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Sierra Sacramento Valley
MEDICINE 4
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25
We Must Do Our Part to Fight Systemic Racism
COVID Chronicles II: Readers Respond
Shattered but Unbroken
PRESIDENT’S MESSAGE
John Wiesenfarth, MD
OPINION
Megan Babb, DO
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Yes, It’s Safe to Go to the Doctor
Physicians March Against Racism
EXECUTIVE DIRECTOR’S MESSAGE
PHOTOS
Aileen Wetzel, Executive Director
Photos by Ian Kim, MD
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OPINION
Zooming In On Futility
Spread the Word! #DoctorsOfficesAreSafe
Caroline Giroux, MD
Lindsay Coate
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How Your Practice Can Survive the Pandemic—and Thrive After It Ken Smith, Managing Editor
The HART of Medicine Cindy Ma, MS III
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The Thief and the Chihuahua
POETRY
Eric Williams, MD
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Board Briefs
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New SSVMS Members
We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below. Authors will be able to review articles before publication. Letters may be published in a future issue; send emails to SSVMedicine@ssvms. org. All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the Sierra Sacramento Valley Medical Society for permission to reprint.
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You Can Help Shape Health Care Policy in California as a CMA Delegate SSVMS Staff
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THE LAST WORD
It Takes an MD to Spell Comedy Vincent Ma, MS II
Faith Fitzgerald, MD
Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Open free to the public 9 am–4 p.m. M–F, except holidays.
VOLUME 71/NUMBER 4
Cover photo: Members of Sacramento White Coats Against Racism join in protests at the State Capitol following the death of George Floyd.
Official publication of the Sierra Sacramento Valley Medical Society
5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org
Photo: Ian Kim, MD
SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx
July/August 2020
1
Sierra Sacramento Valley The Mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community.
2020 Officers & Board of Directors
John Wiesenfarth, MD, President Carol Kimball, MD, President-Elect Christian Serdahl, MD, Immediate Past President District 1 Jonathan Breslau, MD District 2 Adam Dougherty, MD J. Bianca Roberts, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD District 4 Ranjit Bajwa, MD
District 5 Sean Deane, MD Farzam Gorouhi, MD Paul Reynolds, MD Roderick Vitangcol, MD Angie Yu, MD District 6 Marcia Gollober, MD
2020 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Anand Mehta, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD
District 1 Alternate Brian Jones, MD District 2 Alternate Vacant District 3 Alternate Ronald Chambers, MD District 4 Alternate Vacant District 5 Alternate Vacant District 6 Alternate Natasha Bir, MD
At-Large Delegates R. Adams Jacobs, MD Barbara Arnold, MD Megan Babb, DO Helen Biren, MD Jonathan Breslau, MD Amber Chatwin, MD Mark Drabkin, MD Adam Dougherty, MD Gordon Garcia, MD Ann Gerhardt, MD Richard Gray, MD Richard Jones, MD Carol Kimball, MD Charles McDonnell, MD
Leena Mehta, MD Sandra Mendez, MD Mohammad Khan, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD Tom Valdez, MD John Wiesenfarth, MD
At-Large Alternates Christine Braid, DO Lucy Douglass, MD
Rachel Ekaireb, MD Karen Hopp, MD
Margaret Parsons, MD
Sandra Mendez, MD
Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising.
CMA President-Elect Lee Snook, MD
AMA Delegation Barbara Arnold, MD
Editorial Committee Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD George Meyer, MD
Meghana Pisupati, MS II Karen Poirier-Brode, MD Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD
Executive Director Managing Editor Webmaster
Aileen Wetzel Ken Smith Melissa Darling
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Listen and subscribe to Joy of Medicine - On Call on your favorite Podcast App or visit joyofmedicine.org
Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests.
CMA Trustees, District XI Douglas Brosnan, MD
HOSTED BY LOCAL PHYSICIANS
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Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Š2020 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bimonthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.
| FEATURED CONTRIBUTORS |
John Wiesenfarth, MD
Caroline Giroux, MD
It’s time to address systemic racism as Americans, as physicians and as individuals, SSVMS President John Wiesenfarth writes this month. It’s an affliction that has been unaddressed for far too long.
Futility has become an everyday element of life in a pandemic, Dr. Giroux says, so it’s important to find the things in life that provide joy and even a little normalcy in times that are anything but normal.
Ian Kim, MD
Faith T. Fitzgerald, MD
Dr. Kim is a newly graduated physician and amateur photographer. His photos of the recent protests at the Capitol appear throughout this issue and he urges everyone to take action against racism.
Reader favorite Faith Fitzgerald, MD is back again with another story in which she recounts how a thief who ended up in her emergency room was thwarted in his efforts by a small and unlikely opponent.
drjohn@winfirst.com
iankim2011@gmail.com
Eric Williams, MD imango@att.net
Dr. Williams, a vascular surgeon and poet, is as graceful with his words as he is with a scalpel. In “Shattered,” he beautifully illustrates the despair, difficulty and determination behind overcoming an addiction.
cgiroux@ucdavis.edu
ftfitzgerald@ucdavis.edu
Vincent Ma, MS II
vincent.ma6644@cnsu.edu
Megan Babb, DO
mbabb1522@gmail.com
Dr. Babb’s report last issue on the struggles of physicians across the country generated some of the largest reader response in recent years. She shares those reactions of shock, anger and gratitude.
Cindy Ma, MS III
cindy.ma3504@cnsu.edu
Cindy tells us about the Healer’s Art course that has become an important part of her medical school education. The course develops an essential element of the next generation of physicians: their humanity.
Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.
Vincent had a career plan. He wanted to be a healer and change people’s lives. He knew he had the talent, that he could lift spirits and make an impact. Instead, he decided to go to medical school.
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| PRESIDENT’S MESSAGE |
We Must Do Our Part to Fight Systemic Racism By John Wiesenfarth, MD drjohn@winfirst.com
T
childbirth, or suffer the crushing blow of infant mortality. We also know that the Black community has been hit especially hard by COVID-19 due to a combination of holding many of the jobs that are considered essential and an increased prevalence of underlying conditions, such as high blood pressure, that this virus seems to attack. In addition, healthy food choices are often not readily available or promoted in communities with large minority populations, leading to greater obesity and chronic conditions that could be lessened in severity or even prevented altogether with a healthy diet. The reality is that racial inequality exists in all parts of society and medicine is not immune. The gut-wrenching death of George Floyd has made all of us become more introspective about our own attitudes toward race, an activity that can be as unpleasant as it is eye-opening. We can all do better to confront racism, be more understanding of the challenges many of us have
Photo by Ian Kim, MD
o say 2020 has been a year we’ll all remember is probably a huge understatement, and we’re only halfway through it. What will be most important is not that we remember, but what we remember and how we move forward with what we’ve learned. The year started with a pandemic unlike anything we’ve seen in 100 years and cases continue to spike in the country, including here in California. At the same time, we are once again seeing the symptoms of another insidious affliction, one that has gone unaddressed for too long: systemic racism in our society. I know that the vast majority of physicians are dedicated to healing, no matter what the skin color or ethnicity of a patient may be. Unfortunately, the numbers show that there are severe inequities in the health and care among people of color. Blacks are more likely to get diabetes, die during
Doctors from Sacramento White Coats Against Racism make their voices heard outside the State Capitol. 4
Sierra Sacramento Valley Medicine
never had to face but are experienced daily in the Black and Latino communities, and step up as healers to be part of the solution. One step I have taken, as president of SSVMS, is to appoint a Health Equity Advisory Committee whose first task will be to listen. They will then discuss what they learn and make recommendations to the Board of Directors on ways the medical community can do more to address systemic racism. Our goal is to find ways we can contribute, both as a medical society and as individuals, to confront disparities in health care and improve outcomes in minority communities. We should be very proud of the number of white coats that participated in the peaceful protests at the State Capitol and around the country. Their presence and high visibility sends a message that the health care community cares and will help lead the way to change. I know that as physicians, our immediate tendency is to say that all lives matter. But an analogy I recently heard brought home the importance of stating that Black lives matter: Sure, you can say that all the houses on your block matter, but the one that is on fire is the one on which everyone needs to focus their attention.
The startling and horrifying videos we’ve all seen recently of Black lives being lost unnecessarily and often cruelly at the hands of police makes it clear whose house is indeed on fire, and it is frightening to think of how many incidents we don’t know about because they weren’t caught on camera. I want to make it clear that we respect and appreciate the commitment and professionalism of those serving in law enforcement who put their own lives on the line every day. We work with first responders and know how dedicated they are, but changes need to be made. It’s also true that the medical community’s own failings and unconscious biases have unfortunately contributed to harming communities of color. SSVMS and I are committed to working toward eliminating racial inequities in our profession and society as a whole. The equality all Americans deserve may not come quickly, but with compassion and awareness it will come. If we fail to make a commitment in our personal and professional lives to ensure good health and opportunity for all Americans, if we are passive, more lives and futures will be lost. We take an oath to do no harm; doing nothing will lead to exactly the opposite result.
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| EXEC UTIVE DIRECTOR’S MESSAGE |
Yes, It’s Safe to Go to the Doctor
Safety Protocols Give Patients Confidence to Return
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t the time this article was written, the Sacramento region was showing positive trends in the number of COVID-19 infections and many physician practices are working to restore their levels of routine patient care. The Sierra Sacramento Valley Medical Society encourages physician practices to adopt comprehensive protocols to ensure the safety of patients and staff. Here are some ways, in the ongoing age of COVID-19, providers can help restore confidence that patients can safely access health care when they need it and get the preventive care vital to heading off serious health complications.. Maintain physical distancing. Your office space and workflow should be structured to encourage physical distancing. Consider limiting points of entry to your medical office or facility, and if possible arrange your office flow so that patients enter and leave through separate doors. For patients who are waiting to be seen, give them the option to check in by phone or text message and wait in their car until an exam room is ready. For those who prefer a waiting room, ensure social distancing by separating chairs by at least six feet. You can also limit waiting and exam room access to the patient only, with the exception of parents or guardians of younger children. If you haven’t already, post visual reminders for patients such as signs and posters about hand hygiene, respiratory hygiene, and cough etiquette at the entrance and also in strategic places such as waiting areas and elevators. Be sure to post similar reminders for office staff in areas they frequent. Signs and posters in multiple languages are available for download from the CDC website. Here are some other important steps to take: • Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub with 6
Sierra Sacramento Valley Medicine
By Aileen Wetzel awetzel@ssvms.org
60-95% alcohol, tissues, and no-touch receptacles for disposal at practice entrances, waiting rooms, and patient check-ins. • Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact between triage personnel and potentially infectious patients. • Put away items such as magazines, toys, water dispensers, or anything else that may be handled by infected patients. • Complete the check-out process in the patient room, rather than at the front or back desk.
SSVMS has launched an awareness campaign to assure patients it’s safe to resume medical visits. Ask patients about symptoms before they arrive. Patients should be asked at the time they schedule an appointment if they are experiencing common COVID19 symptoms such as dry cough, fever, etc. Patients reporting COVID-19 symptoms should be screened telephonically and referred for testing, if possible, before coming to the office. To limit the potential spread of the virus and reduce the time patients are together in waiting areas, schedule patients so that only a few are in the office at any one time. It’s also important to instruct patients to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection such as a cough, sore throat, or fever on the day they are scheduled to be seen. When appointments are scheduled, ask patients to bring their own masks but also have a supply available for those who don’t. We recommend requiring patients to wear wear a facemask upon entry and throughout the office visit.
For the safety of your staff, ensure that everyone has an adequate supply of personal protective equipment. All staff should be trained on the proper use of PPE and CDC guidelines for the extended use and reuse of PPE. Make sure patients are aware of proper protocols upon arrival and during the office visit. Patients should immediately see notices posted at the entry to the office instructing them not to enter if they are experiencing symptoms. When patients do enter, they should be asked again—even though they were asked when the appointment was made—about the presence of COVID-19 symptoms. Other key steps you should take include: • Consider having patients, regardless of symptoms, as well as practice staff and physicians have their temperature checked with a no-touch thermometer before entering the office. • Triage personnel should have a supply of facemasks for patients who arrive without one. • Ensure that patients and staff are following appropriate hand washing protocol. • Care should be taken to disinfect door handles, chairs, countertops and exam tables between patients. When appropriate, continue to use and encourage telehealth. This will have the effect of limiting the number of patients who appear in the office, preserve office time and space for patients who must be seen in person, and also help increase the number of patients your practice sees. Clear, concise communication
with your patients about what to expect before, during, and after their visit will help set expectations and ease patient concerns about safety. Consider emailing your patients to let them know you are open for routine and non-urgent visits and to advise them of the protocols you have implemented to ensure the safety of patients and staff. To help alleviate patient concerns about visiting their physicians’ offices, SSVMS has launched a public
service campaign to assure patients that it is safe to resume routine and non-urgent medical visits. The PSAs can be downloaded from the SSVMS YouTube page at https://tinyurl.com/ y7m2zmpx or use the QR code on page 20. Physicians are encouraged to share the campaign with your patients and on social media. Whatever your need, SSVMS is here to help you reopen your practice and resume routine medical care.
Please read before entering. IF YOU HAVE
Fever or Chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Please call our office before coming inside. Clinic Phone # The clinic staff may ask you to wear a mask or use tissues to cover your cough.
Thank you for helping us keep our patients and staff safe. cdc.gov/coronavirus CS 317503-A 06/11/2020
The CDC has a variety of posters, videos and other downloadable resources on its website available for free to physicians and businesses.
July/August 2020
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| OPINION |
Zooming In On Futility Boundaries and Routines Fall in the Days of Social Distancing
I
f there is something other than an explosion of meetings via Zoom that this pandemic has brought, it is the illumination of futility in so many aspects of our lives. I had already embarked on the path of purging major wastes of brain space as much as I could over the past few years, but this new era has accelerated the effort. Still, the problem is, even though we see the futility more, it doesn’t go away. Maybe worse, more futile acts are generated every day. Clunky processes that require so many logins and passwords. Useless clicks to complete EMRs in an overflowing in-basket. So many arbitrary, tyrannical deadlines. And by the way, who really thinks that there is such a thing as a “friendly reminder for chart completion”? I can’t believe I still receive those… Routines? Futile. No one will follow them anyway; with the loss of learning environment cues school provided, or just easy access to the pantry, everyone’s different biorhythms are now allowed to unleash idiosyncratic habits without restrictions. A clean kitchen? Futile. I can’t have anyone over anymore, plus my kids eat constantly so I can never keep up with the pile of dishes (oh, and by the way our dishwasher broke just at the beginning of this catastrophe back in March). 8
Sierra Sacramento Valley Medicine
Fancy dishes? Futile, as being more at home means statistically more wear, tear and breakage. One of my sons broke my favorite wine glass by making it land a little too hard on the counter as he was drying the dishes. But this is replaceable. When I can go to the store again. And at least he was trying to be helpful! Wearing professional clothes? Futile, as no one can see my patterned, colorful tights or skirts
By Caroline Giroux, MD cgiroux@ucdavis.edu
any school email that contains more than three sentences, including those with two different sets of instructions that also have two sets of login and passwords. My kids’ assignments? Maybe not so futile, since their teachers have put so much effort into this and their learning has to continue. Even scheduling Zoom meetings, which are supposed to be the answer in these socially distancing times, are often futile because of
I make room for what really matters, because I can’t deny the fact that as a result of the pandemic I am more confronted with my own mortality. anymore, and I must dress comfortably because to survive simultaneous homeschooling with three different curricula I must doubleand triple-dose on micro-yoga or micro-meditation sessions between holding patient video visits and troubleshooting kids’ assignments. A need for my own space? Futile at best and depressing at worst, given the fact that boundaries have fallen apart between work and home, and within our home, to accommodate every single being’s new life. Words? Also futile, as I crave silence and stillness of mind more than ever. I no longer understand
conflicts that keep me from attending. The fragmentation of time and daily homeschooling schedule for the kids means the days blend together, each day ending with a backlog that will need to be carried over to the next day. Each week is now like one long day with a mini-break—called sleep—between the steps to achieving the major life task of holding our kids’ success, our own duties and our sanity in the same mental space at all times. Even the welcome break of holidays have become futile because we can’t do much out of the ordinary to celebrate. I feel like I have been catapulted
into the role of an insufficiently trained air traffic controller who deals with an accelerated version of reality. It is like being the sole player on one’s team for a constant game of Quidditch with too many Bludgers, but with no Golden Snitch in sight. Overnight, I’m getting school Zoom invites on a short notice, often less than an hour. And to test my sanity, the kids for whom these sessions are held immediately resist, refuse, question, argue. They hate Zoom. In order to make sure that they attend the sessions (some of them are mandatory; for instance my oldest gets points for attendance), I had to find a way to deal with the rise of panic in me, the unbearable thought of suddenly behaving like a “problem household” in the eyes of the school district. So, out of utter despair and
creativity, I started bribing my boys with chocolate bars. My nightmare is now complete. I now officially totally lack imagination. I feel like my whole life is futile. I am just a weak hyphen trying to make all the pieces hold together. In the eyes of a few, acts of futility can seem like a pseudoaccomplishment. They can become so ingrained into daily life that they are no longer noticed or, even worse, become part of someone’s identity. But it is generally a distraction from what matters the most, or it is meant to let the world stagnate (or even worse, sometimes regress). It is the counterproductive making us waste precious resources and unfortunately maintain inequities. But hey, what a great opportunity to weed wack our lives and priorities! We can create our own Golden Snitch! Yes, a little glittery reward,
or meaning. Still, I find myself walking over the piles of futility each day instead of picking them up, like a tired version of Sisyphus. I make room for what really matters, because I can’t deny the fact that as a result of the pandemic I am more confronted with my own mortality. I always check in with myself: If I were to die of anything in the near future, would I have any regrets? I would probably have to admit yes, but it wouldn’t matter too much because if you ask me, “Would I say that I led a full life?” I would answer yes. My life is still full despite having shifted to a more inward journey, the introvert’s dream. I am just slowing down and going deeper. I have some mileage I can be proud of in my life, and this is what I want to continue focusing on: the legacy I am trying to build each day, wishing
July/August 2020
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it will never be complete. We need to keep the flame alive and going, we need to leave the workshop open and in disarray so the next ones can take over and start with something tangible. This legacy thing is an expression of the deep core values I am trying to transmit, even if I have to do it as part of a mosaic on a Zoom screen. Sitting down and doing what I enjoy the most, such as writing, is what I should continue doing. It gives me a sense of agency and maintains a bit of normalcy in my daily life. Writing has been a continuous thread since childhood, like an anchor during storms. And I can rejoice by telling myself that at least COVID-19 didn’t take that from me, and it maybe even offered some inspiration. My writing gives a glimpse into my soul, and sometimes, the souls of other parents who are struggling, just like me, trying to juggle too many things, intercept too many Bludgers. Maybe my words will transcend the futility stage and resonate in some people. Maybe they will bring comfort, as people will realize that we are all in the same boat of not having answers, or be stepping stones towards higher consciousness. Ultimately, life is a game of uncertainty and there comes a point, even in my household version of air traffic control, when chaos cannot get worse. I decided instead to zoom in on what I can control in my life and expand those areas of freedom, whether it is my yoga mat, the dance of the pen on my notebook, or the words or silence I share faceto-face with those in my life I don’t have to Zoom with. Well, at least not yet…
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| PANDEMIC |
How Your Practice Can Survive the Pandemic— And Thrive After It W
thing Dr. Tyler Smith did was notify patients that their surgeries were postponed due to hospitals closing off facilities for many elective surgeries and that for the immediate future they would have virtual visits. Physicians throughout the Sacramento region have faced unprecedented challenges to their practices in 2020. Many general practitioners and specialists offering vital but non-emergency care saw tremendous drops in their patient loads or shut down completely for extended periods. Many had sleepless nights wondering
Photo by Ken Smith
hen the COVID-19 pandemic started to take hold in February, Dr. Richard Gould, a Sacramento pediatrician, was on vacation in Chile. As infections grew and travel restrictions loomed, he cut his vacation short to return to a much different California than the one he had left just a couple of weeks earlier. “When the initial shutdown occurred, everybody cancelled everything,” Dr. Gould said. “The pandemic dropped our visits to 25 percent of the usual volume.” At the Sierra Spine Institute in Roseville, the first
By Ken Smith, Managing Editor ken@kdscommunications.com
A huge drop in visits caused by the pandemic forced Richard Gould, MD to rethink strategies for his practice.
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Sierra Sacramento Valley Medicine
Time Can Be a Gift
Dr. Gould, who manages Pediatric Medical Associates of Sacramento, which includes seven pediatricians located in offices in Sacramento and Folsom, said his initial reaction to the drop in volume was to “work harder.” But then he decided it would be more effective to take a step back and do some research, so he immediately began building strategies based on recommendations from the American Academy
Photo by Ken Smith
how they could meet bills, whether staff would need to be let go, and considering the biggest question of all: Will patients come back? Drs. Gould and Smith believe they will if physicians actively take steps to recognize the new normal. In fact, both expect their practices to emerge stronger than they were just a few months ago because of changes and strategies they were forced to adopt during the lockdown. “Breakdowns lead to breakthroughs,” Dr. Smith said. The circumstances of their practices differ greatly—parents bringing their children to a wellness visit are more likely to postpone appointments than spinal patients who are motivated by pain to pursue relief, for example. But both cited three basic strategies they consider essential to carrying their practices through the pandemic and beyond: • Use the downtime to your advantage; • Embrace technology, because even if you don’t know it, patients already have; • Maintain connections with patients.
Dr. Gould has found telemedicine to be a popular and effective alternative, especially with parents hesitant about going out.
“I recaptured a couple visits with patients who would have been sent to the emergency room. Because I was able to have a billed video visit, I was able to capture revenue that would have been lost.” of Pediatrics as well as SSVMS and other medical societies. He signed up for webinars and also quickly got in line for financial support programs from the Small Business Administration. “The main message I got from a lot of the websites and other information was that now is not the time to close yourself away, it’s time to work really hard to figure out what you’re really going to be doing,” he said. A provider at his practice was immediately put in charge of disaster management and keeping up with the CDC’s guidelines on how to safely maintain care for
patients. Some of the recommended changes, such as having patients wait in the car, may continue after the pandemic subsides. Because slow periods were so rare for the practice, however, it also provided an opportunity to determine how staff could be repurposed to take advantage of the time. He said everyone was put to work scanning records that had backed up, which helped the practice retain jobs. Patient flow largely continued at Sierra Spine Institute, but there was still time to take a look at where improvements could be made.
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Photo courtesy of Sierra Spine Institute
Tyler Smith, MD says reaching out to patients is key to bringing them back. “We were not functioning at 100% capacity, and we took the downtime to refine processes and workflow, and to engage a couple consultants,” Dr. Smith said. “We were going to sharpen our sword in the downtime, and we didn’t waste a minute. There is no doubt my practice will be stronger coming out of this. No doubt.”
Patients (and Providers) Are Embracing Telemedicine
Working remotely has become the norm throughout the business world over the past few months, and medicine isn’t immune. Enabling your staff to work at home can keep a practice functioning during the pandemic and also help to improve work-life balance during less dire times. “We were already set up with an infrastructure that
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was capable of pivoting quickly,” Dr. Smith said of his practice’s responses to the statewide call for employees to work from home. “When we shut down on a Thursday, by Friday everybody was working from home and functioning.” Both doctors also see the increased use of telemedicine as a business advantage that patients are embracing. Because the response to telemedicine visits from patients has been “overwhelmingly positive,” Dr. Smith’s practice is now committed to online patient care whenever possible. He sees patients online from home in the morning, then goes into the office in the afternoon to see others in person. “My PA’s schedule is reversed,” he explained. “He sees patients in person in the morning, and then he goes home and sees them with Telehealth in the afternoon. That also minimizes the overlap for the flow of physical patient traffic in the office.” “We don’t want to have any sick patients at the office if we can avoid it,” said Dr. Gould, even though that sentiment would have seemed directly opposite to a medical practice’s business model just a few months ago. Telemedicine is now part of his practice’s screening process for appointments; if an in-office visit is needed following a virtual one, the two visits are combined to count as one office visit for billing purposes. Not only do parents also like the flexibility of telemedicine, he said, but it can allow his visits to be more effective. “I think telemedicine is super-better than an inperson visit if, say, I have an overweight child and I’m asking questions about their diet,” he explained. “It’s a lot more effective for me to ask them to open the fridge and let me take a look because you immediately get the information you need. That’s something I could never do in the office.” “I can see patients a lot more efficiently, the satisfaction rate is higher for the provider and the patient, and from an outreach standpoint it just breaks down all the geographic barriers,” Dr. Smith said, noting that telemedicine had allowed him to work with patients as far away as Florida. “Most of us are trained that between the history and imaging, that’s about 80% of the diagnosis. It’s just talking to people, and that didn’t really change.” Dr. Gould found that telemedicine also helped him hold onto revenue that would have gone elsewhere.
“Breakdowns lead to breakthroughs. There is no doubt my practice will be stronger coming out of this. No doubt.” “I recaptured a couple visits on the weekend with patients who would have been sent to the emergency room,” he said. “Because I was able to have a billed video visit, I was able to see and assess the injury quite well and then have them come in for a tetanus shot first thing Monday morning. I was able to capture that revenue that would have been lost to emergency.” Dr. Smith noted that patients are far more savvy than they used to be about using apps such as FaceTime, which has been authorized by the federal government as HIPAA compliant during the public health emergency. Even when health care-specific telemedicine platforms are used, both doctors have found that patients are mostly able to get online easily and appreciate the convenience.
“It’s OK to Be Proactive”
Some physicians may be reluctant to “chase” patients, but both doctors agree that reaching out to patients and strengthening bonds are key to a healthy practice both now and post-pandemic. While doing his research, Dr. Gould realized how important it is to contact patients for both their benefit and for the practice’s. Rather than being annoyed, patients appreciated the outreach and it helped him start to fill canceled appointments. “They were really happy to be contacted,” he explained. “They figured we would be busy and they didn’t want to be exposed to COVID. We were able to explain that their least risk of COVID was coming in this week, because next week we may have more sick patients.” Physicians aren’t the only ones struggling in the pandemic environment, and contact from a trusted physician can be welcome. “It’s OK to be proactive,” Dr. Smith said. He found patients were thrilled to have contact with someone who could give them insight on what was going on with By Jon Davids, MD COVID-19. Dr.jdavids@shrinenet.org Gould also noted that in today’s times, patients’ needs may extend beyond standard medical care. They might need social workers or be food inse-
cure. Making that call provides an opportunity to check up on what they truly require. Dr. Gould said one comment that stuck with him from his research was that “if the phones aren’t ringing in, they should be ringing out.” In other words, if patients aren’t calling you, you should be calling them and asking important questions about how they are doing and what they need. “If you’re loyal to your patients, they’ll be loyal to you. This is an opportunity to see how we can really be loyal to our patients,” he said, adding that a patient’s loyalty is worth more to him than “all the money I could earn in a different business.” Dr. Smith agreed. “If you’re continuing to connect with them, they’ll seek you out when the dust settles. That’s really the key. You still want to be top of mind when they emerge.” Using downtime to check in with patients and colleagues to make sure they are providing the best possible care is the best avenue to success, Dr. Smith said, “You can’t help but grow if you follow down that pathway. The results are inevitable to the process.” Both doctors also had one last piece of advice: Keep the faith, as hard as it may be right now. Dr. Gould said he still feels “like I ate a whole bunch of ice cream and I’ve got a terrible brain freeze.” There are plenty of sleepless nights and worries, and even some questioning of career choices, but it’s important to remember the talents and work that have gotten you this far. “We’re not failures, we’re successes,” Dr. Gould said, noting that some of his colleagues have suddenly questioned the work they have dedicated themselves to. “How do we leverage our success against everything we’ve done to cope with a new reality? It’s not the reality we would have chosen, it’s just a reality. “Those of us who have been successful, we’ve got the skill set we need to be successful [again] and rewarded and satisfied in our work. But boy, you have to dig through a lot right now to get to that.” Ken Smith is the managing editor of Sierra Sacramento Valley Medicine.
July/August 2020
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| OPINION |
COVID Chronicles II
Readers React With Shock, Anger at Fate of Colleagues And Express Appreciation for Support Locally
W
By Megan Babb, DO mbabb1522@gmail.com
hile the COVID-19 pandemic has been devastating across the globe, there are silver linings to be seen. If there has ever been a time when exposing the ugly truths of America’s health care system has been needed, it is now. COVID-19 has exposed the country to all of the system’s vulnerabilities and exploited them. As a physician practicing in the greater Sacramento region, I am incredibly proud of the leadership and teamwork that has emerged to keep health care workers and patients safe. While the fate of COVID-19 is yet to be determined, for this day, we can be proud of the camaraderie and support our profession is showing for those of us practicing in this region compared to the far more dire situations seen elsewhere in the country. We should all applaud our state’s quickness to enforce social distancing, the initiatives taken by health care administrations to make our hospitals safe, and the willingness of physicians to work around the clock to ensure the community spread of COVID-19 remains low. I received numerous comments from local physicians to the COVID Chronicles article in the last issue of Sierra Sacramento Valley Medicine. The majority expressed shock and surprise at what our colleagues are experiencing outside of our region. Here is a sampling of their responses (reader comments have been edited for length and clarity when necessary).
Internal Medicine: The health care system I work for is often one I don’t see eye-to-eye with, however it is clear that their efforts have been extraordinary comparatively.
Pulmonologist: I had no idea physicians across the country were experiencing such hard times. How do we help them?
Hospitalist: It breaks my heart to read all the stories of what is happening to my colleagues across the country. Every voice needs to be heard.
Pediatrician: This puts into perspective how well our systems have adapted in California. I am completely surprised to know that other physicians don’t feel safe to go to work. I am lucky my system has been so proactive. 16
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Surgeon: Wow. At what point did things get so bad? My head has been in the sand. Family Physician: Thank you for shedding light on the horrible conditions physicians and other health care workers have been forced to work within. It is time that our profession begins to support one another.
Eyes wide open now. Family Physician
Pediatrician: This pandemic is making the ugly realities of the health care system we work for available for all to see. I hope those who have an opportunity to change the system do so.
Nephrologist: Thank you for bringing light to the situation. Our profession needs to understand that if one physician is hurting, it hurts us all.
Our physicians are our health care system’s greatest assets. It is time real change happens. I promise I will start to walk the walk and lead by example. Thank you for giving a voice to others. Hospital Administrator
Internal Medicine: Physicians have lost control over the practice of medicine. While we have been busy healing, government regulations have been making it possible for our work to be exploited at our expense to benefit others.
Pediatrician: Thank you for giving a voice to the physicians who are silenced. My heart is heavy today.
Family Medicine: The actions taken by most in the Sacramento region shows how dedicated we are to the safety of our patients. I am proud to be here. I am sorry others are not as lucky.
Family Medicine: Well, that was certainly difficult to digest. Thank you for sharing.
Pediatrician: How did we allow this to happen? So grateful that those who feel silenced have an opportunity for their voice to be heard. Pediatrician: After reading these, I feel so helpless. I had to stop reading multiple times and read it in small sections because I felt so angry for these physicians’ experiences. It is truly a defeating feeling. Thanks for sharing. Hospitalist: I am so grateful for the system I am in. They have allowed physicians to make the recommendations on how to proceed to limit COVID exposure. We have had a say in every stage along this process. Cardiologist: This was very disheartening to read. It confirms how I have always felt but never been able to fully confirm and comprehend in its fullest extent, how dire our situation currently is. Physicians across the country need to support one another. Neurologist: While I am so grateful what action has been taken in California, it calls into question why things are not at least safe and equitable for others elsewhere.
Hospitalist: I would really love to hear the thoughts of those who run health care corporations. Do you think they feel even a shred of guilt or responsibility? OB-GYN: I think that the response of those in the area has been great. However, why aren’t other hospital administrators speaking openly and outwardly against the atrocities that are occurring to health care workers? If they are not speaking up, they are complicit. Intensivist: I had no idea this was happening to our colleagues. I have been practicing for over twenty years and was unaware things have gotten so bad.
July/August 2020
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Physicians, Students March Against Racism Over 200 local physician members of Sacramento White Coats Against Racism came together at the State Capitol on June 1 to support their Black colleagues. The theme was “Today Is the Day I Become Anti-Racist.� The rally led SSVMS to create the new Health Equity Advisory Committee to address racial inequality.
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Sierra Sacramento Valley Medicine
Photos By Ian Kim, MD iankim20112@gmail.com
July/August 2020
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Spread the Word! #DoctorsOfficesAreSafe New PSAs Aim to Bring Back Patients
By Lindsay Coate lcoate@ssvms.org
M
any physician offices and emergency rooms saw their caseloads drop by 50% to 75% over the past several months due to stay-at-home orders and patient concerns about COVID-19 infection. As a result, practices have struggled and health care workers, including physicians, have been furloughed or laid off. With proper precautions, doctors’ offices and emergency rooms are some of the safest places to visit. To support our physicians as they work to rebuild their practices, SSVMS created a series of public service announcements in May that already have over 200,000 views on Facebook and YouTube. The PSAs highlight different specialties but all focus on a single theme: It is safe to visit your doctor. Drs. John Wiesenfarth (emergency medicine), Bianca Roberts (family medicine), Jackie Agee (pediatrics), Christian Serdahl (ophthalmology) and Margaret Parsons (dermatology) each participated in specially targeted videos. Making a video during a pandemic proved to be a bit tricky, but each physician was game to make it work! Two videos were recorded via Zoom conferences, two were recorded by the physician’s office staff, and one was recorded by a physician’s spouse. Each PSA is 15 Scan this code seconds long and appears ahead of with your other videos posted on Facebook phone to see and YouTube. the PSAs. Please help us keep this campaign going by sharing these videos with your patients and others on your social media pages! You can find the videos at https://tinyurl.com/y7m2zmpx or simply scan the QR code with your phone’s camera. These PSAs are part of the ongoing effort at SSVMS to support our members through these challenging
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The SSVMS public service announcements have been widely viewed on YouTube and Facebook.
times, whether it’s by providing PPE through Operation Shields Up to those on the front lines of COVID-19 care or physicians at the other end of the spectrum who have seen their practices suffer during the pandemic. We want to thank all the doctors who participated in this campaign, which was made possible through the support of community donations and our passionate physician members.
Lindsay Coate is director of programs at SSVMS.
Telehealth Services Joy of Medicine Resiliency Consultations
P sy c holog ists
Daniel Rockers, PhD (916) 273-1740 daniel.rockers@gmail.com
Amy Ahlfeld, PsyD (916) 799-3866 drahlfeld@gmail.com
Lori Roberto, PhD (916) 206-1741 drlori@drloriroberto.com
Patricia L. Bach, PsyD, RN (916) 662-0767 pbachpsd@gmail.com
Members and non-members may utilize this service. To schedule a virtual appointment, contact a Vetted Provider directly, ask what virtual platform they support, and mention that you are accessing the SSVMS Joy of Medicine Program.
L if e C o a c hes
Angela Trapp (305) 962-1936 3coaching.cc@gmail.com
With the increasing stress and pressure physicians are facing, SSVMS is committed to providing all physicians with a place to turn to during these difficult times. SSVMS will sponsor up to six wellness sessions with vetted psychologists and/or life coaches for physicians in Sacramento, El Dorado, Yolo, and Placer Counties.
Steve Seay (916) 715-9252 stevendseay@gmail.com
Confidential Convenient Competent Cost-Free
JoyofMedicine.org
July/August 2020
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| JOY OF MEDICINE |
The HART of Medicine
Healer’s Art Course Explores, Develops Humanity in Medicine
T
he Healer’s Art (HART) course is a wellness elective offered each spring semester to medical students and physicians at California Northstate University College of Medicine. The course was originally founded by Rachel Remen, MD in 1991 at UCSF, and it is currently run by Remen Institute for the Study of Health and Illness (RISHI) programs. Since its inception, more than 22,000 medical students across 100 schools in the U.S. and abroad have completed the course. The Healer’s Art course is a 15-hour elective spanning five class sessions. Each session is dedicated to different topics for students to reflect upon and then to discuss in both small and large group settings. These sessions cover topics about humanity in the practice of medicine that providers often may not feel comfortable sharing with each other, including wholeness, grief and loss, mystery and awe, and service as a way of life. This year’s HART course at CNSU welcomed 67 students and 13 physicians, bringing the total number of course graduates to nearly 200 over the three years that it has been offered. This means more than 40% of medical students who have graduated from CNSU have Students and faculty from this year’s Healer’s Art class at CNSU. 22
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completed HART. I am proud to say that I am a Healer’s Art graduate and a student director for the past two years under the guidance of course director Rochelle Frank, MD. I’m often asked why I took the course twice, taking time that could be used to study for Step 1. The reason is I believe this course has equipped all of us HART graduates for our careers beyond Step 1 so that we can become the caring, compassionate physicians that we all dream to be. Each day of the class usually kicks off with a large group session that is lead by the course director. These sessions serve as an introductions for the topics to be discussed and consist of personal reflection, short journaling exercises, and
By Cindy Ma, MS III cindy.ma3504@cnsu.edu
other large-group activities. Topics are explored in further depth when participants break off into small groups of no more than six people that are comprised of medical students and faculty members who may not already know each other very well. Participants are encouraged to share any insight or experiences in this safe space, but are not required to say anything, which is a unique aspect of this class. However, they are highly encouraged to actively listen to their colleagues, especially since the conversation may flow naturally towards more sensitive topics they may have never shared outside of this safe space. The emphasis on listening often helps class participants realize how
comfortable they can become with silence in conversation The faculty member is present simply to help guide conversations along, as they are also participants learning from the small group experience. Establishing the faculty’s role in this way helps redefine the traditional classroom dynamic in which the physician/professor delivers information for students to learn. The discovery and experiential model of this course allows for natural conversations in which both parties can learn from each other. Ultimately, many realize that while we are all at different stages of our medical careers and have unique life experiences, we are more alike in our emotions, experiences, and motivators than we may lead ourselves to believe. We, as healers, often empathize, grieve, and experience awe in very similar ways, as well as share the passion to care for others physically, mentally, and emotionally. With these realizations and the focus on listening, HART encourages physicians and physicians-in-training to develop stronger relation-
ships with each other and with their patients to maintain the passion in their work. Altogether, the Healer’s Art course empowers participants to build supportive communities of health care providers, be authentic and practice self-care that will help combat the burnout we are all too familiar with. The last session, “Service as a Way of Life,” is designed to have people look at their own purpose, best described as their own personal Hippocratic oath. This was my favorite session because it closes the course with a small, ceremonial wrap-up honoring the course graduates. Healer’s Art graduates across the world receive pins with a small, red heart symbolic of the program. This pin serves as a reminder of our shared growth and experiences in HART and is also a signal to other HART graduates that they have someone with whom they can connect on a deeper level. The pin also serves as a conversation piece for curious patients that can start a stronger relationship. Beyond receiving the Healer’s Art pin, the last session is a time
of optimism and hope that unites participants together to reflect upon all of the experiences and lessons we wish to keep with us throughout our practice. In this final session, everyone has the opportunity to affirm how they will commit to the practice of medicine in their own unique way. This year, after hearing all of the affirmations of my colleagues, I am reminded that I am never truly alone in my service and journey in medicine, and I believe that sentiment is shared among my fellow HART graduates. So far, Healer’s Art has permeated every aspect of my experiences as a medical student. From chatting with my classmates and interviewing standardized patients, I have had many opportunities to practice some of the lessons I’ve taken away from the course. I’ve become a better listener by being more present in the moment for those around me, I’ve found myself more grateful than before, and I’ve been able to find more meaning in my day-to-day activities as a physician-in-training. Outside of CNSU, I’ve been very fortunate to create deeper, more meaningful connections with other medical students, faculty, and preceptors because of the pin adorned on my white coat as I care for patients in the community. As a rising third year medical student heading off to the wards in the next few months, I will keep the guiding ideals of Healer’s Art close to my heart with each opportunity I have to work with new patients and new colleagues. I am excited for what the future holds for me as a physician, and optimistic that the culture of medicine is making shifts to more authentically support patients and healers alike. July/August 2020
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| ESSAY |
The Thief
And the Chihuahua I
was the attending on the General Internal Medicine Service when a 40-year-old man was admitted with multiple dog bites to his feet and ankles, leading to fever, swelling and rising erythema of both legs. He also had scratches on his hand. He had been started on antibiotics in the emergency room and then sent upstairs to us to treat and follow him until bacterial cultures, taken in the ER, had been read by the lab. When I went to his room to meet and examine him, I saw that he was shackled to his bed by handcuffs and that a policeman sat in a chair nearby. I introduced myself to the patient and, seemingly in no distress, he gave me a smile, then laughed and said, “Can you help me escape?” “Sorry,” I said. “I’m not allowed to do that, right, officer?” “Right,” the policeman responded, chuckling, and went back to reading an old and tattered magazine. “Tell me what happened,” I asked the patient. “Well,” he said, “I’d be more comfortable if the cop wasn’t here. I’ve asked for a lawyer, but it will take a while before he or she appears.” “No problem,“ said the officer, “I’ll wait outside the door. Call me if you need me, Doc.” When he had left the room and closed the door, the patient told me the following story: “I’m a professional thief, “ he said. “Oh!” “So I break into houses in affluent neighborhoods and steal things when nobody’s home.” “Ah!” “My major problem as a thief is that often their dogs are home, on guard, and may loudly bark at or bite me when I get in.” “Yeah?” 24
Sierra Sacramento Valley Medicine
By Faith T. Fitzgerald, MD ftfitzgerald@ucdavis.edu
“So I worked out a system, bringing with me raw chunks of meat with sedatives in them to toss to the dogs when I break open the door or a window. I like dogs, I have two myself, and would never want to hurt one. Happily, most big dogs love meat, take the bait, then go to sleep without injuring themselves or me while I gather the goods.” “Aha!” He laughed. “But in this house there was a Chihuahua. And boy, did he ever come after me! He ignored the meat, took bites to my ankles, then ran back and forth barking—more like screaming, really—before I could catch him, and did it again, and again, and again. I could not stop him. I tried to throw a sheet over him but he kept on barking and screaming at me so loud that I thought the passersby or next door neighbors would hear him and either come to the house or call the police. “So I picked him up—he bit me again as I did—and put him into one of the bedroom pillowcases. Then I went outside to my car, put him in the car trunk, and drove about four miles to a big outdoor park. He barked and screamed all the way. I let him out, still bundled up in the pillowcases, on the grass between the trees and quickly ran to my car to go back to the house and finish up my thieving. “Just as I was ready to leave with my booty, the police were at the front door, as was the Chihuahua; he had run all the way home. It seems a neighbor called the police to the house to complain about the Chihuahua’s noise and ferocity.” The thief was taken to the ER, but his next stop after the antibiotic therapy on my service would be jail and the courts, all because he was a dog lover. I am a dog lover myself (I have two of them, one of which is a Chihuahua). I really kind of liked this man, even though he was a thief, and, since that time, I regard my Chihuahua as my possible protector from thieves rather than just a screaming, barking, disobedient and periodically incontinent beast.
| POETRY |
By Eric Wiliams, MD imango@att.net
Shattered but
Unbroken My life is shattered And the pieces are like broken glass Big unreflective pieces of time and Tiny shredded splinters Seemingly impossible to recompose Putting the pieces together Sharp edges Fingers bloodied with the effort Pained and unsatisfied Impossible unrewarded efforts Never to be the same but I choose the pieces that will reflect the new Me.
July/August 2020
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| BOARD BRIEFS AND NEW MEMBERS |
Board Briefs
D. Cheema, MD; N. Keith McMurry, MD; Raja K. Sivamani, MD; Kim L. Wang, MD; Ann Yen, MD. For Reinstatement to Retired Membership — Geoffrey E. Woo-Ming, MD.
May 11, 2020 THE BOARD: Received a public health report from Peter Beilenson, MD, Director, Department of Health Services, Sacramento County. Received an update from Senator Richard Pan, MD regarding the bill he has authored, SB 1029, Oversight of Medi-Cal Managed Care in Sacramento. Approved the establishment of the 2020 Nominating Committee as follows: Chair, Christian Serdahl, MD, Immediate Past President; Representing the six geographical districts, Ruth Haskins, MD, District 1; Margaret Parsons, MD, District 2; Barbara Arnold, MD, District 3; Anand Mehta, MD, District 4; Paul Reynolds, MD, District 5; Tom Ormiston, MD, District 6; At-Large Members, Richard Jones, MD and Katherine Gillogley. The committee is charged with nominating physician members to vacancies on the Board of Directors and the SSVMS Delegation to the CMA. Approved the 1st Quarter 2020 Financial Statements and Investment Reports. Approved Changes to the SSVMS Delegation from Alternate-Delegate to Delegate: Amber Chatwin, MD; Gordon Garcia, MD; Ann Gerhardt, MD; Lena Mehta, MD; Neil Parikh, MD; J. Bianca Roberts, MD; Tom Valdez, MD.
APPROVED THE FOLLOWING MEMBERSHIP REPORTS March 23, 2020 For Active Membership — Shaun Rafael, DO. For Reinstatement to Active Membership — Chandan
For Termination of Membership — Richard S. Bermudes, MD; Oana Galicki, MD; Priyanka Priyanka, MD; Kevin R. Rosi, MD. For Resignation — Jocelyn Kim-Dunlavey, MD. April 27, 2020 For Active Membership — Nikhil Gupta, MD; James A. Hall, MD; Thomas R. O’Toole, MD. For Reinstatement to Active Membership — Lesley J. Baladjay-Lindley, DO; Caron A. Houston, MD; Yuen W. Kwan, MD. For Reinstatement to Retired Membership — Samia G. Fosher, MD. For Termination of Membership — Adam T. Krouse, MD (expired license); Kara L. Toles, MD. May 11, 2020 For Active Membership — Shravan Cheruku, MD; Melody Chin, MD; Xi Z. Damrell, MD; Mathew Herrick, MD; Manjit S. Sran, MD; Rajinder Trewn, MD. For Reinstatement to Active Membership — Elizabeth K. Peterson, MD; David S. Whalen, MD. For Retired Membership — John Kelly Nations, MD. For Transfer of Membership — Kamara W. Graham, MD (to Yuba-Sutter-Colusa). For Termination of Membership Due to Expired License — Richard Atkinson, MD. For Termination of Membership — 107 members for nonpayment of 2020 dues.
New SSVMS Members
The following applications have been approved by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. — J. Bianca Roberts, MD, Secretary.
New Active Members
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Xi Z. Damrell, MD, EM, Vituity
Thomas R. O’Toole, MD, HNS, The Permanente Medical Group
Specialty abbreviated following name
Nikhil Gupta, MD, P, The Permanente Medical Group
Lesley J. Baladjay-Lindley, DO, FP, The Permanente Medical Group
James A. Hall, MD, PD, The Permanente Medical Group
Rajinder K. Trewn, MD, IM, Mercy Medical Group
Shravan Cheruku, MD, AN, Vituity
Matthew P. Herrick, MD, EM, Vituity
David P. Whalen, MD, AN, Vituity
Melody Chin, MD IM, Mercy Medical Group
Pritam Neupane, MD, PUD, MMG
Sierra Sacramento Valley Medicine
Manjit S. Sran, MD, P, Vituity
You Can Help Shape Health Care Policy in California as a CMA Delegate
Y
ou can make a lasting impact on health policy in California by joining colleagues from around the state as a member of the California Medical Association House of Delegates. The Sierra Sacramento Valley Medical Society currently has vacancies in our delegation, and we’re looking for physicians who would like to make a difference and guide CMA as it works to support physicians in California. The CMA House of Delegates convenes annually to establish
broad policy of the organization on current major issues affecting the practice of medicine and public health. Policies adopted by the House of Delegates are either implemented by the CMA Board of Trustees at the state level or referred for national action or legislation. Delegates and alternate delegates are responsible for representing the interests of your colleagues from Sacramento and the Northern Valley. Delegates must attend and actively participate in all sessions of the House of Delegates as well as
on quarterly delegation conference calls held during the year. Because of the pandemic, this year the House of Delegates will be a virtual meeting scheduled for October 24, 2020 from 1 p.m. to 5 p.m. Two major issues have been proposed for consideration: 1) Pandemic Response and Preparedness, and 2) The Future of Practice in a Post COVID-19 World. For more about this rewarding experience, contact SSVMS Associate Director Chris Stincelli at (916) 452-2671 or cstincelli@ssvms.org.
July/August 2020
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| THE LAST WORD |
It Takes an MD to Spell Comedy
For This Medical Student, Entertaining Patients is a Virtue
S
“
o, Vincent. What do you want to do for a living?” For a great majority of my life, there was only one answer. To me, it was dead simpIe. A field rife with opportunities to heal, to change people’s lives, and to generally make a positive impact on those in my company. I imagine many of you already know where I’m going with this (and probably even had it in your personal statement), so you can guess the profession in question. That’s right. “I want to be an actor!” Specifically, in comedy; at the time, this is how I answered when incessantly asked what I’d like to do for a living, an answer that was usually followed up with requests to reconsider. I spent years chasing after it, unable to picture doing anything else. Scriptwriting, improv, plays—nothing brought me more joy than eliciting a chuckle, out of pity or otherwise, from an audience. Granted, there were times that my humor wouldn’t land and the receiving party would wish for a quick and painless death (a sentiment that, as a medical student, I can relate to), but the failures could never match the magnitude of the successes. Sadly, there was one obstacle that seemed insurmountable: the sheer statistical improbability of making a decent living. The general chances of becoming a semi-successful actor are pegged at around 4%. With stability being a big concern, I thought it best to seek another career, which I found in a place that is widely considered to be decidedly devoid of humor: the hospital. While spending time working with patients in emergency departments and palliative settings, I found that a small quip here and a little wit there elicited a laughter that, for whatever reason, felt more worthwhile than
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Sierra Sacramento Valley Medicine
By Vincent Ma, MS II vincent.ma6644@cnsu.edu
chortles I heard from the stage. Some of the earliest and fondest medical memories I have involve bantering with Beth (name changed for privacy), a cancer patient with the loveliest white rose pinned outside her door. She often requested company and the occasional massage to soothe her aches and, to my delight, I found that this frail old lady could easily verbally spar with entertainment titans.
A small quip here and a little wit there elicited laughter from patients that felt more worthwhile than chortles I heard from the stage. We spent many hours bantering and joking about, all the way until I found the bed in her room occupied by another patient. This was the beginning of the end for me, as following a series of financially regrettable decisions, I found myself in medical school. To this day, I still think about the sheer look of amusement and sense of comfort from Beth whenever I dropped a gag-inducing pun or a deadpan joke, and I hope to get the same reaction from patients that I see throughout my career. I may not be drawing raucous uproars from a delighted crowd, but teasing out giggles from sick children and smiles from haggard patients is infinitely more gratifying. I couldn’t be happier.
Editor’s Note: Shortly after writing this article, the author realized that the cost of his medical tuition could have sustained him for a decade as an actor, even a failed one. While he periodically has some regrets about not following his acting career, his parents do not.
Contact SSVMS to Access Your
M e m b e r O n ly B e n e f i t s
info@ssvms.org | (916) 452-2671 BENEFIT
RESOURCE
Reimbursement Helpline FREE assistance with contracting or reimbursement.
CMA’s Center for Economic Services (CES) www.cmadocs.org/reimbursement-assistance | (888) 401-5911
Legal Services CMA On-Call, Legal Handbook (CPLH) and more…
CMA’s Center for Legal Affairs www.cmadocs.org/legal-resources | (800) 786-4262
Insurance Services Life, Disability, Long Term Care, Medical/Dental, Mercer Health & Benefits Insurance Services LLC www.countycmamemberinsurance.com | (800) 842-3761 Workers’ Comp, Cyber Liability etc.
Career Center Member groups receive free basic job postings and access to the Career Center resume bank.
California Physician ™ Career Center www.careers.cmadocs.org
Mobile Physician Websites Save up to $1,000 on unique website packages.
MAYACO Marketing & Internet www.mayaco.com/physicians
Auto/Homeowners Insurance Save up to 8% on insurance services.
Mercury Insurance Group www.mercuryinsurance.com/cma
Car Rental Save up to 25% - Members-only coupon codes required.
Avis or Hertz
CME Certification Services Discounted CME Certification for members.
Institute for Medical Quality (IMQ) www.imq.org
Student Loan Refinancing Members receive a rate discount of 0.25% off the approved loan rate.
SoFi www.sofi.com/rate-discount-25
Healthcare Messaging Free secure messaging application
DocBookMD www.docbookmd.com/physicians
HIPAA Compliance Solutions Members receive a discount on the Toolkit.
PrivaPlan Associates, Inc www.privaplan.com
Magazine Subscriptions Members get up to 89% off the cover price of popular magazines.
Subscription Services, Inc www.buymags.com/cma
Confidential Physician Wellness Resources 24-hour confidential assistance hotline is free and will not result in any disciplinary action. Additional Physician wellbeing resources also available through SSVMS’ Joy of Medicine.
Physicians’ Confidential Line (650) 756-7787 www.cmadocs.org/confidential-line www.joyofmedicine.org
Medical Waste Management Save up to 30% on medical waste management and regulatory compliance services.
EnviroMerica www.enviromerica.com
Office supplies, facility, technology, furniture, custom printing and more… Save up to 80%
StaplesAdvantage
Physician Laboratory Accreditation 15% off lab accreditation programs and services Members only coupon code required
COLA (800) 981-9883
Security Prescription Products RxSecurity Members receive 15% off tamper-resistant security subscription pads. www.rxsecurity.com/cma-order
SSVMS Vetted Vendor Partners Maloof Law Group Nicholas Maloof, Esq. Estate planning, business transactions. Physician members receive a 10% discount on all services. Cooperative of American Physicians (CAP) Medical professional liability protection to over 12,000 of California’s finest physicians. NORCAL Group Medical professional liability insurance, risk management solutions and provider wellness resources.
Sotheby’s International Realty Mela Fratarcangeli is consistently ranked in the top 5% of all real estate agents in the Sacramento Valley serving the buyers and sellers at all levels in the Sacramento Region.
Crumley & Associates Drawing on more than 120 years of experience, Crumley & Associates emphasizes sound financial planning, along with a variety of personal financial services.
The Mortgage Company The Mortgage Company brings a wealth of experience to every purchase and refinance loan, and exceptional concierge level service.
Bank Card USA By eliminating the middleman, Bank Card USA is able to offer special pricing for our members.
www.ssvms.org/physician-resources/vendor-partners. Questions: dbrooks@ssvms.org