Matt Hollon, MD MPH FACP
At this moment in time, it simultaneously feels like there is both so little to say and so much to say. On the one hand, there is the exhausting work of adapting and re-adapting in the face of what feels like the never-ending story of the pandemic, leaving us all feeling like we are making so little progress in this journey. The monotony of the same conversation over and over again leaves us with the sense that we have been cast in our own version of Groundhog Day. What more is there to say when the entire global experience of daily life is dominated by the impact of a pandemic.
On the other hand, the world has been turned inside-out and upside-down by the pandemic and societal unrest. In the face of so much uncertainty and with a fragile health care system in the U.S., there is the sense that further unraveling is possible. There is collective worry about the unpredictable future. The profound uncertainty has us all speculating on the myriad of ways that we must adapt and the endless possibilities for what may lay ahead as we face a contagion that is out of control and a reckoning with injustice deeply woven into the fabric of our society. We have so much to talk about.
In times like these, it is good to have a road map to help us navigate. Once again, the American College of Physicians has been at the forefront of providing that map for internists and the broader physician community. I hope we all value our membership and appreciate the College for its ongoing leadership in the face of these historical challenges. At the start of the year, the College released its critically important vision for the U.S. health care system, Better Is Possible. A comprehensive policy statement to help guide conversation during this election year on next steps to make our health care system more accessible and robust for all. And from the earliest days of the pandemic, the College has been at the forefront of collating and disseminating information and resources about COVID-19: CORONAVIRUS DISEASE 2019: INFORMATION FOR INTERNISTS. More recently, the College has stepped up to provide guidance in an important policy statement as we navigate the racial health disparities, prejudice, and violence that continue to impact our patients and our communities.
Regardless, we move forward. There is no other choice. Hopefully, with decent maps and the right amount of effort we can see our way to a destination that guarantees accessible and affordable health care for all, maintains robust public health infrastructure, and is grounded in justice and equity no matter anyone’s life story. Ultimately, we move forward because we decide to step up and do what we can, to do what is right. In addition to our usual updates and features (such as Dr. Joey Parker’s Teaching Corner) this newsletter features reflections and stories from Chapter members (and their families) taking these critically important steps in these uncertain times. A resident, Dr. Rasheed Durowoju, and student, Nobel Nguyen provide short reflections on these challenges. Dr. Koch-Leibmann captures the sentiment of optimism in the face of challenge in her story, A Natural Disaster. Dr. Pagalilauan, Dr. O’Connor, and Mehr Grewal model facing the challenges head on. Their stories are all of our stories. We know all of you have stepped up during this time. We know you have colleagues who stepped up and we hope we can continue to feature and celebrate the work that is being done by all of you to get us all farther down the road and to a better location. One excellent way to recognize our members is to nominate them for Chapter Awards.
With support from many of you, our Chapter also moves forward. Under the guidance of Dr. Deepthi Mani and Dr. Anita Chopra our Council for International Medical Graduates has hosted a number of excellent webinars over the summer on topics ranging from women physicians perspective on the pandemic (in collaboration with our Council for Women in Medicine) to tips on writing letters of recommendation with an upcoming one on “Using the Microbiome to Interrogate the Colonic Polyp Microenvironment“. Under the leadership of Dr. Genevieve Pagalilauan and Dr. Carrie Horwitch, our Health and Public Policy Committee is being reinvigorated and hosting a series of listening and learning sessions. We also anticipate our second annual resident career forum in September, which will be held virtually and provide valuable guidance on career steps after residency. And speaking of “virtual”, importantly, we have finalized the plan for all components of our Annual Chapter Meeting, which will be entirely virtual this year, with further details and registration coming soon! The road is in front of us. While we won’t be coming together in person as a community this fall, I am confident we will see this through together. I look forward to celebrating our members’ and Chapter’s stories and successes that lie ahead as we step up and navigate these historic challenges.
Governor || Washington Chapter – American College of Physicians Twitter: @HollonMD
2020 Chapter Awards
- Washington ACP Internist of the Year
- Washington ACP Community Service Award
- Washington ACP Chapter Service Award
- Washington ACP Golden Apple Award
- Washington ACP Full-time Faculty Clinician-Educator of the Year
- Washington ACP Hospitalist of the Year
Health & Public Policy Committee: Listening & Learn Sessions
By Co-Chairs Genevieve Pagalilauan, MD FACP & Carrie Horwitch, MD FACP
“Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience and the passion to reach for the stars to change the world. “ Harriet Tubman Advocacy is when an individual or group supports and influences political, economic and/or social decisions. The goal is to gain support to create change for the better. The HPPC committee just held our first virtual advocacy event. The goal of the event was to listen to your concerns and areas of interest for advocacy issues that we can focus on, particularly advocacy at the Washington state level. ACP has a wonderful website that has an advocacy toolkit that everyone can use to get started. Particular areas of advocacy especially this year are: racism and discrimination-including changes in law enforcement practices , safety and practice in the era of covid 19, climate change, firearm safety and our continued work on reducing regulatory burdens on physicians. Please take the opportunity to look over the ACP website: https://www.acponline.org/advocacy We also hope you will join us for the next virtual advocacy event and listening session Thursday Aug 27, 6-7 pm for Members: REGISTER HERE Thursday Sept 24, 6-7pm for Medical students: REGISTER HERE Thursday Oct 8, 6-7 pm for Residents and Fellows: REGISTER HERE. We would look forward to hearing from you if you are interested in being on the HPPC committee or any particular areas of interest. Please contact either Carrie or Genevieve Email: firstname.lastname@example.org or email@example.com.
Resident Career Forum
Looking for a job after residency? Or just interested in finding out what opportunities are out there? We invite all residents and early career physicians to our second annual ACP Career Forum event live online via zoom. The evening will feature special sessions for physicians entering or early in practice including the following:
- Recruiters Panel – Recruiters will peel back the curtain on things you should know about the recruitment process
- Early Career Physicians Panel – Breakout rooms with Primary Care & Hospitalists sharing pearls on “what they wish they knew” when searching for the ideal job
- Employment Lawyer – Things you need to know before signing that employment contract
- BONUS Financial Advisor Talk – Top 3 Things Residents Should Know About $$$
Register for this free online event HERE.
Annual Chapter Meeting Preview
By Anna Hagan & Leah Marcotte, Meeting Co-Chairs
We are excited to announce that we are still holding the Annual Meeting this year! For the first time, the meeting will be fully virtual due to the pandemic. Thank you to all who completed the survey giving input on this decision – it was very helpful in shaping plans. The agenda includes high-yield content condensed primarily into one day, Friday, November 6th. We are planning a mix of plenary sessions as well as interactive sessions such as a debate on diagnosing and treating UTIs in elderly patients with dementia/delirium, and working through a challenging case in “The Art of Clinical Reasoning.” Content will be eligible for CME credit and we will include short pre-recorded CME “On The Go” sessions to tune into after the meeting for additional learning. In the current meeting schedule, we have been able to fit virtually all of the plenary speakers we had invited prior to the pandemic. Additionally, we will have two keynote speakers, Jeff Duchin, MD to discuss the public health response to COVID-19 and Edwin Lindo, JD to discuss structural racism in medicine. While we will not be holding workshops this year, we will be looking forward to a stellar lineup in 2021.
Joey Parker’s Teaching Corner
Somebody once said, “Repetition is the mother of mastery.” How true this is. As internal medicine physicians, the vast amount of knowledge we are required to learn can be staggering. Remembering that knowledge and being able to call upon it from patient to patient can also be a huge endeavor. This is one of the most common challenges our learners face as they go through training. When I teach residents, I ensure I build repetition into teaching. For example, I ask the same question to my learner multiple days in a row until that pearl can be taught back to me. I will also ask one resident to teach another resident what I taught him or her, in order to practice quick recall. Finally, at the end of our week on service together, I put together a small handout on the topics we covered organized by organ system, as a means to help them recall what they learned and apply that to their next patients who will have similar disease pathology. This last technique also helps our learners realize how much they learned throughout the week, and this learning is something they should be proud of.
Member Stories From the Past Few Months
Teamwork For Our Community
By Genevieve Pagalilauan
This is me and my fellow Dr. Kim O’Connor and I a couple hours ago when we finished seeing patients in our clinic and hustled over to a local retirement community. They had a person pass from COVID and had a few members who tested positive last week. We went in with a small team of physician volunteers to re-test all the residents tonight. Kim and I were paired together knocking on doors and swabbing each resident we were assigned including known patient patients. We did this because these lovely people are high risk and testing is important (this will add to CDC epidemiology data). We are trying to slow the spread of this deadly virus. We are doing this because we made an oath. We understand we are putting ourselves and our families at risk. We will take on that risk to protect the health of our community.
Mobile Infection Prevention Units
Submitted from Deepthi Mani
Mehr Grewal is the daughter of chapter member Anita Chopra. She is a middle school student in Bellevue, who is passionate about community outreach with a focus on public health. She has been running a successful campaign called “clean hands save lives” over the past 6 years, triggered by the influenza epidemic. Now in the current COVID-19 pandemic, she has expanded efforts to make mobile infection prevention units (mobile IPUS) for the community. These units are geared towards people who may lack access to hand hygiene amenities. They include clean water, sanitizing solution, soap. There are chip counters to count the number of hand washes. These hand hygiene stations also have masks for people to pick up. This is an effort to encourage hand hygiene which is a do-it-yourself vaccine and one of the most powerful preventive steps towards Covid-19
A Natural Disaster
By Angelika Koch-Leibmann, MD FACP FHM
The text message arrived at 8:07 pm on Feb 28: “Coronavirus positive. Call me.” I could almost feel my heart stop. A patient of mine in the ICU, admitted from a nearby nursing home, had developed worsening respiratory failure that week, without a clear etiology, and tested positive for SARS-CoV2 as soon as CDC testing guidance changed. Suddenly the world transformed: I was put in quarantine, unable to see my teenaged boys, unable to support my colleagues on the front lines. My patient passed away. As I paced the house, afraid of developing a fever and respiratory failure myself, phone calls and emails flooded in. Monthly work meetings became daily meetings, where we discussed constantly changing CDC and DOH guidelines, PPE and testing, isolation of patients, discharge guidelines, the no-visitor policy. After ten days in quarantine, I hardly recognized our hospital anymore. Gone was the steady flow of traffic through the hospital hallways, with patients being admitted for strokes, heart attacks and scheduled surgeries. Instead one only heard muffled voices from hospital staff communicating through N95’s, goggles, and face masks, avoiding any closeness. Smiles were replaced by serious and concerned looks. A few years ago, I visited Mt. St. Helens and was astonished by nature’s power. After the volcano erupted, the summit vanished and the mountain around it was destroyed under a thick blanket of ash. Now it felt like the world around me had again changed just as quickly, but invisibly and with a more cruel and devastating impact. In those starkest, earliest days of the pandemic, Shirley and Bob came to the hospital from their assisted living facility, both positive for COVID-19. They had been married 52 years. Shirley was a young nursing student when she met Bob, who worked as a carpenter. They had two children and five grandchildren. Shirley’s eyes lit up when she talked about Bob and the adventures they had together, then she would melt in tears as she spoke about his death. I attempted to console her, desperately trying to find the right words. She did a better job than me, expressing her gratitude that being infected with coronavirus allowed her to be with Bob during his last hours. Had she tested negative, she wouldn’t have been allowed to be with him when he passed away. How humbling, her words. Tigger and Eeyore – the nicknames of another COVID positive couple – had been living in a Memory Care Unit. Tigger was feisty, suffering from dementia. Her husband Eeyore had previously had a stroke and now could hardly speak; we expected him to decease quickly. Tigger said Eeyore loved his stuffed donkey, but there was no one to bring the donkey from their home. By chance, a colleague’s stuffed donkey looked almost like Eeyore, and the patient passed away peacefully with a stuffed Eeyore in his arms and his real Tigger at his side. In the aftermath, Tigger occasionally forgot that her husband had passed, but you could feel her deep love for him when she hugged her stuffed Eeyore tightly. The pandemic has transformed me into a social worker, chaplain, and a distant family member, in addition to my physician role. My days now go towards providing more emotional than physical support to patients and their loved ones. Patients aren’t the only ones that needed emotional support. Nurses, RT’s, OT/PT’s and all the support staff feel unmoored during this crisis as well. Since COVID-19, our floor nurses have witnessed more deaths on a daily basis and in a crueler way. Isolated, gowned, goggled, gloved and masked, they provide end of life care without being able to hold their patient’s hand to tell them goodbye. One of our cheeriest nurses who always cracked jokes has eyes filled with tears regularly as another of her patients expired; I can’t help but hug and cry with her. Not all has been tears and death. Some patients overcome this unpredictable virus after a valiant fight, and some barely seem touched by it. Paul, the 47-year-old father of a 10-year-old son, was intubated in the ICU for almost 14 days, extremely sick and weak. After a four-week hospital stay, I was able to discharge him home. Sue, a 95-year-old lady admitted after a fall at her assisted living facility, was only tested because of the pandemic, and didn’t cough once. Our society is now a few months into this crisis. Life has changed for all of us. We are slowly getting adjusted to this new world of universal masking and social distancing. It is too early to envision how the future will look for us as healthcare workers, or for my two sons and their friends, who are becoming young adults. May 2020 marked the 40th anniversary of Mt. St. Helen’s eruption. Although everything appeared to be lifeless and destroyed after this natural disaster, deep under the ground, there was life. Slowly, new plants were able to bloom again like the purple-blue wildflower, Prairie lupine, with the help of the pocket gopher. I vividly remember how colorful they were in contrast to the desert-like surroundings after the blast. Full of hope, I strongly believe that with time, we all also will arise from the ashes, recover from this COVID-19 pandemic and able to see the beautiful side of healthcare and the world again. There are seeds of hope everywhere, waiting to bloom.
Resident Perspectives During A Pandemic & Social Injustices
By Rasheed Durowoju, Resident at UW
As a young black physician training in unprecedented times due to a global pandemic intertwined with social unrest around injustices affecting primarily people of color, the past four months have been incredibly eye-opening and trying. The positives from my experience include the incredible level of support and action being taken by my colleagues and training faculty, ensuring social injustices do not go unaddressed as we strive to curb the impacts of COVID-19. I have been inspired by the community’s response to the ongoing pandemic, including support for front-line workers through morale boosting efforts such as providing food and supplies for work. Overall, I appreciate that our community is a long way from fully grasping the long-term impacts of both the pandemic and the current social movement, on life as we know it in Washington State.
Medical Students Perspective
By Nobel Nguyen, MS3
I was on Spring break when I read the unfaithful email, “All students pulled from rotations.” As a second-year medical student at that time, I did not think this would affect me. I was not on clinical rotations and the next three months were dedicated to Step 1. If anything, it might have been a blessing because I would have fewer distractions and can become more focused –or so I thought. The next three months turned to be my most challenging moment in medical school so far. I did not realize how many of the small things in life contributed to my overall well-being as a student, such as lifting at the gym for a quick study break or going to a coffee shop for a change in scenery. By the end of boards, I was drained physically, emotionally, and mentally. COVID has taught me to appreciate all the blessings in my life and not to take some of life’s simplest moments for granted.
Member Images Needed for I.M. Proud Campaigns
ACP is proud of the work our members are doing to fight COVID-19 and how our community has rapidly embraced telemedicine. We are looking for images of you, our leaders and members, in action during the pandemic and in your current practice setting.
Some suggestions of images include, but are not limited to, working with teams, patients, doing testing, telehealth visits, outpatient and inpatient settings, with other health care workers, or anything that captures your current daily life.
Thank you for sending your images a few months ago. We were able to create the Recognizing Internists video. Your new images will help us to continue show casing our members doing what they do best, putting patients first and exemplifying the best in medicine.
Please upload your photos here by Friday, August 21
ACP and DynaMed® Free ACP Member Access Extended to 2023
DynaMed, a valuable benefit of ACP membership, is a leading evidence-based decision-support tool for use at the point of care. ACP continues to work closely with DynaMed editors to help make DynaMed the best comprehensive clinical content resource for internists. As of August 2020, ACP has peer-reviewed the Overview and Recommendations section of over 300 of the most highly used internal medicine topics by ACP members.
DynaMed also includes many features to ensure the best possible user experience, including:
- Ease of Access
Use your ACP login credentials to quickly access DynaMed on your desktop or through the free mobile app.
- Comprehensive Content, Guidance You Can Trust
Rigorous, evidence-based methodology for content development; robust systematic literature surveillance with frequent updates; and clinical expertise that both complements and clarifies the evidence provide guidance you can trust.
- Personalized Experience
Easily follow clinical topics relevant to your interests by setting up customized alerts.
- Earn CME/MOC
CME and MOC are automatically tracked within your account as you use DynaMed.
Access DynaMed today at acponline.org/dynamed
Upcoming Webinars from National
ACP will present several webinars developed especially for key member segments through the beginning of September. Attendees will have the opportunity to ask questions following the presentations. We encourage chapters to promote these webinars to their members. Please contact us at firstname.lastname@example.org with any questions.
Foundations of Team-Based Care
Tuesday, August 11, 2020, at 3:00 p.m. ET
Janaki Deepak, MBBS, FACP, and Mangla Gulati, MD, FACP, help international and foreign medical graduates navigate the structure of U.S. hospitals and medical teams in this free 1-hour webinar. Explore the roles and functions of different members of the medical team and how they come together to care for patients.
Navigating the 2021 Internal Medicine Match during the Time of COVID-19
Wednesday, August 12, 2020, at 7:00 p.m. ET
The COVID-19 pandemic has drastically disrupted the residency application and Match process, leaving students applying in the 2021 cycle with many questions about how to optimally navigate this already anxiety-provoking critical step in their medical career.
Sponsored by the ACP Council of Student Members and presented in conjunction with the Alliance for Academic Internal Medicine (AAIM), this webinar will feature experienced medical student educators and residency program directors from different types of training programs. Panelists will address the likely impact of pandemic-related changes on the residency application and Match process and provide the best available advice for students applying in internal medicine.
Achieving FACP through the ACP Guided Fellowship Program
Tuesday, August 25, 2020, at 3:00 p.m. ET
Achieving the FACP credential is a significant milestone for post-training physicians—one that shows leadership and commitment to excellence in the practice of medicine. In this one-hour webinar, Saba A. Hasan, MD, FACP, member of the ACP Credentials Committee, will provide an overview of ACP’s Guided Fellowship Program. Open to members who finished residency in June 2020, this program provides a framework toward meeting professional development goals, along with guidance and mentorship, in order to obtain the FACP credential over three years.
Communication Skills for Effective Presentations
Wednesday, September 2, 2020, at 9:00 a.m. ET
Developed especially for ACP’s international and IMG members, this one-hour webinar will explore best practices for presenting information effectively to a variety of audiences. Speaker George M. Abraham, MD, MPH, FACP, FIDSA, ACP President-elect, will review the delivery skills needed to make presentations more informative, engaging, and successful for both face-to-face and virtual formats. CME will be available.
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