Health and Wellness Blog

Health and Wellness information for the Ascension Providence Hospital Educational Community

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

 

March 13: 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: http://in-housestaff.org/resident-wellness-is-a-lie-part-1-1319

Part 2: http://in-housestaff.org/resident-wellness-is-a-lie-part-2-1354

 

- 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 (my.ascension.org) - 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
     E = EXERCISE
     D = DIET
     I = INTERPERSONAL REALTIONSHIPS
     C = COMMUNITY
     I = INTROSPECTION
     N = NARRATIVE
     E = ENGAGEMENT

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.

 

EVENTS:
     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