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  • “Socializing” in the “New Normal”

    Many people wished they could just stay home to avoid getting COVID 19. Even the variable successes of the community quarantine convinced us of the benefits of personal hygiene, social distancing and staying at home. Prolonged social distancing however is increasingly difficult, given that many essential human actions required “physical” socializing. The benefits of socializing has been recognized in literature, be it in health, or the survival and propagation of the human specie in general.

    T1. Do you agree with easing out the community quarantine in your respective geographic locations? Explain.

    Loud protestations from the medical community did not stop the government from easing out community quarantine, even if we had a vague idea of what the “new normal” is. The “new normal” has been the subject of many discussions, including previous COVID #HealthXPh chats. None of these “new normal” descriptions were definitive and will evolve.

    T2. Is there a benefit to “socializing” in the new normal? Please explain.

    An interesting observation about the new normal is the acceptance of the different degrees of socializing. Socializing was never a binary choice for many of us to begin with. It wasn’t a “I socialize or I don’t” choice. We all socialize in different degrees.

    Our path to accepting this begun with another less striking, but equally important adaptation- the human specie has this propensity for “risk assessment and harm reduction”. This pandemic highlighted these both and will probably be an integral part of socializing in the new normal.

    T3. Give a specific personal example of “risk assessment strategy” you employ before socializing in this new normal.

    T4. Give a specific example of socializing – personal or work related in the new normal.

    Our emergence and socializing into the new normal will be partly governed by two things- our ability to assess risk and reduce our chances of getting COVID. This will be the topic of June 6, 2020 #HealthXPh twitter chat. Join us at 9PM Manila time with this guide questions:

    • T1. Do you agree with easing out the community quarantine in your respective geographic locations? Explain.
    • T2. Is there a benefit to “socializing” in the new normal? Please explain.
    • T3. Give a specific personal example of “risk assessment strategy” you employ before socializing in this new normal.
    • T4. Give a specific example of socializing – personal or work related, you employ in the new normal.

    Image by Drazen Zigic on Freepik

  • 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

  • The Doctor is In, Love: How health professionals balance love and work

    People in different professions deal with work related pressures, fatigue, and challenges. The medical profession is one such field. Recent studies have shown the detrimental effects of extended work hours to the professional’s mental health and personal well being. Although stories abound, the effects of work related pressures on the personal relationships of health professionals is still a controversy.

    As in any profession, there are perceived advantages and disadvantages of going into an intimate relationship with a health professional. In the medical profession, what constitute a life enhancing, long lasting or nurturing intimate personal relationship at least controversial. Even health professionals don’t agree on what constitute a successful, life enhancing or nurturing relationship!

    T1. As a health professional, what defines a life enhancing, intimate relationship for you?

    Our society often demand almost superhuman performance on health professionals, that sometimes intimate relationships suffers. The extended work hours for example, often eats up on time intended for our personal relationships. The objective, emphatic but emotionally protective way of communicating by healthcare professionals at work often backfires when applied to interpersonal, intimate relationships.

    T2. What work related factors affect the intimate, personal relationships of medical professionals?

    How health professionals balance their personal and professional life is an art itself. More so with intimate relationships. By experience, it has never been easy. Tipping the balance either way may wreak havoc on the other or worse, destroy both. There are numerous, often funny and sometimes scary anecdotes of health professional’s “love life” gone awry. The demands of healthcare profession is often blamed, although early stage recognition of attributing factors is never even considered. As in work, early diagnosis and “treatment” could have save a potential life enhancing intimate relationship. What constitute “treatment” for a failing health professionals intimate personal relationship is another practice guidelines we have yet to develop.

    T3. As a health professional, what coping mechanism have you employed to nurture a life enhancing, intimate relationship?

    How health professionals cope with the demands of work and sustain a life enhancing intimate personal relationship is the topic of our chat this Saturday, February 15, 9 PM Manila time. Join us in our #healthXPh tweet chat!

    Image by Gerd Altmann from Pixabay

  • The Pursuit of Happiness in Healthcare Workplace

    “Mam, where’s our patient?!” As the OR nurse calmly enumerated a litany of reasons why our patient isn’t yet on the table as scheduled, I’m welling up with frustration. “Excuse me” I said. I silently went back to the empty OR dressing room. I threw a one-two punch -high kick in the air, closed my eyes, took a deep breath and sat momentarily. Grabbing my hospital coat, I went to the patients room, talked to the patient and tried fixing whatever I could, so the patient can have the procedure on a later time. I did that with all the warm smile I could muster. Deep inside? I was screaming for reason. “Am I still happy doing all these, despite the challenges?”

    The news and internet is teaming with bleak stories of healthcare workers worsening mental health, burnout and job satisfaction. WHO recently updated its definition of burnout:

    Burn-out is a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions: (1) feelings of energy depletion or exhaustion; (2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and (3) reduced professional efficacy. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

    WHO, 2019

    Evidence points to a staggering 1 in 2 healthcare workers has had or is experiencing burnout. Yes thats 50% of health workers! Burnout evidently affects health professional mental status and is tied to job satisfaction according to recent studies.

    T1. Have you experienced or is experiencing burnout in the healthcare workplace? Please describe.

    Don’t get me wrong. I’m not turning a blind eye to the systemic problems besetting the health care industry. The causes of health workers burnout are multifactorial and systemic.

    Work system factors of the systems model of clinician burnout and
    professional well-being.

    I am for systemic solutions and we need it yesterday, or maybe five years ago. But while our health leaders are drafting solutions, we’re left to cope with burnout and find happiness in an adverse workplace. By that I mean, finding happiness on a personal level, cherry picking “tips and tricks” to cope with burnout, perform above par at and still appreciate the career we so love doing. It’s not unusual nowadays to be approached by a colleague asking “How do you find happiness in this shit hole of a workplace?!” Cynical, but a very positive way of looking for happiness in the chaotic sea of workplace challenges.

    T2. How do you find happiness in your healthcare workplace? Please elaborate.

    Systemic solution are often innovative to induce radical changes in the health care industry. The US National Academy of Medicine came up with a systems framework for addressing health professionals mental well being. I’m hopeful our health leaders will get their acts together and come up solutions to this problem. These solution need to trickle down to the grass root health workers fast. By fast, I mean five years ago. In the meantime, we’re left to cope with burnout and find happiness in the workplace. If these personal “tip and trick” miraculously worked for us, we happily share it to our colleagues and sometimes with our bosses or managers.

    T3. What workplace happiness would you share to a colleague or even to your boss and managers?

    Join #HealthXPh tweet chat this Saturday 9PM Manila time as we discuss coping with health professions burnout by finding happiness in what we do. This should guide you through the discussions:

    • T1. As a health professional/student, have you experienced or is experiencing burnout in the workplace? How did you cope up with it?
    • T2. As a health professional/ student, how do you find happiness in your workplace?
    • T3. What workplace happiness would you share to a colleague or even to you boss and managers?

    See you all on Saturday!

    References:

    National Academies of Sciences, Engineering, and Medicine. 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521.

    Shanafelt TD , Balch CM ,  Bechamps GJ , et al . 2009. Burnout and career satisfaction among American surgeons. Ann Surg 2009;250:107 15. doi:10.1097/SLA.0b013e3181ac4dfd

    Rosales, Rheajane & Labrague, Leodoro & Rosales, Gilbey. (2013). Nurses’ Job satisfaction and Burnout : Is there a Connection?. International Journal of Advanced Nursing Studies. 2. 10.14419/ijans.v2i1.583.

    Jabonete, Fritz Gerald & Dayrit, Aubrey. (2018). Reported Work-related Stressors among Staff Nurses in Metro Manila, Philippines.

    #HCLDR. (2019, December 5). Reconnecting To Joy in Work [Blog post]. Retrieved from https://hcldr.wordpress.com/2019/12/05/reconnecting-to-joy-in-work/

    Credit: Image by Halcyon Marine Healthcare Systems from Pixabay

  • 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