Health and Wellness Blog

Health and Wellness information for the Ascension Providence Hospital Educational Community

Questions: Contact Dr. Paul Lessem or Dr. Debra Hollander


December 5, 2019: Jam blog

If all goes well with G Suite, it is my hope that the blog that I have set up on Jam will become our Wellness blog for this hospital. My blog on Jam will only be accessible to Ascension associates and not to the public at large. This blog is open to the internet at large and that may have been a factor for many individuals not sending things for me to enter. Jam will be available to associates of Ascension only. This offers the possibility of collaboration across the organization on Wellness issues from the point of view of associates and excludes the public. This means also that any associate can make a direct entry and that they will be known if they do so. The blog can still be used to make anonymous communications but that would occur by the respondent sending the message to me directly via my email and then my entering it for them as part of a blog entry substituting anonymous for their name.

We did have a very useful discussion in the Caregivers rounds which I will be writing up and posting on my blog in a confidential manner. The conference which is usually attended by 30-50 associates, mostly residents and faculty but open to all healthcare associates, uses a case-based format to discuss difficult issues in patient and family care which may arise whose management may cause us some difficulties with respect to our feelings.


The blog is currently reachable by clicking the My Ascension icon; then entering one's User ID and password; clicking "myHR"; expanding the page which opens and finding the list of quick links in the corner of the page which opens and then clicking on Collaboration(JAM). Alternatively, you can go to "" and then login with your User ID and password. The Jam page opens up and one then searches for my name in the “All” search box which is central on the page and in the second tier down from the very top. Access to my blog should come up. This is a temporary arrangement which will be perfected as everything gets installed and in a final arrangement.


- Submitted by Paul Lessem, MD



November 1, 2019: Pain and suffering

We always seem to link pain and suffering in our common usage of language. We can help ourselves and our patients if we separate and consider these elements. Pain is a neutral event on its own and often a constant. We generally categorize it as acute, chronic, etc. It is often useful in our diagnostic process. Suffering is something that we do in response to pain which is often negative and multiplies the damaging effect of the pain. The suffering we can mitigate in ourselves and so can our patients. The pain is often a constant. Something we often have to live with but which we can also sometimes mitigate by putting it into the background through managing our suffering. Pain is also a label we use for non-physical but bothersome features of our lives. It may help to mitigate these features if we acknowledge them and manage the suffering that we do about them when we cannot change them.


- Submitted by Paul Lessem, MD



October 31, 2019: Negative treatment of surgical residents

There is an excellent article in the October 31 New England Journal of Medicine on a survey of the incidence of negative treatment of residents in surgery training programs.. The article beginning on page 1741 is in regard to the results of a survey done during a surgery in-training exam so that there was almost 100% response with respect to incidence of perceived negative treatment during residency. It is very interesting and perhaps alarming to read.


The survey, because required, got around the apathy of survey response. The average is 11% in the medical profession. It would be good if all specialties giving in-training exams would incorporate such a survey. Perhaps the ACGME could be induced to develop a standardized survey suitable across all specialties that might be usable and could become a good tool in assessing an important aspect of training.


- Submitted by Paul Lessem, MD



August 2, 2019: Residents and Fellows Empowerment Forum

We now have another tool to use to foster communication and information regarding Wellness: The Residents and Fellows Empowerment Forum. I have sent all of the residents information about this. We will be continuing the blog and I hope that anyone in the hospital community who is concerned about their well-being in their life in healthcare will feel free to read this blog and contribute to it. However, our discussions here must be generic and not convey proprietary information. We can still discuss important issues in general and make viable suggestions for improvement, and I hope everyone will feel free to do so.


I hope that everyone is aware of the issues which have been brought to our attention with LARA’s ruling regarding flushing narcotics and the new rules that will be going into effect mid August (; click on "Non-Household Drug Disposal").


Materials regarding the Resident and Fellow forums are now on New Innovations. The confidential blog is not yet there. We are figuring out if and how we can establish a confidential blog using New Innovations.


In the meantime, the current blog is still available and reachable on the Wellness website, the link for which is listed in the left hand column with the blue background on the Providence Medical Education website.


- Submitted by Paul Lessem, MD



July 23, 2019: Improving communication

I wonder if anyone has any ideas about how we can improve communication? Isolation and loneliness are frequently cited as issues in modern day life. It is interesting that in a society in which many individuals spend a large part of their day texting and finding information, that so little real communication occurs. It is not unique to hospital environments. I hear a lot about it from people in various life situations. It may be more distressing here as we have a high stress environment where critical information is shared and misunderstandings can have severe consequences. Anyone have any ideas about this or how we can rectify it?


- Submitted by Paul Lessem, MD



July 22, 2019: Orientation

Sorry for the hiatus in blog entries. Hope that orientation went well for everybody. I hope that everyone new here recognizes that the blog is here and will send me things that they would like to communicate on it, and that everyone will feel free to contact the Wellness line regarding questions and concerns having to do with orientation or other issues as they start or continue their lives at Providence. The blog is not confidential and limited. The Wellness line is totally confidential at 1-877-603-4070.


- Submitted by Paul Lessem, MD



May 21, 2019: Minimizing stress in healthcare coverage

Every associate should carefully consider and plan for healthcare for themselves and their families. I am not advocating for any plan on behalf of myself or the Department of Medical Education. Ascension provides insurance coverage and there are several avenues available to research its options and resources. Access to these are at the end of this entry and are posted on the Bulletin Board of the Wellness Website. Residency program coordinators can guide you to these resources as well.


There are several principles to keep in mind. We make our best decisions about complex issues when we are not under stress. It is best to read the plans and contact facilities and providers that you might wish to access. Learn the insurance coverages that they accept and build a plan before you or a family member requires care. Healthcare and its funding are ever-changing complex entities. Benefits change, and facilities and providers change their participation in insurance plans.


Definition of costs which are incurred:

     1. Deductible - how much you must pay before your insurance coverage begins

     2. Co-payment - the percentage of the total bill that you pay for services after the deductible

     3. Fee attached to facilities such as emergency rooms and urgent care facilities which are subject to 1 and 2

     4. Annual maximum - the total amount that you must pay after which you are fully covered. This may be specified as an annual amount for some plans. Some plans have a lifetime limit. Plans may have exclusions; that is, things which you will pay which cannot be counted for your maximum.


With these things in mind know that there are 2 tiers of coverage available from Ascension to its associates (employees). Tier 1 has the lowest deductible and co-pays. Tier 2 has a higher deductible which may approach or be equal to 50% of the bill and may exclude some services covered under Tier 1. The term Tier 3 is applied to providers and facilities not covered by Ascension. There is no prohibition for employees buying additional insurances at their own expense.


Human Resources can inform you of some offsetting benefits that may be in your employment contract. These include Health Savings Accounts, and Health reimbursement accounts.


Contacts for useful resources:

  • Members website
  • Smart Health Customer service phone number: 1-888-492-6811
  • Once you have an employee log in ID go to: My Ascension Portal => MY LINKS => Human Resources => BENEFITS => Benefits Landing Page => Benefits eHandbook (in right margin). There is an animated assistant "Alex" who will help guide you through selection of benefits.
  • Ascension Ministry service center phone number: 1-855-288-6747
  • Ascension Providence website and the Smarthealth Provider Website are reachable on the intranet from a hospital computer by clicking the e with a halo icon (i.e., Internet Explorer v. 11)
  • You can discuss your concerns about this with one of the Wellness physicians on the Wellness line (1-877-603-4070) who will not advocate a plan but may help you reduce your anxiety by listening to your concerns and asking clarifying questions.


- Submitted by Paul Lessem, MD



May 8, 2019: Wellness strategy

I have heard from some residents that they would prefer to keep our wellness efforts restricted to the Resident group or to Medical Education as they fear our diluting our efforts. Please feel free to join the discussion and let’s do it through the blog as I am doing now. I will always summarize printable versions of multiple responses, publish direct quotes where the residents give me permission, and leave it anonymous where that is preferred.


There are several things to consider:

     1. There are some projects, such as maternal support, parental leave, and child care, which will actually be helped by having larger numbers of women who are affected and also more women who will be retained because Providence will have better benefits than it now has.

     2. Individual interest groups can still run their own projects, and with several projects going with different people working on them, there is the possibility of sharing information and services back and forth as that becomes appropriate.

     3. The more people that are talking about and doing things for wellness, the more wellness and communication become valued in our community culture.


Feel free to join this conversation.


- Submitted by Paul Lessem, MD



May 7, 2019: Health coverage

I have been researching our health coverage at Providence, and a new guide for selecting your coverage will soon be distributed. Please look at what you have already selected and consider if you need to make any changes. You may wind up spending a lot for medical care or having to go a long distance to get the care that you need. If you have the hospital’s coverage, you should consider several things now:

     1. Is your doctor in your plan?

     2. Is the facility that you would go to in your plan?

     3. Should you set aside a Health Savings Account to cover medical expenses out of your salary?

     4. When do you have to pay if your facility is not covered?


A high deductible renewable every year means you must spend out of pocket before your coverage kicks in! A co-payment for all services is generally either 10 or 15% of your bill at a SmartHealth office or facility. If you go to a practice you only pay the practice. If you go to a facility, such as an Urgent Care or a hospital emergency room, you also pay a facility fee or a co-pay of the facility fee. If you have had a bad experience or a good experience, please write to the blog about it so that your colleagues who read the blog will be able to know about it.


- Submitted by Paul Lessem, MD



April 29, 2019: Educational Community Update Meetings

The Medical Education Department is establishing 90-minute luncheon updates for all residents and fellows. These will occur on the second Tuesday of each month. These will be voluntary. The house officer population will be divided into 4 groups of approximately 50 trainees. Each house officer will be invited to attend 3 times during the year.


Each group will attend the Update luncheon three time a year. At these luncheons we will convey information regarding the status of the educational program within the hospital, provide opportunity for discussion of the status of the educational community, and discuss the impact of training on the well-being and professional status of the trainees.


You will hear brief reports from Dr. Dubaybo, Dr. Flynn, our safety officer Kerry Asbel, a faculty mentor engaged in QI and myself. We will discuss as many of your questions regarding these reports or issues which you submit in writing or bring up from the floor as time allows.


These meetings will be scheduled for 11:45 AM and end at 1:15 PM on the second Tuesday of the month in cafeteria D where a large square table will be set up. The house officer population will be divided into 4 groups.


The whole group will not be able to attend a given meeting due to work hour, post call and other emergent contingencies. Hence it will only be mandatory that everyone attend one luncheon a year. Coordinators will arrange house officers’ schedules so that this is possible.


The invited group will be notified by their program coordinator and will RSVP by one week before the scheduled meeting. One faculty member from each program within the group will take call for the residents attending who should only be contacted for emergencies during the meeting.


A light luncheon will be served including a vegetarian option. Attendees may submit written questions by email or written note, signed or anonymous, up to a week before the meeting. We will also take questions from the floor as time allows.


We will publish a summary report in the Wellness Blog of information relevant to the whole house officer population that comes out of the community meeting.


- Submitted by Paul Lessem, MD



April 26, 2019: Emergency pediatric care

An issue came up in the Graduate Medical Education Committee meeting regarding the presumption that Providence does not have emergency care available for young children, because a resident was referred to Ascension St. John on Moross, the implication being that care was declined here. I have spoken with Dr. McGraw who confirmed that we do not turn away pediatric problems from any of our emergency facilities. All our Emergency physicians are trained and certified in emergency pediatric care. Critically ill infants less than 90 days old are transferred as indicated to dedicated pediatric facilities on an urgent basis when the Emergency Department physician judges this to be necessary. Please write to me or phone me so that we can discuss the details of any situation where you feel that care has been unavailable to you in our system. I will help clear up any misunderstandings and where we do have a problem we will work with you to fix it. Part of wellness is knowing that your hospital has your back. My family and I have made use of our services several times over the course of my career here and have never been disappointed. Dr. McGraw told me that his team would not turn a pediatric case away and he would like to know the source of any misunderstanding. He can be reached on PerfectServe.


Also please remember that Dr. Hollander and I, although we do not provide physical medical care, will do whatever we can to help members of our medical community get to appropriate medical care for themselves or their families when a problem arises. The Health and Wellness Referral line can be reached through PerfectServe.


- Submitted by Paul Lessem, MD



April 22, 2019: Wellness champion

New development: Dr. Dubaybo has approved and forwarded a request for money in the amount of $75 per resident to be spent on retreats for improved functioning and feeling as physicians at Providence Hospital. It is very important that the residents, who are meant to benefit from this proposal, have a major input into how this money will be spent in the next academic year. I have asked in the past that the residents in each program select a Wellness Champion. I am renewing that request. Please ask your residents in whatever mechanism that they use to appoint a Wellness Champion for the coming year. This person will take the lead in organizing a retreat program and if your program director approves will be the first line resident mentor for new residents entering the program in July. This person may be but need not be one of the program’s chief residents. Please submit the named person to me by May 7.


We are having our next Hospital Wellness Committee Meeting May 9 at noon. It would be great if that person would come to the wellness committee meeting or would at least be listed in the group and participate in wellness communication. I understand that nobody feels a need for more meetings, but I am available to meet with anyone among the coordinators or residents singly or in groups to discuss the directions that we would like to take to promote our less stressful functioning within the hospital community.


I have also sent the previous announcement to the residency coordinators. Please think about being a Wellness Champion!!!


- Submitted by Paul Lessem, MD



April 8, 2019: Medical hypocrisy

Have you ever seriously thought about the "unwellness" inherent in our medical practice?  I always think about it at our Doctor’s Day celebration which seems arranged by the hospital to accommodate our expected schedules. There has been tremendous research on the importance of adequate sleep and the dangers of ignoring our inherent Circadian rhythm which from time immemorial has been largely pegged to available light and has a built-in fatigue period in the early afternoon. There has also been huge research on appropriate diet and food intake. So Dr.’s Day breakfast is scheduled beginning at 7 AM and is over by 9:30 AM. It features omelets, cheese, and whipped crème and frosting covered pastries in great perfusion. We have meetings and lectures during and immediately after lunch rather than taking a break and stretch our days, skipping lunch and working into the evening.


We have made some improvements. There were limited healthy breakfast alternatives available; I can remember when there were none. I also remember from my early clinical training watching a general practitioner from the days before Family Medicine was a specialty lecturing an inpatient about the evils of smoking with a cigarette hanging from the corner of his mouth.


Any thoughts on how you handle the discrepancy between how we manage our professional lives and what we tell our patients to do?


- Submitted by Paul Lessem, MD



April 3, 2019: The Psychiatry Update 2019

Sorry that there were no entries the last 2 weeks. I was in Chicago loading up on CME’s at The Psychiatry Update 2019, a conference of the American Academy of Clinical Psychiatrists. This conference is the brainchild among other individuals of Richard Balon, a professor of psychiatry at Wayne State who was the director of medical student training who sent us WSU medical students years ago when Richard and I were both a lot younger. Our research often requires us to deconstruct ourselves into pieces of behavior and physiology small enough to study, keep track of and write something about. When we do that, we are at risk of omitting issues which help pull things together and teach us humility. One of these is the burdens that the physiological and sociological side effects that our treatments place on our patients.


During part of the conference I spoke with a master’s level pharmacist from Quebec whose clinical assignment on the psychiatric wards and medical wards where she works was to manage some of what the physicians throw at her. In baseball terms, she is a specially trained catcher whose job it has become to handle medical knuckle ballers and prevent passed balls thereby keeping her patients in the game. Our talk reinvigorated my determination not to throw any wild pitches.


- Submitted by Paul Lessem, MD



March 13, 2019: Resident feedback

Dr. Mariko Rajamand, a graduating Chief Resident in Obstetrics and Gynecology, has sent me the following email. The links are to "in-House", a non-profit electronic journal published by residents and fellows nationwide.  The links capture what residency looks like to the significant other of a resident with respect to the humanity scale.  The story speaks to complex issues which affect all physicians. How much can we improve our wellness if we cannot directly affect two aspects of wellness: the structure of medical practice in our economic, philosophical technology-driven cultural milieu and demands specifically placed on residents in their struggles to grow in skills and knowledge and survive emotionally in that environment?


It argues that our well-intentioned efforts to improve our well-being may be seen as ineffectual window dressing that may obscure but not alleviate problems. The text of her email is in italics:


"How true this article sounds. Maybe it’s the outsider perspective that makes the convoluted idea of resident wellness a little more clear. But I couldn’t agree more with what the author says."


Part 1:

Part 2:

Part 3:


- Submitted by Paul Lessem, MD



March 12, 2019: Ketamine for depression

There is a lot of press lately regarding ketamine and its derivatives as useful in treatment-resistant depression. Like many new trends, it may be a money maker and may get over used. This is not a new chemical. It has been used as an anticonvulsant for some time. It has also been used recreationally. In that usage it is known as “Special K”, a psychedelic that has been somewhat popular for quite a while. For the wrong person, “Special K” has induced long-lasting psychotic symptoms. I would approach this drug very cautiously. If people ask you about it, suggest that they see a psychiatrist or psychologist who can do a careful evaluation for two things: 1) the reasons for the severity and persistence of their depression, and 2) their potential vulnerability for a psychosis.


- Submitted by Paul Lessem, MD



March 11, 2019: Feedback

We are beginning to get responses to the blog. When you are communicating a response which you want posted, please specifically indicate that in your email. Some emails come to me for other purposes and I have been checking to be sure if things are meant to be published as I get emails for multiple purposes. Checking slows the process down.


I do get “How to information” from some of you and will be creating a “How to “section on the Bulletin Board where we can get answers to a variety of operational questions, directly or indirectly. Please send such things to me as you get your questions answered.


- Submitted by Paul Lessem, MD



March 5, 2019: Sleep

Please feel free to send suggestions that you have found to promote your efficiency, self-confidence, sense of good feelings, memory or whatever to the blog, and we will grow our own recipe book of things that help us here at Providence.


Here are some suggestions from my readings regarding sleep from a seminar that I attended with some colleagues.

     1. Our normal sleep cycle physiologically includes midday fatigue as is reflected in the fact that much of the world believes in siestas. It is physiologically normal to have down time after lunch and attention to lectures and learning fall off at that time. In western society we fight that reality. You may not be able to get a siesta but there is good data that a short nap at that time may help you through the rest of the day.

     2. "All-nighters" interfere with retention of material. We need deep non-REM sleep to consolidate long term memory. Retention actually improves and is more accurate if you have a full night’s sleep after studying. The accuracy of our memory actually improves following deep sleep. As you have all learned we don’t retain what we cram. The physiology involves transfer of data from the hippocampus to the cortex during deep sleep. When we do not allow this we not only do not retain but we do not empty the hippocampus which is responsible for poor learning after cramming and the feeling many of us get that you cannot cram any more knowledge in after a period of sleep deprivation. We need to sleep 7 or 8 hours to have the best retention of factual material. More verbal material seems to be retained earlier. Our world would be a better place if we had time to get our full 7-8 hours. Sleep deprivation as we all learn in wellness lectures here is equivalent to alcohol intoxication. Sleep deprivation is not easily made up. Recommended reading: Why We Sleep by Matthew Walker.


- Submitted by Paul Lessem, MD



February 25, 2019: Associate discounts

There are many benefits available to us as associates which it seems that many residents are not aware of. There are discounted programs and services available to us. Thanks go to Amy Turik, an active member of our wellness committee, for the following post.


There are 2 ways to access the discounts page:

     1. From the hospital's intranet page (access via hospital computer) - in the right margin, note "Associate Discounts" under "SJPHS Community"

     2. From the My Ascension website ( - go to My Links > Associate Links > Human Resources > Benefits > Associate Discounts Page


For those associates who are experiencing financial difficulties, you can access the Employee Assistance Program from My Ascension too - go to My Links > Associate Links > Human Resources > Benefits > Benefits Landing Page



- Submitted by Paul Lessem, MD



February 14, 2019: MEDICINE

Fawaz Habba, who is one of our dedicated energetic medical students from Michigan State University, has coined a very cogent mnemonic which captures much of what we strive for to defeat burnout and have wellness in medicine using the word MEDICINE. Please see his paper which is posted in our online wellness library. The mnemonic is as follows:

     M = MOOD
     D = DIET

Thank you Fawaz for enriching our community with your involvement in Wellness. We hope to be able to post your poster around the hospital.

- Submitted by Paul Lessem, MD



February 7, 2019: Negative wellness

Dr. Valerie Overholt made me aware of an article in The DO about a study published in the journal Academic Medicine. The study identified 4 factors which were associated with increased negative wellness in first year internal medicine residents using the Patient Health Questionnaire-9 as the research instrument.


The 4 factors were:
“1. A lack of timely and appropriate faculty feedback
2. Working longer hours
3. Negative learning experience during inpatient rotations
4. Higher research ranking.”


The lead author on the study, Karina Pereira-Lima, is from the University of Michigan Medical School in Ann Arbor, and the study was first published ahead of print on December 18, 2018 in Academic Medicine.


- Submitted by Paul Lessem, MD



February 6, 2019: Bulletin board

Have news of a local or national program or project that you are working on or a suggestion that you would like to share?  We have established a bulletin board for these purposes. Send an announcement, description of the project or a comment or suggestion to the Wellness website vial email to me and if there are no copyright violations, we will post it as is on the site or post a notice of it which does not constitute a copyright violation. If there is an article that you have found useful, we cannot post it unless the author has declared it to be in the public domain but we can post the reference and any link that the author has provided on our bulletin board.


- Submitted by Paul Lessem, MD



February 1, 2019: Book club

I have picked a book for our narrative medicine group which is open to interested staff, residents, students, nurses, etc. It is Oliver Sach’s autobiography "On the Move".  We need to pick a meeting time and place. There are still some openings. Please get in contact with me re. your ideas.


- Submitted by Paul Lessem, MD



January 31, 2019: Active shooter training

I did not see many residents or students at yesterday’s conference on some of the more frightening aspects of workplace violence recognizing and avoiding becoming a victim of workplace violence beginning with how to avoid becoming the victim of an active shooter. Fortunately, such occurrences are rare and they place a burden upon us as healthcare providers because our success depends upon our being open to and encouraging contact with all kinds of people, some of whom are not happy to be seeing us. The presenter, Dr. Kenneth Wolf, made some important points that apply in general for all of us. Most valuable I thought was the statistics of how we are perceived and perceive others. 38% of it comes from our tone of voice, 55% from our nonverbal cues both of which we generally do not pay much attention to and only 7% comes from what we say verbally which gets most of our attention. This is unfortunate because when we are hurried and doing several things at once, we may not be sounding and looking as welcoming as we should. However, it is fortunately true also of our patients. Watching and listening to their tone of voice gives us a lot of information about the effect that we are having on them.


Not coming across like you would like to, think about this and get feedback.


- Submitted by Paul Lessem, MD



January 25, 2019: Helpful hints

One of the things that has occurred to me is that many of us have come up with good ideas for how to manage particularly stressful situations within the hospital, things that might save time, or work arounds to help adjustment with difficult situations that come up from time to time. Also, some programs have come up with unique things which they do that are especially helpful that others do not know about. It would be great if any of you reading this had such ideas to share. Please write to me for their inclusion in the blog.  We can credit you or make them anonymous at your preference. We can post them and subsequently save them in the Wellness library under a helpful hints heading.


- Submitted by Paul Lessem, MD



January 10, 2019: Book club

There is some interest among the residents and medical students in “narrative medicine”. I would be happy to form a book club, if there are enough interested individuals. I would think that we would be looking for 7- 10 people and plan on meeting monthly. Please let me know if you are interested. I have a few books in mind that would meet our needs. Let me know your interest via phone or email.


- Submitted by Paul Lessem, MD



January 4, 2019: Working with a therapist

If you have been thinking about starting the new year with outside help in terms of seeing a therapist and prefer to do this entirely on your own, here are a few bits of advice:
     1. If finances are a problem think about consulting someone who will take our insurance which currently allows for unlimited sessions with a small co-pay. The fee charged by social workers and psychologists generally falls under the limits in our policy.
     2. One cannot just show up for an appointment and find a crowded waiting room. Therapists schedule definite appointments, a session lasts 45-60 minutes, and are unhappy if someone misses a session with no notification or less than 24 hours notification. Some therapists on our list will see patients in the evenings, may give a lower fee, and may have some flexibility. I have indicated situations where that was the case when I last checked. If there is no indication about this on the list then you would want to check with the therapist regarding fee and scheduling issues to see if these will present a roadblock before starting with the individual.
     3. Clinics have intake procedures and may require a screening visit and/or a psychiatric visit before or after beginning with a non-psychiatrist therapist.


- Submitted by Paul Lessem, MD



January 3, 2019: Happy New Year!

I hope that everyone got a chance for some rest and is returning refreshed. If you have any wellness ideas that you would like share do not hesitate to share them by emailing me and I will put them on the blog.


- Submitted by Paul Lessem, MD



December 10, 2018: More communication

One of the major factors frequently cited as contributing to unwellness in Healthcare trainees and professionals is a feeling of isolation that involvement in medicine seems to bring with it. An antidote to this would seem to be communication. Our wellness website and blog were established with a view toward creating greater communication within our community.


The blog was created to communicate important information to our residents, fellows and medical students and to serve as a forum for discussion in general terms of issues which impinge on our wellbeing. We are not getting the type of feedback that we would like to have to the blog. Admittedly it has the disadvantage of having to be closely monitored to protect confidentiality and maintain a level of professional tact which a forum that a healthcare facility open to the public requires. However, I am told that it is being visited by coordinators and the occasional member of the medical staff in addition to other healthcare personnel. I have invited the medical staff to read the blog and the wellness site as well as the nursing staff. Feedback would be great.


We are building the website, adding a library and self-assessment. We would like you to tell on what would be useful to have on our wellness website that you cannot find on the many wellness sites already peppering the internet?


We are waiting to schedule further Speak-Up luncheons for you to give us suggestions of the sort of things that you would wish to discuss. There are several things that might be of interest that we could bring into being if there is sufficient interest. Among them:
     1. A young parents’ support group
     2. A narrative medicine book club
     3. A monthly movie night or other social function in the hospital
     4. Special interest groups and focus groups with a variety of topic


One service which is being under-utilized is exam preparation and anxiety reduction evaluation and counseling. Some of you have been paying several hundred dollars an hour from national companies to get ready for the USMLE and other exams. You could start off with an initial assessment here for no charge which might identify and help you fix a problem that these programs seem to overlook.


 - Submitted by Paul Lessem, MD



December 4, 2018: Feedback

Residents, fellows, students, we want to hear from you regarding our difficult social and wellness issues. Please read the blog and feel free to answer questions and give opinions. I am the gate keeper to guarantee confidentiality and professional focus. Therefore, things should come thru me or thru Dr. Hollander. I do get a lot of feedback informally on the fly and in focus group sort of situations which is frequently fragmentary. Please write.


I have asked several times for questions that you would like to focus on in further Speak-Up luncheon sessions. I will post them and relay them to Dr. Dubaybo whose wish is to have focused sessions where we can look in detail at improving problems in a focused forum as a possible first step and perhaps a progress check on things which have come up. A few concerns have been expressed to me in various forums:
     1. Confidentiality, a feeling that it is not safe to speak up.
     2. Difficulties in getting things done due to a scarcity of support personnel since the cutbacks.
     3. Trainees feeling that abusive treatment continues to exist.
     4. A preference to do gatherings department by department off site rather than across departments.
     5. A feeling that this is a place that does not feel like a professional home.
     6. The sense that medicine is becoming more isolative as a profession.


We would like your help in making everyone as comfortable as possible. It was always a personal help to me in medical school and subsequently in residency to feel that I was not in this alone. What do you think we should do about isolation as we expand our efforts to be inclusive in wellness to the whole hospital community?


     - Submitted by Paul Lessem, MD



November 30, 2018: Caregiver rounds

The Caregiver rounds this Tuesday will be presented by Family Medicine at 7 AM in Cafeteria D in Southfield. This will be Family Medicine’s first presentation as a formal contributor to the rotation of cases and issues that we discuss. Caregiver rounds was a forum initiated here by Dr. Terebelo many years ago under the title of Schwartz Rounds, as a forum to discuss our difficulties in caring for patients. It is open to all departments and nursing, social work, and clergy also attend. Family Medicine has been involved in case presentations as well on many occasions in the past. However, the prior meeting time made it difficult for Family Medicine to be a regular contributor.


Any clinical person who is aware of a case that has presented social, emotional, ethical or psychological challenges to our work can bring that case to our attention and all caregivers who had central roles in the case‘s management can participate in a panel discussion of the case. The presentation should preserve strict patient confidentiality and our observations should be directed in a constructive and supportive manner so that everyone can feel comfortable speaking up and presenting their feelings. In the past this had been a monthly conference. It became an every two-month conference a few years ago and meets the first Tuesday at 7 AM of even-numbered months.


     - Submitted by Paul Lessem, MD



November 19, 2018: Wellness update

Sorry for the delay in blog entries. We have been undergoing growing pains for the Providence website of which this blog is a part. If you have suggestions for the design team working on the website in terms of things which would make it more attractive to you or would provide added utility, please contact Dr. Adrian De Gifis or Dr. Doris Tong.
     1. Many of you experienced the CLER visit. Please let us know your impressions of the experience and mention any suggestions or concerns which occur to you and send me an email. I will be happy to summarize and make anonymous any feedback that you might have.
     2. There is interest being expressed to have a young parents support group. We can help put one together and develop several potential foci for it depending on its size. If you have this interest, please email me about this and I will champion it to get it going
     3. I know that the House Officers Organization has been working with the idea of having community social evenings in a suitable room at the hospital to promote more of a cohesive feeling and to give everyone an opportunity to get out of their silo and meet colleagues in other fields. Is this something that should be pursued? There are also residents who would like to socialize but prefer to be outside the hospital as they feel being in house does not allow sufficient distance to allow true relaxation. Also, no alcoholic beverages may be served in house at a hospital function.
     4. Please be aware that the legal limit for blood alcohol content in Michigan for physicians is .06% not .08%. Alcohol-impaired physicians apprehended in Michigan face a protracted legally-enforced rehabilitative program. Legalization of marijuana will not make it OK to use if you are a physician in training working in a hospital. A hospital cannot afford to have medical staff which tests positive for marijuana as this would be seen as an indication of impairment in the case of a bad patient outcome. Marijuana as we know can stay in your system for up to two months. It would not be a provable defense to state that one who tested positive was not impaired.
     5. When would we want to have another Speak-Up luncheon?
     6. Please respond to me or Dr. Hollander regarding any of these issues. We will make the community aware in general terms of your impressions. We will summarize rather than quote specifically unless specific quoting is your desire in your email. Nor will we quote anyone by name unless this is desired.


I hope you all take the time to enjoy your Thanksgiving holiday!


     - Submitted by Paul Lessem, MD



October 29, 2018: Know thyself

Thoughts for the coming week:
     1. Med Ed is working on a universal calendar which will help with scheduling problems, and the Graduate Medical Education Committee is mindful of residents being overcommitted. 
     2. I hope that everyone is feeling ready for CLER (Clinical Learning Environment Review by the ACGME). Feel free to write back with observations. 
     3. Write back and please share your ideas about being part of the community and any solutions which occur to you. 
     4. There was an interesting article in the Sunday Review of the New York Times which demonstrates some key features in combating burnout in another field ("Who Says Allie Kieffer Isn’t Thin Enough to Run Marathons?"). A runner much enamored of her sport suffered what we would call burnout from failing to know herself. She inefficiently followed recommendations about distance running and how she should fit in. She took these to be inflexible rules of her trade and when her times did not improve, and the stress got to be too much, she burned out on running and dropped out. Later she found meaning in her running on her own terms regarding exercise, food intake and how she viewed her body, and came back. She has found fulfillment, joy and meaning in her running, has gotten to know herself and how she fit in to distance running. She has demonstrated true resilience and balance and may well win the woman’s section of the New York marathon. Showing grit is OK and knowing yourself is helpful in recognizing and making appropriate choices. Grit is best applied for success where the activity that it is serving has become meaningful to the person who is applying the grit.


     - Submitted by Paul Lessem, MD



October 22, 2018: Burnout

Several questions for residents to consider:
     1. Are you feeling over scheduled with meetings? There has been low attendance at several meetings including the RPEC and the HOA. Let me know if you have concerns and can suggest solutions if this is the case?
     2. Suggestions regarding the Speak up sessions regarding frequency? Format?
     3. Do you believe that your benefits and medical leave time are not on a par with other residency programs locally? The medical staff is looking into these issues.
     4. What wellness tools or techniques are you using to help yourselves cope?
     5. Are there programs that you are working on where Wellness services could be a help?


We had a very useful Caregiver rounds on October 2, talking about feelings that we have when we identify with a patient and that patient, despite our best efforts, does not do well. Anxiety, helplessness, fatigue, and sadness were common. Also the feeling of relief that one gets when a long and unsuccessful treatment relationship ends with the patient being transferred or leaving our care. A lot of guilt was experienced about the feeling of relief. The key point that was stressed but perhaps not well registered is that many of these feelings are normal and unavoidable in difficult circumstances. Some, like the feeling of guilt when one has done nothing wrong, are not appropriate. We need to work to tone them down or eliminate them if possible, as they are major contributors to the symptoms of exhaustion, depression, numbing and feelings of futility which we call Burnout.


    - Submitted by Paul Lessem, MD



October 10, 2018: Speak-Up luncheon #2

A total of 9 people showed up for the Speak Up meeting on October 9. Surgery, Medicine and Transitional years were represented by residents and 3 coordinators representing 5 programs were represented. The poor turnout was discussed as were several other issues. The participants were encouraged to submit ideas to be posted including the types of resource that they might like in the library.


Possible Factors for poor turnout cited by participants:
     1. Need for a central calendar and calendar keeper to coordinate and communicate regarding meetings throughout the hospital, in view of many other commitments that residents and others have which are rapidly changing.
     2. Multiple resident time commitments including committee assignments to committees with functions overlapping with wellness. Duties related to Interview season.
     3. No compelling incentive to attend
     4. Although the residents asked for a Speak Up follow-up there is no clear understanding regarding how to use the Speak Up opportunity
     5. Need for persistent commitment from program directors and coordinators

Suggestions and comments from resident participants:
     1. Survey residents with one question: What wellness tools are you using, what wellness services would be helpful
     2. More training in computer software usage tailored to the specific needs of each program
     3. Post all wellness activities on the Website in more of a billboard fashion rather than in the Blog
     4. The blog and website are appreciated


     - Submitted by Paul Lessem, MD



September 27, 2018: Relevant issues from Graduate Medical Education Committee (GMEC) meeting

Three critical issues came up at today’s GMEC meeting regarding resident communication. Feel free to contact me for clarification.
     1. All communications which are destined for a potentially public record must be professionally phrased and well organized. They should not be venues for angry communications or political statements. We are making a record of our clinical and professional activity as an institution in these communications.
     2. We must be careful not to put protected information into emails which could be accidentally sent where they are not intended. Something which is meant to be private should be encrypted and not left where it is accessible or can be distributed as an accidental transmission.
     3. Clinical presentations whether oral or written should be organized to be clinically helpful. These should focus on core issues which are to be communicated about the patient. There are variations in specifics depending on specialty. However, one should be rapidly identifying the patient, the clinical problem or problems being treated, key findings ordered from most vital to least vital, and the current plan including the investigations which are key to further therapeutic interventions.


     - Submitted by Paul Lessem, MD



September 26, 2018: Wellness update

Welcome to the Medical Education wellness blog. We will be posting important messages regarding wellness events (In the hospital, locally, and nationally), changes to the hospital, to its community and to its programs which have wellness implications, and thoughts and opinions gleaned from your responses. On the website you will find resource phone numbers and emails and a library of resources which is currently under construction.


     1. There is one previous entry which is a summary of our first Speak-Up luncheon which was held on September 11.
     2. The Caregiver rounds is being held on Tuesday, October 2, at 7 AM in cafeteria D in Southfield. All students, residents, fellows and interested faculty and medical staff are encouraged to attend. As of this writing we need an interesting clinical case that can serve as a focus of supportive discussion of how to manage difficult issues which elicit strong emotional reactions in caregivers.
     3. Our second Speak-Up luncheon will be held on October 9 as soon after noon as we can begin. We are seeking a room for this meeting. We would like at least one resident or fellow from each training program to attend. In addition, any trainee who wants an opportunity to speak up about an issue where they have a positive suggestion to improve our wellness is welcome to attend. We will have lunches available for the first 25 attendees. Room announcement to follow.


     - Submitted by Paul Lessem, MD



September 11, 2018: Speak-Up luncheon

The first Speak-Up Luncheon was held on Tuesday September 11th in the Simulation Center classroom at Ascension Providence Hospital, Southfield campus. All residents and fellows were invited. The House Officers Association was asked to have representatives from all training programs attend. The 19 attendees included representatives of several programs, Dr. Basim Dubaybo, the wellness physicians and the administrative staff of medical education. Dr. Dubaybo welcomed all students, residents and fellows as coworkers and partners in education, recognized the difficult paths that they have chosen and promised that we will do everything that we can to help them to succeed. They were welcomed to share concerns and ideas for strengthening our community and Dr. Dubaybo expressed the wish that they would join our hospital committees that maintain and work to improve all aspects of our functioning as a hospital and an educational community. A list of these committees will be made available where medical trainee membership, ideas and energy would be greatly appreciated. Dr. Dubaybo stressed that collectively we can figure out ways to be more efficient and effective.


Gains have been made in several areas since the Speak-Up Forum. Utilization of our many wellness services has improved and been extended to more members of our community. All residents will soon have stickers on their meal cards informing them of resources that they can call for assistance and to report situations where improvements are needed. The creation of this blog and website will speed communication regarding health and wellness issues. The website will have an up-to-date list of important contacts. The blog will focus on new developments, events and critical health and wellness information. The program coordinators will electronically contact all members of their programs when there is something of immediate significance to be read on the blog. The resource library will be a repository of wellness information and offer opportunities for self-assessment to be perused at one’s leisure.


There are many monitoring opportunities now available to all levels of trainees as the programs have implemented their wellness plans. We are working on wellness programming of mutual interest with other disciplines, notably nursing. The resident gym is being well utilized.


Several residents mentioned the need for more feedback regarding their suggestions. Dr. Dubaybo cited gains that have recently been made in reporting and feedback regarding problem areas.


It was mentioned that colleague’s stories of how they have managed the stressors of career development and day-to-day functioning have been helpful. Development of a conference with this as a focus might be useful.


The tone of this first meeting was very positive. All attendees seemed enthusiastic and friendly. Our next meeting is scheduled for October 9 (most likely in the same location). Check the blog for further developments.


     - Submitted by Paul Lessem, MD