A Story About Maryam

 From the January 27, 2023 issue of the Transformational Times

Associate Director's Column

A Story About Maryam 

By Cassie C. Ferguson, MD 

 Dr. Ferguson, who is a reknowned mentor and educator at MCW, tells the story of one student who came to her when on the edge of academic despair ...

The most rewarding mentoring relationship I’ve had with a medical student began the day she came to see me in my office to tell me about her experiences on academic leave. Maryam* had heard that I started a task force to learn about our school’s remediation process and wanted to share her story with me. I now know her to be a fierce, determined daughter of immigrants, but that day in my office she sat hesitantly on the very edge of her chair, backpack on, and glanced frequently at the door, as if she hadn’t yet decided to stay. Her voice was flat, and she rarely made eye contact when she spoke. She told me that after failing a course by less than a percentage point, she was asked to take an academic leave of absence before her first year ended. She might be able to come back, she was told, in the fall and repeat her entire first year. What she was not told was that when she drove to school the day after her leave began, her student ID would not work, and she would not be let into the school’s parking lot.  

“They just threw me away,” she said.   

Maryam’s story—her whole story—would take me years to learn. How she was diagnosed with multiple sclerosis during her first year of medical school after months of attributing her symptoms to stress. How she learned that she was dyslexic in her second year of medical school. How intense test-taking anxiety finally drove her to seek help from a psychologist. That information would be given to me in pieces as she grew to trust me, and I have slowly and carefully put those pieces together. Even now, four years after we met for the first time and three years of meeting with her every other week, I know that Maryam has not revealed all the pain she felt during that time, or during the struggles she has had since. I believe that this is in part because of her reluctance to seem as if she is making excuses, in part because of the intense shame that accompanies failing in medical school, and in part out of deference for the archaic medical hierarchy that still hangs over our profession, and the accompanying perception that my time is somehow more valuable than hers.  

That hurt we embrace becomes joy. / Call it to your arms where it can change.

-Rumi 

Medical school is not for the faint of heart. As a result, supporting medical students—particularly those who are struggling—requires love, grit, and fierce compassion. I have learned both through my own experience with failure and from working with students like Maryam that if we are to live up to the titles of teacher, mentor, and advisor we must walk with our students; we must show up even when showing up is uncomfortable. It is precisely when things get hard that we need to lean in and wade through the uncertainty and pain with our students. This requires that we recognize that we have something to offer because of our own life experiences, but I believe the bigger imperative is that we acknowledge that the boundaries of our experiences limit our ability to know what our students are going through. The only way to begin to truly understand is to get very quiet and listen to their stories.  

When we listen to a story, research using fMRI demonstrates that our brain activity begins to synchronize with that of the storyteller; the greater our comprehension, the more closely our brain wave patterns mirror theirs. The areas of our brain involved in the processing of emotions arising from sounds are activated, particularly during the more emotional parts of the story. Even more amazingly, when we read a story, the networks of our brain involved in deciphering another person’s motives—in imagining what drives them—prompts us to take on another person’s perspective and even shift our core beliefs about the world. 

It is impossible to engage properly with a place or a person without engaging with all of the stories of that place or person.

-Chimamanda Ngozi Adichie 

These findings should not come as a surprise to those of us whose work includes caring for patients. As an emergency medicine physician, I have heard thousands of stories. Whether they are snapshots relayed through EMS of how a 14-year-old child was shot in the head at two in the morning on Milwaukee’s north side, an exquisitely detailed account of a 3-year-old’s fever and runny nose from her mother, or a reluctantly provided history of pain and despair that led a 12-year-old to try and kill himself, each of these stories should transform us. They should move us to want and do better for our patients, for our communities, and for our world.  

At the same time, it is essential that as physicians and educators we also recognize what Nigerian author Chimamanda Ngozi Adichie describes as the “danger of the single story.” As an emergency medicine physician, I only hear stories of peoples’ suffering; I am listening to them when they at their most vulnerable, on what may be the worst day of their life. I only hear of the tragedies that have befallen a neighborhood we serve. As an educator who mentors students who are struggling, I often miss out on their stories that are not about failure or crisis. Adichie warns that when we only listen for the single story, there is “no possibility of feelings more complex than pity, no possibility of a connection as human equals.”  

So then our charge as physicians, as educators, and as human beings is to make room for more than just a single story—to remember that all of us are much more than our worst moments, and that compassion and connection arise authentically when we recognize the full spectrum of humanity in one another.  

*Names have been changed.  

Cassie Ferguson, MD, is an Associate Professor in the Department of Pediatrics, Section of Emergency Medicine at MCW. She is the Associate Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Read this Issue. Your or Your Colleague’s Life May Depend on It.

From the 5/14/2021 newsletter

Director’s Corner

Read this Issue. Your or Your Colleague’s Life May Depend on It. 

Adina Kalet, MD MPH

This week, we focus on suicide and its prevention. Dr. Kalet urges you to read what is likely our most compelling issue ever of the Transformational Times, curated by Dr. Jeffery Fritz and the Kern Student Leadership group. You will learn a few things, be moved, and be better prepared to save a life …

The MCW-Milwaukee medical school graduating class of 2021 has suffered the loss of two of its cohort to suicide. This has been devastating for the families and close friends of these individuals. Their grief, profound and deeply personal it must be, and has been, treated with tenderness and respect for desired privacy. 

As new physicians, this class joins a profession where suicide is all too common. An estimated 300 US physicians take their own lives each year and the rates may be rising. It is likely that each of us have been, or will be, touched by suicide amongst our colleagues and friends. 

For many people who are contemplating suicide, prevention is possible. As colleagues, it requires each of us to be proactive, skillful, and brave in facing our own acculturated barriers to reaching out to others in times of despair. On a personal level, we must all learn to identify and skillfully intervene with friends and colleagues at risk, and vow to accompany those family members and friends who are left to deal with the grief and guilt that suicide leaves in its wake. It is good news that more than 90% of people who survive an attempted suicide never go on to die by suicide. Intervention and treatment save lives.

We also know that, in some cases, there is little that we can do. Some people are committed to ending their lives without intervention and offer no detectable warning or cry for help. With these deaths, we must care for the survivors, enact the self-compassion to digest and deal with our own thoughts and feelings, and develop meaningful ways to acknowledge the loss.  

What we know about suicide

Suicide is among the most common causes of death in those under 55 years of age. The rate of suicide has increased from 17 to 22 per 100,000 over the past twenty years, rising particularly among white and Native American men. Other Americans with higher-than-average rates of suicide are military veterans, people who live in rural areas, and workers in mining and construction. Lesbian, gay, bisexual, or transgendered young people have higher rates of suicidal ideation and behavior compared to their straight peers. There is a rising concern for adolescents who have been socially isolated during COVID-19. Those with mental health diagnoses, such as major depression and bipolar disorder, and those who struggle with alcohol or other substance abuse disorders are at increased risk. Because of their access to lethal weapons, people who live in homes with firearms are at higher risk. About 60% of firearms deaths each year in the US are suicides.

Systemic approaches to preventing suicide include cultural and institutional efforts that eliminate professional burnout and enhance wellbeing. This requires, as Dr. Cipriano points out in this issue, viewing suicide through a public health lens. Meaningful prevention of suicide on a population basis will require comprehensive approaches that strengthen financial safety nets and coping skills, promote connectedness, and enhance access to excellent mental health care. 

What to do when the person in front of you is suffering

Preventing suicide while in the presence of an individual who concerns you requires your active intervention. Learn to ask about suicidality. Be willing to remain present and keep the individual safe. Help the person stay connected to others and follow up. In this issue, our students describe their efforts to disseminate these basic principles. 

The experience of relatives and friends 

I find hearing that someone has killed themselves is always disorienting and unfathomable. While not ubiquitous, it is common for families to close ranks and feel both stigmatized and ashamed for a time. Traditionally, many cultures and religions have created a stigma around suicide although, as a result of work to raise awareness around these issues, most groups have faced down their stigmatizing actions. As one of this week’s authors, Toni Gray, points out, things have changed for the better through research, public awareness campaigns, and the compassion of mental health caregiving.  The key is to try, follow the lead of those who are grieving, and remember that they will be dealing with the loss for their lifetimes. 

Suicide in medical settings gets uncomfortably close

Suicide has touched my personal social circle a few times over the last years, including a teenager and more than one adult with loving families and seemingly rich lives. 

When I was just starting out in medical practice, it was a commonly held (and incorrect) belief that asking someone, especially someone who was desperately fragile emotionally, if they were considering killing themselves might “plant the idea in their head.” This approach likely cost lives. Now we know better. Many people who attempt suicide have seen a physician, usually not a mental health expert, in the weeks prior to the attempt. Physicians and healthcare workers in every specialty must understand their obligation to recognize and intervene.

In medical settings, I have noticed that suicides tend to happen in waves. A few years ago, a medical student, well known and loved by his peers and teachers and who had no known personal or academic troubles, jumped from the roof of a building in New York City. Soon thereafter, two other young physicians in our community died by suicide. Four senior physicians at a hospital where I have worked took their own lives over the course of a year; this was attributed to workloads of over 100 hours a week. 

MCW has been similarly touched. These are profound shocks for any educational institution and, despite having policies, protocols, confidential counselling, and employee assistance offices, deaths still occur. Each suicide is devastating. With each occurrence, we look for answers. We redouble our commitment to reach out if we are concerned about colleagues, friends or patients. We educate ourselves. We plan to simply ask, “Are you thinking about killing yourself?” and then commit to sitting and listening.  Each loss leaves the community diminished.

We hear the voices of people who have struggled

Like our anonymous student essayist, survivors of profound depression and grief often become so focused on their own suffocating isolation that they can see no other option. Shakespeare reminds us that, "Everyone can master a grief but he that has it." It falls to those of us nearby to accompany the person suffering, offering safety, connection, and help. As the student tells us, “As I am connecting with this other human, their logic and compassion towards me overpower the force of self-destruction.” We might be the one to save a life.

We are deeply grateful to those who contributed pieces in this issue. Students, staff, and faculty members who have struggled personally or vicariously through close relatives and friends, share their stories. We hear from Brett Linzer, a physician who, having experienced the loss of a number of colleagues and friends to suicide, as he faces his own burnout with the help of his loved ones. Although reluctant at first, he seeks the coaching that strengthens him with skills and support, enhances the joy he experiences in his work, and compels him to use his experience to work toward systems change for all of us. We get to know Kerri Corcoran, Student Behavioral Health and Resource Navigator in the MCW office of Student Services, who is committed to providing direct support for our students. MCW-Central Wisconsin students write about their work at self-organizing, with great creativity, to do suicide prevention work. 

This is a difficult, ongoing, and devastating problem that disproportionately touches us as physicians. We desperately want to do this right and welcome your experiences and efforts. 

I urge you to read this issue. You never know when it will be your turn to save someone’s life. 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Many Hands, Many Voices: Suicide Prevention Work at MCW

 From the 5/14/2021 newsletter

Perspective/Opinion

 

 Many Hands, Many Voices: Suicide Prevention Work at MCW

 

 David J. Cipriano, Ph.D. - Director of Student and Resident Behavioral Health and Co-Chair, MCW Suicide Prevention Council

 

 Dr. Cipriano, Co-chair of MCW’s Suicide Prevention Council, describes how the council is approaching this critical topic through the development of peer support, beginning at MCW-CW …

 

 Many hands, many voices – a common call for community collaboration – describes the progress of our Suicide Prevention Council (SPC).  I reported a few months ago on our identification of two risk factors for suicide that we chose to focus on this year:  isolation and stigma.  And, I promised to report back on our progress. 

Last time, I spoke about the culture change needed to reduce these risk factors.  We began to plan for a public health model to promote such culture change.  There are three categories of prevention: Primary prevention focuses on various determinants in the whole population. Secondary prevention comprises early detection and intervention. Tertiary prevention targets for advanced recovery and reduction of relapse risk. Our model utilizes trained peer supporters as the main change agents in the secondary prevention component. 

 We looked to Drs. Alicia Pilarski and Timothy Klatt’s Supporting Our Staff (SOS) program to address “second victim” - or vicarious trauma - amongst clinicians, and our program is closely modelled on theirs. The primary prevention component seeks to raise awareness, educate, and begin the conversation through events, media, and other means.  These are the seeds of the culture change needed beginning with stigma which keeps mental health in the shadows and isolation, perpetuated by shame and pride which keep us from reaching out to peers and colleagues.  Tertiary prevention involves removing barriers to access to care for those who need it.  We have made good progress on this over the past few years, but there is more we can do.

 

A student-led suicide prevention initiative at MCW-CW

So, whose hands and whose voices?  Dr. Jon Lehrmann, Chair of Psychiatry and Behavioral Medicine and co-founder of our Suicide Prevention Council, kept directing us back to the Pilarski/Klatt SOS program.  He saw the benefits of the public health approach and of the peer support component. MCW-Central Wisconsin medical student, Margaret (Meg) Lieb, pointed out the difference between peer support programs that encourage the active outreach of peer supporters, versus passive models where it is the responsibility of those in distress to reach out.  Then, our terrific community member of SPC, Dr. Barbara Moser, jumped in with her wealth of knowledge of training tools and experiences needed to prepare these peer supporters.  

So, what’s coming next?  Meg Lieb has assembled a group of fellow students with a passion for the mental health and wellbeing at MCW-CW.  They will launch a pilot program next month. You will be hearing from several of them in this issue of Transformational Times.  Meg and her team have been putting together the training materials, recruiting peer supporters and have even secured funding through Dr. Lisa Dodson, Dean of MCW-Central Wisconsin from a grant she received.  All this, while Meg is preparing for the Step 1 exam! 

I’ll stop here and let these amazing students tell their story.  I will make another promise here – while they are running their pilot, we on the SPC will continue to make plans for extending this program to our MCW-Milwaukee and MCW-Green Bay, as well.

 

 

David J. Cipriano, Ph.D. is an Associate Professor in the Department of Psychiatry and Behavioral Health at MCW and Director of Student and Resident Behavioral Health. He is a member of the Community Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Minding our Mental Health

 From the 5/14/2021 newsletter

 

Perspective/Opinion

 

Minding our Mental Health

 

Toni Gray - Office of Diversity and Inclusion

 

Ms. Gray writes about her family’s experiences and how unconscious bias disproportionally affects communities of color …

 

I was nineteen when I got the call. My mom was in the hospital. She had swallowed several pills. She had attempted suicide. The emotions that filled my body included anger, sadness, shame, and back to anger. My mom, a mother of seven, felt that the best thing she could do to solve her anguish, her sadness, was to take her own life and leave the lives that she had help create; searching for answers and never getting them.

Fortunately, my mom survived, but she would continue to deal with depression and anxiety. It is something that runs in our family, and I would soon lose two cousins at early ages to suicide.

As I reflect on why I wanted to write about this painful subject, it was clear that my personal experience was important to me. One of my favorite quotes is: “Make your mess your message.” Isn't it true how so many of us suffer in silence because we are ashamed of the personal struggles that we face, the trauma that we hold, and the doubts that we cater to? They hold us in a guilty place where we do not often know who we can turn to and trust with our deepest, painful secrets.

However, mental health is becoming less of a stigma and I am so grateful for that. We are opening up the door for conversation and connection which allows compassion to reign. But we dare remind ourselves that part of the mental health stigma depends on the color of your skin and your culture.

In the African American/Black community, there is a strong spiritual basis that we hold to our hearts that is handed down in tradition by our great grandmothers and grandfathers, and our ancestors. That is the idea that a higher power can heal all our illnesses. And that if we have depression or anxiety, we are not relying on the higher power enough which compounds the feelings of guilt that we may already be holding. Our faith is called into question. This stigma has plagued the African American/Black community for many decades. Besides that, we still have the effects of systemic racism where African American/Blacks were denied access to health care and now even in the 21st century health care still remains an access and economic issue plagued with unconscious biases.

When you are trying to open up your heart with innermost thoughts, you want someone that you can trust and someone who may relate to you. Compounded by the economic restraints and access to therapist is that often you cannot find a therapist that looks like you if you are a person of color. They say representation matters. I second that and elevate that it is imperative. People feel connected to people who look like them in a society that villainizes you for looking a certain way. We need to find people who can relate to the unique societal struggles that people of color face.

As an institution, I believe we are truly committed to creating equity in healthcare. We are committed to building awareness with intentionality around intersectionalities that people come in with and finding ways to address unconscious biases that impact health care outcomes for people of color. That includes the mental strain of poverty, police brutality and profiling, the killing of Black and Brown bodies by police officers, on top of the ongoing effects of this pandemic. We have much work to do in the mental health space, but I am grateful that we are now understanding that our mental health matters just like any other health concerns we may have.

As I reflect on my mom’s journey of resilience, I am comforted by her story. She realized the need to see a therapist to get the tools she needed to deal with her depression and anxiety. Hearing stories like this makes us feel not so alone in our pain. We are human; we bend but we do not have to break. However, we need the resources accompanied by compassion so that we can stand up straight again and embrace a full life we all deserve to live.

 

Toni Gray serves as the Learning and Growth Program Coordinator in the Office of Diversity and Inclusion at the Medical College of Wisconsin. She’s been with MCW for 10 years. She oversees, leads, and creates learning and growth experiences in the equity, diversity, and inclusion space.

 

 

Coaching is Vital to Preventing Burnout in Physicians

From the 5/14/2021 newsletter

Perspective/Opinion

Coaching is Vital to Preventing Burnout in Physicians

Brett Linzer, MD

Dr. Linzer shares how some of his peers suffered, then explains how coaching and intentional support can build resilience, improve the work environment, and restore meaning in our work …

My internal medicine/pediatrics friend Alex Djuricich, MD killed himself a few years ago. He was one of my resident partners and eventually became the internal medicine/pediatrics program director at the Indiana University School of Medicine.  He was a mentor to many internal medicine/pediatrics physicians and a father of two teenage daughters. When he died, I promised myself that I would do what I could to help other physicians.  It has taken me a long time but, with some of the work I am doing, I feel as though I am making good on that promise. 

I spent years trying to figure out why doctors hurt themselves. I am not sure if I have figured out much, but I have learned a lot along the way.  

One of the most important things I have learned is that I do not have all the answers to my life. But, I found a lot of the answers through coaching.

Why is coaching important?

The idea that we, as physicians, can figure everything out on our own and not rely on others to help us is, at best, a poor strategy for success and, at worst, a dangerous myth. Physicians are highly trained and skilled in certain areas but may lack mastery in relationships and communication. After residency, there is little emphasis on personal growth and especially emotional development.

Coaching can bring wide-ranging benefits to any organization. Most experts agree the cost of replacing one physician, including lost revenue, can be around $1M. A well-coached physician is more likely to stay in their current position and, therefore, save the cost of recruiting a replacement. In addition, there is less physician burnout, improved mental health, more effective physician leadership, and more balanced and engaged physicians. When physicians are at their best, everyone wins.

The struggles hit close to home

During my training, I was no stranger to suicide. A medical school classmate killed himself. 

Then, an international graduate with two children and a family in China hanged himself during the second week of our internship. We all knew he was struggling but had not known what to do. We were treading water ourselves.  The next morning, the residency program director brought our group of ten interns into a room and talked to us. "This is bad,” he said. “We care about you.  Here is the card for the psychologist. Call if you need help." I looked around the room at the other confused faces and honestly thought, what does he mean by “need help”?  I said to myself, Look Brett, screw your head on straight. You are on call and have a busy service. You need to get back to work.  

Two years later, my chief resident shot himself. I thought he had all the answers. He was a smart guy and had a desirable GI fellowship lined up. At the funeral, I went up to people I knew. Do you understand this? Can you explain this to me? Can you please tell me he had some label or diagnosis or something that I do not have? Chronic depression, alcohol abuse, or schizophrenia? Something? Anything?  How do I know I am not next in line?  There is always a line. On average, one physician commits suicide every day in America.  Every day!

But I was not next in line. Next in line was my friend Alex. He was considered by many to be the ideal internal medicine/pediatrics academic physician. I went to his wedding.  He met his wife when she was a fellow intern with me and Alex was our resident.  He had a family.  He even looked like me. How are they different than me? How close was I to where they were?

Look Brett, I said to myself. Screw your head on right.  You have a lot of … wait … it is not working.  You cannot figure it out. Who's next in line?

Then, one of my best friends and close partners left our organization. I had difficulty understanding why he left and felt the effects even more acutely when I had to absorb a number of his patients. This was the height of the opiate epidemic and some of the patients were very difficult. I did not know how to manage them well. In addition, I had an unmotivated, depressed medical assistant working with me and I did not know how to communicate with her. The triage nurse in our small clinic was not motivated to do her job. I was not comfortable with conflict, so I avoided her and did extra triage work. The clinic manager was too scared to confront the problems. The administration was well-meaning but not helpful. 

I felt like I was playing a new game and I did not know how to play it well.  I did not even know how to tell if I was successful.  Press Ganey surveys did not do it for me. About this time, Epic came online, and I struggled with efficiency. My wife had chronic debilitating migraines and we had three teenagers at home with no family support. I had extended family challenges. I was cut off from my emotions and I unknowingly built walls to contain them, not knowing I was cutting off my good emotions as well. 

A turning point and finding help

In 2014, my survival skills were not serving me. Life was closing in. I was tired, frustrated, angry, irritable, confused, fearful, and more. I took care of depressed patients and I prescribed SSRIs for them.  Would an SSRI help me?  I did not even have a doctor. Maybe counseling would help, but I did not know where to turn.  I did not have the time. 

I was too scared. During one particularly rough patch, I asked myself if I was suicidal. 

One night, I was sitting at home and finishing Epic charts. My wife handed me a card that said, "I think you need some help." I looked at the card that suggested I contact Dike Drummond, MD from the burnout prevention program,  www.TheHappyMD.com 

I said to her, “Don’t worry.  I just need more time. I can figure this out on my own. I just need to work harder.” 

My wife had heard me say this before. She was losing patience and my words were not as convincing to me as they had been before.

I asked myself, “Am I depressed?” 

I called Dike and set up a discovery session. This is a free one-hour “get to know you” session with the burnout counselor. At that point, I still did not trust him or anyone else. More than once, I almost cancelled the call. I thought, he does not know me. I am a very private, introverted person with my special problems.  

The next week, I completed the call and was shocked to discover within twenty minutes that he could see right through my walls and defenses. He saw the scared kid behind the walls. He saw and knew my patterns of behavior and thought. He knew where that place was, because he had been there. I broke down and agreed to work with him.

Dike explained that many of my patterns of behavior and emotion were not unique to me. There are patterns that are unique to physicians and emerge from our training.  Many of these are survival adaptations. This stunned me and was so reassuring. He told me I was not broken. There were patterns I could learn about and then modify.

Here are some of the typical patterns and misconceptions that Dr. Drummond described that physicians adopt that lead to burnout:

• If I just work harder, things will work out.  
• I am a smart guy/girl, so I will figure it out.
• I need to do it all by myself.
• I do not want to deal with this difficult patient, nurse, etc.
• Compassion is important for other people but not for me.
• My emotions are not safe.  I need to protect myself.
• I feel like an impostor.

My work with Dike centered around twice-a-month one-hour coaching calls where we worked on emotional and skill development. We started every call with five minutes of gratitude and appreciation. What would I like to congratulate myself for?  What did I do right?  This was actually hard for me because I was more in the habit of beating myself up for what I had done wrong. I could easily list all the negatives, but I had trouble seeing the positives. After that, we would complete the work for the day. Some of the emotional work involved processing difficult emotions like shame, fear, anger.  I realized I had a lot of shame. For example, we discussed:

• How to gain better access to my emotions and feelings.  
• How to trust myself and others.  
• How to have more self-compassion and more compassion for others.  
• How to absorb positive feedback and not deflect it away.  
• How to have a soft front and a strong back.

The area of skill development was wide-ranging. Communication skills were huge. I realized if I could be a better communicator, I could save a lot of time and prevent a lot of negative emotions. As I became better, I noticed how ninety-minute disagreements could turn into fifteen minutes. Three meetings could be one if I was more effective. Three-day arguments could be resolved in thirty minutes with deep listening and full presence.  

We did in-depth personality testing and self-awareness, and I learned how to more effectively interact with different personality types. I learned how to deal with difficult people like the nurses and patients. We did role-play and scripting.  

I realized that as I took more responsibility for the interactions, I developed new skills and the nurses changed their behaviors. In the past, I had believed that my role was to give the right answers, but I learned it was more important to develop the art of asking the right questions. I discovered how to run an effective meeting. What is the goal?  How do we know if we achieved the goal?  Can we stop after thirty minutes and consider it a success if we reached our goal?  I mastered Epic documentation techniques, created succinct, appropriate notes, learned stress management breathing techniques, mastered time management/batching approaches, practiced delegation, adopted marriage skills, enhanced my communications, and made firm dates on the calendar. I had been transformed.

Emerging from the other side

Coaching has changed me.  When physicians are at their best everyone wins.  As physicians, we need to trust, ask for help, and be supported along the way.  We need good leadership that makes coaching easily accessible, affordable, and encouraged.  We could spend one-tenth the amount it takes to replace one physician and invest it in the few hundred we already have. 

It is critical to understand that coaching programs are not just for impaired or problem physicians. These approaches are for growth minded, striving physicians who want to improve their lives and the lives around them. Highly achieving people in many fields have coaches.  Every sports superstar has a coach.  Most high-level business leaders have coaches.  Every coach I know has a coach of their own.  And the people at the top   the ones who train the other coaches - have networks of support and growth systems around the country.

It starts with each of us

Here is what you can do.  It all starts with you.  Take care of yourself and trust that others may be able to help you. Realize that you may not have all the answers to your life.  Reach out to others for connection and for mutual support.  Consider coaching for yourselves.   

Brett Linzer, MD is board certified in both internal medicine and pediatrics. He has been in practice with ProHealth Care for over twenty years. He has been a part of the Medical College for 18 years as a preceptor and mentor to 4th year students in his ambulatory clinic in Oconomowoc. He is the recipient of the Marvin Wagner preceptor award, ACP Wisconsin Community Physician and mentor award and the Milwaukee Academy of Medicine award for excellence in teaching. He can be reached at balinzer@phci.org 

A great miracle is happening here. Rededication is needed.

 From the 12/18/2020 newsletter

 

 

Director’s Corner

 

 

A great miracle is happening here. Rededication is needed. 

 

 

Adina Kalet, MD MPH

 

 

This week Dr. Kalet reflects on this season of miracles in our medical, societal, and spiritual lives, as we celebrate some remarkable achievements and ready ourselves for the future ...  

 

 

The photographs are spellbinding: first responders, nurses, environmental service workers, transporters, laboratory technologists, physicians in full PPE, sleeves rolled up at the ready to receive the vaccine. The science – messenger RNA presenting small bits of the SARS-CoV-2 spike protein to recruit our immune systems – is a miracle. The rapidity and coordination with which the basic and clinical scientists and government approval processes advanced to save lives is astonishing. The administration and engineering know-how enabling mass production, distribution, and inoculation is wonderous. 

 

Like the generations of physicians who experienced the end of the polio epidemic, the taming of tuberculosis, and the turning of HIV/AIDS into a chronic manageable disease, this generation should be inspired by the awesome power of civil and political society, health care systems, science, and medicine pulling together to address the existential threats to humanity. Many have been overwhelmed from the sacrifice, work, commitment, and persistence it has taken to make the miraculous a reality. Many on the front lines have been infected. Some suffer from late effects of the virus. Some have died. Modern miracles are not magic. 

 

At the same time, the Electoral College met and affirmed that we will have a new president and vice-president this coming New Year. Never in my lifetime have the gears of democracy been so transparent and inspiring. The campaign, the voting during a pandemic, counting and recounting, certifying and recertifying, and vigorously defense of the “voice of the people” were affirmed through the judicial process. We have disagreed and debated, we have exerted ourselves and have made a choice. This process has opened fissures in our civic life. We are in the midst of a major social upheaval, a tipping point, a moment of reckoning. We are exploring new territory. It has been truly miraculous and grueling.  

 

As I write this, it is the sixth night of Chanukah, a word that means “dedication.” On Chanukah, we celebrate a “Great Miracle.” We light candles and eat fried potato pancakes, jelly doughnuts, and chocolate coins. We play games and exchange gifts. We are celebrating, literally, having to clean up and make do after having survived a horrific era of bloody war and civil unrest. Chanukah recalls an historic, not biblical, event that took place during the 3^rd Century BCE.  The metaphorical miracle of Chanukah is that a bit of lamp oil lasted way longer than it should have, keeping the “eternal light” in a nation’s holiest space aflame while a a fresh supply could be procured.  But the miraculous thing we celebrate is that we had the privilege of cleaning up the mess and rededicating our places and spaces to the important work of the body, mind, and spirit. And many of us survived to tell the story. 

 

As 2020 ends, we have now breeched over 300,000 COVID-19 deaths in the US alone. More deaths from a single cause than in any war, although not unusual when compared to other pandemics.  Boxes of vaccine have landed in airports in every state, placed on trucks, delivered to the receiving docks of health care facilities, defrosted, and injected into the arms of our colleagues, friends, and family. 

 

The masked front-line workers in the photographs receiving their immunizations are people who continue to care for us, our health care team, our community, and our most vulnerable. It will likely be many months until we are free to lower our masks, but an end is in sight. 

 

I am looking forward, along with our MCW Kern Institute community to taking stock, cleaning up, and reorganizing in a better way, facing the austerity and dedicating ourselves to the challenging tasks ahead both within the house of medicine and well beyond. Together, we await the miracles yet to come. 

 

 

Adina Kalet, MD MPH, is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

 

 

Loving Each Other Through the Darkness

From the 12/11/2020 newsletter

Perspective

 

 

“Loving Each Other Through the Darkness”

 

 

Alicia Pilarski, DO & Cassie Ferguson, MD

 

 

“My patient was talking with me a few minutes ago and then he just coded…we tried everything we could. Breaking the news to his family over the phone was awful.”

 

“I just can’t unsee what happened to my patient. She was so badly abused and injured and I can’t imagine what she went through…”

 

“I made a mistake. I thought our patient was suffering from congestive heart failure, but it was sepsis. I never gave antibiotics and caused further damage from giving diuretics. I’m not sure how I can go back to work tomorrow.”

 

As physicians and learners, we see people suffer with protracted and difficult illnesses. We see lives instantly devastated by a new diagnosis or injury. We are asked to bear witness to the death of patients too sick to be surrounded by their own family. And then we kneel alone, face in our hands, before rising quickly to take care of the next patient. We are not taught or given the space to process these tragedies aloud.

Death, loss, and errors are inherent to the practice of medicine, yet a false sense of separation keeps us from reaching out to one another when their impact becomes too much to struggle with on our own. This sense of separation exists for many reasons, but is certainly driven by the isolating medical hierarchy, our unforgiving culture of blame and shame, and our own sense of exceptionalism; this erroneous belief that we are inherently different from one another, that we are the only one that has struggled in this way, that others have somehow handled it by themselves. Our current social situation exacerbates these issues, offering less opportunity to be physically present with our work family and making resources harder to recognize.

These obstacles to connection fuel our unwellness. They prevent us from seeing that our suffering is not exceptional; it is universal. We hope you know that we see you behind that mask and know that patient’s death made you think of your own mortality and wonder if someone in your family is next. We see you on that Zoom call stretching every ounce of your energy and patience in order to be a mom, a teacher, a researcher, a physician. And we see you sitting six feet away from us in the break room struggling with that last case that shook you to your core.

 

We see you. We are you.

 

We also know that connection is a remarkable force and have witnessed its power in our own lives. Talking openly about our struggles with one another reminds us of our humanity and wakes us up to the reality that we are not so different from one another. It is also a powerful force for healing; sharing our anxiety, grief, anger, and fear with someone who will listen empathically strips these emotions of the shame and paralysis that are often attached. And in turn, your story of how you overcame what you experienced can become “someone else’s survival guide.” (Brené Brown).

We encourage you to ask how you might tap into and add to the incredible power of our community and draw on the collective compassion of your colleagues. We want to be your first line of defense when what you’ve seen saturates your coping mechanisms. We want to be there for you like someone was there for us.

Dr. Rana Awdish phrased it most beautifully in her book, In Shock:

 

“How we care for each other during life is the true restoration—the definition of agency…Our ability to be present with each other through our suffering is what we are meant to do. It is what feeds us when the darkness inevitably looms. We cannot avoid the darkness, just as we cannot evade suffering. Loving each other through the darkness is the thing to look for and to mark. It’s there, in the shadows, where we find meaning and purpose.”

 

Resources for providers, trainees, learners, and staff:

 

·   Our institution has several resources and opportunities to reach out for support, both for peer support and more advanced support.

 

• For a list of the current Froedtert & MCW Supporting our Staff (SOS) Peer Support team, please visit our website: https://infoscope.mcw.edu/MCP-Medical-College-Physicians/Practice-Initiatives/Peer-Support-Program.htm
• If you need immediate support, please page the SOS Team (414-314-1763) or email Dr. Alicia Pilarski (apilarski@mcw.edu) or Dr. Timothy Klatt (tklatt@mcw.edu).

 

 

Alicia Pilarski, DO is a Associate Professor in the Department of Emergency Medicine at MCW. She serves as the Graduate Medical Education Patient Safety and Quality Officer. She is the Associate Chief Medical Officer at Froedtert Hospital. She is actively involved in Wellness in the Kern Institute, MCWAH, MCW, and the hospitals.

 

Cassie Ferguson, MD is an Associate Professor of Pediatrics (Emergency Medicine) at MCW. She leads the MCW M1 and M2 REACH curriculum focused on promoting wellness. She is the director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

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