Advance Praise for the Book:

“Sometimes funny, sometimes heart wrenching, and always on the money, placing the patient first and foremost. Dr Hassaballa’s take on life in the ICU may be written for fellow doctors, but it provides a real life window into the joys, challenges and agonies of the ICU wards, experiences shared by the doctors, nurses, caregivers, patients and their families. A must read for new caregivers entering the ICU and a fantastic guide for families seeking to navigate the often daunting world of the ICU. I’d love to see this book on tables in every ICU waiting room across the country.”

Dr. Robert Turner
Founder, Medika Life


“Dr. Hesham Hassaballa brings so much more to the bedside than his medical expertise and skill – he brings his expansive heart and soul to the timeless mission of healing people who arrive at the ICU and gives hope to the families who wait for their recovery. “How Not to Kill Someone in the ICU is a masterful – transparent and transformative – must-read penned by someone who has dreamt of being a physician since childhood and now shoulders the responsibility to search out and speak to the healthcare system’s underlying illnesses. This is a breakthrough book – almost poetry – written by someone who knows what is at stake for all who seek to heal or hope for healing.”

Gil Bashe, Chair Global Health and Purpose, FINN Partners
Editor-in-Chief, Medika Life

The post Dr. Hassaballa’s Latest Book is Now Available: “How Not To Kill Someone in the ICU” appeared first on Medika Life.

In the past, brevity was lauded. In fact, I myself was praised by my colleagues for the brevity of my notes: they were short and to the point. Times have changed. Brevity can no longer suffice.

I recently wrote an appeal on a case where the insurance company denied a diagnosis of type II myocardial infarction because the doctor documented:

“Elevated troponin. Likely type 2.”

Now, every clinician understands what this means. Yet, the insurance company wrote in their denial that there is no such diagnosis as “Type 2” and denied the DRG, claiming that they therefore overpaid the hospital and were demanding a refund. It was so very obnoxious.

At the same time, the doctor in this case gave the insurance company the knife with which it stabbed the hospital in the back because he did not write two words: “myocardial infarction.”

I had a similar experience: an insurance company actually denied the diagnosis of acute respiratory failure in a kid who got intubated for cardiac arrest in his home. They had the audacity to claim that “airway protection,” which was the reason documented for why the kid had acute respiratory failure, is not a diagnosis. It was one of the most egregious denials I have ever appealed. Again, the clinicians in this case gave the insurance company the knife. Brevity beware.

The Centers for Medicare and Medicaid Services changed the documentation rules in January of this year, de-emphasizing history and examination and strongly emphasizing medical decision making. I lauded the changes.

Finally, I don’t have to worry about documenting silly, irrelevant things like a “review of systems,” and I can focus on what matters: what I feel is wrong with my patient and what I am doing about it. And brevity can no longer suffice.

No longer can we say: “UTI. Continue antibiotics.” No longer can we say: “Elevated troponin, likely type 2.” No longer can we say, “Patient intubated for airway protection.”

We need to answer the questions: how is the UTI? Is it better? Is it worse? How is the patient responding to treatment? Why aren’t you discharging the patient when the vital signs and labs all look good? Why are you admitting the patient to the hospital in the first place?

We need to write, “Elevated troponin is most likely secondary to type 2 myocardial infarction”; we need to write, “Patient intubated and placed on invasive mechanical ventilation due to the inability to maintain an open airway due to acute metabolic encephalopathy.” Brevity in our documentation can no longer be best practice.

When I give lectures to clinician trainees and practicing clinicians alike, I say the same thing: if your documentation is poor, prepare to have a difficult time. This is true when doing a Peer-to-Peer discussion with an insurance company Medical Director, or when appealing a denial, or most distressingly, in a medical malpractice case. Poor documentation hurts everyone involved, and it can even compromise patient care.

Will this likely take more of our time? Yes. And it is essential that we take this extra time to make our documentation as robust as possible. CMS has tried to help by changing the rules so we can take more time on medical decision making. We need to take advantage of this. We can no longer afford to have brief notes that say nothing, just like we absolutely can no longer afford to have a note that is 15 pages long and also say nothing.

We need to up our documentation game to a whole new level. Brevity can no longer cut it, clinicians. Brevity beware.

The post From The Appeals Desk: Brevity Beware appeared first on Medika Life.

While it is seems that these denials are random in nature – and many times they really are – and there does not seem to be any way to completely avoid them, there is one strong defense against these denials: our documentation in the medical record.

The only thing that we can do to strengthen our cases against denial is proper documentation. This is especially true when the acuity of the patient may be borderline or – most especially – when the length of stay is relatively short. I interviewed an insurance company medical director, and he told me, “Oh we love those one day stays…” He said that because it is fodder for a denial in payment, and it sets off a lengthy process to get these denials overturned.

We need to document accurately and properly. We need to take the time to document our thinking process, and explain why we are doing what we are doing in the record. At the time we see the patient, it may be self-evident to us. But, when looking at the record months or even years later, it is not self-evident to the person reviewing the chart.

This cannot be overstated. This cannot be overemphasized. Documentation in the record is everything. It establishes the proper diagnoses for the Diagnostic Related Groups (DRGs); it establishes the severity of illness for a specific patient case and hospitalization; it sets the reimbursement for services rendered to care for a patient; and if documentation is poor, it gives powerful ammunition for insurance companies to deny payment. This is not even mentioning the fact that good documentation protects you in medicolegal cases…(that’s another newsletter at some point).

Does this mean that insurers will not deny payment for cases with good documentation? Of course not. At the same time, with good, detailed documentation, it becomes that much easier to defend the care during a Peer-to-Peer discussion; it becomes that much easier to defend the care in an appeal letter; with good documentation, it becomes that much easier to defend the care to an Administrative Law Judge. Good documentation is everything, and poor documentation just makes everything that much more difficult.

Documentation. Documentation. Documentation. It is so so important that we document properly. Yes, we are all busy. And with today’s technology, it is so much easier to document well. In a few seconds, I can document an entire paragraph in the record. It is time very well spent, and in today’s healthcare environment, there really is no excuse for poor documentation.

The post Your Best Defense Against Denials: DOCUMENTATION appeared first on Medika Life.

It was a great conversation. During the conversation, a fellow physician remarked to me about a common clinical scenario: An elderly patient will present to the hospital emergency department looking quite sick. He has a urinary infection, acute kidney injury, altered mental status, and a low blood pressure. We evaluate said patient and aggressively intervene with IV fluids, antibiotics, and close monitoring. The patient greatly improves by the following day, and he is discharged from the hospital. It is a great patient care win.

The insurance company – weeks to months after the fact – will then send a denial notice to the hospital, refusing to pay for the care that was delivered because the “patient was not that sick” and did not warrant the inpatient level of care. And then the fight ensues, frequently enlisting Physician Advisors like me to argue the case for proper reimbursement.

There’s the rub, it seems. If that same patient had gotten sicker, developed acute renal failure and shock, needed invasive mechanical ventilation, and was admitted to the intensive care unit, there would be no question (one would hope) that the hospital would receive the proper reimbursement for all the care that was delivered. It is a strange and frustrating paradox, and it highlights an important point:

We do not get credit for being good clinicians.

There is no diagnostic code for “could have become septic if we didn’t intervene.” There is no DRG that says, “this patient is sick, and I can’t wait for her to get sicker.” There is NO WAY that I would EVER wait for a patient to develop organ failure so that I can definitively diagnose her with sepsis according to the Sepsis-3 definition. And yet, if I even smell sepsis on a patient, if I have the slightest suspicion that a patient is septic, I will aggressively intervene so I can prevent that patient from developing multiorgan failure and death.

And if I don’t get credit for that, then so what. Who cares. It is why I became a doctor in the first place.

At the same time, there is something we can do as clinicians to better tell the story about that sick patient upon whom we aggressively intervened. We can document our thinking process much, much better.

For example, for that patient scenario mentioned above, if we write in the medical record:

Assessment and Plan:

1. UTI

• Admit for IVF and IV antibiotics

This doesn’t really capture “how sick” the patient really was. It does not capture our clinical concern, our “gut feeling” that – if we do not aggressively intervene – the patient will get worse and develop “full blown” sepsis.

Contrast that with this documentation on the same patient:

“This is an elderly man with multiple comorbid conditions that place him at very high risk for adverse outcome and acute deterioration. He presents with a urinary tract infection, acute metabolic encephalopathy, acute kidney injury, and hypotension. All of these complications are likely related to the urinary tract infection itself. He looks quite ill on examination. If we do not aggressively intervene, he is at great risk for sepsis, organ failure, and death. As a result, he will be admitted to the hospital for close monitoring, IV antibiotic therapy, IV fluid resuscitation, serial laboratory assessment to monitor renal function, and serial reassessments.”

Now, if this patient gets better by the following day, the commercial insurance company may still deny the care for “lack of medical necessity” for inpatient admission. Yet, it is so much easier to defend the care of the clinician who wrote the second paragraph. This second paragraph better encapsulates how the patient appeared to the clinician and why the clinician decided to admit the patient as an inpatient in the first place.

It all comes down to documentation. It is the only thing upon which everyone – other clinicians, regulators, payers, third parties, and auditors (like myself) – relies: the clinicians’ documentation in the record. If it is poor, everything becomes that much harder.

Poor documentation makes it much easier for a commercial insurance company to deny medically necessary care. Poor documentation makes it much easier for an auditor to go back and deny this diagnosis or that. Poor documentation adversely affects so much in today’s healthcare world. In the era of EMRs, dictation, and technology, there is really no excuse for poor documentation.

Yes, it is true that we do not get credit for being good clinicians. We do not get more reimbursement if we do the right thing and aggressively treat a patient and prevent organ failure and death. If anything, commercial insurance payers may penalize us by refusing to pay for the care at the appropriate level deserved. It is annoying. It is infuriating. It is patently unfair.

We push back against this by properly documenting in the record what we are doing and why. And, at the end of the day, if we do right by that patient and prevent him from dying from sepsis, then that is a wonderful thing. It is why we went into healthcare in the first place.

The post We Get No Credit For Being Good Clinicians appeared first on Medika Life.

When I saw him, he was skin and bones. He looked exhausted. And what’s more, it was his birthday. He turned 85 that day. I really didn’t want to give this man — who clearly was dying — a birthday gift of jamming a tube down his throat. 

And so, after assessing the patient, I had a conversation with his children, the people who, I was told, wanted “everything done” for their father. I explained to them what “everything done” meant: that if Dad goes on a ventilator, he may never come off of it, and it may only make things worse. 

The most important question I asked them was this: “If Dad stood where I stand now and saw himself, what would he say?” The answer was clear: he would not want any of this. 

And so, together as a team, we decided not to place him on a ventilator. We would continue to fight for him, but if he became worse, we would focus on making him comfortable. He did not go on a ventilator on his birthday, and he died — peacefully, with his family around him — two days later. 

One of my biggest fears — almost two years into this terrible pandemic — is losing my empathy, losing my compassion. With death, after death, after death, it’s become much easier to just “swim down” and say “why bother,” not feeling for my patients and how I care for them. So many of my colleagues have suffered from this, and I’m afraid it will happen to me, too. 

And with the exhaustion, the exasperation, and the frank anger we are all experiencing with this latest wave of Covid patients — largely unvaccinated and senselessly getting sick and dying — I am greatly worried I will no longer have any empathy left to give to my patients — whether or not they have Covid — who need my care in the ICU. 

This case gave me great relief. Had I not had any empathy left, had I not cared at all, I wouldn’t have taken a step back and talked to his children. I would have just put the tube in his throat, place him on a ventilator, start drugs to put him a deep coma and called it a day. 

Had there been no empathy left in my heart, I would have simply said, “whatever,” and tortured this poor man all the way to his inevitable death. But, after just one look at him, there was just no way I could do that. 

I immediately said, “There is no way I’m intubating this man on his birthday.” And, thank God, we (myself and his family) were able to give this man dignity at the time of his death; we were able to give this man a good death, and I am so happy for it. 

This pandemic has broken a lot of things: it’s broken our sense of invincibility as a nation; it has broken our healthcare system; it has broken our economic system; and most importantly, it has broken the lives of hundreds of thousands of people and their families. 

The pandemic has also broken the spirits of so many healthcare professionals; it has left them scarred and hurt, angry and unempathetic. I continually fear that I may be one of those broken spirits. Yet this man, who came to my ICU on his birthday, showed me that Covid has not driven away all of my empty; Covid has not completely broken my spirit. 

And for that, Beautiful Lord my God, I am forever grateful. 

The post COVID Has Not Driven Away All Of My Empathy appeared first on Medika Life.

The Houston Methodist Hospital System is now the first US hospital to require all staff to be vaccinated against Covid-19. The bold move toward mandatory vaccination comes on the heels of a new CDC report showing the messenger RNA vaccines are 90 percent effective at preventing COVID-19 infections in healthcare workers and first responders.

Bloomberg reported Chief Executive Officer Dr. Marc Boom notified the staff via email of the new vaccine policy. The Methodist system currently requires all new staff to be fully vaccinated. The new mandate will require all staff to receive their first vaccine dose by the middle of April.

The Houston Methodist system employs 26,000 people. Currently, 83% have started the vaccination process. Dr. Bloom encourages hospital staff to demonstrate leadership through vaccination to help create a safe environment for patient care. He stated, “When we choose to be vaccinated against COVID-19, we are prioritizing safety by helping stop the spread of this deadly virus and keeping our patients, visitors, and colleagues safe,”

The Houston Methodist system is now the first hospital in the US to mandate employee Covid-19 vaccination. This company decision by a private company is likely to be a driving force to encourage widespread vaccine adoption. Recent data from the Center for Disease Control (CDC) show this controversial decision is back-up by clinical evidence.

The CDC published updated information on vaccination’s safety and efficacy in healthcare workers in the March 29th Morbidity and Mortality Weekly Report. This update analyzed Covid-19 vaccines in a real-world setting. The findings showed the Pfizer-BioNTech and Moderna were 90 percent effective at preventing COVID-19 infections among healthcare personnel, first responders, and other essential frontline workers.

Improving the number of vaccinated workers reduces the risk of spreading the infection from health providers to patients.

Many people still report uncertainty regarding Covid-19 vaccinations. There are three FDA-approved vaccines for Covid-19. The two messenger RNA vaccines from Moderna and Pfizer offer 95% protection against Covid-19. The Covid-19 vaccines from Pfizer and Moderna use messenger RNA (mRNA). A single strand of mRNA delivers instructions to human cells to produce an antibody against the SARS-CoV-2 spike protein.

The Johnson and Johnson’s Janssen vaccine offers 72% protection against infection and 86% against severe disease. The Janssen vaccine uses Adenovirus 26 (AD26) as the vector to deliver DNA material into our cells to provoke an immune response.

The Moderna and Janssen vaccines are approved for those 18 years old and up. The Pfizer vaccine is approved starting at age 16.

All three vaccines are highly effective in preventing death

Many vaccine-hesitant individuals express fears over the vaccine approval process. The Food and Drug Administration (FDA) has a strict protocol for vaccine approval. Enough data to qualify for emergency use authorization of the Covid-19 vaccines was made possible because of the substantial $10 billion financial investment combined with the virus’s high prevalence worldwide. The FDA did not rush the vaccine approval. It was well-funded, and there were a massive number of trial candidates.

An effective vaccine is only useful if people get it

Public support for vaccination is already changing. Many workers prefer an employee vaccination mandate. This CNBC poll shows the rapidly changing public perceptions.

Recent Equal Employment Opportunity Commission guidance indicates employers may mandate vaccination. The Houston Methodist system may be the first hospital to require vaccination, but other industry employers may be motivated to encourage vaccine compliance to avoid lost workdays, reduce remote working, and prevent increases in health insurance premiums.

Other companies outside of healthcare are exploring options.

In an article in Forbes, Qantas Airways CEO Alan Joyce reported his plans to restrict airline travel to those who have been vaccinated or have documented immunity. During a CNBC interview, Live Nation CEO hinted at the potential for immunity documentation before issuing tickets to concerts and sporting events. Ticketmaster released a vague but clarifying statement on their website, stating, “We are exploring a number of safety features for event organizers to utilize as they look to welcome fans back to events.”

During a Yale Chief Executive Leadership Institute poll at a virtual summit, 72% of current and recent CEOs of major companies signaled an openness to vaccine mandates. Companies participating in the Yale summit include Walmart, Goldman Sachs, and eBay.

The post Houston Hospital First In Nation to Require Staff Covid-19 Vaccinations appeared first on Medika Life.

That is what it feels like taking care of Covid-19 patients for almost a year now. It is the same thing: they get sick, they come to the hospital, they get worse, they come to the ICU, they go on a ventilator, they stay on a ventilator for weeks, and then they die.

Lather. Rinse. Repeat.

Sure, we have had some successes. But they are very few and very far in between. I think I can count on one hand the number of patients who actually made it alive and well after critical illness due to COVID-19.

Lather. Rinse. Repeat.

It’s gotten very old, the death. It’s gotten very old, the destruction. It’s gotten very old, the terrible suffering we see our patients going through.

We are tired, nay, exhausted. It is tiring to see patient after patient die a miserable death. We are so ready for this pandemic to be over, but with the slow rollout of the vaccine, the hesitancy of a substantial portion of the population (including healthcare professionals) to get the vaccine, and now these worrying SARS CoV-2 variants, Covid is going to be with us for a long time.

That is depressing, because we know that this will mean more death, more destruction, and more suffering on the part of our patients. It seems that it will be a while yet before the cycle of “Lather. Rinse. Repeat.” will finally go away. Very depressing, indeed.

It’s gotten very old, the death. It’s gotten very old, the destruction. It’s gotten very old, the terrible suffering we see our patients going through.

Yet, in this distress, in this fatigue and anguish, there is a silver lining. It means that we still care, we still have a heart that is filled with compassion.

If we really didn’t care about the suffering of our patients, then why would the scale of death and destruction bother us? If our patients were nothing more than carcasses to us, why would seeing so much suffering gnaw at our very souls? If we didn’t care at all, we would be totally fine with the pain all around us.

But, we do still care. We still have a heart that aches in pain for our patients and their families. Our hearts have not been hardened and ossified completely to the point of no return. That is very reassuring, and it brings me a modicum of peace and light in the overwhelming darkness of this pandemic.

Now, I do not make light of the moral distress that has been brought to bear on clinicians the world over. For far too many, this moral distress has hardened hearts and led to burnout. It has also led to many suicides among physicians and other clinicians. This is horrible, and we need to do all we can to help treat the moral distress which plagues far too many of those in our field.

That said, as much as I am growing tired of this pandemic and the ceaseless “Lather. Rinse. Repeat” cycle of death and destruction, there is a small part of me that is relieved. This is because it means that I still have a heart that is full of compassion and care. And I thank the Beautiful Lord for that.

The post The Silver Lining of Our Moral Distress with Covid appeared first on Medika Life.

Just imagine if we could cure everything. We could all pack our bags and go home.

You assume you have a right to be healthy, or at the very least, expect health as a prerequisite for a good life. We are all born with this assumption programmed into us and if you don’t believe me, ask yourself this question. When you are sick or unhealthy, what tends to be the first thought that crosses your mind? Why me? It is as though the gods of ill intent have personally singled you out for a dose of pain and misery.

We use the term ‘health’ freely to describe, well, pretty much anything related to our ‘health’, but what do we actually understand of the word, in terms of definition. What does your ‘right to health’ actually entitle you to? Does it relate just to your physical state and being free of disease or does it encompass more? Should you be considering your social and economic conditions when you pose the “why me’ question and are they a part of your ‘health’?

How does the ‘healthcare’ industry interpret this term? It’s an important question as this directly impacts the treatments and outcomes you can expect from your health providers. Are doctors, for instance, tasked simply with your physical wellbeing (illness and disease), or do their duties extend beyond that. 

Let’s turn to the organization that is arguably seen as our global gatekeeper for health, the World Health Organization (WHO) to explore the answer. How do they define their very reason for existence? How do they define ‘health’? 

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” 

World Health Organization

That’s a pretty tall order and a seriously extensive scope of responsibility for one single term and to bring home the further complexities of modern healthcare, this diagram from America’s Health Rankings (AHR)shows the overlaps of various disciplines considered in the field of health when they compile their data

What’s important about the little diagram above is the center, entitled health outcomes. It’s become a watchword for American healthcare. Successful outcomes are how we now gauge healthcare in America. The factors listed in the diagram, Behaviours, Physical Environment and Social Factors shouldn’t be confused with your understanding of health or the WHO definition. These environmental, social, and geographic factors are however crucial in developing healthcare’s responses and planning with regards to the care they provide you. So indirectly, they do affect your ‘health’.

Let’s explain this through the use of an example. America, in global terms, ranks terribly for infant mortality at birth. In fact, out of the 36 OECD countries measured, America comes third from last. Let’s use the 2020 data provided by AHR to support this statement. 

As an aside, if you’re wondering which state is best for pregnancy care, Vermont scores the highest, and statistically, your birth is safest in Massachusetts (3.8 deaths per 1000) and most at risk in Mississippi (8.7 deaths per 1000). According to the AHR 2020 report;

In 2018, over 21,000 infants died in the United States. According to the Centers for Disease Control and Prevention (CDC), the leading causes were birth defects, low birthweight and preterm birth, maternal pregnancy complications, sudden infant death syndrome (SIDS) and unintentional injuries.

The U.S. infant mortality rate has been consistently higher than other developed countries, and 1.5 times higher than the average (3.8 deaths per 1,000 live births) among Organization for Economic Co-operation and Development countries. Research indicates socioeconomic inequality in the United States is likely a primary contributor to its higher infant mortality rate.

According to the CDC report referenced above, race affects these figures in the following way. Sections in bold added by way of explanation.

Black women had the highest mortality rate (10.75), followed by infants of non-Hispanic NHOPI (Native Hawaiian or Other Pacific Islander: 9.39), non-Hispanic AIAN (American Indian or Alaska Native: 8.15), Hispanic (4.86), non-Hispanic white (4.63), and non-Hispanic Asian (3.63) women.

So that part of our diagram above, entitled Social and Economic, is actually the driving factor that increases the risk of your baby dying at birth. Does this have anything to do with your health and your child’s health, other than implying you move to Vermont for your pregnancy and deliver the baby in Massachusets? What if you’re black? Will moving help or is your race a fixed determinant in your child’s chances at birth? 

This where it gets complicated and where healthcare treads on quicksand. Your race, from a genetic point of view, does not affect your risk of infant death at birth and that is what makes the figures above so damning. These figures have nothing to with genetics or you but are rather an indictment of how the color of your skin, your sex, and your economic and social situation determine your access to healthcare and a healthy lifestyle. In effect, your right to ‘health’.

Racism, it turns out, kills babies, not race. Being socially disadvantaged kills babies. Being financially impoverished kills babies. 

In terms of health, the above are all classic WHO indicators of physically healthy people living in an unhealthy society. If we are to judge by the WHO definition, then American healthcare, in its current state, fails to live up to the lofty goals set, and it isn’t just in the field of infant mortality that it falls short. 

The question is, can we blame the American healthcare system for social and racial disparities? How can you hold doctors responsible for generations of institutionalized racism, sexism, and social inequality? No fair.

There is a quandy at the heart of modern healthcare. Is your provider merely required to treat your symptoms or do they have a moral and ethical responsibility to look beyond the diseases, to identify the causes and address these, to seek cures, rather than treatments? Where does their remit begin and where does it end?

The dangers of mixing the fields of medicine and health with finance, economics, societal politics, and race are that the lines begin to blur. Boundaries are necessary for the effective functioning of any system. Act beyond the scope of your boundaries (profession) and you dilute both your efficacy and your impact.

While we cannot hold Healthcare accountable for societal racism, sexism, and general inequality, we most certainly can expect the industry not to engage in any of these practices. That is sadly not always the case, but the industry is beginning to assess itself more introspectively with a view to rooting out these practices. Empowering and recognizing the voices of women within Healthcare is a massive step in the right direction.

Patients can also, and rightly so, expect health care providers to address the imbalances in their communities that lead to the racial disparities so clearly underlined by infant mortality in America. 

Let’s clarify that statement as it’s a weighty one. This expectation does not involve doctors and nurses dropping their stethoscopes and picking up banners for the next BLM protest. It refers to them addressing these imbalances from within the scope of their professional abilities. A clear set of “non-medical symptoms” or parameters exist to identify the at-risk and healthcare needs to respond accordingly by pre-empting the 8.7 dead babies for every 1000 born in Mississippi.

The healthcare profession is about exactly that, health. It isn’t about creating a revolving door of repeat business, but rather seeking out the lofty aspirations of the WHO. To treat a ‘sick’ society as their primary patient, particularly if that patient lies at the heart of burgeoning illness and disease. 

Providers need to encourage free weekly clinics in marginalized communities, governors need to increase budget allocations for communities that are in dire need of healthcare, free medication needs to be made available for those unable to provide for themselves., courtesy of a cash-rich Pharmaceutical industry. All of these things and more need to be put into action. Not to act is to be aware of the growing tumor and refusing to treat it. 

It leaves the industry with blood on their hands.

By now, I hope you understand that your ‘health’ means far more than simply waking up in the morning with all your fingers and toes accounted for. To be truly healthy, you need to strive for a stable social and economic environment, for you and your family. Achieving this is within everyone’s reach and when we encounter obstacles intentionally placed in the way of people achieving their true health, it falls on everyone’s shoulder to speak out and speak up.

Not just healthcare.

The post Racism, It Turns Out, Kills Babies, Not Race appeared first on Medika Life.

It is consistently working to improve the delivery of medical care, as well as better understand issues pertaining to public health, as evidenced by its work to maintain the International Classification of Diseases (ICD), a diagnostic tool for epidemiology and disease classification. Similar to other diagnostic tools such as the DSM, it is one that has been frequently updated over the years to reflect the latest research.

One of the more recent updates to the ICD saw a more thorough classification of the concept of ‘burnout’, for example. It is now recognized as a syndrome, resultant from “chronic workplace stress that has not been successfully managed”. It is important to note that this applies explicitly to an occupational context. Burnout is something that can be seen across a wide array of industries; however, physician burnout is one that is of increasing concern in the wake of the pandemic.

As many states and cities across the globe are seeing new surges in coronavirus cases, hospitals and healthcare providers continue to grapple with the dynamics of the pandemic. Many are facing shortages of essential Personal Protective Equipment (PPE) and other medical supplies, despite being months into the pandemic.

Although some supply chains for different goods have adjusted, the healthcare industry is still plagued by deficiencies. This has critical implications. Without the needed supplies, healthcare providers risk unnecessary exposure for themselves, their patients, and their families. This, coupled with the increased amount of patients, is a recipe for stress, and eventual burnout, for many physicians.

Medscape’s 2020 ‘National Physician Burnout & Suicide Report’ found that 42% of the 15,000 physicians surveyed reported being burned out. Half of those surveyed said they would give up at least $20,000 in annual income to reduce their working hours. This was released in January, just months before the WHO had declared the novel coronavirus a global pandemic. The situation has only become worse, as hospitals are often understaffed or otherwise ill-equipped to handle the new demands on the healthcare system as a result of COVID-19.

Physicians are combatting the novel coronavirus, as well as fighting for their mental wellness. It is essential that we raise awareness of mental health for everyone, especially for those upon whom we all rely on our well-being. Doctors around the world are thankfully taking notes and researching ways to help provide interventions to help ease the burden. For the sake of all providers and their patients, let us hope this sheds more light on the issue and leads to actionable change.

The post Coronavirus and Physician Burnout Are Adding Fuel to the Fire appeared first on Medika Life.

Feeling burned out and overwhelmed? Here are some strategies that might help you during these very difficult times.

Check-in with yourself

Are you feeling anxious? Depressed? Angry? Scared? Worried? Try to identify all of the emotions you are experiencing. If it helps, write it down in a journal. Exploring your recent thoughts and feelings enables you to make sense of what is happening in your inner world and how the health pandemic is impacting you.

Access mental health supports

If you need professional help, reach out to your doctor if you are noticing difficulties with your sleeping and eating patterns, mood, energy, and if you are having distressing thoughts. You can use the Employee and Family Assistance Program (EFAP) mental health services available to you through your workplace for free, short term counseling for you and your family members.

The Ontario COVID-19 Mental Health Network offers temporary, free, short term, individual counseling to healthcare workers, where interested workers are matched with a therapist through their network website .
The Canadian Psychological Association is also offering free, short-term therapy by registered psychologists and has more information on their website.

Another resource is The Centre for Addiction and Mental Health (CAMH), which offers short term psychotherapy and psychiatry services via their website.

If you feel you need more intensive or ongoing psychosocial support, reach out to a therapist through Psychology Today to find a counsellor who has a therapeutic approach or style that fits with your needs.
If you need urgent support, call a crisis line in your local area, which you can find through websites such as this one. In mental health emergencies where you feel you are at risk of harming yourself, call 911 or go to your nearest hospital emergency room.

Challenge negative thoughts

In health care, where you are surrounded by upsetting news daily, it is common to have a whirlwind of thoughts going around in your head that might further increase your stress and anxiety.

Some examples may be: “I’m going to get COVID-19”, “I’m going to give COVID-19 to my patients”, “My family will get COVID-19 because of me”, and so on.

While there is sadly no guarantee in life that these things won’t happen, we can still try to challenge these thoughts with more positive ones that may feel real to us, such as: “I’m following all of the safety protocols to protect myself, my patients and my family”, “I’m doing everything I can to be safe”, “I’m washing and sanitizing my hands regularly and that is the best strategy to stay healthy”, or “By staying at home when I’m not working, I’m doing what I can to slow the spread of the pandemic”.

Insert any other positive thoughts here that may help you manage your anxiety, stress, and overwhelm.

Remind yourself of your professional values and interests

In this pandemic, it is hard to think about anything but the risks associated with working in health care and it may be hard to see beyond that. If you find yourself questioning everything and feel unsure of yourself in your role or position, it may be useful to keep in mind why you went into your field of practice in the first place.

Was it because you always knew you wanted to help people? Or because you wanted to make a difference in the world and contribute to society? Or perhaps you have a unique interest in a certain client population or area of expertise and this is your specialty now? What other reasons led you to do the meaningful work you do?
These reminders might ground you and help you feel refreshed in an unsettling and confusing time.

Know that you are doing the best you can

When you feel that you aren’t doing enough to make a difference, take a moment, stop, and look around you.

See the clients or patients in your line of sight that you have helped. Notice their smiles of thanks, the gratitude you hear in their voice, and the efforts they make as they try to follow your recommendations and guidelines.

These types of mindful moments will help you shift your focus away from your stress toward focusing on why you chose to do this valuable work in the first place — to provide excellent care to your clients and patients.

Talk to coworkers you confide in and trust

The people you work with are the people you often spend the most time with as so much of our days are spent working. In your group of colleagues, hopefully, there is at least one person you really connect with and who you feel you can talk to. Reach out to them if you need a moment to vent, to share a funny story, or discuss how you are feeling. This helps foster a sense of trust, community, and shared experiences.

Connect with loved ones

Calling and video calling your close family and friends and spending time with your spouse or partner or children during this time of uncertainty can help manage feelings of stress and burnout.

Talking with important others about things that are not related to the pandemic can help get your mind off of it. This allows you to focus on other topics that interest you and make you happy while also investing in key relationships in your life.

Limit media

Watching the news or reading articles on your phone or computer constantly can add to your anxiety, stress, worry, and overwhelm. You may already be supporting patients who are COVID-positive daily, you may be concerned about eventually working with COVID patients, or perhaps you are worried about passing it on to or getting it from others. Constant consumption of media further feeds into this stress and exacerbates it. This cycle of thoughts can continue to spiral if they are not kept in check.

A mental break from all things COVID at points throughout your day can be just what is needed to help you refocus. Permit yourself to turn off your phone and computer when you need to.

Focus on the basics

Eat. Drink water. Sleep. Exercise. No need to follow a perfect and ideal routine here, but try to do what you can, when you can. Do activities that help refuel and relax you, such as deep breathing, yoga, meditation, mindfulness-based activities, or anything that rejuvenates you, such as losing yourself in a hobby that you are passionate about. Building in positive habits and routines, especially when you feel stressed and overwhelmed, can go a long way toward helping you feel better.

Focusing on these basics can motivate you, re-energize you, and keep you going through those long and tiring workdays.

This is a very challenging time for everyone. Your health is number one and needs to be stable before you can fully help others. Take care of yourself and be well so that you can continue to do the important work you do to support patients and clients every day.

The post Working in Healthcare During COVID-19? Tips for Reducing Burnout and Overwhelm appeared first on Medika Life.