Dueling Pandemics

From the President                                     Rajneet Lamba M.D.

Here we are at the halfway point of a very thought-provoking year. It has been a pleasure to reflect on the times in these columns with you all.  I am very grateful at this moment to have a platform to share my musings, hone my analytical skills, and encourage discussion of issues in healthcare.  I would like to thank our CEO and executive council for the opportunity to lead a diverse and nimble board as President of the society. 

On February 20th, I shared information with readers on the SARS-CoV-2 virus, first identified in the US in Snohomish County.  Exactly 1 week later, CDC guidelines were updated to reflect person to person transmission in the United States and I found myself with a very plausible cause for the many cases of ARDS that I was seeing that day.  I successfully advocated for testing in a patient under my care that would ultimately become the first reported death from COVID-19 in the United States.  Over a hundred thousand deaths later and America is still constrained by the optics of our messaging.  Local, state and national case counts are raising concerns that we could overwhelm contact tracers and hospitals again.  
Last month, King County declared racism a public health emergency.  During dueling pandemics, I have been reading of dueling consciousness.  Dr. Camara Jones, former APHA President, has shared a highly effective framework in her national campaign against racism which encourages public health advocates to begin with these three tasks:
1. Name Racism,
2. Ask, “How is racism operating here?” 
3. Organize and strategize to Act.  

Naming Racism is the key step towards the antiracist action thinking and action of subsequent steps.  I have sprinkled additional touchstones from Dr. Jones through this article in italics.  
Although racism manifests on several levels, attention to dismantling institutionalized (structural) racism is key.  Interestingly this framework seems appropriate for any of the –isms that sap the strength of our society through the waste of human resources.  Challenging the –isms that are embedded in our society takes a significant degree of effort.  Acknowledging saneism may sound counterproductive to medical professionals, but with 40% of hospitalized patients having comorbid psychiatric illness, it may help us provide better care for diagnosed or undiagnosed patients to be conscious of this form of discrimination in our practice.  At the intersection of saneism and racism is a uniquely American psychiatric diagnosis of “Freedom” frequently applied to Black Americans into the 20th century.  Described in Stedman’s medical dictionary as Drapetomania, this label illustrates problems that occur when medical institutions apply their biases to behavior.  

American Exceptionalism and an ahistorical perspective often limit our ability to identify –isms and while many of us are part of great institutions, it is important that we not let our confidence in their exceptionalism prevent us from doing good work to improve culture.  Racism is a system, not an individual character flaw.  Regarding sexism, nearly 80% of the healthcare force are women and they make up perhaps 20% of key leadership according to a US Bureau of Labor Statistics report.  

Mechanisms of institutionalized (structural) racism are identifiable and addressable.  These mechanisms are in our structures, policies, practices, norms, and values of decision-making, especially as these pertain to who is and isn’t at the table.  Last year’s WSMA annual meeting provided an opportunity to hear from Dr. Patrice Harris, the first Black woman to serve as President of the AMA.  Under her leadership, the AMA has created an Office of Equity with Dr. Aletha Maybank serving as the current Chief Equity Officer.  She has been sharing excellent content across the platform and I highly recommend her webinars which center underrepresented groups in medicine.  Please see Dr. Girolami's info below on how to serve as a KCMS delegate to this year's WSMA annual meeting to push priorities at the state level.  

There has been a strong interest in expanding diversity, equity and inclusion (DEI) committees within universities and hospitals given the current interest in social justice.  The greater business community has already demonstrated a practical value in providing cost savings in employee retention, recruitment, and risk management.  Providing a voice for underrepresented groups allows an organization to address blind spots for employee and patient satisfaction and find efficiency gains.  I commend those individuals and institutions seeking to create justice-oriented culture, but must also acknowledge that individuals in the minority who advocate for systemic change have always faced challenges of tokenization, further marginalization, and even retaliation.  Please encourage their efforts, make space for their opinions, and see DEI resources below.  

With ongoing hope for a more equitable society,
UW Health Equity Toolkit
AMA Center for Health Equity
Job Post: Swedish Health Chief Health Equity Officer
TEDx Allegories on Race and Racism - Camara Jones
History - Desegregation in medical societies and hospitals

Ensuring equity and coverage for future coronavirus vaccinations

DANIEL H. LOW, MD, AMISH DAVE, MD, MPH,                      RAJNEET LAMBA, MD, & NANCY BELCHER, Ph.D., MPA                                                           Published KevinMD.com on JUNE 26, 2020

We are pleased to see progress in global vaccine development.  It is imperative that we create a plan NOW to allow for broad vaccination without insurance constraints and without passing costs through to health care providers.  This opinion carries the support of our board.   Take a dive into some background policy including a look at the current Children's Vaccine Fund as a model to work from.

Full Article: Ensuring Vaccine Equity

Payroll Tax Exemption Request

Letter from KCMS Board of Trustees to Mayor Durkan & Seattle City Council
July 6, 2020 
Mayor Jenny Durkan and Members of the Seattle City Council

Honorable Mayor Durkan and Members of the Seattle City Council: 
On behalf of the King County Medical Society (KCMS)... 
Many of the physicians who make up our membership have been on the front lines of this public health crisis since the beginning, managing not only their patients’ health but the health of their practice as well. It has been trying and stressful as you can imagine - like most businesses striving to keep their doors open, the loss of income has threatened the survival of health practices both big and small. We have in fact lost practices in the region already, with many more on the brink.     

KCMS understands and deeply appreciates the dire circumstances the City also faces managing the health crisis while laying the groundwork for future economic recovery. Balancing increasing needs with dwindling resources demands new thinking and bold proposals.   
That said, the physician members of the King County Medical Society believe that levying a payroll tax at this time, as proposed in Council Bill 119810, would impede our ability to deliver health care, especially to vulnerable populations, and we, therefore, cannot support it in its original form. While per-patient operating costs have increased, the actual volume of patients has dropped precipitously. Adding to their cost burden at this time would only strain these practices further at a time when most are struggling with long-term sustainability already.   
Full Letter: Payroll Tax Exemption Request

Upcoming Delegate Council Meeting

By: Teresa Girolami, MD, Immediate Past President KCMS
Please consider joining our Delegate Council. Our first meeting is scheduled for this Wednesday, July 9th at 6 p.m. It will be a virtual meeting, so attending will be easier than ever before. The flyer with details is below.
Looking forward to working with you all!

How Are We Responding to Stress?

By: Nancy L. Belcher, Ph.D., MPA, CEO of King County Medical Society

As your CEO, I am honored to serve you all. My primary mandate is to represent the full membership,  and at times it has been challenging to know how to respond to the vast array of concerns and voices. The magnetic combination of uncertainties related to patient care, rising COVID-19 cases, lack of PPE, clinics closing, lost wages, political unrest, taxes, anger, depression, and for some,  a hyper-responsiveness is stirring-up a complicated cocktail.
With our lobbyist, we are working to identify ways to help navigate our changing legislative landscape. As the flyer above shares, our Delegate Council starts Wednesday. This may be a great outlet for you.
Additionally, with our Physician Wellness Committee, we are working hard to share and create ways to help you find healthful ways to respond to not only the pandemic, but the challenging times we all are living in.
Please consider listening to the CME presentation below, and the concert advertised in the flyer immediately following. As always, please reach out and let me know if you have other resources that you'd like to share. 
All my best, 

Hope through collaboration, connection, and community

By: Lucy Doyle, MD
With a short spell of "white cloud" COVID numbers in our hospitals, we take a look back at writing from the early days of the pandemic.  Dr. Doyle met her husband Ali N'Simbo MD, MPH while working together during a cholera outbreak in a remote area of the jungle in the Democratic Republic of Congo.  When the COVID-19 outbreak began in King County, she was able to leverage contacts in China to glean clinical information from the world's most experienced physicians.  She describes hope through collaboration, connection, and community below.
Medium Article: A Stone to Beat COVID-19

Communicating Effectively During Times of Stress

By: Edward A. Walker, MD, MHA
Friday, July 17 from noon–1 p.m.
Join the next webinar in the Continuing Professional Development series. This webinar will help physicians and physician assistants describe a general framework of an effective communication process; detail the advantages and disadvantages of five different communication modes; and give three examples of how communication style, mode, and content might be adjusted to account for the needs of the message recipient.
This activity has been approved for AMA PRA Category 1 Credit™.
Edward A. Walker, MD, MHA, Sr Physician Advisor, Center for Leadership Development, WSMA
Register: Communicating Effectively During Times of Stress

Hitting Bottom - A Necessary Evil?

By: J. Kimber Rotchford, M.D., M.P.H., Member of Jefferson County Medical Society

This essay argues against the assumption that hitting bottom is a prerequisite for change, especially as it relates to the common shaming and punitive approaches to mental illnesses.  Mental illnesses, which include substance use disorders, need not get worse before an intervention.  Dr. Rotchford offers some suggestions to move beyond hurtful and ineffective ways of addressing mental illness.  People with mental illnesses do not have to hit a "low bottom" of pain, despair, and gross disability. 
Full Essay: Hitting Bottom - Necessary Evil?
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