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Postcall Podcast

Author: MDedge

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We know clinicians are tired. They spend hours and hours each week entering data into EHRs, checking protocol, and hopefully, treating patients. This is about an hour every week where they can come to talk about the things they love, the things that burn them out, and the reason they got into this in the first place. The next time you're post-call, or even if you just feel like it, spend it with us. The information in this podcast is provided for informational and educational purposes only.
48 Episodes
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National Suicide Prevention Week interview with Janae Sharp of the Sharp Index, which is a resource for physician suicide awareness, prevention, and research.  Emi Okamoto, MD, and Nick have a mini journal club about the med student perspective on suicide and burnout and how Groupon can save you and/or your patients money on some medical procedures.  Time stamps:  Journal Club (01:51) Groupon saves money (02:22) Trump administration moves to ban non-tobacco flavored e-cigarettes (08:00) Med student perspective on suicide (09:47) Interview introduction (14:02) Interview with Janae Sharp (17:51) Relevant links: Journal club articles Groupon (Medscape) Med student perspective (Medscape) Flavored vape ban Interview: Janae Sharp LinkedIn Janae Sharp Twitter Sharp Index Questionnaire Donate Scholarships  You can contact Postcall by emailing Nick and/or Emi at podcasts@mdedge.com or finding Nick on Twitter @Nick_Andrews__    
A special lecture for suicide prevention day, week, and month from our sister podcast, the Psychcast.  Click here for more episodes of the Psychcast. Show Notes By Jacqueline Posada, MD Introduction Suicide in general population increased by 30% since 1999. The suicide rate was 14 people in every 100,000 up from 10.5 people per 100,000 in 1999. 400 physicians die per year. However, there is not great data collection about profession-specific suicide Suicide is the leading cause of death in male residents and the 2nd leading cause of death in female residents This represents a serious loss of the medical profession as well as the thousands of patients who lose their physician as well    Risks factors for physician suicide   Psychological: Physicians tend be contentious, perfectionistic, and compulsive. They are able to cope with delayed gratification, and this may lead to a false sense of ability to cope with all obstacles, without failures. Medicine presents physicians with many obstacles such as the deaths of our patients and human frailty. Human imperfection and physician failures are juxtaposed against these traits listed above Historical and genetic risk factors: Past suicide attempt and presence of mood disorder Untreated depression is an especially high risk for physicians as they may leave their mental illness untreated due to stigma As of 2017, 32 of 48 state licensing boards continue to question doctors about their mental health history. There is increased risk of suicide with the presence of the long arm version of the serotonin transporter gene and history of childhood trauma Workplace risk factors: Physicians identify electronic medical records (EMR) and increased documentation demands as contributing to burnout and less job satisfaction EMR means that doctors feel like they spend more time with records than face to face with patients. With EMR there is less eye contact and direct connection with patients so it’s hard to foster relationships Physicians feel the stress of increased use of technology and connectivity via cell phones and the need to “keep up”    Change in culture As a profession we are starting to talk about physician suicide; acknowledgment of the issue can lead to change. ACGME and other workplaces are starting to integrate physician wellness into curriculums and culture. References:  NCHS Data Brief No. 330. 2018 Nov.“Suicide mortality in the United States, 1999-2017” Yaghmour, NA et al. Acad Med. 2017 Jul. 92(7):976-83.“Causes of death of residents in ACGME-accredited programs 2000 through 2014” Implications for the learning environment” Babbott S et al. J Am Med Inform Assoc. 2014 Feb;21(e1):e100-61. Electronic medical records and physician stress in primary care: Results from the MEMO Study” Gold KJ et al.Gen Hosp Psychiatry. 2013 Jan-Feb;35(1):45-9. “Details on suicide among U.S. physicians: Data from the National Violent Death Reporting System” ACGME Symposium on Physician Well-Being
Physician mental health policy grades for every state, microplastics in stools all around the globe, and a moving eulogy for a hospital? After penning a eulogy for the hospital that agreed to train her as a surgical resident, Lynsey Daniels, MD, (@DanielsLynsey) joins Nick to talk about the closure, the hospital's finals days, and moving forward.  Nick and Emi Okamoto, MD, talk about microplastics in people's stools all over the world and break down how states measure up with regard to mental health policy for physicians.  Time Stamps: Quiz (01:30) Microplastics in stools (05:55) States' grades for physician mental health (08:57) Interview with Lynsey Daniels, MD (17:15) Relevant Links: Quiz References: Question 1 Question 2 Question 3 Question 4 Question 5 Microplastics turning up in human stool Physician-friendly states for mental health: A review of medical boards A medical resident's eulogy for Hahnemann Hospital  
New York Times contributor Danielle Ofri, MD, PhD, joins the show to talk about writing, the clinic, the system, and the Bellevue Literary Review. Emi Okamoto, MD, is back on the program.  Time Stamps: MDedge Quiz (01:18) Checking in with Emi (08:19) The WHO and Malaria (13:19) Interview with Dr. Ofri (19:00) Relevant links: Weekly Quiz The following links lead to the articles that are referenced in the answers to the MDedge MD-IQ weekly quiz. Question 1 Question 2 Question 3 Question 4 Question 5 The WHO and malaria Danielle Ofri, MD, PhD Website Biography (Wikipedia) Twitter TEDMED Buy her books New York Times op-ed    
MedTwitter stars and clinicians give their best advice for medical students as medical school resumes and @dr.skinandsmiles (Julie Amthor Croley, MD) joins Nick Andrews to talk about doctors on social media, podcasting, long-distance doctor marriages, and more.  Links: Twitter advice for medical students thread Dr. Julie Amthor Croley Instagram Profile Resident Take Overs On social media in dermatology Being on-call as a derm resident Tips on patient communication Prescribing combined OCs Dr. Croley on MDedge MDedge Podcasts Blood & Cancer Cardiocast  Daily Medical News Derm Weekly Psychcast You can email the show at podcasts@mdedge.com you can email Nick at nandrews@mdedge.com, and you can follow Nick on Twitter @tribnic For more MDedge Podcasts, go to mdedge.com/podcasts  
Dr. Richard Balon gives a lecture on physician burnout and mandated wellness and Nick Andrews talks to Damian McNamara about the final days of Hahnemann University Hospital in Philadelphia.     Masterclass guest Richard Balon, MD: professor of psychiatry and training director at Wayne State University, Detroit. In March, Dr. Balon spoke at the American Academy of Clinical Psychiatrists 2019 annual meeting in Chicago, sponsored by Global Academy for Medical Education. Global Academy and this news organization are owned by the same company. Lecture Notes By Jacqueline Posada, MD, who is a consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va.   Physician burnout and effective interventions The scales (for example, the Maslach Burnout Inventory) do not necessarily represent the full extent of burnout: If physicians work 12 hours but find fulfillment in work, they will be tired but not necessarily burned out. However, if physicians work 12 hours a day feeling frustrated by the systemic problems, then burnout can ensue. Common contributors to provider burnout: Excessive workload: Pressures of working with an electronic medical record, extensive time spent on documentation; lack of work satisfaction and job control; lack of respect for the work; and student loan burden. “Moral injury”: The emotional burden that occurs when physicians cannot deliver ideal care/treatment to patients, especially when limited by resources (such as insurance or poverty), or other systemic health care issues. Work environment and organizational culture: These factors also contribute to physician burnout. Burnout is a problem for health care organizations as a whole Two main ways to address burnout: physician-directed interventions (focused on individuals) and organization-directed interventions. Organization-directed burnout prevention strategies include: Reducing workload; reducing time spent on documentation, such as decreasing time spent in front of EMRs; cultivating effective teamwork; fostering a sense of job control. Organizations prefer individual-focused interventions over systemic changes: Examples include mindfulness teaching, yoga, cognitive-behavioral therapy techniques, education about burnout, and education. Individual-focused interventions are great, but they are not realistic for changing the culture that contributes to burnout. Interventions for burnout In a systematic review and meta-analysis in JAMA Internal Medicine, Maria Panagioti, PhD, and colleagues found that: Burnout interventions focused on individual physicians have small, significant effect on physician burnout. Organizational-directed approaches result in greater treatment effects, especially when interventions focus on promoting healthy individual/organization relationships. The impact of individual interventions can be improved when supported by organizational interventions. Interventions targeted at more experienced physicians within primary care settings show greater treatment effect than interventions targeted at less experienced physicians within secondary treatment settings. Approaches identified by staff can lead to meaningful change, as outlined by in a New England Journal of Medicine article by Melinda Ashton, MD. A Hawaiian health care system queried individuals (physicians and mid-level and nursing staff) to identify which parts of EMR documentation were poorly designed, unnecessary, and could lead to unintended burdens contributing to burnout. This type of survey improves the efficiency of a system and illustrates that the health care organization cares about preventing clinician burnout. References Panagioti M et al. Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Intern Med. 2017 Feb 1;777(2):195-205. Ashton M. Getting rid of stupid stuff. N Engl J Med. 2018 Nov. 8;379(10):1789-91.      
Red Hoffman, MD, ND, talks palliative care, her touching essay in JAMA, and how she climbed the hill to med school. Dr. Hoffman is an acute care surgeon and co-director of surgical clerkship at the University of North Carolina at Asheville.  Time Stamps: Quiz (2:10) Neil deGrasse Tyson tweet (6:35) Dr. Hoffman intro (11:45) Postcall recap and pillars (13:00) Interview with Red Hoffman, MD, ND (21:15) Relevant links: Quiz sources Q1 Q2 Q3 Q4 Q5 Carl C. Bell obituary Neil deGrasse Tyson tweet Gun Violence Psychcast  Dr. Hoffman: Doximity LinkedIn Twitter JAMA Essay Dr. Hoffman resources: Surgical Palliative Care: A Resident's Guide Surgical Palliative Care textbook Palliative Care Immersion Course Primary of Palliative Care
Mara Antonoff, MD, of the MD Anderson Cancer Center, joins Nick to talk about female physicians being referred to by their first names. Nick and Emi Okamoto, MD, discuss a study that shows 40% of PCPs do not accept into their practice new patients who are using opioids.   Time Stamps: Quiz (01:09) Acupuncture for chronic stable angina? (06:26) 40% of PCPs would not accept patients prescribed opioids (10:01) Introducing Mara Antonoff, MD (13:18) Interview with Dr. Antonoff (18:00) Relevant links: Quiz: Q1: Textured implant recall Q2: Advanced brain MRO in Havana Q3: Adults using aspirin for CVD Q4: Pregnancy/Birth stats Q5: UAB neurologic disease funding Acupuncture for chronic stable angina 40% of PCPs not willing to accept patients on opioids for pain JAMA research Twitter thread Mara Antonoff, MD: Official Bio Dr. Antonoff on Twitter You can contact the show at podcasts@mdedge.com. You can find Nick Andrews on Twitter @tribnic and you can find MDedge on Twitter @MDedgeTweets.  
The interview is with the host of the podcast Explore the Space, we find out where in the world Emi Okamoto, MD, is off to, and how purpose in life appears to be impacting mortality.  Time Stamps: Congrats on getting married (00:22) Quiz (02:01) Emi's announcement (05:30) Association Between Life Purpose and Mortality Among US Adults Older than 50 Years (11:24) Introducing Mark Shapiro, MD (12:52) Interview: (16:37) Links and References: Quiz Articles Question 1 Question 2 Question 3 Question 4 Question 5 Weekly Reading: Nick: Comic Relief Emi: Life Purpose and Mortality Explore the Space EPIC EHR Episode Dr. Shapiro on Twitter You can contact the show by emailing podcasts@mdedge.com or you can follow us on Twitter @MDedgeTweets.
Shannon Tosounian, DO, aka @Shanny_DO is an internal med and GI fellow. She also blogs and coordinates an Instagram account with more than 50,000 followers.  Postcall hosts Nick and Emi Okamoto, MD, pick Dr. Tosounian's brain about being an "influencer," blogging, and how to manage time.  Links: Shanny_DO on Instagram @shanny_do Dr. Tousonian's blog CBD blog Childbearing years blog   For more MDedge Podcasts, go to mdedge.com/podcasts You can contact the show by emailing us at podcasts@mdedge.com or by interacting with us on Twitter @mdedgetweets.       
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Comments (2)

Nick Andrews

Enjoyed this lecture fr Dr. Balon

Aug 22nd
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Archie Smith

Nick Andrews Great!

Aug 23rd
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