing stored away in the hope of maybe attending next year. All of this was replaced with a year of commuting to a local college as my mom attempted to transform his room into a dorm room stocked with all the college essentials: a mini refrigerator, an endless supply of water bottles, a beanbag chair, munchies, and a colossal white board calendar. This façade was not the college experience any one of us had expected, but that’s the unpredictability of a marathon. One mile you are coasting, the next you are trudging. My brother tried to embrace his new reality as he escaped for hours into his new “territory.” WWW.PHYSICIANO U T LOOK . C OM | 9

CREDIT ANONYMOUS

The illness began to engulf the outsiders. Once spectators, we were now running the race, stride by stride. We were in unison with every high and every low, every hill and every plateau. Mental illness became our third family member. Our new partner affected each of us differently along the race. As my mom and I began to run the marathon with my brother, we realized that no one else would really ever understand the depths of our pain. We knew we could not slow down. What first appeared as dehydration in my brother’s body slowly emerged as heart palpitations for my mother. My mom took her pit stops through the support and comfort of her family and friends. My mom watched from the sidelines, crossing into the race’s path on occasion, cheering, stretching her emotions, drinking extra fluids and continuing to remain hopeful that he would finish the race. My mom still has not lost 1 0 | AU G U S T / S E P T E M BER 2020

hope, five years later. Soon thereafter I felt the chaffing. Worry began to engulf my school days with constant phone calls from my mom asking of my brother’s whereabouts and when I had spoken to him last. One too many times my days were cut short as I rushed home, hoping that by a miracle I would find him peacefully taking a nap, instead of the dreaded nightmare that haunted us. After a year of running, the marathon appeared to become a quest for failure. At this point, it was time for my course to diverge from the team. A new location, a new academic challenge, a new life was before me and I had no choice but to accept this off-road trail. Leaving home for college that August day, anxiety filled every pore of my being. How can I possibly leave my teammates behind after how far we had run together on this journey? But running a marathon is unstructured and unpredictable, one

must learn to adapt to any obstacle before them. So adapting is what our team did. Through daily phone calls home and letters of encouragement, I continued the race. When the time came to return home for fall break I had no idea what to expect. Shock met me at the front door. Welcome home. Marathons change people - 26.2 miles is a euphoric event. Since my first visit home my stride has adjusted. Today my brother is not the person I grew up with. He is not the same easy-going brother I built Lego castles with in our basement. He is not the same brother I roller-skated with in the driveway until the sun melted away. He is not the same brother I have loved for eighteen years, but he is still my brother. The main difference between mental health and running a marathon is choice. People who run a marathon choose to run a marathon. People who have mental health disorders never choose this diagnosis. Regardless of the power of choice, people continue to push through the grueling miles of a marathon and people continue to battle their mental health disorders through the relentless and unpredictable challenges. After a marathon, a runner is forever stronger. Stronger, because he or she knows the magnitude of their accomplishment and even when the course seemed unforgiving and endless, they continued to wage forward. Individuals with mental health disorders, although they may never know exactly what waits at the finish line, continue to wake up everyday, ready to run more miles and continue on with the race, gaining strength with every stride. Every day I go for a run, not a single mile passes that my brother does not accompany me, but I allow him to stride alongside. This is how I process the cruelty of a mental health illness, this is how I mourn the loss of my brother, and this is how I accept the new brother I am so grateful to have and to love. Our family love is unconditional and can easily withstand more than 26.2 miles. 1

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B A B B LIN G S

Fo u r | T w e lv e: T h e

The Sekhmet Writing Project 4/12 THE PROTECTIVE ONES

Wri t t en by D r. M ega n B a bb

any years ago while my husband and I attended a wedding, I found myself sitting next to and speaking to a former World War II pilot. Though he appeared to be in his late eighties his memory would give a different perception. His memory was sharp. Riveled mine though sixty years his junior. Albert stood five feet and ten inches tall. He had silver hair with a well-kept beard. His dapper suit stood the test of time and looked as though it came straight off of Cary Grant. He not only chose a bow-tie in lieu of a traditional tie but it was made from ostrich feathers. Albert spoke of three things: his life as a pilot, his passion for flying, and his 1 2 | AU G U S T / S E P T E M BER 2020

love for his late wife. I sat for almost an hour listening to him and the stories he had acquired throughout his life. What intrigued me the most were the stories he shared pertaining to his career as a commercial airline pilot. Mainly because I found so much similarity in his passion for pursuing safety for the passengers he flew with my passion as a physician to advocate for the safety of my patients. At the time when a new physician graduates medical school, they pledge themselves to the Hippocratic Oath. Which is to say many things, however none more important than the following: Do no harm, hold sacred the patientphysician relationship, and teach the secrets of medicine to the upcoming

generations of future physicians. In the last couple of decades, the healthcare system has been controlled less by those with the highest level of training (the physicians) and more so by profitdriven healthcare corporations. For many reasons (of which I discuss in an earlier essay in Physician Outlook titled: The Hippocratic Oath 2.0) healthcare administration has wedged themselves in-between this sacred oath physicians take and the care we provide to patients, making it more difficult than ever to practice medicine. When speaking to Albert, I learned that my profession was not alone in the oath we take. I also learned that we weren’t the only profession that strived to uphold the oath we swore

h e p r ot e ct iv e O n e s

ourselves to. In America, there exists a large shortage of physicians. This is a complex situation that is deeply rooted in federal funding that has not increased since the 1980s. As a result, America has a critical shortage of physicians on its hands. However, instead of fixing this problem by expanding educational opportunities to produce more physicians annually, the profit-driven system has found a (perceived) cheaper alternative by mass-producing NPPs (non-physician providers) like nurse practitioners. Decades ago, the education of a nurse practitioner was vetted by the brick and mortar institute which produced them. However today exists hundreds of strictly on-line nurse practitioner

programs that aim for one goal: produce a mass-quantity of NPPs. The problem with this solution means that the quality of education received gets sacrificed and many graduating today are grossly unprepared to manage even the simplest of medical conditions. As a result, this has placed patients in a frightening position they are completely unaware of. In twenty-four American states/territories, patients are receiving medical care from individuals who have been granted the authority to practice medicine independently, though the education that some received has neither been accredited by the Board of Medicine nor standardized by the Board of Nursing. In our conversation, Albert and I spoke

about this. I asked, “As a well-seasoned pilot, what would you do if authority was given to a group of individuals to f ly commercial airplanes that carry hundreds of passengers with each flight, who earned their pilots license from an on-line program and whose only experience flying an aircraft was through shadowing experienced pilots, never actually flying one them self?” His response, “If that ever happened, I would only travel by boat, train, or car. But that would never happen because no path in this country exists where an individual can take a shortcut to becoming a pilot.” When I told him this was happening in America’s healthcare system, he was aghast. “You are in a tough spot, kid,” he said. “And now that I think about it, so are a lot of Americans.” He was spot on. At the time of our conversation, what was yet to come to fruition was a much-needed advocacy group that would help shed light on this ever growing issue that was only beginning to surface. Enter: Physicians for patient protection PPP is a grass-roots physician-led non-profit organization founded in 2017 by five female physicians, Drs. Rebekah Bernard, Carmen Kavali, Ainel Sewell, Amy Townsend and Purvi Parikh. The mission of this organization (as stated on their website): Ensure physicianled care for all patients and to advocate for truth and transparency regarding healthcare’s [non-physician] practitioners. 1

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ADVO C AC Y IN AC TIO N

Drug Prices THE UNMASKED TRUTH BEHIND LEGAL KICKBACKS Wri t t en by Al i c i a Ro s e l l i , Edi t o r-In- C hi ef

ur very own contributors, Drs. Rupali Chadha, Marion Mass, and Mary Tipton are back in the news, speaking out and speaking up against the “kickbacks” enjoyed by Pharmaceutical Benefit Management corporations - AS LEGALIZED by the Safe Harbor protection of PBMs for practices otherwise against the law. Hundreds of billions of dollars are diverted from the patient consumers, and directed to those who add no value to the medical services being rendered and received. Artificial shortages and inf lated prices for common prescription drugs are the norm. As we featured last month, the executive orders signed by President 1 4 | AU G U S T / S E P T E M BER 2020

Trump are a huge and positive step forward - according to some more than any other president has done for the patient consumer as it relates to prescription drug costs. However those orders “expire” when President Trump is no longer in office. To protect the progress made, congressional action is required. That will only happen if the constituents “get woke” to what goes on behind the shady scenes and demand the repeal of the Safe Harbor laws. Read more in the article Patients suffer while doctors try to reform ‘corrupt’ prescription drug policies, by T. H. Lawrence, originally published in mdstatewire.com on August 20, 2020, excerpted below

They’re doctors, after all, not politicians or lobbyists. But they are united to stand against a system that must be changed to provide affordable prescription drugs to their patients, all three told the Maryland State Wire. Drs. Marion Mass, Mary Tipton, Amber Colville, Rupali Chadha and Christine Saba share a strong opposition to the current process, which they say adds needless costs to drug prices and makes people in need of prescription medicines pay unfair amounts or face serious, even fatal health risks. “It’s scandalous that we have lawmakers in our country that allow this to go on,” said Mass, a Philadelphia-area pediatrician.

P HOTO C REDIT OF WH ITE H OUSE .GOV

Philadelphia-area pediatrician Dr. Marion Mass | Twitter Mass is also a writer who serves on the editorial board of the Bucks County Courier Times and The Doylestown Intel, and she does public speaking as well. She is also vice chair of the Practicing Physicians of America, a member of the Bucks County Health Improvement Partnership and belongs to the Pennsylvania Medical Society. Mass is one of 70,000 doctors who belong to Free2Care. The group’s Twitter feed says it is a “national coalition of over eight million patients and doctors dedicated to solutions that make health care affordable and accessible.” Mass says that pharmacy benefit-management firms have seized control of prescription drugs and

are squeezing money out of patients – a lot of money, as an estimated $250 billion went to these middle managers in 2013, according to the American Prospect. Medical expenses have exploded in the last 50 years. A 2019 report from the Peterson-Kaiser Family Foundation Health System Tracker, based on National Health Expenditure (NHE) data from the Centers for Medicare and Medicaid Services (CMMS), said it had increased from $74.6 billion in 1970 to $1.4 trillion by 2014. The numbers continued to spike, with healthcare costs – including direct care, prescription drugs, administrative costs and insurance – reaching $3.6 trillion in 2018. Please visit www.PhysicianOutlook. com to read the rest of the story. 1

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ADVO C AC Y IN AC TIO N

The Comeback Kid A BIG FISH WITH A BIG HEAD Wri t t en by Dr. B o bby C a mpbel l

Hometown Values I think every stage of our lives can influence the choices we make, and as I think back, my road to addiction was a long journey that began early in my childhood. I grew up in a small town where my graduating class was less than 100 people. Making friends was easy for me and high school did not present too much pressure for me, it was easy. At home I had a supportive and loving family that was overbearing and my reaction to that probably helped shape my arrogant sense of entitlement where everything I did was “gold,” and I could never be wrong or do wrong in their eyes. As a child I did not know anything different, this was my normal. Entering 1 6 | AU G U S T / S E P T E M BER 2020

college with this mindset turned out to be detrimental for me because I did not have the coping skills and the sense of responsibility to deal with real problems or recognize I had any issues. Growing up I was infallible, I was perfect and thought no matter what I did, I would always come out smelling like a rose. I believe the lack of responsibility and accountability made it easier to fall into the dark hole when things came crashing down around me years later. College Life I attended a small, private college in rural Pennsylvania where I majored in biology. At Westminster, I was part of a fraternity, had a scholarship to play base-

ball, and got good grades without having to exert much time or energy into my studies. I was the stereotypical frat boy; I played baseball during the day and drank beer with the guys at night, even though I did not really drink in high school. What seemed to remain consistent during college is that I was still a big fish in a small pond, I was untouchable. I did not have to exert much effort to feel loved and respected by everyone, it was a high like no other and I realize now it was nothing but arrogance. The Road to Medical School I knew I wanted to go into some sort of medical field where I could help people, but mostly I wanted to make good

PHOTO CREDIT OF DR. BOBBY CAMPBELL

money and live the lifestyle. Up until my Junior year in college I really had not put a lot of energy or work into taking the necessary steps and preparation for any field of medicine. By now, most students had been studying for years and prepping themselves for the MCAT, possibly doing research to bolster their resume as well as working part-time or volunteering in the field of medicine to gain experience. I did none of these things. In fact, it was during my yearly check up with a physician near my school that changed everything. He asked me what my plans were after college. I told him I was thinking about Optometry. He asked me why. I told him I thought it would be a low stress career that was also lucrative. “Why

not medical school?” he asked. I really could not give him an answer. Then he asked, “when you go to the bar and you see a hot girl with her less attractive friend, which one are you going to try to take home?” I answered the hot one. He said “yes, the hot one. The hot one is med school. Go for that first.” And there it was, the seed was planted in my mind that I was going for the “hot career,” I was going to medical school. A short while later, I enrolled in an MCAT prep course even though I was not nearly ready nor fully committed. It seems that I was not fully committed to anything until I was in medical school. My overall GPA in college was around a 2.9. My GPA in medical school was just

shy of a 3.8. I even scored better than 92% of the nation on Part II of the USMLE STEP exam, which decides if/what residency program you get into and if you get into a specialized field. All the way back to my college days I didn’t put much preparation into anything except what nights we were going to pre-party, what fraternities we would visit, and how many beer pong tournaments we would have at our off-campus apartment. Tune in next month where I share how my lack of preparation led to a very embarrassing effort on medical school entry exams and how my college professors basically told me I would “never make it into medical school, yet alone be a physician.” 1 WWW.PHYSICIANOU T LOOK . C OM | 17

O F F IC E S PAC E

Give Amazing Presentations

Wri t t en by D r. B rent La c ey

ublic speaking is the #1 fear for a huge percentage of people. It’s above the fear of dying for many people. How can you think about giving a great presentation when you’re worried about even giving a basic presentation? I’ve been doing public speaking events for over a decade, but it definitely wasn’t an easy journey. It’s hard to get comfortable talking in front of groups of 10 people, let alone a hundred or a thousand. Still, this is a skill that you can learn and even master with some study and practice. 1 8 | AU G U S T / S E P T E M BER 2020

Let’s look at some major “do’s” and “don’ts” for creating a great presentation. 11 “Do’s” for Giving a Great Presentation 1. Believe that giving a great presentation is a learnable skill. Giving a good presentation is a learnable skill. Even true introverts can give excellent presentations. In fact, introverted people actually tend to plan better presentations though they may be more afraid to give them. Extro-

verts are more likely to “wing it” but are more naturally comfortable being on a stage. Both approaches have value, but both have their pitfalls. Learning to give a great speech isn’t like putting a hammer to a nail. It’s an organic process, and it takes time to get good at it. But, through practice and repetition, you can be an amazing presenter! 2. Prepare for the presentation! It takes a tremendous amount of work to make something appear effortless. My general rule of thumb is to

3. When you’re with your peers, it’s ok to “speak your geek.” Know your audience! If you’re speaking to a group of colleagues, you don’t need to “dumb things down.” It’s good to speak in layman’s terms with patients and audiences who are unfamiliar with your work. However, with peers, feel free to use technical jargon that’s widely understood.

PHOTO CREDIT OF INGRAM IMAGES

4. Use stories to transform your communication. Listeners will only remember data 5% of the time, but they’ll remember stories 60% of the time. That’s because stories are how we naturally communicate! Our brains are wired to think that way. Every presentation is more memorable with stories. In fact, stories may be the only parts of your presentation that anyone remembers. One thing you can do is build a “story library” for yourself. Basically, that’s a collection of 10-20 stories that are memorable/ impactful to you that you can pull out and use in a variety of different presentations when the need arises.

allocate 45-60 minutes of preparation time for every 5 minutes of speaking time. So, for an hour-long presentation, I may prepare 10-12 hours ahead of time. One important question is whether to script the entire speech. It depends on what you’re speaking about, but it’s generally not advisable to script 100% of your remarks. It’s good to rehearse but not “sound rehearsed.” Outline the presentation, make notes of any stories you want to tell and major points to drive home. But, it’s not critical that you script every single word.

5. Develop a good “pre-talk ritual.” Immediately prior to your presentation, what are you doing to get yourself ready to go up on stage? Some people like to “pump themselves up,” and others prefer to “calm themselves down.” I’m more of a calm-yourselfdown kind of presenter. If I’m presenting at a conference, for example, I like to sit in on the presentation right before mine and just listen. I shut my brain off and don’t think about my presentation at all. It’s helpful for me to be calm and just relax. Otherwise, I find that I “get in my head” too much and I start getting anxious. I know other people that prefer to listen to some Rocky music and box an imaginary punching bag. Whatever your needs, pick a pre-talk ritual that helps you get in the right frame of mind so you can go out on that stage and crush it!

6. Follow the structure of a great presentation! Nancy Duarte is a world-class expert on public speaking. In her research, she discovered the scientific structure of a great speech. That research shows that you should go back and forth between where a person is, and where their “ideal situation” is. Contrast these two things repeatedly, starting with the current situation and ending with the “new bliss.” 7. Use repetition, familiar phrases, imagery, and metaphors to help transport the audience. If you’ve ever listened to Martin Luther King’s “I Have a Dream” speech, you’ll hear him use a lot of references that would have been familiar to his audience. These references include Scriptures, hymns, and cultural references. He also used repetition to great effect. The phrase “I have a dream” appears 8 times in his speech. That repetition made the speech more memorable and helped transport the audience to a new plane of comprehension. 8. Have the right level of emotional appeal to fit your audience. Passion and emotion are good, but it needs to fit the “mood” of the audience to some degree. You’re probably not going to do well giving a eulogy if you’re yelling and pumping people up like it’s halftime at the Super Bowl. Emotional appeals are good and can help audience members feel the weight of your words in a more high-impact way. Just make sure to “read the room” as you consider how to bring emotion into the presentation. Sitting in the presentation before yours can be a great way to gauge how the people in the room are feeling. 9. Use your presentation to translate to real growth in your business. If you’re doing public speaking, what’s the point? That is, what value WWW.PHYSICIANOU T LOOK . C OM | 19

does the speaking engagement bring to your business? If you’re just in it to make money or get some experience, that’s fine as far as that goes. But, a speaking engagement could be more valuable in propelling your business growth forward. Are you going to a conference? You can network with other presenters and look for opportunities to collaborate. You could meet the attendees and perhaps earn some new clients. Speeches can also help establish you as a thought leader. If your speech is being recorded, a great presentation can even be an opportunity for free promotion. Whatever your plan, be intentional! If you get invited to speak at an event, take that opportunity and use it for real business growth! 10. Use a speaking coach. I haven’t used a speaking coach before, but I’ve definitely been considering it since my interview with Nancy Duarte. Even the most seasoned veterans can benefit from coaching. A good speaking coach can show you how to change your inflection, insert pauses and places to emphasize your points, and help you craft the structure of your speech. You might not be able to afford one when you’re first starting out, but it’s worth considering if you’re going to be doing public speaking on a regular basis. 11. Use data to support your presentation. Data is important to support the validity and authority of your talk, but you’ve got to weave it effectively into the story structure. Don’t just spout random bits of data with no context. Offer the data as supporting evidence within your story narrative. 6 “Don’ts” for Giving a Great Presentation 1. Don’t be the hero in your story. Always be the guide in your story! The audience is the hero. You don’t 2 0 | AU G U S T / S E P T E M BER 2020

want to be Luke Skywalker! You want to be Yoda!! The hero is the lead character in the story. If you make yourself the hero, the audience who already thinks of themselves as the hero sees you as competition in the story. If you play the guide instead, the audience looks to you to help them solve their problems. Always be the guide, not the hero!! 2. Don’t be afraid to speak “off the cuff ” occasionally. I don’t generally advise “winging it,” but sometimes a little extemporaneous speaking is called for. This is where the “story library” idea can come in handy. You may be able to tell the same story in a variety of settings and emphasize different aspects of the story each time. This strategy can give the feel of spontaneity but with the confidence of you generally knowing what you’re going to say. 3. Don’t create slides in a “ linear fashion.” When you’re creating a slide deck, don’t just do it in a linear fashion (e.g. slide 1, slide 2, etc). Start with the guiding light or main central point, and then every slide serves to drive home that central point. You should be constantly driving your audience towards that central point. All slides support that central point because it may be the only point your audience remembers. 4. Don’t read directly off the powerpoint slides. I have gotten up and left in the middle of lectures when the lecturer was reading directly off the slides. It’s so boring! I can read faster than they talk. They aren’t saying anything new by the time I’m finished reading, so I’m ready to move on to the next thing. Powerpoint slides are fine, and you can even use it as a sort of teleprompter, but just don’t read directly off it! Did you know you can hit the “B” button to turn your screen black or “W” to turn

Listeners will only remember data 5% of the time, but they’ ll remember stories 60% of the time. That’s because stories are how we naturally communicate! the screen white? Then, you could use the powerpoint as a teleprompter and the audience doesn’t see it. Put one central point on each slide and use it as a way to jog your memory for what you want to say. You can have a couple of hundred slides with only one point or image per slide and it’s better than having 20 that are jam-packed with too much info. 5. Don’t use the podium as a crutch. Move around the stage! It projects confidence and keeps the audience engaged. The best way to feel comfortable moving around the stage is spending a lot of time preparing the presentation beforehand. Then, you’ll feel more confident breaking away from the podium. 6. Don’t be so afraid of public speaking that you never give it a try! Public speaking is a genuine fear for a lot of people, but it’s so much fun! You can do it! Just give it a shot! Final Thoughts Public speaking isn’t an innate talent, and it’s not limited to extreme extroverts and “naturally charismatic” people. Anyone can learn to be a public speaker. If you’re worried about how it’ll go, start small. Join the Toastmasters or similar club in your area. Get with a speaking coach. Read, study, and learn the tips and techniques of the best speakers. Then, start looking for opportunities to speak to others. Start with yourself, your friends, and your family. Move up to local clubs and organizations, then gradually step it up from there. There’s so much value in being good at public speaking, and I think it’s worth it to step out in faith and try! 1

P HOTO C REDIT OF IN GRA M IM AGE S

O F F IC E S PAC E

Trust Toolbox INBOUND PHONE TRIAGE Wri t t en by N a t ha n Ec k el

ow’s your relationship with the phone? In today’s COVID-19 health landscape, many physicians want to shield their staff from unnecessary stress. And much of this stress comes from the phone. We know the phone is a powerful tool that many patients prefer - yet it can become an unnecessary drain of time and energy - the very margin that gives you extra grace throughout your day. The thing is, you never know who’s calling or how taxing their situation might be. It takes intentionality to figure out a plan that maximizes your use of the phone. At its best, phone contact plays up your strengths, especially for indepen-

dent physicians. It can showcase how accessible and human you and your staff are. But at other times, phone calls can be uncertain and you never know what emergency is on the other line. Especially during COVID-19. I’m not a physician, but I know firsthand how critical staff are to your day-in day-out operations. When my father opened his rural practice in 1979, I would cut the grass and trim the weeds around the parking lot - taking care to steer clear of the patients returning to their cars. And as I walked into the office to return the shed keys, I would see countless interactions between patients, staff, and my father. Of all the challenges of managing a practice over 40 years, guess what was possibly the most difficult one for my father?

It wasn’t the constant threat of lawsuits or mistakes. It wasn’t shrinking reimbursements. It wasn’t even the stranglehold of managed care. It was unexpected staff turnover. It was the scramble to figure out how to find the right person. It was the performance lag as staff dynamics recalibrated. If you’d like to protect your staff and yourself from unexpected turnover, you will want to consider reinventing the use of the phone via Inbound Phone Triage. This is just one of several tools in the “Trust Toolbox” that we are developing to strengthen your ability to serve your patients. For an early peek at how to implement this, reach out to me at nathan@ patientpaperwork.com. 1 WWW.PHYSICIANOU T LOOK . C OM | 21

TIM E F O R YO U

From Fat to Fit ONE WOMAN’S QUEST TO BE THE BEST VERSION OF HERSELF

Wri t t en by JR Hill

lena Shifrin may have always seemed like the quintessential physician’s wife on paper, she has an amazing husband and two beautiful daughters. She loves being a wife and mother and she’s had the privilege of living in communities both big and small while her husband worked in the medical setting. She’s made deep and powerful connections wherever she goes and even misses the small, rural community in PA where she used to live. But just 10 years ago, Alena was deeply ashamed and embarrassed by her staggering weight. At just 37, she weighed 350 lbs and her husband was very concerned about her health and the possibility that she may not be around for her children as they grow. 2 2 | AU G U S T / S E P T E M BER 2020

He would speak of the dangerous health conditions that could affect her if she didn’t make a change. Alena recalls the humiliation of asking for a seat belt extender on airplanes, how she couldn’t fit in a restaurant booth and how she couldn’t go on rides at amusement parks all because of her weight. One day the reality of her husband’s words came crashing down and she knew she couldn’t bear the thought of missing out on her daughters lives. She was tired of being excluded from so many activities with her family so she made a vow to get fit by 40. Having 3 years to meet this goal, Alena tried many different things, some worked, and some did not, but her key to success was that she never quit, even when faced with a setback.

As you can imagine, losing 150 lbs. requires some education, a lot of patience, self-care and grace. We often put these unrealistic expectations on ourselves because our false beliefs about weight loss and transformation are largely shaped and influenced by the media, Hollywood and even parts of the fitness and wellness industry: all you have to do eat this diet and the weight will MELT off, or do THIS workout and shed those unwanted pounds or try THIS Hollywood secret cleanse to lose weight like a movie star!! And if these don’t work then it must be because you did not give it enough time, you didn’t give it your all, or you cheated too often on your meal plan. Thankfully Alena didn’t buy into any of that, her 3-year journey was one

day at a time where she studied nutrition, learned different eating styles, diets and tried several different meal plans. She also started to exercise. The key to exercise is finding something you love, something you will stick with because you enjoy it. For Alena that started with Zumba. Her energy and enthusiasm soared when she started Zumba. She found herself happy again and excited to go to class. Her energy was felt by so many others in the group that she was even approached to become an instructor. When asked what she thought made the biggest difference in her weight loss journey she responded: “One thing I stopped doing was eating out of boredom or stress. I don’t eat to celebrate anymore; I eat to nourish my body; I eat to fuel my body.” She continues, “I took what I learned from people like Dr. Mark Hyman, and programs like Weight Watchers, South Beach Diet, and Jenny Craig and I made them work for me.” Alena used these tools and resources and began tracking all of her food and learned how her emotions and thoughts about food had contributed to her weight problems and her mindset. Just a few months after her 40th birthday Alena hit her goal weight and she’s kept it off for 7 years. Today she couldn’t be happier with herself and her new life that knows no limitations. She has since become a Zumba instructor and was featured on the Dr. Oz show. She also teaches spin, body sculpting, and senior fitness. She holds a nutrition certification from NASM (National Academy of Sports Medicine). Alena has a coaching business that provides accountability, education and advice to help others and you can reach her at Alenashifrin@gmail.com. Alena lives in Mt Kisco, NY with her husband, Dr. Seth Shifrin who works at Caremount Medical Group where he’s board certified in Pediatrics, Internal Medicine, and Sports Medicine. He can be reached at www.CaremountMedical. com. 1

The key to exercise is finding something you love, something you will stick with because you enjoy it. WWW.PHYSICIANOU T LOOK . C OM | 23

IN T E L L I GE N CE O N TH E M OV E

An Ethereal Rant Wri t t en by Dr. C hri s C a ra mi a

It was a moment. I held a hand today. She was nervous, understandably, as many patients are. She saw that I was tired and I saw that she was scared. I had been a patient well before my role as physician. So, we shared a nuanced understanding of this experience -- one of vulnerability, trust and hope. Although the foundations and history of the doctor-patient paradigm are ancient, here we are, under the vault of the same heaven with the same humanity, today. Here, we are at the same moment, time-sensitive, yet, timeless. Human nature is what it is, encumbered with human suffering and frailty. 2 4 | AU G U S T / S E P T E M BER 2020

She was not wearing a mask at the time. Neither was I. So, there we were: unmasked yet undaunted. In all that, all that was needed was a moment and a held hand. Sometimes, the most simple things are the most powerful and profound. For those of us fortunate to live a professionally clinical existence, it is authenticity that keeps us most grounded. I held a heart today. As I sat for a moment, I appreciated how caring her nurse was toward her. Until a few moments ago, she could have been just a name on the schedule, absent of the context of her life and what she means to those that surround her. She was

there for care, despite whatever diagnosis, prognosis or outcome may await her; and, her humanity remained intact. I saw hope in her. I saw heart in her staff. I saw the better angels in a burdened system, a system that is actively and unrelentingly burning out the workhorses, at times with reckless abandon. Despite the checklists, production pressure and overtures for the impression of efficiency, she was cared for with sincerity. Despite a system that is evolving and administratively top-heavy, it is still anchored by strings of heart in these good people. I held a mind today. Yes, I noticed. I notice my generation. I notice we are

CREDIT PHYSICIAN ARTIST DR. DOUNA MONTAZER

“Hierarchies in teams are natural, effective and necessary.”

face-mask deep in a conformational paradigm shift in the practice of medicine. I noticed how the generations before me deserve my respect and care, and how they need us. Despite their flaws and mistakes, we owe them. The fact that some of the net effects of our generation is not without blemishes is utterly inescapable. I notice how the generations after mine are capable, savvy, talented and impressionable. I notice the peril that could come as technology outpaces morality. I worry for a system whose clinicians were formed during a time of rampant corporate sophistry, in the fog of unrelenting narratives and the litany of clinical

buzzwords and acronyms. Indoctrination can become its own handicap…or, it may go unnoticed entirely…whichever is more tragic remains to be seen. Will they be able to see through the fog should those days come? I held an eye today. Although we willingly entered a service industry, I watch the attempts to affix a blue-collar to our white coats and profession. I watch as they refer to patients as customers, or the attempt to redefine us all as “providers,” although I never went to provider school. I watch them try to equilibrate providers of various levels and years of training, essentially, trading a genuine, collaborative dynamic

for a competitive one. I watch the net effect of this strategy undermine the teams I rely upon. When the dynamics are aligned, hierarchies in teams are natural, effective and necessary. I watch them attempt to superimpose and retrofit a corporate ethic upon a medical ethic. I watch, as it is lost upon them, that one cannot commoditize providers any more than they can legislate talent, technical proficiency or clinical ability. I watch, as should we all, attempts to undermine physician autonomy and the integrity of the doctor-patient bond. Of late, we’ve had to watch politicians play doctor, administrators play provider and doctors play celebrity. These eyes have beheld interesting times, and we are not yet finished. I held a tongue today. It was mine— sullen and circumspect. Weighed down by the trenches of clinical medicine and the cascading narratives, we all tire. Fatigue is an inevitable consequence and “burnout” has become a cottage industry. I appreciated a recent analogy in an article from Becker’s Healthcare regarding this topic and the impingement on physician autonomy, that physicians had become, [instead of] “tiger cubs that were born to be at the top of the food chain,…simply the caged tigers in a circus.” (1) Time will tell whether the forces that have led to that will have been locked on the inside of these cages as well. So, that moment, though fleeting, remains powerful and its effects, enduring. This spirit continues with a sense of gratitude, humility, stewardship and awe. Let nothing pilfer the authenticity of what we do. In that instant, as I held her hand, I understood that she was holding mine. 1 Reference: Julianne Ip MD & Garry Choy MD “Caged Tigers” – The root cause of physician burnout. Becker’s Healthcare. Jan, 16, 2018 WWW.PHYSICIANOU T LOOK . C OM | 25

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IN TELLI G EN C E ON T HE MOVE

Dictum

Intense.

In my place

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In my race, color, gender, or a

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since the beginning of prejudice

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vulnerable and resistant

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over to have but one class

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always submit to being ill defined

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threat

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Of minimizing 1

WWW.PHYSICIANOU T LOOK . C OM | 27

CREDIT PHYSICIAN ARTI ST DR. NANCY PRENDE RGAST

Writte n b y D r. J e an Rob e y

T H E LA S T WO RD

Lessons Learned FROM THE FIRST SIX MONTHS OF CORONAVIRUS COVID-19 PANDEMIC

Wri t t en by C ra i g M . Wa x D O

he first known human case of COVID-19, caused by infection with SARS-CoV-2, was diagnosed in Wuhan province, China on November 17, 2019. The communist Chinese government not only covered up the subsequent spread, but arrested and forced whistle blowers to recant and “apologize“ for warning the world about the looming pandemic. Meantime, disease spread like wildfire through China and Asia. Because of the mobile nature of today’s society, it likely began spreading worldwide during December or maybe even earlier. Concerns about the origin of the virus were largely brushed aside. Was it a mutated bat virus that crossed over to humans? Was it an experiment led by the communist Chinese government 2 8 | AU G U S T / S E P T E M BER 2020

that went horribly wrong? Or is it a globalist attempt at population control or a scheme to reduce the influence of first world nations? It seemed to be a respiratory-spread virus that targets elderly folks and those with concomitant medical conditions like diabetes, atherosclerotic vascular disease and even obesity. Apparently it is more contagious than influenza. The disease also can lead to runaway inflammation which makes it harder to fight. The World Health Organization (WHO), funded largely by the United States, but controlled by China, didn’t release its findings on the matter until February 1st. By this time the virus had spread worldwide to most countries from travelers to and from Wuhan. President Trump immediately called for a

travel ban to and from Asia and infected regions but was met with great resistance for political, not rational, reasons. At the time, American congressmen and women were reassuring the public that the virus was no worse than the flu while urging them to continue their usual social activities. China was still under reporting infections, hospitalizations, and fatalities. By early March, it was clear that America had infections in New York and a few other large cities on both coasts. This is when state governors began locking down citizens. Governors demanded ventilators but that would prove not only unuseful but counterproductive to patient outcomes in certain cases. Five governors issued executive orders forcing nursing homes and long-

CREDIT PHYSICIAN ARTIST AKOP JACK SEKSENYAN, MD, PHD

term care facilities to take COVID-19 coronavirus patients against their objections and concerns, and against CDC guidelines. Case in point, New Jersey governor Murphy with his executive order 103 on March 9, 2020. As of the time of this writing, over 7,000 seniors have died as a result. (covid19.nj.gov) Politicians made the jump from reassurance to lock down, abridging and eliminating individual constitutional rights. Executive orders started with “two weeks to attempt to delay disease spread,” but infections were already widespread. The lockdowns went on for at least 12 weeks in many states. This would prove a colossal mistake because citizens’ civil rights were in jeopardy, both their physical and mental health worsened, and everyone’s finances and

economics headed toward ruin. Many businesses that were mandated “nonessential“ and closed, will never reopen. FEMA reports that 40% of businesses shutter permanently after a disaster. The news media lit the fire and spread the panic; and politicians seized the opportunity. Great divisions were created and magnified to keep people fighting with each other, while politicians continued to struggle for money and power. In fact, it is the very definition of tyranny for the Government to use force majeure and rule of law to stop people from earning their living, while still demanding tax dollars to benefit politicians and pet projects. Politicians, as they always do, campaign for the November election by magnifying the philosophical differences in approaches to virus prevention and treatment. They try to assign blame, rather than working together on solutions. They play doctor by promoting, or in most cases, obstructing different potential treatments based likely on their own financial holdings or on what their opposition supports. Some states even made it practically illegal for physicians to prescribe for their sick patients. Testing has become available but still suffers from inaccuracy, and long waiting times, complicating and delaying treatment. Data is manipulated and used by politicians and media to scare people into compliance. For example, absolute numbers of cases and previous cases, were all lumped together. Some governors held daily press conferences merely to aggrandize total numbers, which were likely inaccurate, and read death notices. Very few states had clinically-based plans that also aligned with economically-based plans. People are forced to wear facemasks in public places, a policy based on very little actual evidence and science. Some individuals can’t physically or mentally tolerate masks but must conform nonetheless. Again, the media magnified and capitalized on the legitimate difference of opinions over the efficacy and implementation of mandatory masks.

“Politics is the art of looking for trouble, finding it whether it exists or not, diagnosing it incorrectly, and applying the wrong remedy”.

Ernest Benn

Constantly, people were barraged with the news media reporting exorbitant numbers of “cases.“ This seemed intended by politicians to scare people into compliance with their policies and to vote for them in the upcoming election out of fear. Merely reporting numbers of cases accomplished nothing productive. This was indeed the first time in history we had testing of major numbers of incidences of virus in the populace, whether they were affected or not. This only added to the confusion and data overload. The politicians and media never figured out that we were seeing the natural spread of a virus through the population, that we’ve never seen before. Thousands died but millions lived; not bad odds for a global pandemic. But, it seemed to amplify the cries for politicians to take rash actions against the “invisible enemy,” and cause tons of collateral damage as the government, who pays no price for being wrong, always does. Overall, most states and the federal government made critical errors. In New Jersey, Governor Murphy’s handling of the crisis gets a grade of F for killing thousands in nursing homes, ruining physical and mental health of the citizens, and the financial stability and livelihood of New Jersey citizens. Similar errors have been duplicated, time and time again, in other states. As we reopen, we must ask ourselves, “should we have ever shut down?” I think not. Common sense solutions, not panic, should prevail. Closing borders to those from countries and states with massive infection? Yes. Quarantine the sick and protect the elderly and infirmed? Yes. Physical distancing, respect for individual’s space, handwashing and personal hygiene? Of course. Economic closures and State citizen lockdowns? Never again. 1 WWW.PHYSICIANOU T LOOK . C OM | 29

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Publisher: Dr. Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Assistant Editor: Alejandra Suarez Assisting Editor: JR Hill VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Contributing Authors Dr. Megan Babb; Dr. Bobby Campbell; Nathan Eckel; JR Hill; Dr. Brent Lacey; Dr. Jean Robey; Dr. Craig Wax, Dr. Chris Caramia Cover Art: Dr. Nigam Sedhai (front cover); Juliet Moore, daughter of M. Christina Lee, M.D. (back cover) Other Art: Dr. Douna Montazer; Dr. Nancy Prendergast; Ana Paula Velez, MD, FACP, Akop Jack Seksenyan, MD, PhD Published By “Physician Outlook Publishing” Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues. The views expressed herein are those of the authors and/or those interviewed and might not reflect the official policy of the magazine. Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@ physicianoutlook.com “Physician Outlook is a registered trademark” WWW.PHYSICIANOU T LOOK . C OM | 35

ORIGINAL ART BY JULIET MOORE, DAUGHTER OF M. CHRISTINA LEE, M.D