"Escape From Life": Cover Art by Wildlife Photographer Daniel D'Auria, M.D. by Physician Outlook Magazine

VOLUME 1

WINTER 2021 2021: THE YEAR WE OVERCOME

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

Cover Art by Physician Artist Daniel D’Auria, M.D.

IMAGE C REDIT: SEREN ITY META L P RIN T

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

Sensible Serenity OVERCOMING IN THE AGE OF COVID Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.

“God give us the grace to accept with serenity the things that cannot be changed, courage to change the things that should be changed, and the wisdom to distinguish the one from the other.” Reinhold Niebuhr, 1944

or me, the arrival of 2021 was a time for reflective gratitude, celebration of accomplishments, mourning of losses, planning for the future, and hopeful expectation of better things to come. COVID19’s abrupt arrival and virulent intercontinental spread collectively made the human race lose its sense of balance and calm. My own soul strives for calm and balance, but unfortunately I have a lifelong unenviable habit of serendipitously 2 | WINTER 2021

finding myself in a variety of “Forrest Gump” types of medical and life situations, and this past year was no exception. I had barely finished reading a journal article about the outbreak in Wuhan when a febrile student who had just returned from China showed up on my clinic’s doorstep. Barely two months later, I was dealing with COVID in my own home, as my daughter earned the dubious honor of being one of the first confirmed cases in the state of Pennsylvania. The pandemic has forced me and many others to relinquish control over our lives, to learn to adapt and pivot as changes arise, and to not depend on the periscope’s limited viewfinder. Serenity has been elusive and fleeting.

When I launched Physician Outlook in January 2020 I had a simple mission: to start a magazine that would help to restore the sanctity of the physician-patient relationship. It would give physicians a voice and focus on the criticality of autonomy. What sets PO apart from other publications is that we are primarily a physician-facing (not a generic “provider”-facing) publication that understands and addresses physicians’ struggles, as well as what gives us tremendous joy. Another differentiating factor is that we are national and non-conflicted. Our primary support comes from subscribers and collaboration with other grass-roots groups, and we have grown organically via word-ofmouth. Our readers and writers don’t

always agree on every issue, but we are respectful and kind to one another and value inclusion in every sense of the word. We are building a community of just and ethical professionals that span the age-range, and we do so in a way that does not exclude nor discriminate. We present ALL points of view, and we tackle tough issues head-on. We entertain, we brag, we laugh and we share the good, the bad, and the ugly. In 2021, our mission hasn’t changed – but over the course of our first year we learned that only hindsight is 2020, and as humans, we live, we (hopefully) learn, we course correct. We find the courage to change what we can. Physician Outlook has a new and simplified set of categories this year: The Doctor’s Bag, The Humans of Medicine, and Pleasures and Pastimes. Fairly self-explanatory but visit the website for additional context. We are blessed to have a growing number of contributing authors and artists, and this year we welcome additional perspectives from medical students, residents and fellows. These young people are the face and the future of medicine, and we need them to learn from our mistakes and to triumph from our victories. This future generation is teaching us how to use the power of social media to disseminate information to circles outside of our own communities, and they are also being taught to prioritize self-care and self-awareness early in their careers. For them we are very grateful. We are most proud of our beautiful print Physician Outlook magazine (which can be previewed in “digital” flip form on our website www.PhysicianOutlook.com). It is our “pièce de résistance.” The human brain thrives on the positive sensory feedback that holding a paper magazine or a real book in our hands transmits through our synapses. The art in the magazine is breathtakingly beautiful and showcases the many dimensions of talent our brothers and sisters in medicine possess. Almost all of

the artwork and photographs in the magazine are the original work of physicians, many of whom have become extra productive during the past pandemic year. “Why a print magazine?” Re-discovering my purpose through the magazine and finding common ground with others has been a saving grace for me, as has learning about opposing points of view that I would not normally hear if I chose to remain within my own head or within a group of people who all think the same way as I do. We need to get out of our own echo-chambers every once in a while to learn, grow and acquire wisdom. The power of the words in the Serenity Prayer have guided my actions and mindset unconsciously since I was a young child, but I had never thought to research who had first written those words. I discovered that the prayer’s author, Reinhold Neibur, changed his beliefs over his lifetime to adapt to the times and their challenges, but he never morally swayed from the words he first uttered in the early 19th century. He learned to accept the things he could not change, but he went to great lengths to effect change where he could, and he clearly had the wisdom to know the difference. At Physician Outlook we will continue to report what is happening in medicine, and do everything in our power to uplift and protect physicians, as medicine is OUR house. It is WE who took an oath to “DO NO HARM,” and it is our duty and obligation to protect our noble profession so that we can continue to best serve our patients. There may be things that we cannot control or change, but together we shall overcome, so long as we allow wisdom and good intentions to prevail. 1 Dr. Marlene Wüst-Smith Publisher

“Wherever the art of Medicine is loved, there is also a love of Humanity. ” ― Hippocrates

2021: THE YEAR WE OVERCOME VISIT WWW.PHYSICIANOUTLOOK.COM TO LEARN MORE!

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FEATURED SHOWS...

Podcasts are a useful and entertaining way of dispensing information related to all kinds of topics. In fact, this technology has made it easier for content creators to talk on any niche of their choosing. It’s no wonder that the popularity of podcasts in general keeps increasing. Over the last year or so, it has been especially exciting to see physicians create more and more podcasts addressing various aspects of physician life. That’s where Doctor Podcast Network comes in... Founded in June 2020 by Dr. David Draghinas, a Dallas-based anesthesiologist, Ryan Inman, a fee-only financial planner for physicians, and Desiree Leos, a sole proprietor of her own content development and podcast production company, Doctor Podcast Network was created for the purpose of helping physicians feel supported throughout their podcast journeys. Simultaneously, “DPN” brings together in one location many quality podcasts that are essential listening to physicians and their families.

Dr. Draghinas and Ryan are both podcasters. Desiree built their teams to help support them and others to consistently produce content. All three knew how challenging that was to do in the midst of busy schedules, competing priorities, unpredictable monetary compensation, and fluctuating motivation. Physician podcasters are there for the doctors and healthcare providers that make up their podcasting audience. But “this can be a tough and lonely journey for the podcast creator.” Doctor Podcast Network is there for the physician podcaster. It’s a place where they can come together, learn from, collaborate, and confide in one another, as well as facilitate the monetization of their shows. Having soft launched with 15 founding members in October 2020 and formally launching in January 2021 with 17 shows, the network has shown its capability of creating the community and environment that podcasters need to thrive.

Doctors Unbound is a podcast created for doctors who are busy with unique side passions outside of their normal schedule. Dr. David Draghinas shares their stories of triumph, learned lessons, and, ultimately, their humanity. Financial Residency is geared toward early-careered physicians looking for practical ways to manage their finances. Ryan Inman is usually found nerding out over phoned-in questions by his listeners asking about student debt, investing, insurance, and balancing budgets. The Physicians Guide to Doctoring is hosted by Dr. Bradley B. Block where he seeks to answer the question, "what should we have been learning while we were memorizing Kreb's cycle?" His podcast is a practical guide for practicing physicians and other healthcare practitioners looking to improve in any and all aspects of their lives and practices.

AMPLIFYING PHYSICIAN VOICES

VISIT US TODAY AT WWW.DOCTORPODCASTNETWORK.COM Find other physician-hosted shows on Doctor Podcast Network’s website, www.doctorpodcastnetwork.com. You’ll find a list of amazing shows, focused on various aspects of physician life. They’d appreciate your support by subscribing to (for free) and sharing their shows. If you’re a doctor who is either wanting to launch your own podcast or join with your existing show, the network is accepting submissions. If you are a physician that enjoys listening to podcasts, check out DPN for new shows that will bring value into your life.

Table Of Contents

WIN T E R 2 0 2 1 | VO L . 1

FROM THE PUBLISHER

Sensible Serenity by Marlene Wust-Smith, MD/p.2 THE DOCTOR’S BAG

Therapy For A Desperately Sick Healthcare System by Marion Mass, M.D./p.6 HumanOS.me: An Operating System For Healthy Living by Josh Turknett, M.D./p.8 What If I Can’t Get the COVID Vaccine Right Now? by Niran Al-Agba, M.D. | Artwork by Annabelle W., daughter of Jenny Shih, M.D./p.12 Four Competencies Of A Change Leader by David Norris, M.D., M.B.A./p.14 COVID-19 S.O.A.P. Notes: Month 1 by Nathan Eckel/p.16 PLEASURES AND PASTIMES

Escape From Life: The Wildlife Photography Of Daniel D’Auria, M.D. by Marianna Seefeldt/p.20 Valentine’s Sunday Sauce by Alicia Roselli/p.22 Changing The World: Through The Eyes of Children Essay by Mirabelle King, niece of Christina Dewey, M.D. Artwork by Zoya S. and Alma S./p.24 THE HUMANS OF MEDICINE

Maggie’s Musings: “D.O.”ing Med School by Margaret Hurley, Student Physician/p.26 The Reverend Doctor: A Spotlight On Dr. Marta Illueca by Marlene Wust-Smith, MD/p.28 The Comeback Kid Returns: Against All Odds by Bobby Campbell, M.D./p.30 THE LAST WORD

#OpenSchoolsNow For The Health Of Students And Teachers Despite COVID-19 by Craig Wax, D.O./p.32 Cover Art by Physician Artist Daniel D’Auria, M.D. WWW.PHYSICIANO U T LOOK . C OM | 5

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Therapy For A Desperately Sick HEALTHCARE SYSTEM

Wri t t en by Mari o n M a ss, M . D.

aking a thorough history and performing a full physical exam are integral skills familiar to all of those who practice medicine. Understanding the root cause of any problem helps to establish a cogent differential diagnosis and is an essential step that allows us to formulate an appropriate treatment and plan. Our ailing U.S. healthcare system needs to be treated like any other chronically ill complex patient we encounter. We rely on good historians to obtain and document a pertinent review of systems, and these same historians must succinctly and accurately present the case in a manner which can be easily understood and acted upon. The 6 | WINTER 2021

American public remains too much in the dark and confused about the way our $3.6 trillion-plus healthcare economy works. Meanwhile, the costs continue to rise — premiums, deductibles, outof-pocket expenses, taxes, employer contributions, weak wage and salary increases because of employer contributions — and the public pays more and more, while receiving less and less. Gaining access to quality care is becoming harder. Polls show that patient frustration is steadily rising, along with dissatisfaction over the severely limited time with a physician when one finally reaches the examination room.

How did we get here? Typically, blame is placed on parts of the system that the consumer of medical care can see — physicians, insurers, and the drug manufacturers (aka Big Pharma). Consumers have a sense of being gouged by a system that can’t continue without some form of intervention. But the reality of our $3.6 trillion-plus healthcare economy is vastly more-complicated than what the consumer sees. It’s largely in the shadows where the general public never glances and doesn’t have the time to penetrate and peel back the layers; but that’s where the special interests, the lobbyists, the politicians, and the regulators play.

Vaccine Priority List The docs find out where they rank on the vaccine priority list.

Do you think that fully repealing “Obamacare” will lead us to paradise? How about “Medicare for All,” something along the lines of the nationalized healthcare systems seen in other countries? Is that the path to Healthcare Heaven? If that’s the way you think, be forewarned. The slogans on the bumper sticker are poor tools for understanding how the American healthcare system has become so desperately sick. And they won’t help in crafting a treatment that shows a serious understanding of what’s wrong. An underinformed public can easily be conned. In a series of articles, I will explain “the drivers” of cost in our healthcare system, how certain entities you may not ever

“...the public pays more and more, while receiving less and less...”

have heard of have risen to positions of control and self-enrichment. We will “follow the money,” pointing you to sources you can follow up yourself, and suggesting what you can do to advocate for a better path forward. Our topic next time: American healthcare’s staggering administrative overhead. Printed with permission of The Bucks County Courier Times, on which Dr. Mass serves as a member of their editorial board. This first installment was initially published in February of 2020. 1

Unlock The Future Of Healthcare RESTORING THE RIGHTS OF PHYSICIANS AND THEIR PATIENTS. VISIT HPEC.IO TODAY!

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HumanOS.me AN OPERATING SYSTEM FOR HEALTHY LIVING

Wri t t en by J o s h Tu rk net t , M . D.

he modern world poses many challenges to our health. What is the true nature of the battle we fight and how do we get what we really seek? Humans are extraordinary, including you. Each and every one of us is capable of feats of body and mind unrivaled in the animal kingdom. Sixty million years of primate evolution has resulted in human bodies and minds that are exquisitely tuned to thrive in our natural habitats and to enjoy lasting vitality and well-being throughout our lifespan. There’s only one problem... we don’t live there anymore. Our world has changed exponentially just over the past century and 8 | WINTER 2021

continues to do so at an accelerating pace. We find ourselves now living in a habitat very different from the one in which our bodies and brains were shaped to thrive in. In other words, the world we live in now is mismatched to the one that our bodies and brains expect. Human biology remains precisely synchronized to the rhythms of the natural world. Yet today, through technology, we can lead lives completely detached from those rhythms, leading to bodies and minds that are out of sync. Because of that, most of us go through life carrying an invisible weight that keeps us from reaching our full potential in all the things in life we care to do well.

This mismatch between our modern and natural habitat diminishes our resilience, reduces what we can achieve with our minds, and accelerates the aging process. It drives the rising burden of chronic diseases from Alzheimer’s to cancer to heart disease and stroke, each of these a symptom of living in a mismatched world. This decline in our health and resilience over time is now so pervasive that we expect it. We expect bodies to lose strength, to gain weight, to have aches and pains, and to continuously fail with age. We expect our minds to decline, to experience brain fog, problems focusing, and forgetfulness. This decline in body and mind has become the norm because the forces that

IMAGE CREDIT: DAN PARDI, MS, PHD FOUNDER HUMANOS.ME

In today’s mismatched world living healthfully is a set of skills that we master over time through consistent training and practice.

drive it are invisible and insidious. Invisible because they are a part of ordinary life. The modern world feels like our natural habitat because it’s all we’ve ever known. And they’re insidious because the advancement of technology and the reliable change it produces are a constant in today’s life. But none of these health issues are inevitable. That’s right...none of them. They are only inevitable when our bodies and minds don’t receive what they need to thrive. So is there a way for a human at any age to realize its potential? To return to this higher state of health and performance we are all capable of? A way that doesn’t involve ditching all that we love

about the modern world? Better yet, is it possible to get the best of both worlds - to reach this higher state of health and performance while still enjoying the wonders of modern life and technology? We think so. Thanks to science, we understand a tremendous amount about why bodies and minds fail and the root causes of modern disease, and we understand why and when our body works at its best. Knowledge we can use to achieve our goals. But how do we do this? To unlock this potential, what must we learn? What must we do? In other words, how do we develop all the skills we need and then stay present to use those skills on a daily basis? The journey of health mastery is a lifelong pursuit. Mastering any complex skill, whether it’s the piano, soccer, or a martial art doesn’t happen in a few days, and it doesn’t happen without training and practice. In today’s mismatched world living healthfully is a set of skills that we master over time through consistent training and practice. What is our reward for that training and practice? The realization of potential that would otherwise remain locked away. Human.OS is a tool for mastering health, one that provides the training and practice needed to create your unique and personalized expression of living an effective and healthy life in today’s world. Human.OS provides the training and tools that everyone needs but few receive. Simply by using the tools you will be leveraging the latest in Behavioral Science to help make your journey to mastery smooth and enjoyable. Humans are extraordinary. We all have amazing potential and are capable of so much. 1

MARCH 20, 2021

MALIBU MICROBIOME MEETING VIRTUAL CME EVENT

PHYSICIANS, GOVERNMENT, AND INDUSTRY SHARE THE LATEST IN MICROBIOME RESEARCH, DISCOVERIES, AND NEWS.

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

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

www.facebook.com/PADPCA/

www.twitter.com/padpca

IM AG E CR ED IT: ANNAB ELLE W., DAU G HTER O F J ENNY SHIH, M D

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What If I Can’t Get the COVID Vaccine Right Now? Wri t t en by Ni r an A l -A gba , M . D.

f you are not immediately eligible for the COVID-19 vaccine or are afraid to get it, what else can you do? New research shows a vaccine in use for the last 50 years looks promising in the fight against COVID-19. Medicine lives in patterns. To understand our modern problem, let’s look back 250 years. In 1768, John Fewster, a country surgeon based in Thornbury, England and two colleagues, Hugh Grove and Daniel Sutton, began inoculating people against smallpox, a highly contagious, disfiguring, and deadly disease. Despite repeated exposure to smallpox, some patients seemed inexplicably immune. A farmer wondered if his natural resistance was related to another infection, “I have had 12 | WINTER 2021

the cowpox lately to a violent degree, if that’s any odds.” Cowpox was a viral infection contracted by humans through contact with cow udders while milking. It turns out all of those “naturally immune” to smallpox had been previously afflicted with cowpox, which protected against smallpox infection. In fact, that farmers’ fortunate observation exposed a pattern which facilitated development of a vaccine which eradicated smallpox from the world. In March 2020, Jeffrey E. Gold, a data analyst, thought it was interesting that children were relatively spared from severe COVID-19 disease. He wondered whether a specific intervention, like vaccination, protected them. Whereas, the

COVID-19 death rate climbs quickly after 50. CDC statistics reveal 97% of COVID-19 deaths have occurred in those aged 45 and older. The timing of one vaccine in particular, the MMR vaccine—against measles, mumps, and rubella—seemed to best fit the bill. First introduced in 1971, most recipients fall into the under 50 age group. Looking deeper, Gold found that a number of countries with low COVID-19 death rates had conducted large-scale measles-rubella vaccination campaigns over the last few years. For instance, physicians in American Samoa vaccinated nearly 90% of the population with MMR, including children and adults, during a widespread measles outbreak in September 2019.

American Samoa has seen just 3 cases of COVID-19—all contracted outside the country—and no deaths from the virus. Whereas, COVID-19 penetration seemed far more extensive in countries with lower MMR vaccination rates, like Italy. Due to public mistrust in vaccines, following the publication of Andrew Wakefield’s fraudulent research linking the MMR vaccine and autism in 1998, Italy’s measles vaccine coverage was one of the lowest in Europe. Might these associations be just coincidental? But then there is this. Like SARSCoV-2, measles, mumps and rubella viruses are also RNA viruses with spike proteins. The spike proteins on the measles, mumps and rubella viruses share 30% of their protein structure with the SARS-CoV-2 spike protein. The reason I am telling you this is because the degree of similarity might cause the body to “think” COVID-19 is related to measles, mumps, or rubella virus and therefore, fight it preemptively. A preliminary study, recently published by the American Society of Microbiology, lends support that the MMR vaccine could protect against severe COVID-19 disease. Fifty people, previously vaccinated with MMR, had their mumps antibody blood levels (titers) analyzed. Participants were grouped according to severity of COVID-19 infection and levels of mumps titers in their blood. All of the asymptomatic COVID-19 patients had high mumps titers. All who were hospitalized and required oxygen had extremely low mumps titers. To look at this another way, what if eating bananas prevented headaches? Researchers would ask 50 people to track banana intake and headache frequency for a month. Imagine if all those who ate the most bananas had no headaches, all who ate 10 bananas reported mild headaches, and all participants who ate no bananas had severe headaches? While bananas might be completely unrelated to headache frequency, this kind of relationship between two variables, during a

A preliminary study, recently published by the American Society of Microbiology, lends support that the MMR vaccine could protect against severe COVID-19 disease. viral pandemic, is the stuff from which dreams are made. Effectively, that’s what may be happening with the MMR vaccine: those who get the shot seem to avoid the worst consequences of the virus. If we return to the mumps study for a moment, there is one more striking finding. One-fifth of the group reported exposure to household contacts who had active symptoms of COVID-19, yet never developed evidence of infection. They could be “naturally immune”— like the Thornbury farmer was to smallpox. Since receiving an additional MMR booster is not harmful, ironically, I received an MMR shot in September 2019 after inadvertent exposure to measles in my clinic. This might explain why I did not get sick with Covid last February, despite being exposed to a handful of patients with unexplained coughing and shortness of breath who now have evidence of COVID-19 antibodies in their blood. While this study is not definitive, I am not alone in my excitement about the possibility that MMR protects against severe COVID-19 disease. In August 2020, The Bill and Melinda Gates Foundation funded a randomized, placebo-controlled trial with 30,000 participants, to assess the effectiveness of MMR II in preventing COVID-19 in healthcare workers. This column is in no way intended to suggest the MMR vaccine is an alternative to the COVID-19 vaccine, however for those who are not at the front of the line, the information might be worth a second look. To me, the study findings were so remarkable that I sent my 78-year-old mother to get her first MMR the very next day. 1

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PHOTO CREDIT BY IN GRA M IMAGES

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Four Competencies OF A CHANGE LEADER

Wri t t en by Da vi d No rri s, M . D. , M . B . A .

hysicians are, by training and default, change leaders. Whether employed and called to lead by a large hospital system, or self-employed in a private practice, or face-to-face with a patient in an exam room, physicians need to recognize and develop these four core competencies in order to lead successfully. Leading change is one of the most challenging things any leader will do during their leadership career. Inertia permeates every organization when it comes to change. Objects at rest want to stay that way. Change requires energy. Change also requires leadership. If you are leading change in your organization, here are four key competencies that will help you initiate and attain the results you need. Listening. Strong leaders must be willing, be able, and have the self-discipline to listen. Listening goes beyond the perception of the auditory inputs you experience. That’s hearing. Listening is your ability to assimilate, relate, and understand the messaging others are sending out. A leader must be able 14 | WINTER 2021

to adjust their frequency, much like the old AM radios of yesterday. You must adjust your perceptions of what you hear and change that frequency just a bit, so the signal becomes clearer. Once you do that, the static of the situation will drop out, and you’ll understand the concerns of those you lead. Communication. Leaders must have strong communication skills. You must be willing to communicate your vision of the future, your objectives, and your goals. Communication takes work and effort. Some have an innate ability to communicate so that others easily understand their message. Other folks have to work at it a bit. The important lesson is that you expend the energy and thought to broadcast your message in a way that those you lead will understand it. This requires that you consider the point of view of the other party and translate your message accordingly. Honesty. A true leader will call it like it is. They are not afraid to speak the truth. They recognize sugar-coating the message might not get the desired out-

come. If something isn’t working, they are open and honest about it and are not afraid to admit when things do not go as planned. They also do not seek to assign blame. If their plan doesn’t work as they thought it would, they will accept the responsibility and craft a new plan. They do not blame poor outcomes on the efforts of those they lead. Instead, they accept the blame and change the plan. Subordination. Subordination means they recognize they are not the vital cog in the wheel. In fact, they might not even be a crucial member of the team that actually gets the work done. They provide guidance, planning, and execution, but they know the organization’s mission and purpose are greater than themselves. They recognize the task at hand is more critical than any glory they may receive. Take a minute and examine your leadership. Which of the four competencies do you have? Hopefully, all four. If you need help with your change leadership, visit www.davidnorrismdmba.com today. 1

CREDIT AVI VA WEI NB ER G, M.D .

To purchase a canvas Amanda Gorman sketch please contact Dr. Weinberg at avivaw@gmail.com or visit https://f ineartamerica.com/prof iles/aviva-weinberg

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COVID-19 S.O.A.P. Notes

MONTH 1

Wri t t en by N a t ha n Ec k el

r. Marlene Wüst-Smith is the medical director of a small private university health clinic when she isn’t publishing Physician Outlook magazine. We recently put into action some of the actual instruments we borrowed from the “Trust Toolbox” to give her back some much needed time in her day. COVID has complicated Dr. WustSmith’s normal workflow. Pre-pandemic, returning to campus for a new semester was relatively easy for Health Services— students showed up and were given their keys, and the only responsibility pre-return was making sure that students had 16 | WINTER 2021

submitted appropriate proof of vaccination. COVID has changed all that. Health Services must now try to ensure that students are not inadvertently bringing that pesky little coronavirus along for the ride, and the rules seem to change by the moment. Every returning student must submit proof of a negative COVID test within a week of arrival, but not all test types count. If the student has had COVID, they MAY not need a negative test…if they can provide proof of a positive COVID test within the preceding 90 days. But not true if the student is from out-ofstate…then they DO need to have an-

other test. The rules and requirements seemingly change by the day, sometimes by the hour. At a macro level, there is a risk to her university which has prided itself on retaining in-person learning at full capacity. Dorms are full, and athletes are practicing. For the purposes of this article, we will focus on the micro view which (only) impacts Dr. Marlene, her 4 staff, and the students. “S” is for “Subjective” This is the second semester of potential student isolation and quarantines, and the scope of this SOAP note

P HOTO BY IB RAHIM B O RAN O N U NSP L ASH

Employment of time-saving tools became an essential component of the University’s crisis management plan. umented. This pushed her workday late into the evening. “A” is for “Assessment” According to this basic diagnostic, this novel virus created a significant level of chaos within the institution. However this chaos was mitigated by a fairly low number of repeat conversations that communicated new protocols. Ultimately the chaos was controlled, but not without enormous time, energy, and relational strain. “P” is for “Plan of Treatment” For this reason, I helped to develop a mechanism to isolate, record, and deploy segments of those conversations. Our goals were 2 fold: 1. Protect the proactive time of the physician and staff. 2. Offload the emotional strain by steering students to the audio feed: • manage expectations • provide basic info • be available to review when students forgot

is limited to communications. Because of the COVID outbreak which abruptly closed campuses across the world in the spring of 2020, when we returned in late August of 2020, the majority of Dr. Wust-Smith’s days were spent simply communicating new procedures to her staff and students. This took enormous amounts of time. Due to the unknowns and recommendations changing by the day, these were not just conversations but often had the potential for confrontations because of the highly emotional and unknown aspects of the virus. There were conversations with students, staff and even

parents. In summary this time period was marked by long hours, even higher strain than normal, and difficulty maintaining morale. Objective To begin the process, Dr. Marlene was given a survey to measure how many repetitive conversations she had during this period, and how long each one took. Review of the data demonstrated that each single conversation would take from 15 to 45 additional minutes on top of her normal work, which would then need to be charted and doc-

This basic mechanism is in the form of an RSS feed, otherwise known as a podcast feed. Instead of the format of a podcast, we are focusing on delivering short minute long target answers to specific questions as well as short policies and action steps for the students and parents to know beforehand. Employment of time-saving tools became an essential component of the University’s crisis management plan Whether or not you practice in an educational setting, can you relate to this scenario - especially as it pertains to COVID? Stay tuned to Physician Outlook to follow this and future case studies. 1 Check out https://pod.co/covid/ to check out these time-savers WWW.PHYSICIANOU T LOOK . C OM | 17

Deers For Fears

n a wintery morning in Canada’s Arctic tundra, caribou slowly gather while trying to identify photographer Dr. Daniel D’Aura hidden along the banks of a lake. This photo received high honors in National Wildlife Federation’s 2019 photo competition which receives about 26,000 entries. The photograph was also used on their invitations to the gallery opening in the American Association for the Advancement of Sciences building in Washington, DC. Dr. Daniel D’Auria

18 | WINTER 2021

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PL E ASU R E S A N D PA S TIM ES

Escape From Life THE WILDLIFE PHOTOGRAPHY OF DANIEL D’AURIA, M.D.

Wri t t en by b y Ma ri a nna S eefel dt

r. Daniel D’Auria is a gastro-

tion. Additional awards include Smith-

most recent honors was to learn that his

enterologist who resides in

sonian’s Aerial America Photo Contest

book “Can a Puffin Puff” is being read

Southern New Jersey, where

2011, a finalist in the Smithsonian’s

to preschool students at the Alaska Mar-

he has been practicing for almost 3 de-

11th annual photo contest in 2014, and

itime National Wildlife Refuge.

cades.

inclusion in the top 100 in Audobon’s

He is an avid photographer, set-

2019 contest.

Physician Outlook appreciates the beauty of his images, and cannot wait

ting the preponderance of his interests

He has written a series of children’s

to see Dr. D’Auria’s future when travel is

on wildlife. His photographs have re-

books about wild animals which he

once again possible and COVID19 be-

ceived a number of acclaims, including

publishes under the alias, DrDAD-

comes a distant memory. Visit his gallery

a highly honored photo in the coveted

Books, Some of his books grace the

on LifeScapes Imaging at https://www.

“Nature’s Best” Photography Competi-

shelves of our national parks. One of his

danieldauria.com/Award-winners. 1

Description of the Front Cover and back cover photos: “The Arctic Tundra”. When it's 40 below zero on the Arctic tundra and the wonders of the universe show you just how awesome they are, Dr. D’Auria shows the universe that he makes up a small but intricate part of its awesomeness. 20 | WINTER 2021

“

Success isn’t always financial. It’s about have a crazy, silly dream and making it a reality.”

Dr. D’Auria upon being asked permission to have his book read to children

ALL PHOTOS BY DR. DANIEL D’AURIA

WWW.PHYSICIANOU T LOOK . C OM | 21

P HOTO BY M A E M U ON U N SP L A SH

PL E ASU R E S A N D PA S TIM ES

Valentine’s Sunday Sauce

Wri t t en by A l i ci a Ro sel l i

emember that old saying “the way to a man’s heart is through his stomach?”

There’s no better way to prove that theory than by surprising your mate with a fabulous Sunday Sauce - try it to be, well, a Sunday! You’ll want to give yourself plenty of time, as this is somewhat of a lengthy love affair. Start the sauce at least 6 hours before show time. These recipes were inspired by Wegmans and Better Homes and Gardens, respectively. I like to think of recipes as a guide - change them up to make it your own. 1 Buon Appetito!

22 | WINTER 2021

PHOTO: O HM YD ISNEY YOUTUB E CH ANNE L

this Valentine’s day, which just happens

P HOTO BY JA SON LEU N G ON U N SP L A SH

SAUCE ~4lbs. bone-in country ribs ~3lbs. hot Italian pork (or turkey) sausage links, cut in half 2 large onions, chopped 20 cloves garlic, minced 1 can (6 oz) tomato paste 2 cups quality red wine (or water) 3 cans (28 oz each) crushed tomatoes 4 tbsp dried basil leaves Heat a small amount of oil in a large sauce pot to medium-high. Brown the ribs and sausage on all sides, set aside. Leave browned bits in the pot. Reduce heat to low. Add onions to pot; cook, stirring, 8 min, until soft but not browned. Add minced garlic, cook, stirring for 2 min. Raise heat to medium. Add tomato paste; cook, stirring, 3-4 min, until paste begins to brown. Add wine; bring to a simmer, stirring to loosen browned bits on the bottom of the pot. Add tomatoes and basil; stir to combine. Return ribs and sausage to the pot. Bring to a simmer. Reduce heat to low. Cook, uncovered, stirring occasionally, 5 hours. Add meatballs;* Cook, stirring occasionally, 1 hour. Transfer meats to a serving platter, let rest at least 15 min. Serve with your favorite pasta or zoodles and grated cheese. MEATBALLS 2lbs. ground beef (85%) 1 cup seasoned bread crumbs 1/2c milk 1 t Worcestershire sauce 1 t salt Pepper to taste 2 eggs, beaten 1 medium onion, fine chopped 2 cloves garlic, minced Preheat the oven to 400(F) degrees. Mix all ingredients well and form into equal-size meatballs (~2”). Place onto a foil-lined baking tray and roast for 10 min. *Add to sauce during the last hour of cooking. WWW.PHYSICIANOU T LOOK . C OM | 23

PL E ASU R E S A N D PA S TIM ES

Changing The World

THROUGH THE EYES OF CHILDREN Essa y Wri t t en by Mi r a b e l l e K i ng, a ge 1 1

Artwork Created by Zoya, age 11 and Alma, age 12 he inspiring words and art of children who are wise beyond their years remind us of the importance of never losing our inner child. Mirabelle is the 11-year-old niece of pediatrician Dr. Christina Dewey. Mira is in the process of applying to go to a new middle school and as part of her interview she was asked to write “how she would change the world”. This is her essay, which she penned in under 30 minutes:

24 | WINTER 2021

f I could change the world, I would. If I could rewrite it like I write the words on this page, I would erase evils like global warming and war and this pandemic. If I could change the world as easily as breathing, I would make sure all of the innocent lost souls became found and that no hurt was committed to a living thing. I would form sanctuaries and peace, and trouble would be behind us. If I could, if the world was a blank page for me to fill, I would draw heaven for those who deserved it and justice for those who didn’t. I could have anything, do anything, know anything, by penning words to card: “And then she knew all.”

I know I would create fantasies. Because of my love for the ocean, everyone would live in golden bubbles and silver nautilus spirals and we would all be friends with the seals and giant tardigrades (I love both seals and tardigrades). We would make merry at night and spin in fairy circles and I would be able to read for hours each day. We would ride sharks and have superpowers and my slightest whims would become real. I could have anything, and the world would be my oyster. (I could probably have a pet oyster too...). But I know that challenge is a key point in my life. I could create my own challenges, and work long and hard on

O RI GI NAL ART BY ALMA, AG E 12

ORIGIN A L A RT BY ZOYA , AGE 1 2

them, puzzling in my sleep. I could spin problems like a spider spins webs, and live in them for a while, and then with a stroke of ink, it could be gone. I know I would cheat. I would find the answers by saying that I found them. I would change my narrative, make life easier. I would be lazy. I would use my powers to serve myself, and if something went wrong, I would heal my damaged ego and arrogance by making things go right. I could be born and reborn, and I could erase World Wars from ever existing over dinner. That’s why I’m glad the world is not parchment to mark up and throw away

to my choosing. Anyone with that power would let it go to their head, even if they were the most humble person. I’m glad that change comes slowly, like vines stemming from seed which then blossom into things we could never have imagined, good or bad. The world works in mysterious ways. But change still happens everywhere. You change the world by breathing; adding a breath that wasn’t there before. In a way, the world might as well be a piece of paper, but a collective one with old graffiti and masterpieces alike on it, to be added to or scribbled over. But not erased, never erased. Every person draws their lines, writes their words, but everyone is imperfect. Sometimes you make masterpieces that other people think are dangerous and badly timed. Sometimes the world is not ready to accept the change you make, the good and bad and in-between that you do, but we all keep going. The change that I want to make is to make the world realize that change is theirs and they only get one chance to make it. 1 Mirabelle King, age 11 #Shes11 #WiseBeyondHerYears #Amazing #Inspiring #Talented #HowToChangeTheWorld #JustWOW

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uber-docs.com WWW.PHYSICIANOU T LOOK . C OM | 25

T H E H U MAN S O F M ED IC IN E

Maggie’s Musings D.O.’ING MEDICAL SCHOOL Wri t t en by M a rga ret H u rl ey, S t u dent P hy si c i a n

’d like to introduce myself to the Physician Outlook family as I chronicle the most amazing journey of my life. My name is Margaret Hurley but I go by Maggie. I was born and raised in State College, PA, home of Penn State University where I earned my undergraduate degree in Biological Sciences and where I decided to commit myself to a career as a physician. Last year, I interviewed at various DO and MD programs and found my new home for the next four years at the Philadelphia College of Osteopathic Medicine (PCOM). This past fall I had the honor of presenting myself as Margaret Hurley, Student Physician. I get goose-bumps just typing that. I’m flooded with emotions - excitement, gratitude, anticipation and undoubtedly some nerves. Medical school is no cake walk. It was intimidating to have to start amidst a global pandemic in certainly unnavigated territory and it compounded my fear of 26 | WINTER 2021

the unknown. I have never preferred an online modality of learning and when it was announced that our first two weeks and orientation were going to be entirely virtual, I was filled with self-doubt. How was I going to adjust my learning style to the rigor of online medical school? How was I going to make new friends? How will I get involved? How will I meet mentors/professors? My list of questions was never ending but, and as cliche as it may sound, I realized that the one thing that IS in my control is my attitude towards it all. Instead of worrying about how I was going to adjust to the rigors of online learning, I adjusted my mindset. I reminded myself of what a privilege it is to be learning the art of the human body. Instead of worrying about how I would make new friends I realized that I was not alone. The other incoming first year medical students were going through the same thing as me. I realized that I

would just make friends in a non traditional way (Zoom for the win!). Instead of worrying about getting involved, I have started researching clubs/organizations and have reached out to some current PCOM students. Instead of worrying about how I was going to meet mentors and professors, I am reminded that my school (and every other medical school) offers an endless list of supplemental resources- they want to see us succeed! I am slowly accepting that a lot of what happens is out of my control, but the beauty of this journey is that it is mine. It will be unique in so many ways but I am here for it, ready for whatever it throws my way. I hope that by documenting my journey, I can offer reminiscing for experienced physicians, relatableness for my fellow physicians in training and inspiration for future physicians! Talk soon, Maggie

not compare your progress to others, because ultimately you are just taking time away from becoming the best version of yourself. I even suffered the loss of my dear grandmother my first term, but I was reassured that everything happens according to God’s plan and that gave me peace of mind - not only with respect to the loss of my grandma but in all aspects of my medical education. I’d like to end by talking about what keeps me going. I am motivated by my future patients and how special it is that they will be depending on me and my experiences to help them. I am motivated by my enthusiasm for many different fields and all of the cool clubs at my school. And, after the loss of my grandmother, I am motivated to keep going. She was my number one supporter in all endeavors of my life - my religion, my academics, my sports, my (currently non-existent) love life and she was most supportive about my choice to go into medicine. I miss her dearly, but her loss reminds me how much of a factor she plays into my WHY medicine! 1 Day 1 of Term 2 Hello again! I just finished my first term! We started with cellular and molecular foundations of medicine - my favorite (said no one ever)! But in all honesty, I finally had the “AHA!” moment with a lot of the basic science content and why it is SO IMPORTANT to medicine! Today I started our anatomy, physiology, development, embryology and histology block and of course, given the current circumstances, we are entirely virtual. Part of my training as an osteopathic medical student is in osteopathic manipulative treatment which is a very hands on art in palpating, diagnosing and treating what we term somatic dysfunctions. It was arguably the best part of my first term because I got to see how the structure and function of the body are interconnected in real life. I’m going to seriously miss this in person lab now that we are virtual - it’s like a little piece of what makes me, me is gone. We are also

all online for anatomy but our school is frontloading lectures and then giving us all anatomy labs after winter break once we have quarantined! I definitely miss in person interaction, but I am so amazed by what our educators are doing for us during this unprecedented time. So far, this has been the hardest thing I have ever done. In this past term I got more stressed than I knew was possible for myself, but I also learned how to cope with my stress (Dove chocolate, exercising, a good country music playlist and an occasional glass of red wine). I cried during online lectures when things were going too fast and confusing me, but I let myself cry because I have learned how to embrace my emotions, good and bad. I even got feedback from one of my first standardized patients that my empathy was natural! I panicked many times when I did not accomplish all that I had planned for the day, but I learned that you can only do what you can do. Do

Always remember your WHY! Until next time, Student Doctor Maggie

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T H E H U MAN S O F M ED IC IN E

The Reverend Doctor Illueca

Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.

was a young scared medical student suffering from constant self-doubt when I first met Dr. Marta Illueca. There is a very common ailment known as “Imposter Syndrome” that afflicts many in the health professions, and I had become “afflicted” very early on. I was surrounded by fellow future physicians who all seemed smarter and more confident than I was. Many were male, and few of the females looked like me. A chance encounter in 1989 with Dr. Illueca, who was then a pediatric GI fellow at the hospital affiliated with my medical school, changed my outlook and perspective. In her reflection I could actually picture myself as a successful, confident physician. I am so fortunate 28 | WINTER 2021

to have her become an early mentor and strong positive role model for me. We are both native-Spanish speaking female physicians with strong connections to our patients, our family, God and our Hispanic culture. We did not let our “different-ness” define us, as we successfully assimilated into a culture that was not our own. She is a life-long learner who is continuously inspiring. Dr. Marta Illueca was born in New York and grew up in Central America. She is bilingual and completely fluent in both Spanish and English, with one of the most charming Panamanian accents you will ever encounter. Her list of accomplishments and degrees is impressive. A physician who graduated with honors

from the Universidad de Panamá, Facultad de Medicina (University of Panamá Medical School) in 1984, she went on to complete her internship and residency in Pediatrics at The New York Hospital-Cornell Medical Center (now NY Presbyterian). She stayed on to complete her fellowship in Pediatric Gastroenterology and then became an Attending Pediatric Gastroenterologist at Cornell. Her love of life-long research led her to leave private and academic practice, and she eventually spent over a decade in various roles, from Clinical Research Director to Medical Affairs Leader to Executive Director of Strategic Development at AstraZeneca Pharmaceuticals, LP in Wilmington, Delaware.

Chronic Pain Research Study

What is required?

Do you have chronic pain? Do you use prayer to cope with your pain? Participate in a study to identify types of prayer that may help your pain.

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30 minutes Age 18+ Chronic pain A belief in or open to the use of prayer All religious or spiritual backgrounds Fluent in English

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Samantha Meints, PhD

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