Cast & Curious

Category: Self – Management

  • Turning Quarantine into Quality Time

    Most healthcare workers and facilities were caught unaware by the corona virus pandemic. Orthopedic surgeons who answer ER calls for acute extremity trauma weren’t exempted from this onslaught. After a short stint at the pandemic frontline, I was back lining COVID-19 front liners with hospital’s emergency incident command (HEIC) group. After about a week with HEICS, a friend told me I was on the verge of collapsing. I made it through another week, just in time for another pull out for yet another task. I thought I was out of the frying pan.

    An article in JAMA Internal Medicine predicted a pandemic of behavioral problems and mental illness in the general population as a consequence of COVID-19. Health workers are already experiencing burnout and “moral injury” even prior to this pandemic. Moral injury “describes the mental, emotional, and spiritual distress people feel after perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” says Dr. Williams. The uncertainties of COVID-19 fight all the more add to this burnout and moral injury. Little has been discussed about the health workers own mental health.

    There are myriad of reasons why many health workers does not verbalize anxiety while frontlining. Front liners are very busy saving others, often to the point of self neglect. Personally, anxiety was at its during the mandatory 2 weeks post front lining quarantine. Doing nothing while on isolation could wreak havoc on mental health if left unaddressed. For example, I had bouts of the “interns’ syndrome”- diagnosing myself to have contracted COVID-19 based on clinical symptoms of the disease. I also had sleepless nights thinking about the “what if” scenarios if I contracted the disease. Yet I survived the isolation days thanks to a network of social support (including social media) that worked from a distance, and these four essential “steps” I learned from the writings of Adam Grant, a Wharton professor. Here are those essential steps:

    Labelling. The same JAMA Int Med article predicts a substantial increase of mental health issues during and probably after pandemic. Problem is, not many in this generation have prior pandemic experience. Even with health workers who deal with a lot of stress may find this pandemic-related anxiety, on a different level. Most psychologists and psychiatrists would just call it “anxiety” but I don’t think I had this level of anxiety before. I will call it “Post Front lining Stress Disorder” just to highlight the elevated anxiety level . Not totally a very scientific way of labelling but yeah, I am very anxious post front lining.

    T1. Are you dealing with pandemic related mental health issues as a health worker ? How did you came to terms with this?

    Reframing. I’m not exactly an introvert, but I’m comfortable being alone. I read books, hike mountains, travel places and photographed landscapes on my own. The enhanced community quarantine however is prohibitive to some of these activities. So I reassessed my isolation, tried to understand and looked for “productive” opportunities in each of these perspectives. The fear of dying alone doing nothing is I’m afraid what inspired me to reframe my isolation.

    T2. What or who was your inspiration for “reframing” your isolation?

    Distraction. The most insane part of the isolation ordeal for me is distraction . I tried cooking, vlogs, zoomongering and social destalking- unfollowing apocalyptic people and news online. I’m pretty surprised about the things I can and can’t do while in isolation. What’s more important was the act of trying to distract myself from a sordid state of self isolation. Just a warning that although “distraction” may alleviate misery on the short term, some “distractions” like alcohol or drugs have destructive effect on people.

    T3. Whats the funniest distraction you did while quarantined or isolated?

    Amelioration. There was a point in my distracted state that I realized, distraction isn’t enough. I have to protect my (and the people I love) health. I have to help protect my work and colleagues and my embattled nation. I have to learn, do or produce something relevant to this COVID-19 pandemic. I learned HEICS ala “The Matrix” in 2 weeks time. But thats another story.

    T4. What was the most productive thing you’ve done while isolated or quarantined?

    Join #HealthXPh twitter chat on April 18 at 9PM Manila Time as we suggest ways of turning quarantine into quality time. Note the following guide questions and append #HealthXPh to all your tweets!

    • T1. Are you dealing with pandemic related mental health issues as a health worker ? How did you came to terms with this?
    • T2. What or who was your inspiration for “reframing” your isolation?
    • T3. Whats the funniest distraction you did while quarantined or isolated?
    • T4. What was the most productive thing you’ve done while isolated or quarantined?

    See you all!

    Image by Freepik

  • Are Healthcare Professionals Coachable?

    I’ve been an orthopaedic surgeon for decade and I thought I’ve done everything I can do to every orthopedic case in my area of practice. My mentors wasted no time training me to be a lifelong learner, provided me skills to handle most orthopedic cases and instilled professionalism and strict adherence to ethical values. These were tested of course and boosted my confidence to handle cases I have minimal exposure before, like wartime injuries. I thought performance was primarily measured by the physician surviving a challenging practice. Clearly, I am mistaken.

    It’s what you learn after you know it all that counts

    John Wooden

    The changing concepts and technology in medicine nowadays increases practice demands. Outcomes measure performance, leadership and business skills determine successful practice and government regulatory mandates are burgeoning by the day. In the field of practice, there’s no reliable way of determining your level of performance as a physician. Did my performance plateaued or dipped. Where or who would you go to? Academe? Previous mentors? Peers? For many physicians and surgeons out of the academe, this isn’t easy.

    Perfection is not attainable, but if we chase perfection, we can catch excellence

    Vince Lombardi

    What is a coach?

    A coach is a a teacher, leader, motivator and critic with typically more experience than the learner . The coach may not be the most talented performers in their field but their intangible “wisdom” from tireless study of the field compensate for this. Ironically, most of the coaches gain their insights in the field from their “failure” in the field.

    Coach Vs. Mentor

    Although both mentors and coaches aim for the success of the mentee or coachee, the former is more of a role model and the coach, a critic. We have our mentors mostly in the academe, during med school or training and they usually remain there. The coach if ever we do actively search for one, are often found in practice.

    You don’t have enough talent to win on talent alone

    Herb Brooks ( US Team Hockey Coach that won over the much talented, physically intimidating Soviet Union team)

    Many of the successful people we admire (particularly those outside medicine) have coaches behind even at their peak performance. Michael Jordan and Kobe Bryant have Phil Jackson, Manny Pacquiao (the boxer) have Freddie Roach. Even tech giants Larry Page, Sergey Brin, Erich Schmidt (Hello, Google) and Steve Jobs ( of Apple) have Bill Campbell coaching them. So why can’t physicians be coached?

    T1. What are the barriers to coaching healthcare professionals?

    If you are going to win games, you had better be ready to adapt

    Scotty Bowman

    Generally, the practice of medicine has this negative perception of coaching. In med school and training, one may easily find a mentor or role models to hone ones craft. In practice, many physicians are on their own and rarely connects with previous academic mentors. To many colleagues, being coached meant a “faltering confidence”, lack of skill and or even lack of independence. Patients who see their physician being coached may interpret this as a sign of incompetence. Consequently in practice, a physician rarely finds a physician coach and there is dearth of physician coaches.

    T2. Are there benefits/ risk to coaching healthcare professionals? Who benefits or who is at risks?

    A coach is someone who tells you what you don’t want to hear, who has to see what you don’t want to see, so you can be who you have always known you could be

    Tom Landry (NFL’s Dallas Cowboy’s winningest coach)

    The benefits of coaching in other fields is almost unquestionable. In medicine particularly in surgery, outcomes are tied to masterful performance of a given skill set or techniques. I tell residents the P2R2- Plan , Practice, Review, Repeat and they have their mentors to follow this through. In physicians practice, critiquing performance is left to peers who often, defaults to self critiquing. We all knew how self bias works.

    The bottom line of an improved performance is improving patient outcomes. Thus, while both the coach and coachee physician improve their performance, it’s the patient that ultimately reaps the benefits of a coaching relationship

    T3. What are the traits of a coachable healthcare professionals?

    Smart alecks are not coachable

    Bill Campbell, Trillion Dollar Coach, coach to Larry Page, Sergey Brin, Steve Jobs, Eric Schmidt, Jonathan Rosenberg

    After med school and training, we physicians though we knew it all. I did. Until we notice that plateauing or worst, dipping practice performance. It takes humility and open mindedness to critique one’s own performance much more so, if the criticisms came from someone else. The flexibility to adapt to changing practice and patient’s needs are also necessary. In my case the active pursuit of a relatable coach that “clicks” with me is the hardest, especially in the competitive field of medicine and surgery. I’d like to change that, even at this stage of my career.

    Join #HealthXPh chat this Saturday Oct 19, 2019 at 9PM Manila time for an interesting discussion on healthcare professional coaching. The following are our chat guide questions:

    • T1. What are the barriers to coaching healthcare professionals?
    • T2. Are there benefits/ risk to coaching healthcare professionals? Who benefits or who is at risks?
    • T3. What are the traits of a coachable healthcare professionals?

    Don’t forget to append #HealthXPh in all your tweets during the chat. See you all!

    Image by David Mark from Pixabay

    References:

    • Dougherty, P & Joyce, B. (2018). The Orthopedic Educator: A Pocket Guide. 10.1007/978-3-319-62944-5.
    • Schmidt, E., Rosenberg, J., & Eagle, A. (2019). Trillion dollar coach: The leadership playbook of Silicon Valley’s Bill Campbell.
    • Gawande A. Personal best: top athletes and singers have
      coaches—should you? 2011. .The New Yorker 2011 issue.
      http://www.newyorker.com/magazine/2011/10/03/personal-best.
      Accessed 18October 2019

  • For using Facebook and other social media platforms, how much of your personal privacy are you willing to give away?

    It blew right in our face.

    The “Facebook Scandal” (FB data breach with The Cambridge Analytica) shook many industries using  this social media platform to “influence” a particular interest.

    “We exploited Facebook to harvest millions of people’s profiles. And built models to exploit what we knew about them and target their inner demons…” Christopher Wylie, the whistleblower who worked with a Cambridge University academic to obtain these data using third party app, told the Observer.

    Mark Zuckerberg & Co built Facebook to fill its users’ need for socialising, online. We all knew however, that Facebook was also created to harvest data in the first place. This is in the fine print of FB’s terms of use you’ve agreed to, when you started using Facebook.   Although the company publicly admitted using data for their own regulated and targeted advertising algorithm alone,  it may have “unknowingly” provided  “limited data” to third party companies thru the various apps. Zuckerberg apologised for the “break of trust” given to them by their users because of this. What those “third party entities” do ( or did) with these data remains a mystery to the public.

    Remember how Target “snooped” on its customers and figured out a teen girls is pregnant before her father found out? By harvesting its customers’ shopping habits and using  predictive analysis, it was able to predict the most likely “next buys” of its customers and “structured” their stores to capture that buying intention. This pregnancy prediction model predicted with 87% accuracy that a lady would soon be delivering a baby if it buys vitamins, supplements, diapers or a blue rug!  We can only hypothesise about the staggering scenarios of “what ifs” if these breached data reached a not so well intentioned party. Elections, politics or buying habits are but to name three.

    In healthcare, privacy breaches are not only considered scandalous. It is  “deadly” as well for it may cost lives.

    To be fair to Facebook, healthcare (willingly or unwillingly) benefitted from some of the platforms “allure”. The relatively inexpensive, easy, accessible and wider user base are very good reasons for educating the masses about health  issues. It is also a very good alternative to ( or in fact dismantling) more traditional, expensive media platforms for getting across messages to a wide range of users.  There are probably thousands if not millions of patient support groups in FB.  Advocacy campaigns aimed at improving healthcare abound in this platform. There are also healthcare professionals who use FB as a listening and or speaking platforms for many well intentioned campaigns. In short, the healthcare industry through its stakeholders, are also benefitting from FB’s social media clout while knowingly giving away part of its privacy. Here’s where the conundrum begin and why this breach opened a  pandora’s box in healthcare.

    Imagine, if user profiles and data went into the hands of not so well intentioned healthcare industry player. What if this data is used “shape”, influence or manipulate minds to buy a particular product? Or tinkered, to accept or debunk certain healthcare issue without the benefit of validated research and recommended protocols by the medical community? What if the data are “manipulated’ to “influence” the medical community itself? This may or may not happen and regulations are something we- the healthcare stakeholders,  have to really look at in so many different ways.

    While social media regulation is still being debated, most rely on “self regulation” on what, when or how they do things on Facebook, to prevent data from falling into the “wrong hands”. Self regulation on social media  is though balancing act itself and remains a huge challenge to many of its users. #HealthXPh believe that educating the masses about health uses of these social media platforms’ plays a key role in this balancing act. This is what #HealthXPh is discussing (on Tweetchat) this Saturday March 24, 2018 9:00PM Manila Time .

    As a patient, healthcare professional, student, policy maker, or advocate, how much of your personal privacy are you willing to “give away” for using Facebook?

    • T1. Why would you or would you not deactivate your Facebook account?
      T2. For using FB, what kind “data” are you willing to give away and why?
      T3. What are your parameters for absolutely stopping Facebook use?

    We are inviting you to a lively discussion thru a twitter chat , this coming Saturday March 24, 2018 9:00PM Manila time. Join discussion!

  • Healthcare Professionals’ Guide to Establishing a Professional, Social Media Presence

    Majority of healthcare professionals have personal social media account(s) nowadays.  None of them, use their personal accounts to engage patients online. These I learned after asking workshop participants’ if they use social media to engage patients online.

    Here are the important points I learned from the participants and workshop I gave on Establishing Social Media Presence at the 1st SKMS Post Graduate Course in St. Louis Hospital last February 17, 2018 :

    1. There’s an increasing number of patients going to the internet and social media to seek health information, join support groups and share their healthcare experiences. 
    2. Majority of healthcare professionals are on social media to update on medical healthcare news, share information or join colleagues in support groups.
    3. Healthcare professionals don’t use their personal social media accounts to engage patients online.
    4. There is confusion as to the benefits of using social media in healthcare.
    5. There is some degree of confusion on how should healthcare professionals (or healthcare institutions) respond when they are tagged in a social media posts.

    I cited several, global and ASEAN studies to support points number 1 and 2. None of the workshop participants (around 300+ of them) raised their hands when I asked if any of them is using social media to engage patients online.  I have no current local study to validate or refute this, so I’ll take point number 3 until proven otherwise.   I discussed the benefits of using a professional social media account to protect one’s reputation online and leave a positive digital footprint to impact healthcare.

    For those interested,  I will be posting my slides at my Slideshare/ LinkedIn account soon. Please visit my profile there.

    References:

    1. Patdu, Ivy. Recommendations for Social Media Use in Hospitals and Health Care Facilities. Philippine Journal of Otolaryngology Head and Neck Surgery, North America, 31, jun. 2016
    2. Marie Ennis-O’Connor (2017). Social Media: A New Dimension In Health Research [PowerPoint slides]. Retrieved from https://www.slideshare.net/ennoconn/social-media-a-new-dimension-in-health-research
    3. Pei-Li Teh & Marc Yates. 2013. Digital Health in Asia. Issue no. 4. Research Partnership. Available at https://www.researchpartnership.com/media/1182/free-thinking-digital-research-in-asia.pd
    4. Warden, Christopher. 2017 Referral MD. www.getreferralmd.com. Accessed at https://getreferralmd.com/2017/01/30-facts-statistics-on-social-media-and-healthcare/
    5. The Healthcare Social Media Shakeup. CDW Healthcare. Accessed http://www.cdwcommunit.com/resources/infographic/social-media/Massachusetts Medical Society Social Media Guide. 2015
      http://www.massmed.org/Governance-and-Leadership/Committees,-Task-Forces-and-Sections/MMS-Physicians–Guide-to-Social-Media-(pdf)/
    6. Gholami-Kordkheili F, Wild V, Strech D: The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities J Med Internet Res 2013;15(8):e184
    7. Chua, ER , Calderon, PE . Ethico-Moral Responsibilities of Health Care Practitioners on Social Media. Proceedings of the DLSU Research Congress Vol 4 2016. March 7-9, 2016
    8. Isip-Tan, Iris Thiele (2014). Establishing a Professional Social Media Presence [PowerPoint slides]. Retrieved from https://www.slideshare.net/isiptan/establishing-a-professional-social-media-presence-86320762

     

  • Patient Education via social media- what sticks and what’s (probably) fake….

    Advocates has long championed social media as a tool for patient education in healthcare. Social media was taunted to increase meaningful patient engagements, an increase health practitioners’ and patient collaborations that would result to improvements in the various facets of healthcare- from physician-patient relationships, quality point of care to increase in surveillance of less familiar but equality important health disease and issues. The use of social media for health education also enabled patient’s (or his / her support community) navigate a complex rapidly changing health system and thus improve his or her quality of life.

    Patient health education via social media needed a critical reflection however. Although there are studies looking at its effect as a tool for health learning,  the results are quite inconclusive. Is it the methods of teaching? The target learner? Or are the the metrics used? There seem to be a confusion on what constitute an effective social media tool for health learning in the general populace.

    From an educators standpoint, the use social media as a tool for learning is a characteristic of connectivist pedagogy of teaching and learning. This theory came about as a result of rapidly changing, many-to-many type of communication and web 2.0 (social media) technologies. If social media is to be effectively used as a tool for teaching and learning of patients in healthcare, one must learn the nuance of this pedagogy and the context of what a typical (Filipino) health learner is. Also, such learning does and goes beyond formal traditional, institutional learning that we knew and have gone through. This author believe, such belong to lifelong learning and is a must learn for healthcare educators to be effective.

    Or, we get fake news, misinformation and worst harm patients and the general public with its inappropriate use

    In this chat,#HealthXPh will discuss health educational technologies and designs with educational healthcare social media pioneers to find that appropriate method of using social media as a tool for health education. Thus, the objectives of this discussion/chat are

    (1) Characterise what constitute typical (Filipino) health learner that are probably receptive to social media as a tool for healthcare learning. 

    (2)Identify educational designs (or pedagogies) of teaching and learning that are appropriate for patient education in the context of health.  

    (3) Give example of patient learner education  design that you ( or someone you know)  effectively applied in practice.

    The following are the guide questions for our chat:

    T1. What characterize a typical health learner that is receptive to social media as a tool for learning?

    T2. What teaching and learning strategy that uses social media as tool is most apt for this typical health learner?

    T3. Give a health teaching strategy using social media that you have applied to practice? What were the results?

    I am aware that objectives and question number one are often labelled as stereotyping.  For most educators, contextualizing learning to a particular set of learners is a must to be effective. Thats all there is to “characterising learners” in education.

    Join us later 9:00 PM Manila time as #HealthXPh listens to experts as we discuss patient health education via social media!