Six Month ReflectionsBy Nancy L. Belcher, Ph.D., MPA, CEO KCMS
It has been 6 months since KCMS received the first reports of Covid-19 related deaths in the US - specifically in Kirkland, WA. What an extraordinarily challenging six months it has been. Like many of you, I have lost dear friends, colleagues, and mourned the loss of those heroes that I could only read about.
I am left wondering what the next six months will bring. I am hopeful that in the next six months, we'll know whether the leading vaccine candidates are safe and effective, we will continue to identify improved treatment options, and provide more testing.
As we work to find answers, we also try to lead as 'normal' a life as possible. My oldest son is hopeful that his long-planned September wedding will be allowed to occur. With the ever-changing restrictions, it is hard to know... and so I watch as my sons, nieces, and their friends 'normal' progression through life is disrupted. However, as my dear mother, Mimi, reminds me, "youth (herself included) have had their paths altered regularly throughout time."
But who would have thought a pandemic, or even wearing a mask, could become so politicized? History would. Unexpected natural disasters (like Covid-19) have a way of pulling back the curtain on undiagnosed pathologies in our economic, social, and political systems.
As a nation, we faced the Flu of 1918 (that's what I choose to call it). I lost a great grandmother to the second wave when the flu came back with an added (mutated) vengeance. In 1918 the US was at war, it was a year full of the election campaigning, and women were not allowed to vote. The voting turnout was very low, and candidates lobbied for votes by writing letters and giving speeches from moving cars. By 1920 the country was just emerging from WWI, the 1918-1919 flu epidemic had killed between 17 -100 million people worldwide (about 675,000 Americans), and the economy had fallen into a sharp recession.
Now, one hundred years later, we have the convergence of Covid-19 and the Black Lives Matter movement that focuses on racial injustice, police brutality, improved access to healthcare, economic injustice, and voting rights. As I read more and more about the parallels between 1920 and 2020 I believe the roadmap is there for us to study, and we need to pay attention.
With that charge in mind, King County Medical Society continues to distribute PPE and telehealth equipment in order to keep our providers safe. We have thoughtfully included information and perspectives about the BLM movement in our newsletters and social media for weeks, and while we have gotten some push-back, we know that these conversations need to occur.
We are working tirelessly to create real opportunities to craft systemic change and we look forward to sharing the details as they emerge - including conferences and CMEs. And of course, we are busily working with our Delegate Council and lobbyist to create resolutions to provide better, more accessible healthcare for all.
Please don't hesitate to let us know if there are other areas where we can further assist you.
Again, I thank you all for the care you have provided, often sacrificing your own personal safety. You are to be commended for your dedication.
Thank you all for this opportunity to serve you.
Sincerely, Nancy
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Good for Us AllBy Rachel B. Issaka, MD, MAS
I began my second year of gastroenterology fellowship after logging hundreds of procedures, scoring high marks in peer and patient reviews, and developing a reputation as a strong endoscopist and clinician. I was proud of my progress but was even more thrilled to no longer carry the department’s on-call pager every other night. One day while rounding on the transplant hepatology service, I met a patient who prescribed me an awkward dose of reality.
That day began like any other. The patient’s primary physician led the conversation while I listened, took notes, and placed electronic orders. Having gotten good news about a pending liver transplant, the patient was in good spirits and insisted each person introduce themselves by name, title, and role. After every introduction, the patient effusively said, “Nice to meet you, Dr. X. Thank you for taking care of me.”
Eventually, the patient and I made eye contact, but before I could state my name and role, the patient asked if I was a student on the team. I responded as others had, “Good morning [patient’s name], my name is Dr. Issaka and I am a gastroenterology fellow.” The patient looked at me curiously, and eventually responded…, “Well, good for you!”
After what felt like an eternity of awkward silence—I was the only Black person on the team, in my fellowship program, and in the entire division at the time—the attending physician broke the silence by sharing the care plan and morning rounds resumed.
The patient’s patronizing verbal pat on the back, “Good for you,” was a reminder that despite my accomplishments, there would always be an assumption by some that I didn’t “belong.” I’ve replayed that conversation and many similar experiences in my mind, feeling as though I’d failed by not responding more articulately. I’ve since realized the constant need to justify my presence is instead a failure of the medical profession. Statements like “good for you” are called microaggressions, and the onslaught of small encounters have an outsized negative impact in reinforcing norms of racial inequality.1 When these norms result in inequitable health outcomes for patients, they are called racial health disparities. Both microaggressions and racial health disparities stem from structural racism.
Structural racism is embedded in medicine’s policies, practices, cultural representations, and norms that reinforce inequities.2 As the United States confronts the disproportionate impact of coronavirus disease 2019 (COVID-19) on Black people, the unjust killings of George Floyd and other Black Americans has ignited the most cohesive civil rights movement since the late 1960s. Despite the focus on law enforcement and criminal justice, medicine’s history of exclusion and exploitation also fuels this racial reckoning; thus, medical institutions must play a critical role in forging a different path forward. The medical profession must acknowledge its history of inequality; the persistent impact on Black patients and medical professionals (including trainees, faculty, and staff); and the implications on the missions of patient care, education, and research.
With respect to microaggressions, the Twitter thread #BlackintheIvory recounts stories of structural racism in academia and medicine. Although it may be uncomfortable, everyone in medicine should feel a responsibility to directly respond in these situations and challenge accepted norms as I have learned to do.
When a patient says, “You’re not what I expected my doctor to look like!”
I now respond, “Do you mind elaborating? What did you expect your doctor to look like?”
When a colleague says, “Do you work here?”
I now respond, “I thought wearing my badge would make it obvious. Was there anything in particular that made you believe I did not work here?”
When a patient says, “I don’t want to see you. Is there another doctor?”
I now respond, “All of our doctors are qualified to provide excellent care regardless of race or nationality, but if you prefer to seek care elsewhere, that is your right.”
Please continue this JAMA Network article by clicking the button below.
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An update from our partners at UMC:
Hand washing opportunities in unexpected placesBy UMC
With over 100 years in business, UMC has a long history of helping healthcare facilities solve problems. Typically, that is through the building of new hospitals like Swedish Issaquah or working on renovations to existing facilities to increase comfort and safety for staff and patients. When the coronavirus hit the nation in February and our construction projects all but stopped, we wanted to find a way to use our skills as a builder and engineer to create a useful product to help our community. From early in the pandemic, hand washing was identified as the number one way to slow the spread of COVID. With many public buildings and retail locations closed, the opportunity for handwashing was greatly reduced; so, we went to work. In a matter of days, we had developed a prototype to provide portable handwash stations to our community.
We have provided these units to construction sites, homeless shelters, golf courses, and other locations throughout the country. Having these stationed outside buildings provides guests a place to wash their hands and helps assure users that those providing these sinks are proactively protecting the people that enter and use the building. Most of the sinks are customizable with branding and logos to identify the provider.
The units have many options to support diverse locations. They can be fully self-contained and not require any connection to water or drainage or integrated into the building systems for uninterrupted service. We are here to help find the right solution for your facility.
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New King County Medical Society Members
On behalf of the Society, we are thrilled to welcome our newest members! To help you get to know them better, we have provided a link to each of their bios.
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Ahana Roy, MD, FACP
is a board-certified internist at UW Neighborhood Woodinville Clinic. Read more.
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Rachel Bender Ignacio, MD , MPH
is a board-certified infectious disease physician at UW and Harborview Medical Centers. Read more.
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Gwen Hanson, MD
is a board-certified family medicine specialist at Rockwood Family Medicine. Read more.
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Elisabeth Poorman, MD, MPH
is a board-certified internist and addiction medicine fellow at the University of Washington. Read more.
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Telehealth Impact Study
The American Medical Association
The AMA has been working on a Telehealth Impact Physician survey in collaboration with MITRE, Mayo Clinic, and others as part of an effort of the COVID-19 Healthcare Coalition. Please see their message below.
You are invited to complete the Telehealth Impact Study Provider Questionnaire by clicking on the link below. The study has been approved by the Mayo Clinic IRB and is part of our efforts in the COVID-19 Healthcare Coalition to address the pandemic. Since COVID-19 started, we have experienced a significant shift towards telehealth. The goal of this project is to learn more about your experience with telehealth to identify the challenges and barriers, as well as the benefits.
Building on existing research, your response will help inform additional resources needed across the industry and health care community, provide insights to federal and state policymakers and identify gaps in current research. Respondent and organization information will remain confidential and will only be reported in aggregate. The findings will be shared and made available to all on the COVID-19 Healthcare Coalition website, as well as shared by the various organizations participating in the Coalition Telehealth Workgroup*.
The COVID-19 Healthcare Coalition is focused on understanding your experience of telehealth as an individual physician, nurse practitioner, or physician assistant. The survey is expected to take up to 15-20 minutes and we ask that you complete the survey by August 13th, 2020. Please remember to press submit when you get to the end of the survey.
We want to hear from as many clinicians as possible to inform our work. If you have colleagues who use telehealth, please consider forwarding this invitation to them.
Best Regards,
Steve R. Ommen, MD, Medical Director, Center for Connected Care, Mayo Clinic
Francis X. Campion, MD, FACP, Principal Lead, Digital Health, MITRE Corporation
*COVID-19 Healthcare Coalition Telehealth Workgroup: American Medical Association (AMA), American Telemedicine Association (ATA), Digital Medical Society (DiMe), MassChallenge Health Tech, Mayo Clinic, and MITRE Corporation. The AMA, while a part of the Coalition Telehealth Workgroup, is not a formal member of the COVID-19 Healthcare Coalition.
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Racism as a Public Health Crisis
By Barry Grosskopf, MD
On March 25th, 1966 at a press conference before his address to the Second Medical Convention for Human Rights, Martin Luther King Jr. said that “of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
Although there has been some redress in the 54 years since that condemnation, inequities remain, clearly visible in the rates of infant mortality, overall mortality, deaths by heart disease, hypertension, diabetes, disease, suicide, and substance use disorders. For those who want the statistics, here are three reports documenting such disparities in King County.
The article that follows from the New York Times, "Milwaukee Said It First: Racism is a Public Health Crisis" is an article worth reading about how a comparable city dealt with their health care inequities.
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