Opinion: Trump's baseless claim that doctors are profiting from coronavirus has consequences

From the 11/2/2020 Milwaukee Journal Sentinel 

Faculty Op/Ed essay 

Opinion: Trump's baseless claim that doctors are profiting from coronavirus has consequences

Jayshil (Jay) Patel, MD - Pulmonary and Critical Care physician

As the COVID-19 pandemic rages in Wisconsin, doctors stand on the front lines, caring for critically ill patients infected by the coronavirus.

But, according to President Donald Trump, doctors are inflating the death toll for financial gain.

Just like veterans shouldn’t have to defend serving their country, I never thought I’d have to defend doctors caring for sick patients, especially after hundreds have died fighting the battle. But here I am.

Doctors must provide clear documentation when billing for their care. Misreporting medical conditions is a crime and violates ethical principles our profession considers sacrosanct. No financial incentive replaces lost family time and the compounded threat to our well-being.

The truth is, health care workers have taken pay cuts while continuing to care for the sick. Hospitals and outpatient clinics have closed, resulting in the loss of an estimated $200 billion and communities losing access to care.

When the president points his finger, there are consequences.

Last March, he pointed to the calendar and said the virus would go away by Easter. It didn’t, and 230,000 have died.

Then, he turned his criticism toward our nation's leading infectious disease expert, Anthony Fauci. Chants to "Fire Fauci" echoed across his rallies as if he were a contestant on "The Apprentice," the reality TV show Trump once hosted.

Now, while doctors stand on the front lines, a line the president has never walked let alone seen, his hot finger points at us. Despite the scorching light cast on us, we will continue to do our job, even if the president doesn't do his.




Jayshil (Jay) Patel, MD, is an Associate Professor of Medicine (Pulmonary & Critical Care Medicine) at MCW. He is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.



Link to the essay: 
https://www.jsonline.com/story/news/solutions/2020/11/02/trump-claim-doctors-profit-coronavirus-baseless-hurtful/6131051002/

Advocating for Safe Voting in Milwaukee – It’s Tough Sledding Out There

 From the 10/30/2020 newsletter

Perspective

 

 

Advocating for Safe Voting in Milwaukee – It’s Tough Sledding Out There

 

 

Christopher S. Davis, MD MPH

 

 

Dr. Davis reflects on some of the important lessons and frustrations as MCW’s Save Voting Taskforce pushed to empower voters and educate the community in safe voting practices during the pandemic …

 

 

The publication of this week’s Transformational Times heralds an opportunity for me to pen a reflection on the efforts of MCW’s Safe Voting Taskforce which I co-chair with Dr. Megan Schultz. Mostly a medical student- and resident-led endeavor, our efforts indeed generated some meaningful successes; however, our victories and defeats were, at the same time, both enlightening and infuriating. If we could have had our cake and eaten it too, we would have actively registered hospital and clinic patients, provided the entire community with safe voting information, and created a highly visible media messaging campaign. However, largely due to the politicization of voter registration (and even mask-wearing--really?), we couldn’t bring home the gold. Nonetheless, I believe that we will still find ourselves on the medal stand, if only for dutifully fulfilling our civic responsibilities of promoting health and voting.

 

 

Our Successes

 

As Dr. Kalet underscores in her Director’s Corner this week, those of us in healthcare must get our houses in order by casting ballots. To that end, we worked diligently with MCW’s deans, center directors, chairs, and the Office of Graduate Medical Education to emphasize both the importance of voting and MCW’s support for these efforts.

 

In an event hosted by the Kern Institute, Alister Martin (from the national VoteER campaign), educated us and fielded questions about engaging hospital leadership to support patient voter registration. As was discussed by Megan Quamme (the engine of the Safe Voting Taskforce) in a recent Transformational Times essay, this effort led to direct patient engagement in both Children’s and Froedtert’s Emergency Departments. Our student-led efforts even extended to Wausau, where Hayden Swartz (MS-3) encouraged North Central Health Care and Ascension’s local hospital systems to adapt the VoteER model to engage their patients to vote and vote safely.

 

Concurrently, our Safe Voting Taskforce sought to engage a much broader audience. In order to avoid any appearance of “taking sides” in the process, MCW’s Office of Government and Community Relations introduced us to Eric Ostermann and Jaime Michael at Badger Bay Management Company. In order to bypass partisanship, Mr. Ostermann suggested we reach out to the Wisconsin Public Health Association (WPHA) to take the lead for a statewide coalition of major health-related groups. WPHA’s board quickly voted in favor of this and on October 8, we held the kick off of “Vote Safe Wisconsin 2020.” Keynoted by Dr. Susan Polan (Associate Executive Director, Public Affairs and Advocacy, American Public Health Association), the event helped secure pledges from numerous organizations in Wisconsin to support our efforts of ensuring that the public had the information it needed to vote safely. In addition to WPHA, the Wisconsin Medical Society, the Wisconsin Chapter of the American College of Emergency Physicians, and United Way of Wisconsin were engaged. By directly reaching at least 15,000 professionals across Wisconsin, MCW and WPHA has led a public health campaign to assure Wisconsin’s citizens that they can vote and vote safely despite the surge in COVID-19 cases.

 

Lastly, MCW and the Kern Institute have continued to actively engage with our partners from MaskUpMKE who launched MaskUp2Vote. This work combines the long-standing public health message of MaskUpMKE with information that voters might find useful in terms of where in Milwaukee to find free masks and the basics of voting safely during a pandemic. MaskUp2Vote also generated an animated public service announcement which features Bango (the mascot of the Milwaukee Bucks) and highlights the ongoing civic engagement and public support from the Milwaukee Bucks organization.

 

Our Failures

 

I am constantly reminded that the work of community engagement and uplifting our patients can be a slow and arduous task. Sometimes, the hurdles appear too numerous or too high. Other times, the resources are too scarce, the time in a day too short, and the willingness of others to do the morally obvious thing too non-existent. For these ailments, I wish I could offer a cure that wasn’t solely based on dogged persistence. Unfortunately, this is the stark reality, particularly in a time when our elected officials have left us in – what the editorial board of the New England Journal of Medicine calls – a “leadership vacuum.” There are now nearly 230,000 deaths from COVID-19 with no end in sight.

 

In Milwaukee County, the key pandemic safety indicators have rapidly changed from green to yellow to red while, at the same time, homicides in 2020 have surpassed the previous record of 174 set in 1993, and are projected to reach 220 by the end of the year. Structural racism is rampant, and, as I mentioned previously, the infant mortality rate in Milwaukee is among the worst in the nation. And as if that is not enough, MCW has lost another medical student – one of our immediate family. We can’t even protect ourselves, and if this doesn’t give us all pause and insight into our failures, it is entirely unclear to me what will.

 

We clearly need a curriculum and culture dedicated to medical student and clinician well-being, public health, advocacy, legislation, and community engagement so we can train tomorrow’s doctors to work within these spheres and remain healthy while doing so.

 

 

Pertaining to MCW’s Safe Voting Taskforce, I believe we fell short in three main ways.

• ·   First, we hit logistical roadblocks at our own institutions. We could not achieve a plan at Froedtert Hospital (and to a lesser extent at Children’s) to actively approach patients to register to vote, cast their ballots, and do so safely. Much of the allowable activities were mostly relegated to signage restricted to the Emergency Department, whereas other hospital systems across the country begin voter registration activities during registration and continue the conversations during the patient-provider interactions.
• ·   Second, we never arrived at a single local, regional, or statewide governmental partner that would embrace concise guidelines for a successful and safe election cycle. There were too many cooks in the kitchen and too many distracting partisan agendas. Indeed, attempts to engage with many elected officials or groups, such as VoteSafe Wisconsin, went unanswered. It quickly became clear that pushing for access to voting and safety protocols during a raging pandemic was not a priority for some people.
• ·   Third, we never achieved a widespread media coverage or public service announcement campaign. I strongly believe that this and other medical student/resident activities were undercut when the Milwaukee Election Commission, fearing a lawsuit, ruled out using the Fiserv Forum and Miller Park for voter registration/balloting sites.

 

There should not have existed the need for us,  as a grassroots group at a medical school, to take on the task of widespread and concise public health messaging about voter safety and empowerment. Yet, as the pandemic rages on and in the midst of a leadership vacuum, we did what we could. We are proud of our efforts, have learned from them, and will continue to work tirelessly with this growing knowledge for the betterment of those in our communities.

 

  

Christopher Davis, MD MPH is an Assistant Professor of Surgery (Trauma and Acute Care Surgery). He is a faculty member of the Community and Institutional Engagement Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Shedding Light on Indigenous People of the Bemidji Area: A Cherokee Nation M2 Perspective

 From the 10/30/2020 newsletter

Student perspective

 

 Shedding Light on Indigenous People of the Bemidji Area: A Cherokee Nation M2 Perspective

  

Morgan Lockhart, MCW-Milwaukee medical student

 

 Ms. Lockhart shares what she has discovered about research gaps, cultural microaggressions, and her vision as a medical student and descendent of the Cherokee Nation …

 

 Boozhoo MCW,

 A novel coronavirus swept the nation and, along with it, many standard summer research opportunities. As a member of the lowest socioeconomic status, unemployment was not an option for me. Since research is one of the forefront pillars of MCW, I decided to pursue research in a field of interest and passion: exploration of my Native American heritage and culture, as I had never had the opportunity to immerse myself previously. After weeks of networking, I found the Great Lakes Native American Research Center of Health (GLNARCH) and was accepted into a research internship created and funded by the Great Lakes Inter-Tribal Council (Glitc). I was the first school of medicine applicant, and I could not be more honored and elated.

 Throughout my life, procuring health insurance, let alone quality insurance, has been an ongoing struggle: I have always been enrolled in public low-income state insurance or been uninsured. This influenced my decision to develop a research project studying health care coverage rates among Native Americans. Based on interest and compatibility, I was partnered with a mentor, Margaret Noodin, MFA PhD, a member of the Ojibwe Tribe and Professor of English and American Indian Studies at the University of Wisconsin-Milwaukee. Due to SARS-CoV-2 disproportionately affecting residents on the reservations, my project needed to be based virtually. My research objectives evolved into a literature review to identify specific barriers that prevent access to and utilization of healthcare coverage and policies among Native Americans.

 In addition to mentoring my research, Dr. Noodin had several other students working on GLNARCH projects. We all convened weekly through virtual meetings. I had the opportunity to network and develop professionally and culturally with my peers. These relationships continue to prosper and we rely on one another, which I found paradoxical because of the importance our society places on egocentrism. The sense of community and proudness of one another goes beyond the individual; it is ethnorelativism, indicative of indigenous culture.

 From Kindergarten to M2 year, I have been one of few, if not the only, Native American in my entire education system. Microaggressions borne out of envy and ignorance have referred to me as a “Native token” or under the baseless accusation that my tuition is financed from “Native American-owned casino profits.” For the first time, I was surrounded by individuals that shared not only my heritage, but unnervingly similar life experiences. For the first time, I was a puzzle piece that was congruent with the edges of those around me.

 After reviewing the literature, I was disheartened to realize how few empirical research studies identified by the NIH National Library of Medicine have focused on the health of indigenous populations in the US. The few articles that have specifically studied indigenous people often amalgamate all tribes into one, despite each being a separate, sovereign nation. It is patronizing and disrespectful to assume the needs of one tribal organization are comparable with another; that is tantamount to claiming the needs of the United States are identical to that of a foreign country.

 Every barrier had a common denominator: profound mistrust that continues to be perpetuated by non-tribal members since 1492. Without a doubt, the most indisputable finding was not the lack of health care coverage illiteracy among Native Americans, but among non-tribal health care providers. The fault of incomprehension always appears to be placed on minorities, but the cultural ignorance should be shared by the majority. To exacerbate the burden imposed by the cultural gap, tribal members often feel invisible and unrecognized by non-tribal health care systems and often do not seek care outside of Indian Health Services and Urban Health Programs.

 Prior to starting medical school, I was optimistic that a culture of inclusivity and diversity would be at the forefront of medicine, but I find that it is still wading in the shallow waters of preliminary stages. As a second-year medical student, I, too, feel invisible and unrecognized; without representation in clinical vignettes, campus organizations, and the racial demographic of all four years of cohorts on all three campuses. In 2019, the AAMC reported that 0.3% of all actively practicing physicians identified as indigenous. According to the MCW Education 2018 – 2019 Report, 0.14% of students enrolled in any program at MCW were American Indian or Alaskan Native. Without indigenous or culturally competent non-tribal health care providers available, we cannot improve the poor health care encounters and outcomes experienced by indigenous people, including myself.

 

 Recently, I had the opportunity to present my findings to the GLNARCH council. My hope is to develop a study that determines the baseline knowledge of non-tribal healthcare providers on Native health care and policy. I aspire to collaborate with tribal leaders, healers, and members to most efficiently educate non-tribal members on the complexity of Native American health care and policy. My priority is to ensure the product of our efforts focuses on the gains that can be provided to tribal nations with education of non-tribal healthcare providers as an added benefit.

 I am now an advocate for the indigenous people, my people, but we are responsible and accountable for actively learning about the culture and needs of all our patients, and it is high time we direct our attention toward the needs of Native Americans. As an initial step, I challenge you to translate the Ojibwe greetings within this text and learn the names of the sovereign nations that reside within Wisconsin.

 Miigwech

 

 Morgan Lockhart is a medical student in the class of 2023 at MCW-Milwaukee.

Physicians have Many Civic Duties and Voting is One of Them

From the 10/30/2020 newsletter
 
Director’s Corner
 
 
Physicians have Many Civic Duties and Voting is One of Them
 
 
Adina Kalet, MD MPH
 
 
This week Dr. Kalet explores why physicians have a stake in the enfranchisement of our patients and, despite being very busy people, must vote.…
 
 

My dear friends, your vote is precious, almost sacred. It is the most powerful nonviolent tool we have to create a more perfect union.
- US Representative John Lewis

 
 
Did you know that physicians vote at a lower rate than the general population? Would you have guessed 14% lower? In a recent study, over half of physicians were not even registered to vote. This is especially perplexing and striking when compared to other educated, wealthy Americans who typically vote at much higher rates than average citizens. I have heard many physicians say that they prefer not to mix “politics” with health care (more on that later) or that as physicians, we just do not have the time to vote. This is not inspiring news about what many physicians understand about the importance of politics to the lives of their patients.
 
 
This attitude starts early. Many medical students and resident physicians, who were registered voters earlier in life, don’t prioritize registering or voting as they relocate. This break in the habit of civic engagement is noxious. By not encouraging and enabling voter registration of students and residents, we silently condone the view that we are just too “busy” doing very important things to vote. But few things are as important.
 
 
There are always barriers to voting for busy people. For instance, the annual national meeting of a large medical education organization regularly takes place on and around US election day, requiring the thousands of American citizen attendees to go out of their way to request absentee ballots. I must admit, I myself have missed voting in a midterm election because I did not plan ahead. Television coverage routinely shows long lines, even for early voting. This year, there should be no excuses.
 
 
Simply put, politics is the way we make decisions as a group about how to distribute shared resources. The majority of funding for health care is publicly funded. The regulations and codes that determine how we deliver health care are legislatively based and can end up being debated in the Supreme Court. The complex machinations of the electoral college aside, in the US, we govern ourselves by voting as individual adults. But typically, just over half of Americans regularly exercise this right and responsibility by voting. Many recent consequential elections have been ultimately decided by a small number of votes. This must change, at least for physicians.
 
 
Social issues and political advocacy are “in our lane”
 
Social determinants of health (SDoH) – affordable housing, food security, high quality education, access to health care, stable loving communities all shaped by political, economic and social policies – are increasingly acknowledged as within the health professionals’ medical obligations. SDoH are associated with race- and wealth-based disparities in health, particularly for Milwaukeeans. These are things we should care about. And while we cannot personally act to address all these issues, we can vote for the people we believe will.
 
 
There are so many examples of why physicians have a professional obligation to care about public governance. Without nationally organized preparation and response to disasters – such as the COVID-19 pandemic or gun violence – the negative impact of SDoH are exaggerated. What if pediatrician Mona Hanna-Attisha, MD MPH hadn’t been activated to do research and conduct the advocacy needed once she realized that many of her patients had elevated blood lead levels – a potent neurotoxin – associated with a switch in the source of Flint’s water supply? Physicians make a difference every day, even though many opportunities are missed.
 
 
So, why don’t we vote?
 
There is no doubt that voter participation and health are linked. Places where few low-income voters turn out have much less generous social welfare systems. This is not surprising, since elected representatives, looking to the next election, prioritize the needs of their voters and donors. Non-participants risk being disenfranchised.
 
Not voting, as individuals or groups, means less influence on elected officials. This is why health care professionals should vote and help patients register, as well. Of course, it is unethical for physicians to coerce patients or anyone to embrace a certain political view but that is not the same as enabling voters to register.  Enabling registration can be done without favoring differing political views or party affiliation.
 
As my husband, Mark Schwartz, MD, pointed out in his guest appearance in this space on October 7, 2020, it is common to hear the following explanations for avoiding civic engagement “We can’t fight big money,” “Science and politics don’t mix,” and “It’s not my job.” See his column for a deeper dive into why those responses are “wrong-headed.”
 
All this makes it even more perplexing as to why some physicians are unlikely to vote.
 
 
Getting and staying involved
 
Physicians, as well as society, must heed the lessons of a traditional civics education in order to protect democracy itself. Across the continents and centuries, the profession of medicine and physicians have not fared well when societies ceded power to autocrats. Consider how medicine was corrupted in Mao’s China or Hitler’s Germany. Physicians acquiesced and were stripped of their ability to protect patients and their profession. Medical “experimentation” led to horrific abuses, genocide, and eugenics.  As has been pointed out, autocracies are insidious because, at first, they make life easier for the educated and affluent, but ultimately physicians cannot assume we will be protected by our ancient traditions, our highly respected place in society, or our valuable knowledge.
 
As I have argued many times in this space, physicians need to be prepared to understand, how local, state and federal law influences how health care is organized and financed. We need to be “good citizens” of the systems in which we work while prioritizing our individual patients and the communities we serve. We must educate ourselves as effective advocates and understand the public health system and structure.
 
Physicians have no defensible excuse for being passive. Democracy is too delicate to leave untended. One in four physicians didn’t vote in any of the last three presidential elections. Let’s change that calculus. Society needs to hear our voices.
 
 
 
 
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