Registering New Voters in the Emergency Department: A Virtual Session with Dr. Alister Martin from VotER

From the 10/16/2020 newsletter

Grand Rounds Wrap-Up

Registering New Voters in the Emergency Department: A Virtual Session with Dr. Alister Martin from VotER

Megan Quamme, MCW-Milwaukee Medical Student

“Are you registered to vote? Would you like to do that while you are here today?” These are two questions that physicians can ask every patient, according to Dr. Alister Martin, an emergency medicine physician at Massachusetts General Hospital and founder of VotER.

Where VotER began

Dr. Martin started the non-partisan organization VotER to make it easier for his patients to register. He first had this idea as a resident working in the Pediatric ED. Dr. Martin was caring for two pediatric patients who had come into the Emergency Department with their mother because they were homeless, new to the area, and living in a car. When trying to get the family shelter for the night, Dr. Martin learned from a social worker that the patients’ mother would only be eligible for a spot at a homeless shelter if she could claim residency in the state. The easiest and fastest way to claim residency was by registering to vote. Dr. Martin had never realized that physicians could register patients to vote at the hospital.

Nationwide impact

Fast forward to 2020, and VotER is now active in over 200 hospitals across the US, supplying medical providers with QR codes, lanyards, posters, and badges that link patients to voter registration resources in their state. (Originally, voter registration kiosks were set up in ED waiting rooms that patients were free to use... and then, unfortunately, COVID hit, so the organization switched gears to touchless registration strategies.)

How we can help

Dr. Martin had a few tips for providers looking to encourage patients to register to vote. First, he recommended updating each of our email signatures to provide information for voting registration/absentee voting. Doing just that will guarantee at least one or two people to get registered. His second suggestion was to add questions about voting registration and having a safe voting plan to your Social History. To help with this, you can always direct patients to www.myvote.wi.gov where they can find state-specific information about polling sites, early voting and absentee voting. The last suggestion was to hang signage with voter registration information in public waiting areas where all patients can see them. This year, during the COVID pandemic, you may want to add some extra recommendations: it is safest for your patients to vote by mail or vote early (with a mask) rather than in-person on Election day.

The big take-away from this talk is that voting is closely tied to healthcare. Making voting safe and straightforward for our patients is another service we can provide as medical providers. Registering to vote is non-partisan and is an important way to participate in our democracy. By encouraging our patients to participate in elections and thus health policy decisions, we are also caring for their physical, emotional, mental, and occupational health.

Megan Quamme is an MD candidate in the MCW- Milwaukee Class of 2023.  

My Reflections on Professionalism - Cassie Ferguson, MD

 From the 10/16/2020 newsletter

Professionalism Perspective

My Reflections on Professionalism

Cassie Ferguson, MD – Winner, 2018 MCW Professionalism Enrichment Award

I have never been inspired by the word “professionalism,” certainly not by how it is typically interpreted. It calls to mind people in suits, confidently shaking hands across a long board room table. While in academic medicine we may describe it more heroically, I would argue that we assess professionalism in our students, trainees, and faculty in a similarly uninspired fashion: Did you attend lecture? Did you show up on time to clinic? Did you wear the “right” clothes? Did you finish your Epic notes?

Our professionalism might be judged by our behaviors, actions, attitudes, and in how closely we conform to an organization’s code of conduct, but I’ve always believed that these outward displays matter less than the intentions behind them. Those people in my life from whom I have learned the most about professionalism in medicine are those who acted altruistically; not out of a sense of duty or with a disregard for their own health or well-being, but rather out of a deeply felt connection and a true sense of belonging to their patients, colleagues, and community.

“From everyone who has been given much, much will be required." 

- Luke 12:48 (New American Standard Bible)  

Growing up, I tried on a long list of potential professions. At some point in my life, I wanted to be a chef, a middle school teacher, a therapist, and a fashion designer. My parents never tried to talk me out of pursuing any of these; they did make it clear, however, that it was my responsibility to be the best at whatever I chose to do. I never understood this as a responsibility to the profession itself; I felt this – as I believe my parents intended me to – as a higher calling to serve humankind in a way that reflected everything I had been given in my life.

“We value respect. We strive for excellence. We practice magnanimity." 

- MCW Professionalism Code 

That calling informs my purpose and intentions as a professional in medicine. My core commitment to respect dictates that I practice radical empathy; that is, I strive to acknowledge the suffering of others and also to be “intentionally critical and actionable with regard to the ways [I] play a role in the pain they are experiencing” (Rachel Elizabeth Cargle). My commitment to excellence is grounded in love for my patients, colleagues, and students and in the humility to admit that while the biases I have that impact my interactions with others may not be my fault, they are absolutely my responsibility to mend (Sebene Selassie). My commitment to magnanimity is an outgrowth of the grace that has been extended to me by my family, mentors, advisors, colleagues, learners, and patients along my path to becoming a physician.

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 well-being and community. She is the director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

   

My Reflections on Professionalism - Jeff Fritz, PhD

 From the 10/16/2020 newsletter

Professionalism Perspective

My Reflections on Professionalism

Jeff Fritz, PhD – Winner, 2019 MCW Professionalism Enrichment Award

When I think about professionalism, three topics come to mind: personalities, people, and practices.

Professionalism and Personalities

If you could talk to anyone from the past who would it be? Each time I find myself posed with this question a long list of people come to mind. When pressed by those around me to select just one person, I usually find myself selecting someone that could guide me in my personal challenges that I’m facing in that moment.

In the area of professionalism that person would be Sir William Osler. Dr. Osler was on the forefront in many areas of medical education. Before there was a Flexner Report, he encouraged integration of foundational scientific knowledge with clinical practice (Osler is one of the founders of medical student learning knowledge and practice skills by the patient’s bedside); he encouraged nurses and physicians to be trained together (an early forerunner of Inter-Professional Education or IPE); he was a vocal advocate for the advancement of women in medicine; and he was passionate about physicians embracing their role to ease human suffering with a concept he termed Aequanimitas1. Unfortunately, I think this concept can be easily misinterpreted to mean emotional disconnection, but as I read Sir William’s writings, he clearly encourages us to seek emotional engagement and connection with others in a fashion that best meets the needs of the situation. Equanimity, from Osler’s perspective, is the discerned application of emotion in the process of easing the suffering of those around us.

Professionalism and People

As we celebrate Professionalism Week at MCW and as I reflect upon professionalism, the first thing that comes to mind is gratitude for the variety and skills of the mentors and coaches who have invested in my development. Having a constellation of people to support my development and encourage me to do more than I imagined has been critical in my development as a person and a professional.

Many thanks to my past and current mentors, coaches, and peers who have had the courage to approach me with difficult growth fronts, support me through those transitions, and encourage me to move beyond my comfort zone. I thank all of you who had the courage to tell me when I had broccoli stuck between my teeth, or adjusted my color of tie before a speaking engagement.

Professionalism and Practices

I do not really spend much time each day thinking about being/acting professional or the long list of professional behaviors but, when I do think of the practice of professionalism, three words come to mind: discernment, compassion and equanimity.

As I progress through each day, I hope to approach each interaction as an opportunity to extend compassion. The challenge comes in the form of my two personal growth fronts: (1) Can I discern the proper application of compassion to the situation at hand? and (2) Given the emotions of the situation, Can I practice equanimity as I work through the process of discernment, thereby sharing the form of compassion dictated by the situation?

Compassion

Before I forget, let me share my understanding of compassion. Compassion sometimes means fighting for justice, sometimes it means standing down, sometimes it means something as simple as helping someone carry stuff from their car to the office. Compassion is not a weak term, but a varied term that aims to ease the burdens of those around us. In this crucible of discernment, equanimity, and compassion is the core of my practice of professionalism. The focus is sharing compassion (easing burdens and suffering), while trying to discern the proper, emotionally appropriate application to the situation (equanimity).

I do not feel by any stretch that I have arrived at some level of noteworthiness in my practice of professionalism. I simply acknowledge that I continue to try and to improve.

Again, my thanks to all who have been patient and encouraged my growth. If I have any encouragement to share regarding the practice of professionalism, it would be to encourage everyone to find a team of supportive people, to focus on extending compassion, and to develop discernment and equanimity in the light of situations that call on us to adapt and grow. To some extent professionalism is the daily practice of character traits, that in my case I’ve simplified to three domains – discernment, equanimity and compassion – which are supported and developed by my constellation of coaches.

Personally, it was humbling to receive the Professionalism Enrichment Award as I feel like I still have a long way to go to discerning the proper application of extending compassion to those around me. My final thought is a quote from Sir William Osler as he addressed a graduating class of health care professionals: “that we are here to add what we can to, not get what we can from, Life.”

1Olser W, Doctor and Nurse, No. II in: Aequanimitas and other Addresses June 4, 1891.

Jeff Fritz, PhD is an Associate Professor in the Department of Cell Biology, Neurobiology and Anatomy at the MCW-Central Wisconsin campus. He is a member of the Curriculum, Faculty & Student Pillars of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

The Emotional Toll of Being a Health Care Provider During a Global Pandemic

 From the 10/16/2020 newsletter

Kern Grand Rounds Preview

The Emotional Toll of Being a Health Care Provider During a Global Pandemic

Paul A. Bergl, MD - Pulmonary, Critical Care, and Sleep Medicine

Dr. Bergl will be part of a Grand Rounds panel discussion sponsored by the Kern Institute during MCW’s Professionalism Week. The presentation will be held virtually on Thursday, October 22nd from 9:00 - 10:00am CT. To register, click here.

When I was asked to contribute a written reflection on the emotional toll that COVID-19 has had on healthcare workers, my first reaction was - and still is - genuine fear. Fear that any public emoting would come off as disingenuous or hyperbolized for rhetorical effect. Fear that I would come off as whiny, as weak, as lacking resilience. Fear that I had little to offer and nothing particularly novel to say about a pandemic that has been covered from every last angle. Most importantly, fear that, as a gainfully employed and financially comfortable white man, I might leave others wondering, “He thinks he has a reason to feel burned out?”

In this loosely chronological reflection, I do not assume that I have captured the sentiments of many of my colleagues; instead, I only offer my own. And I hope that I have made evident my sincere sympathy for those suffering greatly from the fallout of COVID-19 and my perpetual gratitude for those working even harder than I.

The "early" days

February. I remember my first reaction to COVID-19 was blithe naivete. Skeptical of media hysteria, I encouraged friends and families to keep on with their daily lives. “You are far more likely to die from a bolt of lightning than a novel virus spreading overseas.”

After coming to my senses as SARS-CoV-2 spread among our neighbors, I next experienced exhilaration. Here was my moment to fulfill the great dreams I had as a twenty-something applying to medical school... To save lives! To be part of living history! To serve on the frontlines of a crisis! Rapidly elevated to hero status, I dutifully reported to my clinical roles and spent most waking hours helping my colleagues prepare for Armageddon. We developed protocols; we debated how we would allocate scarce resources. We strategized about how to save our medical students’ education. Despite long hours in the ICU and countless email exchanges and Zoom meetings outside of my clinical work, I was indefatigable.

The pandemic continues

Of course, incredible sorrow interspersed these periods of elation. I witnessed patients succumbing to COVID-19 in an airtight room, devoid of any symbol that they indeed were a person. No family. No photos of loved ones. No spiritual guides. No favorite sweatshirt. Who wouldn’t cry after holding the phone to a dying octogenarian’s ear while her family pleaded with an unyielding fate?

Soon, guilt settled in. Guilt that I had regular opportunities to see real actual live people while millions of lonely people huddle indoors, comforted at best by faces on LCD screens and at worst, discomforted by total solitude. I reported dutifully to a job in which solidarity was high... A shared sense of purpose in a fight against a new enemy. Why should I have any sense of grief when so many collected unemployment? Or experienced the exasperation of witnessing racial injustices on two fronts? Or suffered through the grief of losing a loved one to a crisis partly of our own making?

Then came a rising and ultimately unmitigated anger. My fellow citizens began flouting social distancing. My leaders began politicizing every part of the fight. Millions assumed that because most cases were mild that the entire thing had been blown out of proportion. These attitudes depreciated not only the work my colleagues and I were doing in the ICU every day, but also the efforts of our greater scientific, medical, and public health communities. Yes, I am still pretty pissed off.

My own experience as a COVID-19 patient

In August, I suffered the profound malaise of two weeks of a so-called “mild case” of COVID-19 that sapped not only my energy and sense of smell but my optimism that we were turning the corner on a crisis. To add insult to injury, I believe I contracted the virus while performing a bedside procedure that conflicted with my own values... but a procedure that I was ethically obligated to provide nonetheless, at least within the framework of how we provide healthcare in America.

Where we are now

Now, as cases surge to their highest levels, I can see the lassitude that heralds burnout on my own face and those around me. I try to remind myself every day that I am privileged. And I am. I try to ignore the outside noise when I am at the bedside. “Remember Paul, your obligations are to this patient, this human being, and you need to be the best damn doctor you can be right now.” Sadly, there are few outlets to recharge from exhaustion these days. And after all, depersonalization is probably adaptive, right?

Paul A. Bergl, MD, is an Assistant Professor of Medicine in Pulmonary, Critical Care, and Sleep Medicine at the Medical College of Wisconsin. He will be part of a Grand Rounds panel discussion sponsored by the Kern Institute on Thursday, October 22, 2020 from 9:00 – 10:00am CT. To register, click here.