2021-Nov/Dec - SSV Medicine by Sierra Sacramento Valley Medical Society

Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo

November/December 2021

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Sierra Sacramento Valley

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.

MEDICINE 4

Closing the Door on 2021 and an Awesome Year at SSVMS

Khadija Soufi, MS II

PRESIDENT’S MESSAGE

Carol Burch, MD

EXECUTIVE DIRECTOR’S MESSAGE

Physician Action Needed Over Looming Medicare Cuts Aileen Wetzel, Executive Director

Shifa Clinic Brings Outreach, Vaccines to the Underserved

Intersectionality: Seeing Patients, and Medicine, in Whole Polet Loynaz, MS I

2022 SSVMS Election Results

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.

A Salty Lady

Faith Fitzgerald, MD

BOOK REVIEW

Magic and Motivation at the Fifth Joy of Medicine Summit

New SSVMS Members

Without Kindness, Intelligence is Useless Caroline Giroux, MD

Board Briefs

The Uncaring Culture Killing Doctors and Patients Tim Grennan, MD

Eric Williams, MD

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento The museum is gradually reopening. Visit our website at ssvms.org/museum for updates and virtual events.

VOLUME 72/NUMBER 6 Cover photo: Puffins enjoy the shoreline in Iceland during a recent trip to the island nation by Executive Director Aileen Wetzel.

Photo by Sharon David

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

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx

November/December 2021

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.

2021 Officers & Board of Directors

Carol Burch, MD, President Paul Reynolds, MD, President-Elect John Wiesenfarth, 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 Shideh Chinichian, MD District 5 Christina Bilyeu, MD John Coburn, MD Sean Deane, MD Farzam Gorouhi, MD Roderick Vitangcol, MD District 6 Marcia Gollober, MD

2021 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 Janine Bera, MD District 3 Alternate Toussaint Mears-Clark, MD District 4 Alternate Shideh Chinichian, MD District 5 Alternate Joanna Finn, MD 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 Carol Burch, MD Amber Chatwin, MD Angelina Crans Yoon, MD Mark Drabkin, MD Rachel Ekaireb, MD Gordon Garcia, MD Ann Gerhardt, MD Farzam Gorouhi, MD Richard Gray, MD Richard Jones, MD Steven Kmucha, MD

Charles McDonnell, MD Leena Mehta, MD Sandra Mendez, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD

At-Large Alternates Brea Bondi-Boyd, MD Christine Braid, DO Lucy Douglass, MD Karen Hopp, MD Arthur Jey, MD

CMA Trustees, District XI

Adam Dougherty, MD

AMA Delegation Barbara Arnold, MD

Editorial Committee

Sam Lam, MD Derek Marsee, MD Taylor Nichols, MD Ashley Rubin, DO Alex Schmalz, MD Ashley Sens, MD Robert Oldham, MD Margaret Parsons, MD Sandra Mendez, MD

Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD Karen Poirier-Brode, MD Gerald Rogan, MD

Glennah Trochet, MD Kayla Umemoto, MS II Michelle Ann Wan, MS III Lee Welter, MD Eric Williams, MD James Zhou, MS II

Executive Director Managing Editor Webmaster

Aileen Wetzel Ken Smith Melissa Darling

Sierra Sacramento Valley Medicine

HOSTED BY LOCAL PHYSICIANS

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. 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. 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. ©2021 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 |

Carol Burch, MD

Caroline Giroux, MD

Eric Williams, MD

Dr. Burch closes her presidency with a look at 2021, a year of virtual meetings, an endless supply of misinformation, and unprecedented stress. But a lot of good happened and more is to come, she says.

Intelligence is a gift but it takes bravery to fully honor it and put it at the service of the world. Although, she says, it's not what defines us—as she has learned from a very special member of her family.

SSVMS’s fifth annual (virtual) Joy of Medicine Summit opened with some magic and gave physicians new insight into how they can reduce burnout and increase joy. Dr. Williams recaps the event.

Khadija Soufi, MS II

Faith T. Fitzgerald, MD

Polet Sofia Loynaz, MS I

In another of Faith's entertainng tales, she remembers a woman with a very odd condition that was never fully explained. But one startling coincidence was almost, well, biblical in scale.

Polet worked as a Traditional Chinese Medicine practitioner for five years before entering medical school. That experience gives her a unique perspective on what patient-centered care should really mean.

Tim Grennan, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.

carol.md.mba@gmail.com

khsoufi@ucdavis.edu The Shifa Clinic, a UC-Davis-affiliated student-run clinic, was founded to serve refugees from the Middle East and South Asia. But, as Khadija explains, the pandemic forced it to reach out to new communities.

Andrew Hudnut, MD

ahudnut@stanfordalumni.org Dr. Hudnet closed the Joy of Medicine Summit with a poem about community service and how while you heal others, you can heal yourself. Step into the void, he says, and you'll find serenity.

cgiroux@ucdavis.edu

ftfitzgerald@ucdavis.edu

tim.grennan@cnsu.edu

imango@att.net

psloynaz@ucdavis.edu

Dr. Grennan reviews Uncaring: How the Culture of Medicine Kills Doctors and Patients by Robert Pearl, MD, the former CEO of The Permanante Medical Group. He explains why it's a compelling read.

November/December 2021

| PRESIDENT’S MESSAGE |

Closing the Door on 2021 and an Awesome Year at SSVMS

hen we close the door to the exam room, it creates a safe space where patients can tell us their stories so we can help them. For the past year, this column has been my safe space with you, where I have been able to share my story and receive your support. With this column, I’m closing the door on my term as president of the SSVMS Board of Directors. But before that door shuts, I want to acknowledge how much SSVMS has done under often difficult circumstances this past year and look to where the trek ahead should take us. 2021 was a year of virtual board meetings. Not once have I rapped my gavel on the board table in our conference room. In fact, I have been to the Medical Society office three times this year, and two of those visits were for blood donations. I’m looking forward to our one in-person meeting this year, a December year-end gathering of the board. The SSVMS staff has met the challenge of keeping us cohesive as we met virtually. They also helped us through our personal challenges. It struck me at the last Executive Board meeting that several of our board members have had family members die: at least two were from COVID, and my sister passed away from pancreatic cancer. I started the year hoping that the COVID vaccine would help us end the pandemic and that our country would become less focused on misinformation and partisan politics. We have had wins and losses in this arena. The vaccines have been a tremendous win; they protect most of us from severe disease and do this so well, ironically, that we are now disappointed that they do not completely prevent us from actual infection or spreading the disease. On the sad side of this issue is that partisan politics and misinformation remain, and so our vaccination rates are still too low in many counties. The latest surge of infections has overwhelmed many hospitals, but the state still had to mandate vaccinations for hesitant health care 4

Sierra Sacramento Valley Medicine

By Carol Burch, MD carol.md.mba@gmail.com

workers even though they have had an up-close view of the devastating effects of COVID. SSVMS has actively advocated for the vaccination of Californians on social media, through public service announcements and with a letter to patients signed by over 700 physicians that received local media coverage. I am always careful about what I endorse publicly because as a scientist, I feel that I should use my voice as an expert carefully. But I always try to repost what SSVMS shares on social media because it meets my ethical standards for accuracy, and I encourage you to

The vaccines protect us from severe disease so well, ironically, that we are now disappointed that they do not completely protect us from actual infection. do the same. Please follow SSVMS on your social media platforms so that you can like, re-post and retweet these announcements. That’s how these messages go viral, an ironic and unfortunate term in these pandemic days. This latest surge of COVID brought on new concerns about burnout within our community of physicians. One risk factor for burnout is a feeling of a loss of ability to make a difference. This surge seems like it should have been within our collective control to prevent it, but the frustrating flood of misinformation and unwillingness by individuals to see the greater good took it out of our hands. Along with the fatigue the past year and a half has caused, this feeling of loss of agency makes it harder on members of the health care community. At a recent meeting, one of our board members related a story about a co-worker who had been struggling with depression and suicidal thoughts. Fortunately, his coworker is now on the back end of that issue, but it remains a cogent reminder that we need to ask each other how we are doing. I was talking to a couple of the nurses in a hospital COVID ICU and, because of this

story, remembered to ask if they were struggling with their mental wellness. It opened the door to remind them of resources available to them such as Employee Assistance Programs, and for physicians in our area, we have the Joy of Medicine services (visit joyofmedicine. org) including Balint groups and individual counseling. Joy of Medicine has been so successful that our Medical Society was asked to re-apply for grant funding, which was approved and will give us the ability to fund Joy of Medicine seminars for the next several years. If you missed the great presentations at the annual summit in September, you can still view them at your convenience at joyofmedicine.org/annual-joy-ofmedicine-summit. It’s well worth your time. SSVMS has also advocated for several issues this year. We talked with state legislators on Zoom to ask for support of several bills, including ones to support ongoing virtual care, the ability to pass increased costs for PPE to the insurance companies, and to decrease the administrative burden of prior authorizations for services rarely denied. It was great to talk directly to legislators and have our physicians share stories from the front line. I also had the pleasure of joining other Medical Society leaders in interviewing potential candidates for state and national elected offices.

Where do we go next? The pandemic has emphasized the need for a patient-centered approach to care. We have to consider that our expertise in medicine is matched by a patient’s understanding of their own bodies and circumstances. This joint effort toward results allows patients to bring internet research to the table and for us to either agree or disagree with their research. It also allows them to turn down suggestions such as blood pressure medications without upsetting me, even though I might disagree, and it gives me the opportunity to ask what option they wish to pursue as we open a discussion that will help us find agreement on what will lead to the best possible health outcome. SSVMS supports us daily by helping to keep us centered and fulfilled with the Joy of Medicine and by using legislative advocacy to decrease distractions to health care outside the exam room. I encourage you to help move SSVMS forward by becoming involved through leadership positions or by simply reaching out to board members to let us know what difficulties you face and to suggest ways we can support and advocate for you. I can’t thank you enough for giving me the privilege of leading this incredible organization over the last year. It has been a truly awesome experience.

Blood is needed… every season, every day. Because of You, Life Doesn’t Stop.

Schedule your appointment to donate blood today at vitalant.org or call 877.258.4825.

November/December 2021

| EXEC UTIVE DIRECTOR’S MESSAGE |

Physician Action Needed Over Looming Medicare Cut A 10% Payment Cut Could Happen January 1, 2022

SVMS is committed to keeping you informed of current events as they pertain to you, your practice, and your patients. Some of these events require a call to action so that the voices of all physicians can be heard. This is one of those times. In what amounts to a “perfect storm” of payment reductions, physicians are facing a near 10% Medicare payment cut on January 1, 2022. We are encouraging all of our physician members to contact your representative in Congress to urge them to address the Medicare payment cuts to protect access to care. Unless Congress intervenes, the Medicare program will pay physicians up to 10% less for services rendered on and after January 1, 2022. The cuts include: • Expiration of the current Medicare 2% sequestration cut waiver given during the COVID-19 public health emergency. • Imposition of an inadvertent 4% statutory “pay as you go” (PAYGO) budget neutrality sequester resulting from passage of the American Rescue Plan Act. Should lawmakers fail to act, it will mark the first time that Congress has failed to waive statutory PAYGO. • Expiration of last year’s congressionally enacted bill to stop the 3.75% payment cuts to the Medicare physician fee schedule. Physicians were facing these cuts due to budget neutrality adjustments in the fee schedule but, fortunately, Congress stepped in to stop them. • A freeze in annual inflation updates for Medicare physicians. The combined effect of these changes would equate to nearly a 10% cut to physician payments beginning January 1, 2022. These payment cuts come at a time when physician practices are still recovering from the sheer exhaustion of, and financial instability caused by, the COVID-19 pandemic. As the crisis and uncertainty surrounding the pandemic continues, it is crucial that physicians have the stability and solvency to continue to 6

Sierra Sacramento Valley Medicine

By Aileen Wetzel awetzel@ssvms.org

care for patients everywhere. The livelihoods of physicians, and therefore communities, would be put at risk if these cuts are allowed to go through. SSVMS has joined with CMA and AMA to lobby our local Congressional representatives to sign on to a “Dear Colleague” letter. The letter initiative is being led by Sacramento’s own Congressman Ami Bera, MD

The combined effect of Medicare payment reductions would equate to a near 10% cut to physician payments beginning January 1. (D-CA), and Larry Bucshon, MD (R-IN), who are urging the U.S. House of Representatives leadership to stop the Medicare provider payment cuts before they take effect on January 1, 2022. The letter highlights the financial uncertainty within the Medicare payment system and the dangers these cuts could have on physicians’ ability to provide quality care for their patients if Congress fails to enact legislation to address these problems. Congress must act before the end of the year to avert these cuts. We need your help! We are asking all SSVMS members to contact their representatives in Congress and urge them to co-sign the “Dear Colleague” letter. You can do this easily by going to https://www. Use this QR code to urge your cmadocs.org/medicare-cuts. representatives to The impact of this cut cannot co-sign the Dear be overstated. The future of your Colleague letter in practice and access to care is at opposition to the stake. Take action by letting your Medicare cuts. member of Congress know that these cuts would be disastrous to access to care and use your voice to protect the patients you serve.

Happy Membership

70 Years

Leslie Lee, MD William Robinson, MD

50 Years

Anniversary!

Richard Canaan, MD Randall Childers, MD Edward Doehne, MD John Fisher, MD Robert Greene, MD Mark Lischner, MD James Margolis, MD Mark Owens, MD Michael Parr, MD

r, M el Par Micha

"It is hard to believe that my membership in the Medical Society has been for 50 years. I joined immediately after being the first graduate of the Ob/Gyn program at UC Davis. My connection with the organization has particularly been connected by their advocacy for physician well-being. Our work continues to this day."

60 Years

Patrick Clancy, MD Erwin Eichhorn, MD Van Allen Kreis, MD

40 Years

30 Years

20 Years

Jackie Agee, MD John Ballenger, MD Klea Bertakis, MD E. Lawrence Bingham, MD Donald Blythe, MD Michael Catapano, MD Michael Chapman, MD Katherine Cheng, MD George Chiu, MD G. H. Hayat, MD James Joye, MD Mark Mannis, MD Clifford Marr, MD Rahat Saied, MD Emil Tanghetti, MD Larry Wolff, MD

Steven Burrall, MD Mitra Choudri, MD Michael Fazio, MD Thomas Ferguson, MD Suzanne Gibbons, MD Arthur Glover, MD Harjinder Gogia, MD Pat Hardy, MD David Herbert, MD Tse-Lin Hsii, MD Chu Lau, MD Rodney Loeffler, MD John Loofbourow, MD David Manske, MD Walter Martin, MD Charles Moore, MD John Nations, MD Dennis Ostrem, MD Anthony Rayner, MD Christian Serdahl, MD Deon Shortz, MD Howard Slyter, MD G. Jeffrey Smith, MD Lloyd Smith, MD Bryce Tanner, MD Kevin Walsh, MD Jeffrey Yee, MD Terry Zimmerman, MD

Victoria Akins, MD Peter Belafsky, MD Dean Blumberg, MD William Bommer, MD Mark Chang, MD Stella Dao, MD Robert Dong, MD Mark Ewens, MD Scott Fishman, MD Jason Flamm, MD Sukhjit Johl, MD George Meyer, MD E. Andrews Neal, MD Praveen Prasad, MD Kenneth Sumida, MD Stephen Wang, MD Morgan Waters, MD

Clifford

Marr, M D

"I have been and remain enthusiastic about what SSVMS and CMA do to support physicians in their variety of careers and practices."

ahl, M

Serd ristian

"Being a member of the Medical Society is a privilege and I have been honored to be part of our ongoing efforts to support physicians in challenging times."

| OPINION |

Without Kindness, Intelligence is Useless IQs and Diplomas Don't Define Us

uring one morning at the clinic, my patient asked the same useless, almost terrifying question that he had numerous times over the past five years of his psychotherapy: “What is my diagnosis?” This question often makes me uneasy. It’s as if I am given a challenge to find a pigeonhole that can influence the patient’s sense of identity, even life, forever. Plus, it is so counter-nature for me as I tend to de-diagnose people. The fewer labels, the better. My panel has seen too many patients who have been referred to us with an unsubstantiated bipolar diagnosis that not only affects the person’s self-concept for decades, it’s on top of a medication regimen that can have serious side effects. Others claim they have ADHD, trying to justify their request for stimulants while in fact they hope for a performance enhancer. Over the years, since the (unmedicated) ADHD tag didn’t seem to provide my patient with the satisfaction he wanted—he is very fidgety, likes sensation, can be scattered, etc.—I decided to give him a “diagnosis” that doesn’t exist. A diagnosis that is not pathological. I have had plenty opportunities to observe his exuberance, jocularity, desire to connect, indefectible enthusiasm, and pride in improving the mood everywhere he goes. My conceptualization of the diagnosis that isn’t began with hyperthymia, or elevated mood, but as part of a temperament more than a mood disorder. It’s a variant of the average mood fluctuations people experience, which is not a flatline, but some elevations alternating with lows. He seems to be residing in an elevated vibrational frequency most days, but without having the loss of contact with reality or the functional impairment of someone in a manic phase. Another neurochemical way to describe his presentation is a brain that seems to fuel on ecstasy. But on that morning, he had come with news. “I had surgery for my ears, to bring them closer,” he told me. 8

Sierra Sacramento Valley Medicine

By Caroline Giroux, MD cgiroux@ucdavis.edu

“They were large.” I listened to this new fact, taking it in. But in subtext, it is still a familiar refrain, the one from any person needing a name for his or her own reality, in order to not feel alone, maybe, or to legitimize certain struggles. This time, he was searching for a diagnosis that he thought fit his phenotype. “I have an elongated face, I’m bright,” he’d say. He would often brag about his high IQ, then say he struggled in school before reeling off a list of conditions. “I have scoliosis. I have a sunken chest.” He wonders if he has Fragile X syndrome. Or Asperger’s. Even if he’s right, so what? It would not take any of his accomplishments away from him: a family, a

Roger, my mother’s older brother, has a severe developmental delay. He is one of the warmest, connected human beings I know. He makes us appreciate what we take for granted. successful involvement in a team sport as a coach, time on the student paper, numerous friendships, his going back to school. I try to emphasize the gifts that come with ADHD, mild autism and other conditions. “Even someone with a severe mental disability has something to offer,” I told him. I then added that maybe they are free from fabricated torment and can therefore be there to remind us of the beauty of life. He paused, surprised, and in a manner typical of his emphatic nature, exclaimed: “You’re dynamite!” His whole expression glowed. At that moment, I was thinking about my uncle, my mother’s older brother, who has a severe developmental delay most likely due to prolonged brain anoxia during a difficult delivery in which forceps were needed. Roger requires assistance for some activities of daily living but can help with simple tasks. With the exception of a few

syllables, loud laughter and grunting sounds, he is nonverbal. He has always referred to me as “the one with big cheeks” (apparently a distinguishing feature when I was a child) by enthusiastically pinching his before greeting me with a rather moist kiss on the cheek. But his smile and his eyes speak for him. Roger is one of the warmest, connected human beings I know. He makes us appreciate what we take for granted. He reminds us that conceptual intelligence is overrated and that some people were born to comfort us with their presence of quiet light. I cannot imagine my mother’s clan without him. I am sure none of his siblings or my cousins can either. We played tea or house with him as young children, then we became older than him, always with this inalterable affection towards him. An urge to protect him, as if he were the bearer of some mystery about life, at the portal of deep wisdom. Everyone meeting him for the first time seems mesmerized. Once both of his parents had died, he was lucky enough to find a loving family who had known him for a while. Soon he will turn 76. His doctor had predicted a life expectancy into his teenage years. It took a long time for him to have grey hair. It is probably due to the fact that he doesn’t, or cannot, clutter his mind with all our grown-up nonsense, rat race and ruminations. He has emotions, he can experience the pain of loss and detect (and be outraged by) injustice or evil. He spontaneously expresses everything and then he comes back to his baseline of glimmering contentment, whether it is

flipping through an outdated Sears catalogue to admire men’s sweaters or suits (he takes pride in dressing elegantly) or by excitedly unwrapping a present as if it were his first. Gratitude overflows from him. In our highly competitive society, the “survival of the fittest” has pervaded the collective narrative. However, this is not how we will continue to evolve as a species. It is not how we elevate our consciousness and morality. In fact, Darwin has emphasized the importance of collaboration over competition. “In the long history of humankind (and animal kind, too) those who learned to collaborate and improvise most effectively have prevailed,” he famously said. In other words, everyone does better when everyone does better. And there is some infinite, non-categorizable potential that lies within each person. It can’t be measured, as opposed to IQ tests, a pale reflection of a sample of the mind’s expressed skills. Just like IQ tests have tried to capture the functions of the mind, maybe there is a non-tangible “mystical test” for the soul that everyone passes without having to accomplish anything. It makes me cringe when certain people use intelligence as the only parameter defining the value of a person. Or level of education, types of schools attended, degrees obtained, etc. I grew up surrounded by people with intelligence that was not translatable into any diploma. Some relatives I find very interesting and who I am really fond of did not finish high school. Intelligence without kindness is useless. It runs the November/December 2021

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risk of turning into arrogance or contempt, which is destructive. Intelligence is a gift but it takes bravery to fully honor it and put it at the service of the world. Having a delay is another kind of gift, as it is a reminder that cognitive intelligence is only from the world of form, and the essence of a person remains and can lighten up life just by being, rather than doing or accomplishing. A delay is also a reminder to slow down, to pause. I have known medical students who grew up with a sibling who had a disability. I noticed that their humanism and perspective seemed to give them an extra advantage in their role as healers. I wonder if Roger is part of a very special universe or reality that our brains are too limited to comprehend. I will never know because he cannot express this in a language that I am proficient in. He has his own, silent, form of communication. It passes through his animated visage. It is glimpsed through the expression of his hands as he extends them to hug a person he recognizes and befriends. He cannot recite our alphabet, but he has a precise memory of the heart. He never forgets authenticity. Because when encountered, it is a reflection of his pure being. We can all learn something from each other. We all have relevance on this planet. The world needs more people like Roger, or like my patient. The world needs more people like them, who cultivate and spread joy, who help us express awe, gratitude and humility, and who remind us of the sacred interconnectedness of all beings.

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| JOY OF MEDICINE |

Magic and Motivation at the Fifth Joy of Medicine Summit Balint Groups, Wellness Featured at Annual Gathering Held Virtually This Year

n September 25th, more than 75 physicians virtually attended SSVMS’s Fifth Annual Joy of Medicine Summit. Emceed by the Chair of the Joy of Medicine Advisory Committee, Dr. John Chuck, the annual summit explores ways to advance methods of establishing and maintaining resilience and offers a safe space for practitioners to support each other. Physicians who are healthy and aware can provide better care to their patients and to their communities. Allen Chien, a second-year medical student at California Northstate University School of Medicine, opened the summit from his home in Elk Grove by wowing the group through magically matching a playing card Dr. Chuck had chosen in Lake Tahoe. With the help of Dr. Paul Reynolds, he then produced a luggage tag with the name, date and destination that had been chosen seconds before. Magic allows him to fill a niche frequently missing in health care and help him communicate with his patients on a unique level, Chien said. He also discussed his own challenges when he started medical school after moving from Los Angeles to Elk Grove, including failing his first exam. “All of this changed when I realized a few things,” he said. “The first is that healing isn’t linear.” He also began

By Eric Williams, MD imango@att.net

to realize that feeling uncomfortable wasn’t necessarily a bad thing. “Being able to sit with that discomfort was so important. Sometimes it felt like I was going backwards but I was really, in the long run, moving forward.” Chien has performed at the exclusive, members-only Magic Castle in Hollywood and is part of “Magicians Without Borders,” which led to performing in South Africa. As he parted, he reminded us as a medical community that personal care is critical. He advocates for the integration of magic during patient interactions and has practiced his skills in medical school. Despite his youth, Chien was full of wisdom and this field will greatly benefit with more people thinking like him. And despite the wealth of education, knowledge, and intelligence in that summit, many of us are still trying to figure out how he performed some of those tricks.

“Brain Yoga”

Next, Dr. Rochelle Frank of CNSU shared with attendees a “Taste of Balint Groups.” Michael Balint began holding seminars with U.K. general practitioners in the 1950s to explore the psychosocial aspects of medical care using case discussions of physician-patient relationships. The practice came to the U.S. in the 1990s. Importantly, Balint is not intended to answer questions but is better thought of as “brain yoga.” Balint has become prominent in physicians-supporting-physicians groups throughout the country. Dr. Frank offered a hypothetical case and asked the attendees to break into small groups where they could get away from their normal tendencies to work toward problem solving or offering advice, and instead reflect on their own emotions and perceptions of the participants in the case including the patient, the doctor, nurses, and significant others. Allen Chien brought some magic to the Joy of Medicine Dr. Frank said Balint is good for cases that involve summit to open the presentations.

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challenging relationships, patients who have trouble with boundaries, and even when someone you like has a difficult disease. “I’ve had people say that something that has been bothering them for months, they stopped thinking about it as much because they had more freedom with the situation,” she said. “It’s not that they solved it, but they had more ability to face it like they were not alone.” I have attended a few Balint sessions and found them to be low stress, informational, and welcoming. The groups provide an opportunity to see a situation through the eyes of other physicians and to practice this technique in real time with direct patient care, especially during challenging interactions. This experience was echoed by several physicians who provided testimonials. They added that the group appeared to take on the dynamics of the cases and that participants of the group seemed to echo what was in each other’s heads. The impact of Balint is that caregivers’ roles are restored to that of healing rather than fixing. The practice of Balint is rapidly expanding and becoming more readily available, including training for those who wish to lead. Links to local groups and sessions can be found through SSVMS’s joyofmedicine.org or americanbalintsociety.org.

You Can Learn to Be Happy

In “The Psychology of Wellness,” Dr. Amy Ahlfeld, a psychologist who provides therapy sessions through SSVMS’s Joy of Medicine program, provided in-depth insight into happiness, its relationship to resilience, and our ability to function and be human. Happiness is not stable but is flexible and can therefore be modified in a positive or a negative manner, she said. Like math or language, happiness is a skill that can be learned through positive psychology. If you can learn to live for today and tomorrow by learning to balance your personal needs and

A Call to Community Service… A call to community service A cultivation of non-self Action based on the needs of others Commitment to organizations in the non-profit space. Take a break from the rat race Move away from the treadmill of productivity Plant seeds in the hearts and minds of those in need Restore your spirit Live your soul Be guided by compassion Redefine success. Care for the homeless Understand their reality Help people move beyond addiction Help people heal their mind Let this experience change you Heal you Grow the potential greatness within each of us. Teach students Transfer knowledge Attack ignorance Help the next generation move beyond fear Build health foundations within each developing young mind Role model Be present.

By Andrew Hudnet, MD ahudnut@ stanfordalumni.org Delivered at the Joy of Medicine Summit

Step into the voids left by our society Allow this to guide you On a spiritual path Less self More interdependence Guided by balance Find serenity Find peace Live it Share it.

November/December 2021

Recollections of How Teaching and Learning Were Upended in 2020

Pulling off a Joy of Medicine summit that had to be changed from in-person to virtual created some challenges, but the presenters and SSVMS pulled it off brilliantly. Over 75 physicians attended during the course of the summit. long-term goals, your perception and enjoyment of your life will significantly improve. “I think there’s a tendency in medicine for physicians to have to suppress their feelings,” Dr. Frank said, explaining that a lot of our brains’ bandwidth is taken up by logic, rational thinking toward solutions, and large amounts of internal and external data. “There’s not always a lot of room for feelings. But we need to make sure there is permission for you to be human and experience the entire range of emotions.” Dr. Ahlfeld emphasized that “happiness” is provably learnable and, therefore, achievable. She added that, contrary to popular opinion, optimism does not mean denial of reality. Rather, a positive mindset facilitates happiness. Ten to 15 minutes of daily meditation is helpful as demonstrated by fMRI changes in brain activity. Free apps such as ‘Headspace’ can help introduce healthy meditation practices into your daily routine. One activity in particular that has a detrimental effect on a person’s happiness is the inability to say “no.” Saying no is a recognition that overexerting oneself is detrimental. Acknowledging a desire to participate but admitting the inability to do so is more honest to oneself and to others, and leads to a higher level of performance on tasks already underway.

Emotions Are a Compass

For the final presentation of the Summit, “The Wounded Healer,” Dr. Caroline Giroux spoke on traumatized caregivers, the joys and suffering in life, and adverse childhood experiences, or ACEs, that can affect 14

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patients and physicians throughout their lives. She emphasized that neglect or abuse by parental figures could interfere with secure attachment, which she said, “is the foundation to everything from self-esteem to physical growth to cognitive functioning to the ability to relate to others.” ACEs can be used as a screening tool when managed effectively. If you experienced ACEs, the first step to healing is self-compassion, recognizing there was nothing—as a helpless child who was not adequately protected—that you could do to change things. Empathy often drives physicians into medicine, but it can also be what leads to burnout, she said. “Even though we talk about compassion fatigue, it’s actually an empathy fatigue,” she explained, adding that structures in the brain link us with the suffering of the people—and patients—in front of us. “That can lead to emotions that are difficult, such as sadness and fear, and emotional exhaustion. Compassion, on the other hand, activates the reward centers in the brain." She reiterated Dr. Ahlfeld’s point that emotions shouldn’t be suppressed. "There is no such thing as a negative emotion,” Dr. Giroux said. “Emotions are there to invite us to go in a direction, for healing… they are just telling us there is something that's not balanced in our life. They are messengers, they are our compass, so pay attention to what they are telling you.” Lindsay Coate, vice president of strategic operations at SSVMS, also contributed to this story.

Retinal Consultants Medical Group welcomes

The Physicians and staff at Retinal Consultants Medical Group are excited to announce that Dr. Christianne Wa will be joining our practice in September!

Please join us in welcoming her!

CHRISTIANNE WA, MD Retina Specialist

visit us online at www.retinalmd.com

November/December 2021

| VACCINATING CALIFORNIA |

Shifa Clinic Brings Outreach, Vaccines to the Underserved Refugees, Essential Workers, Ethnic Communities Find Access and Support at Student-Run Clinic

t was a late evening in February 2021 when a young woman named Sima arrived at Shifa Community Clinic, hoping to get a COVID-19 shot. She held a six-month-old baby in one arm while her elderly mother waited in the car. Our clinic, one of the 12 UC Davis School of Medicine student-run clinics in Sacramento, had depleted its vaccine inventory that day after twice as many patients showed up as expected. Sima was one of many patients we had to turn away that day. The hardest part of running Shifa’s vaccine clinic is not the countless hours it takes to plan and set up the clinic, it’s looking a patient in the eye and telling them you can’t help them. Sima had heard about our vaccine clinic from an announcement in her native Pashto at the local mosque on a Friday. It took her a while to arrange transportation to the clinic, but now, just two days later, we had run out. Like many immigrants in Sacramento, Sima’s language barrier, limited transportation, and limited health literacy had prevented her from getting a vaccine for several weeks. She had tried to schedule an appointment through California’s online portal but was unsuccessful. I promised her we would call to schedule an appointment for her and her mother the following week, hoping that our promised vaccine shipment would arrive on time. Fortunately, our supply came through and we were able to vaccinate Sima. Once vaccinated, she became one of our most vocal supporters, spreading the word and bringing in many more people from her community to be vaccinated. She felt seen and heard —both critical elements to bridging mistrust of the vaccines and the health care system in general. Sacramento is one of the most culturally diverse American cities and has one of the largest refugee

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By Khadija Soufi, MS II khsoufi@ucdavis.edu

communities in the country. Since 1975, tens of thousands of refugees have chosen Sacramento as their home with more recent arrivals including Afghans, Syrians and Ukrainians. It is also home for many South Asian, Middle Eastern, Hmong, Marshallese and Russian immigrants; the recent census found that if two people in Sacramento County are standing together, there is a 73.3% chance they are of different races. The Sacramento area suffered health and economic disparities among its communities throughout the pandemic. Lower income workers and residents of color were affected more severely than other communities, faced more COVID-19 infections, and had higher rates of hospitalization and limited access to vaccines, according to polls conducted by Valley Vision and Sacramento State’s Institute for Social Research. While Shifa Community Clinic existed long before the pandemic—it was founded in 1994 to address the health care needs of Middle Eastern and South Asian refugees and other underserved populations in Sacramento —it has played a critical role in bringing the vaccines to these communities and others in the greater Sacramento area. As a UC Davis-affiliated, student-run clinic, our workforce is made up entirely of student volunteers, from the undergraduates who staff the intake table to the professional students who provide counseling and administered vaccines. Every Saturday and Sunday, we arrived at 6:45 AM to turn the empty hall at a local mosque into a fully operational vaccine clinic with educational material in six different languages and to train new volunteers for the upcoming weekend. Conversations surrounding vaccine hesitancy in marginalized communities focus largely on mistrust and fear. But my time at Shifa has shown me there is a bigger story, centered around access and language and cultural barriers—all of which are underappreciated obstacles

November/December 2021

Photos courtesy Karen Poirier-Brode, MD

by immigrants and certain ethnic groups that were less likely to get vaccinated without support and some found it difficult to find vaccines at accessible locations. Only about 22% of vaccines administered at Shifa in the first two weeks were to essential workers, and it was astounding to see how many eligible patients were unable to get vaccinated elsewhere even after the county expanded who qualified for an appointment. Our main outreach emphasized partnerships with local religious and community leaders in mosques and Student volunteer Rono Soto prepares a vaccine; below, churches to talk about vaccines and their importance Khadija delivers a shot to a Shifa patient. during sermons, newsletters, and podcasts. Collaboration with community leaders allowed us to reach patients we wouldn’t have for our target communities. been able to otherwise and build relationships with community organizaWe had used a simple online tions. We were no longer strangers among those we were encouraging to get portal for registration, but soon vaccinated and the process also allowed us to gain valuable insight into the realized that many patients were specific needs of refugee and ethnic communities. not able to navigate it easily. We During the month of Ramadan, when Muslims fast from sunrise to sunset, immediately shifted our strategy to we started to face more hesitancy about managing vaccine side-effects and reserve half our slots for seniors whether vaccines invalidated their daily fast. As a clinic operating in the and patients who weren’t techbasement of a mosque started by Muslim leaders to support the greater savvy. This allowed us to allocate Sacramento Muslim community, we were able to address some of that hundreds of vaccines to eligible hesitancy and provide tailored resources and advice. walk-ins and respond to calls from At Shifa, we eased language barriers with interpreters and scribes. One of people registering by phone. We also recognized that for many immigrant and refugee communities, word of mouth was one of the main sources of information. Over 40% of patients were referred to us by family, friends, or community members. In response, we started to reserve up to a third of our slots for eligible walk-ins early on in February and April. This allowed us to prioritize patients whose tiers had already passed, such as the elderly and patients with health barriers that had prevented them from getting timely access. We also actively reached out the core tenets of our vaccine clinic is to ensure that we have trained staff to past patients through small or translators for over six languages each day. businesses that were community We also collaborated and brought in volunteers from other student-run cultural centers and received referclinics and non-profits: Clinica Tepati for Hispanic patients, Nadezhda for rals from UC Davis Health and the Russian refugee community, HLUB for the Hmong population, Nito’s HealthNet. Despite early allocation Wings for Marshallese Community, as well as various local mosques for of the vaccine to essential workers, Muslim populations. During our collaboration with Clinica Tepati and many of these jobs tend to be held others, we addressed undocumented communities’ concerns about vacci-

organizations, religious institutions, and nonprofits, we had great turnout at these events, even as vaccination rates were decreasing across the county. Going directly to community centers, rather than sending community health workers out to encourage vaccinations at centralized sites, led to a sevenfold increase in turnout for Afghan refugees and doubled the number of Pacific Islander patients we vaccinated in one event. More importantly, by talking with participants and Khadjia Soufi (right) and Shifa Clinic manager Sara Abou-Adas make a pitch for surveying their needs at these donations to support the clinic. events, we were able to better understand the push and pull factors for vaccination. nation and not having appropriate documentation. That enabled us to create targeted, more effective It was eye-opening to me; at Shifa, I never had a outreach material. patient come to us with those concerns. But our collaboWhile we focused on phoning patients and collaboratrations with the other clinics and community service ing with local organizations, the most consistent flow of relationships provided insight which ultimately led us people came by word of mouth. To date, Shifa’s vaccine to simplify the ID requirements. and pop-up clinics have administered more than 9,000 It was wonderful to see patients light up when they COVID-19 shots—a testament to the success of all of these were directed to a vaccination table with a medical efforts. The more we were able to learn with and from student fluent in their native language. The process of patients like Sima, the better the vaccination experience getting their vaccines was no longer a series of awkward we were able to provide. The more comfortable they and cold interactions—instead, lively conversations were, the more likely they would return to their families were encouraged and bonds were formed. The simple and friends and tell them to get vaccinated. More than registration processes and multilingual pamphlets 85% of our patients are people of color or those from allowed us to address the informational barrier that underserved communities, and almost three quarters of had prevented many refugees and immigrants from those were refugees and immigrants. coming in for their vaccines. By tailoring the vaccination I see so many emotions at Shifa ranging from appreprocess to these communities' needs and emphasizing hension of needles and vaccines to an overwhelming the importance of addressing cultural barriers, we feeling of stability for the first time in months. Advocacy continued to see more of their members come to us. and community health work takes a lot of patience and Almost three out of four Shifa patients told us they chose foresight but holding on to those small moments made the clinic for the multilingual support and familiarity the larger vision feel closer. with the clinic or collaborating organizations. Shifa is proof that addressing barriers can truly make We held pop-up clinics and found they were a a difference in the lives of thousands of immigrants successful way to reach more hesitant or vulnerable and their families. In medical school, we are taught the populations, as patients were more likely to want to importance of culturally sensitive care, leadership, and get vaccinated at their local mosque or school rather advocacy. At Shifa, we live these lessons. than an unfamiliar location. By working with local

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Member Benefits & Resources

The Sierra Sacramento Valley Medical Society (SSVMS) offers many resources and services exclusively for our over 6,000 physician members. Members receive specialized one-on-one assistance designed to keep your independent practice healthy and viable. Join us today by contacting dbrooks@ssvms.org or by visiting www.ssvms.org.

COVID-19 Advocacy Access up-to-date members-only resources, including financial and practice management tools that will ensure your medical practice is prepared to survive and thrive during and after the pandemic. Economic Advocacy Access to highly trained economic advocates with expertise in physician reimbursement are available to provide one-on-one help with payor issues and contracting at no cost. Statewide, more than $30 million has been recouped over 12 years. Legal Resources Over 5,400 pages of OnCall documents and valuable information for physicians and their staff at no cost. Practice Resources For practices of all sizes, and including HIPAA compliance toolkits, practice management guides, patient forms, resources for starting, closing, or expanding your practice and more. Joy of Medicine No-cost sessions with psychologists and life coaches, CME wellness education, physician interest groups and more. Visit www.JoyofMedicine.org to learn more.

Educational Programs Free CMEs, webinars and in-person seminars. Discounts For insurance services, office supplies, magazines, security prescriptions and more. Partners in Medicine Vetted vendors that provide SSVMS members with exclusive services and discounts. These partners have gone through an application process and provided multiple physician references. They are dedicated to offering special services or discounts to SSVMS members on various products and services designed to accommodate the business and personal needs of physicians. News and Information Stay informed about public health, practice management, and other breaking healthcare news. Leadership Opportunities Serve on the SSVMS Board of Directors, Delegation, or a Council or Committee. Connect with Peers Meet colleagues through virtual networking opportunities.

www.ssvms.org

| EQUITY IN MEDICINE |

Intersectionality: Seeing Patients, and Medicine, in Whole It's Time to Take a New Look at What “Patient-Centered” Care Should Really Mean

odern medicine aims to endorse a “patientcentered approach” by engaging in modalities such as open-ended questions, active listening, allowing time for a proper response, making eye contact, and using layman's terms when communicating. However, should the patient-centered approach be more than just bedside manner and proper etiquette? For that matter, what does patient-centered really mean? At the start of my master’s degree in Traditional Chinese Medicine (TCM), one of my philosophy professors said: “Western medicine has lost its heart and its soul.” He was referring to the transition between old medical practices to newer “modern” practices—those beginning after Hippocrates. At the time, I did not fully understand what he meant. Nine years later, when I had just finished my fifth year as a licensed TCM practitioner, most of the patients who walked into my clinic came in response to what they called a “failed” medical system. They had spent thousands of dollars, time, and effort as they bounced around from specialist to specialist without a working diagnosis, plan or treatment. With no one to look to for answers, my patients found themselves stuck in a place of hopelessness. This is when I understood what my professor meant: my patients were being treated like objects and little consideration was taken when it came to their “heart and soul.” For me, being patient-centered means considering all aspects that make up the patient, regardless of how those fit into the scientific approach. Reductionist medicine, the approach to medicine in Western societies that focuses on the diagnosis and treatment of the individual parts that make up living organisms, is incredible at treating the physical body because the body is better studied by breaking it into its mechanical parts. However, even allopathic practitioners 20

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By Polet Sofia Loynaz, MS I psloynaz@ucdavis.edu

have noticed the lack of consideration that reductionist medicine has for other aspects of a patient’s identity such as their socioeconomic and psychological systems. Paradigms such as Health Science Systems (HSS), an educational framework developed by the American Medical Association's Accelerating Change in Medical Education Consortium that aims to improve patient care by endorsing the study of health care delivery and interprofessional interactions, have revolutionized modern medicine by embracing a more holistic and focused patient-centered approach. The only problem with HSS is that it is a system that will take some time to be fully implemented into medical practice. To help create change and support movements such as HSS, there are some things we can do now by consid-

I propose a three-step paradigm that I call DOC: Deconstructed physician, Open physician, Connected physician. ering one of its domains: inter-professionalism, the collaboration of multiple professionals who are experts in separate disciplines of study to reach a common goal. In this case, the goal is patient care. By acknowledging that all health professionals have a common goal, which is to help patients, we should be willing to work together to maximize their quality of care. Personally having had experience with TCM, I can speak to its value as a contributor to an inter-professional medical field. TCM is a philosophy, an art. It is not a scientific method. Therefore, no matter what our patient comes in with, there will always be a diagnosis and a plan, because in the human spectrum there is always something you can work on and explore. In TCM, we learn to look at our patients as a whole; this

Photo by Polet Loynaz

includes the heart and the soul, their external environment, social interactions and how these all play a role in their individual health. We look at every patient as a unique and dynamic system of constantly changing elements. No patient is the same and no patient stays the same. This methodology is not, in my opinion, mutually exclusive to Western medicine. I believe contrasting perspectives actually complement each other to the betterment of the patient’s overall health. In fact, one of the biggest problems with not endorsing the dynamic reality of our patients is the consequence of intersectionality. Intersectionality, a term originated by Kimberle Crenshaw to describe the interconnected nature of social categorizations, was developed to highlight how different interconnected elements of oppression can hinder an individual's experience and opportunities. I believe this term directly applies to our patients. If we can more fully understand how intersectionality plays a role in our patients’ health, then we can begin to truly focus on the patient-centered approach. Intersectionality relates to TCM in its approach by understanding the wholeness of an individual. For example, if a patient “Lisa” identifies as a disabled, lesbian, and Hispanic woman, then she is all of those and more. Lisa’s health will be negatively impacted by bias and discrimination in multiple intersecting areas if we do not consider the wholeness of her identity. If we only think about Lisa as disabled, and not as Hispanic, lesbian or woman, then we disregard all other social

Being open to working together with other modalities such as acupuncture, chiropractic, Ayurvedic, energetic, nutritional, psychological, and religious healing allows our patients to find faster, more personalized care. avenues of health inequity. Even her reality as a “disabled” person varies from other people’s and is constantly changing as she experiences the world around her. The point here is that Lisa is unique at every moment in time. So how can we be more patientcentered now? To answer this question, I propose a three-step paradigm that I call DOC: Deconstructed physician, Open physician, Connected physician. We are so used, in the Western world, to pattern recognition and reductionist approaches that when it comes to patient interaction it just happens naturally—for example, organizing patients into socioeconomic and illness category groups. However, this dehumanizes patients, their experiences, identity and realities. It also discounts

the fact that individuals are not static, they are constantly changing in a social, physical and biological matrix. It is necessary when dealing with patients to deconstruct our own ideas and beliefs about who our patient is and to allow patients to exist and express themselves unhindered by our judgment boxes and limiting thoughts. Ideally, we should approach Lisa as a blank page and as she tells her story and we do our assessment, then we begin to paint the unique canvas of her reality. Openness to suggestions and recommendations which exist outside of our scope of practice is crucial for a patient-centered approach. There has been a longstanding tension between sciencebased practices and less empirical approaches such as spiritual, philoNovember/December 2021

Being connected means networking and finding a group of diverse practitioners to make a part of your team. Oftentimes, patients go into a treatment room, after waiting for months, just to be referred out to find a specialist on their own without guidance or recommendations. Then, they wait a few more weeks to be referred out again and again until they realize they are just being bounced around. These lag times can create pressure on the patient’s health and are commonly worsened by intersectionality. Finding the right referral team and actually staying connected with them is crucial for proper patient care. Finding a strong team is analogous to forming an extension to our care and services.

Photo by Polet Loynaz

We have to be open and accept that sometimes the best care a patient can receive is outside of the allopathic realm of medicine.

Cupping originated in China and is used to increase blood flow, reduce pain and restore balance to the body. sophical, psychological, energetic, and religious practices. We have to be open and accept that sometimes the best care a patient can receive is outside of the allopathic realm of medicine. Being open to working together with other modalities such as acupuncture, chiropractic, Ayurvedic, energetic, nutritional, psychological, and religious healing allows our patient to find faster, more personalized care which could better fit their needs and beliefs while also maximizing quality and continuity of care. I am not suggesting bypassing allopathic medicine, or to endorse, recommend or guarantee a cure or treatment in a modality outside of our scope of practice. This simply means to be open to our patients’ suggestions and to include in our networking team other professionals who can provide our patients with something we cannot. 22

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In 2016, I decided to continue my education and become a Western medicine physician, not only to gain more knowledge and tools but also to offer my perspective as someone who has seen a bad face of allopathic medicine. I am pursuing this career because of my love for my patients, the medical field and my belief that we (interdisciplinary practitioners) treat patients better together. Thus, only as a first-year medical student I humbly offer my thoughts in the hope that we, as a medical field regain our “hearts and souls” and in doing so, better serve each other and our patients.

| ESSAY |

A Salty Lady

By Faith Fitzgerald, MD ftfitzgerald@ucdavis.edu

was a third year medical student on the Internal Medicine Service when a middle-aged woman was admitted to UC San Francisco’s Moffitt Hospital with profound hypernatremia, her husband at her side. She had been well and active until about a week before her admission, then began to have twitching muscles, confusion, and lethargy. She and her husband ate together daily and he was unaware of any increased intake of salt or salty foods. He had taken her to see the doctor as her symptoms grew worse but the doctor did not find a clue of the cause by his history. He saw the twitching, confusion and lethargy but nothing beyond that was diagnosable through his physical examination. The physician also ordered lab studies and called her husband the next day as her serum sodium was 165. Her doctor advised that she should be taken immediately to the Moffitt Hospital Emergency Room, which her husband did. In the ER, stat redraws of blood for a chemistry panel confirmed the dangerously high sodium level. She was then admitted to my Internal Medicine team to rehydrate her with non-sodium containing sterile water as well as to search for the cause of her bizarre condition. They lived in San Francisco where the outside temperature is not very hot, even in the summer. They shared a bed and her husband said he never noticed signs of sweating, nor did she wet the bed—he believed he would have noticed—so profound dehydration from sweat or urine loss did not seem likely. Moreover, she continued to take in liquids as usual during the days before she fell very ill. We never discovered the cause of her hypernatremia as she died the next day and her husband who was—as she was—an Orthodox Jew, refused an autopsy. When I was a student at the University of California,

Santa Barbara in the first half of the 1960s, I had been intrigued by a course which was available called The Bible as Literature. I signed up for it because it would be very different from all the pre-med required courses of the time, and I loved old literature. In one of our first assignments in that course we were told by our teacher to read Genesis, which we then would discuss in class. Genesis 19 told of the sinfulness of two cities, Sodom and Gomorrah, and their ultimate destruction by God. Only the good people, including a man named Lot, had been warned to leave the two cities. They were led away by angels who told them to never look back. Only one person, Lot’s wife, looked back… and was turned into a pillar of salt. When I was assigned as a medical student to this patient, a woman who ultimately died from the high concentration of salt in her system, I could not stop thinking about this story. Why? Because my patient’s name was Mrs. Lot.

November/December 2021

| BOOK REVIEW |

The Uncaring Culture Killing Doctors and Patients Former TPMG CEO Robert Pearl, MD Examines The Best and Worst of U.S. Health Care

ompelling. Insightful. Disturbing. These are the words that came immediately to mind when I read the latest book by Robert Pearl, MD. Uncaring: How the Culture of Medicine Kills Doctors and Patients is a thoughtful and poignant discourse about the culture of medicine—the good, the bad, and the ugly. Dr. Pearl is the former CEO of The Permanente Medical Group (TPMG is the Permanente part of Kaiser Permanente in Northern California) and The Mid-Atlantic Permanente Medical Group (the corresponding group of physicians in the Washington, D.C. area). Robbie (as his colleagues call him) has been named one of Modern Healthcare’s 50 most influential physician leaders and he also is a professor at Stanford University School of Medicine and the Stanford Graduate School of Business. His first book, Mistreated, won critical acclaim for identifying the arcane practices in the profession of medicine that often result in poor health care Uncaring: How and unnecessary morbidity and the Culture of mortality. He is the host of the Medicine Kills “Fixing Healthcare” podcast and Doctors and a contributor to Forbes business Patients magazine. By Robert Pearl, MD, 334 Relying on anecdotes from his pages; $24.99 own training and career as a plasin hardcover at tic and reconstructive surgeon, Amazon he also weaves in significant published data (over 450 references) to back up his claims about physician culture. It is widely known but underappreciated that health care in America costs twice as much, leaves many individuals without insurance coverage or access, and has poorer outcomes than

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By Tim Grennan, MD tim.grennan@cnsu.edu

many other developed countries in the world. Much of the good in U.S. health care and much of the bad, Dr. Pearl writes, can be attributed to physician culture. Dissecting his topic into five sections, he explores physician culture through issues including training, burnout, communication problems, and challenges to physician autonomy and status. He then looks at how these affect patient care and what should be done to mitigate the problems that result. Dr. Pearl takes us from the current COVID pandemic back in time to medical stories about George Washington, King Charles II, and the fascinating story of Dr. Ignaz Semmelweis. Semmelweis’ principle work The Etiology, Concept, and Prophylaxis of Childbed Fever in 1861 is about puerperal fever and the importance of handwashing (even decades before Pasteur’s germ theory) and how the hubris of physicians allowed obstetricians to ignore his compelling findings. Even to this day, 160 years later, there are still major issues with physicians not washing their hands between patients! A masterful storyteller, Dr. Pearl lays out story after story through the central sections of the book of remarkable care by physicians—and also some care that is not so remarkable. In the second part of the book, “The Physician’s Pain,” he discusses the early days of his tenure as CEO of TPMG at the start of the 1990s and how the organization was losing hundreds of millions of dollars annually. He confides that at one point, TPMG had only two days of cash on hand and had to borrow a third day’s worth of cash in order to meet state insurance regulations. Pearl took a leadership style distinctly different from his predecessor. He traveled to each of the 19 Kaiser Permanente medical centers in Northern California twice a year to hear directly from the front-line physicians about what was good about the organization, but

more importantly what was not good. Through these discussions and insights, along with his own vision of what the organization could be, Dr. Pearl was able to lead a transformation within Kaiser Permanente from a low-cost option for health care insurance to a national leader in quality of care. In “Helping or Harming Patients,” Dr. Pearl addresses the factors that are driving up the cost but decreasing the quality of health care. Drawing on personal stories about his relatives, he pointedly addresses the barriers patients face accessing physicians and the negative effects they have on care. As society has dramatically evolved over the past 50 years, he notes, much of the rituals of medical care and physician culture have not. Dr. Pearl puts a focus on the obstacles to excellence in physician culture: insurance and government regulations, sexual and racial discrimination, social problems (such as gun violence) that have become medical issues, and the difficulties addressing the end-of-life care. “Doctors are ill prepared for the newest challenges presented by life and death,” he writes. “They weren’t taught to help a sick patient die peacefully. They never learned to stand idly by while a child perishes or to let a teenager put her own life at risk. As doctors face a crisis of uncertainty, the physician culture they inherited offers little help.” In the final section, Pearl recounts attempts to reform medical care going back to Franklin Roosevelt’s administration and the Committee on the Costs of Medical

Care (CCMC), which issued landmark recommendations that would have fundamentally restructured—and improved—health care. But again, physician culture and the fee-for-service model precluded the adaptation of the CCMC’s recommendations. From there he gives a brief overview of some of the further attempts at changing health care, concluding with the less-thanperfect Affordable Care Act that became widely known as Obamacare. As part of this discussion, he poses a “what if…?” scenario, speculating what would have happened if the CCMC recommendations had been implemented. “Doctors would value prevention, collaboration, primary care, evidence-based approaches and patient safety. Ultimately, the systemic changes, including integration and capitation, not only would have improved the medical care patients receive, but also evolved the physician culture such that the United States would be the world’s role model for clinical excellence and doctor satisfaction.” The nation’s most efficient and effective medical groups, the CCMC had said, were integrated and prepaid health systems that provided higher-quality and often lower-cost services than doctors in the communities around them. In other words, physician-led, well run organizations are the key to improved health care. Profits from Uncaring are being donated to Doctors Without Borders.

SAVE-THE-DATE

February 26, 2022 SSVMS Honors Medicine Awards Night

November/December 2021

| BOARD BRIEFS |

Board Briefs September 13, 2021

For Resident Physician to Active Membership — Felipe Arredondo, MD; Arlene Reyna, MD. For Retired Membership — William Au, MD; Roger Gilbert, MD.

THE BOARD: Received a report from Eric Williams, MD, Chair of the Future of Medicine Program regarding the program’s goals for the coming year. Approved the 2021 Nominating Committee recommendations for nominations to vacancies on the Board of Directors and the SSVMS Delegation to the California Medical Association. Approved the recommendations from the Scholarship and Awards Committee to provide 2021 medical student scholarships to: Amanda Blake, second-year medical student at U. C. Davis School of Medicine; Adrienne Davis, first-year medical student at Medical College of Wisconsin-Milwaukee; Shreya Kumar, first-year medical student at U.C. Davis School of Medicine, recipient of the Paul J. Rosenberg Medical Student Scholarship; Ashley Kyalwazi, fourth-year medical student at Harvard Medical School; Brynn Sargent, third-year medical student at U.C. Irvine School of Medicine; Lisa Teixeira, fourth-year medical student at Albany Medical College; Wendy Woo, third-year medical student at Virginia Commonwealth University School of Medicine; Approved the 2nd Quarter Financial Statements and Investment Reports. Approved the revisions to the SSVMS Employee Money Purchase Pension Plan.

August 23, 2021 For Active Membership — Angel Alvarez, MD; Yolanda Backus, MD; Sukhkarn Bains, MD; Robert DeBruin, MD; Min Han, MD; Priya Kandaswamy, MD; Jeanne Kim, MD; Michael Massaro, MD; Rohan Naik, MD; David Tran, DO; Sijia Wu, MD. For Reinstatement to Active Membership — Zaida Albarracin, MD; Todd Winters, MD. For Resident Physician to Active Membership — Kim T. Le, MD; Steven Russo, MD. For Resident Physician Active — Neisuke Nakagawa, MD. For Resignation — Moqueet A. Qureshi, MD (moved out of state) For Termination of Membership Due to an Inactive or Expired License — Alison McWilliams, DO; Mark Underwood, MD. September 13, 2021 For Active Membership — Avijit S. Baidwan, MD; Andrea E. Glassberg, MD; Rajpreet S. Grewal, MD; Alex T. Kelemework, MD; Jacob S. Knopp, MD; Carolyn J. Ogborn, MD; Mihir D. Sura, MD; Christianne a. Wa, MD; Aaron Yu, DO. For Resident Physician to Active — Philip J. DeSouza, MD. For Reinstatement to Resident Physician Active — Yasmine Gharbaoui, MD

Approved the following Membership Reports:

For Retired Membership — Richard A. Beyer, MD; A. David Lerner, MD; Franklin D. Robinson, III, MD.

July 26, 2021

For Transfer of Membership — Kyeong SM Kim, MD (to Placer-Nevada).

For Active Membership — Ramesis Bacolod, MD; Spencer George, MD; Neil G. Parikh, MD; Lakhbir Sandhu, MD; George Wong, DO. For Reinstatement to Active Membership — Pantea Hashemi, MD. 26

Sierra Sacramento Valley Medicine

For Termination of Membership Due to Expired License — Adebusola Adesina, MD; Katherine E. Barton, MD; Alana L. Beres, MD; Rosemary A. Cotter, MD; Claire C. Cutting, MD; Kelsey D. McLean, MD; Leonardo M. Rozal, MD.

| NEW MEMBERS |

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

*Physician specialty abbreviated following name.

Zaida L. Albarracin, MD, IM, The Permanente Medical Group

Rajpreet S. Grewal, MD, GM, Mercy Medical Group

Kareem Moussa, MD, OPH, UC Davis Health

Angel Alvarez, MD, PD, The Permanente Medical Group

Min Han, MD, PTH, The Permanente Medical Group

Rohan D. Naik, MD, HOS, The Permanente Medical Group

Asadullah K. Awan, MD, IM, UC Davis Health

Daniel A. Herrador, MD,MS, FP, UC Davis Medical Group - Elk Grove

Chisom O. Ofodire, MD, FP, Mercy Medical Group

Gagandeep K. Azad, MD, FP, Sutter North Medical Group

Natalie A. Homer, MD, OPH, UC Davis Health

Carolyn J. Ogborn, MD, PD, Private Practice

Yolanda A. Backus, MD, FP, The Permanente Medical Group

Adrienne E. Hoyt-Austin, DO, PD, UC Davis Health

Jaymin J. Patel, MD, EM, UC Davis Health

Avijit S. Baidwan, MD, HOS, Mercy Medical Group

Andrew J. Jones, MD, FP, UC Davis Health

Ann M. Powelson, MD, OBG, Mercy Medical Group

Priya Kandaswamy, MD, FP, The Permanente Medical Group

Elizabeth R. Rizza, MD, D, UC Davis Health

Jennifer T. Karlin, MD, FP, UC Davis Health

Gina C. Rossetti, MD, IM, UC Davis Medical Group - Midtown

Jagdeep Kaur, MD, P , UC Davis Health

Steven J. Russo, MD, IM, The Permanente Medical Group

Sukhkarn S. Bains, MD, IM, The Permanente Medical Group Dustyn C. Baker, MD, HOS, Mercy Medical Group Geoanna Marie S. Bautista, MD, NPM, UC Davis Health Daniel J. Brink, MD, FP, UC Davis Medical Group - Davis (Davis Campus Clinic) Jewel A. Brown, MD, OBG, UC Davis Health Joanna J. Buchanan, DO, PD, UC Davis Medical Group - Folsom Daniel A. Cerrone, MD, PD, UC Davis Health Nathan C. Claydon, MD, HOS, Mercy Medical Group Keith A. Corl, MD, CCM, Mercy Medical Group Daniel L. Cortez, MD, PDC, UC Davis Health Robert J. Debruin, MD,FACP, IM, Robert DeBruin M.D. Philip J. DeSouza, MD, OPH, Retinal Consultants Med Grp Daniel S. Dodson, MD, PDI, UC Davis Health Eduard Drannikov, MD, FP, UC Davis Medical Group - Point West Nicole I. Economou, MD, OBG, UC Davis Health Anne N. Flynn, MD, OBG, UC Davis Health Andrea E. Glassberg, MD, PCC, The Permanente Medical Group

Shaina P. Kaye, MD, PD, UC Davis Medical Group - Elk Grove

Upal Sarker, MD, FP, UC Davis Health

Alex T. Kelemework, MD, IM, Mercy Medical Group

Shruthi Shekar, MD, PD, Mercy Medical Group

Jeanne K. Kim, MD, AN, The Permanente Medical Group

Pranav P. Shetty, MD, EM, UC Davis Health

Jacob S. Kopp, MD, IM, Mercy Medical Group

Christina A. Sollinger, MD, NPM, UC Davis Health

Kim T. Le, MD, FP, The Permanente Medical Group

Emily S. Stieren, MD, PD, UC Davis Health

Sherry Liao, MD, HOS, Mercy Medical Group Angela W. Lim, DO, FP, UC Davis Medical Group - Point West Daniel C. Linfesty, MD, IM, UC Davis Medical Group - Carmichael Vinh Q. Luu, MD, IM, UC Davis Medical Group - Elk Grove Michael T. Macellari, DO, HOS, Mercy Medical Group Michael T. Massaro, MD, GE, Mercy Medical Group Steven J. McElroy, MD, NPM, UC Davis Health Justin C. McLees, MD, FP, UC Davis Medical Group - Rancho Cordova Juanita R. Melau, MD, FP, UC Davis Health Jonathan P. Moore, MD, US, UC Davis Health

Mihir D. Sura, MD, ID, Mercy Medical Group Gurmeet K. Talwar, MD, FP, UC Davis Medical Group - Folsom Maria O. Teruel, DO, PD, Woodland Clinic Medical Group David T. Tran, DO, FP, The Permanente Medical Group Lena C. Van Der List, DO, PD, UC Davis Medical Group Midtown Kirsten R. Vitrikas, MD, FP, UC Davis Health Christianne A. Wa, MD, OPH, Retinal Consultants Med Grp Todd J. Winters, MD, IM, The Permanente Medical Group Sijia M. Wu, MD, FP, Woodland Clinic Medical Group Aaron Yu, DO, IM, Mercy Medical Group

November/December 2021

2022 SSVMS Election Results President

Paul Reynolds, MD President-Elect

J. Bianca Roberts, MD Immediate Past President

Carol Burch, MD

District 1 (North): Jonathan Breslau, MD

District 4 (El Dorado County): Shideh Chinichian, MD

District 2 (Central): Adam Dougherty, MD; Judith Mikacich, MD; Susan Murin, MD; Vanessa Walker, DO

District 5 (TPMG): Christina Bilyeu, MD; John Coburn, MD; Farzam Gorouhi, MD; Roderick Vitangcol, MD

District 3 (South): Vacant

District 6 (Yolo County): Marcia Gollober, MD

2022 SSVMS Delegation to the CMA District 1: Reinhardt Hilzinger, MD Alternate: Tanuja Raju, MD District 2: Lydia Wytrzes, MD Alternate: Janine Bera, MD District 3: Katherine Gillogley, MD Alternate: Toussaint Mears-Clark, MD

District 4: Anand Mehta, MD Alternate: Shideh Chinichian, MD District 5: Sean Deane, MD Alternate: Joanna Finn, MD District 6: Marcia Gollober, MD Alternate: Natasha Bir, MD

At-Large Delegates R. Adams Jacobs, MD Mark Drabkin, MD Barbara Arnold, MD Rachel Ekaireb, MD Megan Babb, DO Gordon Garcia, MD Helen Biren, MD Ann Gerhardt, MD Jonathan Breslau, MD Marcia Gollober, MD Carol Burch, MD Farzam Gorouhi, MD Amber Chatwin, MD Richard Gray, MD Angelina Crans Yoon, MD Steven Kmucha, MD

Sam Lam, MD Charles McDonnell, MD Leena Mehta, MD Sandra Mendez, MD Taylor Nichols, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD

Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD Lydia Wytrzes, MD

At-Large Alternate Delegates Christine Braid, DO Lucy Douglass, MD Karen Hopp, MD Arthur Jey, MD 28

Justin Kohl, MD Vong Lee, MD Scarlet Lu, DO Derek Marsee, MD

Sierra Sacramento Valley Medicine

Carlos Medina, MD Vijaya Reddy, MD Ashley Rubin, DO Alex Schmalz, MD

Ashley Sens, MD Risha Sikka, MD Asmaneh Yamagata, MD

Closer to home + enhanced referrals = easier access to world-class care Chief of Pediatric Infectious Diseases Dean Blumberg, M.D., has been sourced on hundreds of media interviews and helped define possible paths of COVID-19 transmission between mother and newborn.

UC Davis Health offers nationally ranked expertise — now with added convenience for our referring providers From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-the-minute diagnostic and treatment options for both adult and pediatric referring providers across Northern California and the Central Valley. Your referred patients benefit from shorter drives, less traffic gridlock, affordable lodging, and more support from local family and friends. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care. Referring your patients to UC Davis Health specialty and subspecialty care is now easier than ever. Our physician referral liaison team is here to serve as direct lines of communication — helping to navigate and expedite referrals, obtain information, resolve process questions, and more.

Our liaisons can also help to: ■

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Facilitate access to our secure EMR system, PhysicianConnect Arrange meetings and/or webinars with our clinicians Assist with UC Davis Health clinical trials and telemedicine Keep you abreast of new services, providers and research programs Share information about CME and events such as tumor boards, grand rounds, lunch-and-learns and symposiums

We welcome you to reach out to your local UC Davis Health Physician Referral Liaison today: Tracy Bayne | 916-281-8734 | thbayne@ucdavis.edu

referrals.ucdavis.edu