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Governor's Newsletter - July 2020

In This Issue

Governor's Letter
The Unmasking of a Broken System by COVID 19
Missouri Contestants Recognized at the National ACP Poster Competition
Councilors and Elections
Committee Updates
Racism and Discrimination
DHSS Launches Comprehensive Cancer Survivorship Campaign
Congrats to our Executive Director

Daniel M Goodenberger, MD, MACP, ACP Governor

Governor's Letter

Six months ago, I couldn't have imagined writing the kind of Governor's Update that this one will be. Six months ago, I was looking forward to attending the annual meeting in LA, learning new tricks, seeing old friends, and taking in a taping of Ellen with my wife.

Then COVID.

Now it's ZOOM meetings and telehealth. Now it's unprecedented and unforeseen earth-shaking stresses on our physicians and practices. In our urban areas, doctors and nurses are exhausted and frazzled; in our small towns, it's mostly anxiety and social distancing and waiting for the other shoe to drop, and hoping that life can become more nearly normal since Governor Parson lifted the stay-at-home orders.

But…

But I'm sure that we will get through this. I'm sure because our immigrant grandparents put down roots, worked, and endured. I'm sure because my parents lived through the depression and the dust bowl and WWII, and endured. I'm sure because your parents lived through Vietnam, Nixon, AIDS, and endured.

And ultimately thrived. As will we. As will the patients for whom we care.

And we will adapt. After surveying residency programs, student deans, past attendees, and our scheduled faculty, we have decided we must convert our 2020 Missouri ACP Scientific Meeting from an in person to a virtual meeting. We're brainstorming with governors from other states, attending webinars on virtual conferences hosted by national ACP, and discussing with members of the education committee. The details are yet to be decided, but we will have lectures with CME, virtual meetings of interest groups (a BYOB Women in Medicine lunch?), and MOC activities. The Laureate award presentation (see below) will be live though remote. The poster competition will also be held virtually, so for all residents and students that want to participate, we are working through the details of this and will share the information with you soon. We look forward to seeing you in person in September 2021.

Until then -

Dan Goodenberger, MD, MACP

The Unmasking of a Broken System by COVID 19

Written by: Fariha Shafi, MD, FACP, Missouri ACP member and wellness chair

2020 has been pretty interesting. We are over three months into a declared pandemic…or are we? We really are close to six months into this situation which was hidden, minimized, camouflaged culminating into the chaos that has engulfed us. It's baffling to think that as a leader of the free world, watching things unfold in other countries which, essentially, should've given us a head start, we were dumbfounded. Anyhow, what's done was done and it fell on the shoulders of the healthcare community and other frontline workers to figure this out. And having a front seat, it's been like a roller coaster that plummets from its zenith but never seems to get back on that upswing. So, when you ask me how I am doing, this is what's going through my mind:

We all know that we went into medicine for a higher calling. We are expected to rise to the occasion and sacrifice. Totally get that! But at what point of time is society supposed to wake up and do its job in supporting us? We are constantly being examined under a microscope and evaluated and critiqued on various platforms. And that's okay as long as society extends the same courtesy to itself. Where is the Personal Protective Equipment when we need it? In the middle of this crisis we were able to send it to other nations but we were unable to secure a supply for ourselves. So every morning when we have to justify why we need that mask, I am not doing so well! A part of me breaks a little every time.

There is no official tally but so far about 78,000 healthcare workers have tested positive for COVID 19. The CDC says that more than 400 have died which is significantly undercounted! The National Nurses United put the fatalities at about 940 with nurses accounting for 15% of those. If you follow the tally of physicians on the National Physicians United-COVID 19 subgroup on social media, you can't help but get a sinking feeling when you read the life stories of the more than 200 physicians who have died! And every day, the list gets longer. It's important to make sure these heroes are not forgotten, that their lives and work are celebrated, that they are not just the 20% of deaths that the health care field is supposed to sacrifice. So no, I'm not doing that great!

We are supposed to be in this together. And somedays, it does feel like an “us against them,” doesn't it? While there is the sacrifice of our lives, family, sanity, there is nothing to expect in return. God forbid that people are asked to wear a mask, socially distance, not go out to eat, and of course, not have a football season!!! Because why should you care about a disease where the mortality is 1-3%? You have not had to bury a loved one, say goodbye on an iPad or not been able to climb a flight of stairs anymore when you used to be a marathon runner. You haven't had to break bad news over and over and deal with that burden of helplessness...yet! When I read comments on social media about this whole thing being a farce and “let us have our football!” part of me dies a little more. So, no, I am not doing so well!

What this is shining a light on is the lack of collective conscience that our society suffers from and so often, it gets confused with socialism in this part of the word. No, not socialism, but basic human decency is what I am talking about. Empathy and compassion for each other. Yes, you have not been to restaurant, I get that, but think about the children who are sleeping hungry because they were dependent on the schools that are closed. This is present day USA. Think about it. Our broken system has a disproportionate number of COVID-19 cases affecting minorities in our country. We are aware of the social determinants of health but when you see it unfold in a pandemic, it shakes you up. When will things change? When will we stop blaming the victims for their poorer outcomes? When will we really THINK about how things got to be this way? When you say, “Maybe it's because this group doesn't wash their hands enough!” A part of me dies a little bit more and NO, I am NOT okay!

As a physician, when I see major healthcare organizations and medical societies watching, it unearths me. We ask residents and even students to volunteer. They have very little offered to them in the face of hazard insurance, life insurance or loan repayment. They are human and have families. And we say that this is what they signed up for. Well, yes, as long as we, as a society try our level best to protect them. Look at the protective equipment our police force has. They look like futuristic soldiers and they SHOULD! But why can't we extend the same courtesy to healthcare workers when they are out battling. It's easy to be a “wartime leader” when it serves a narrative but then to protect and arm your soldiers should also be a part of that, right? When I see the double standard, I die a little more and of course, I AM NOT DOING OKAY!

Where is the advice that we are all yearning for? While ACP, ACEP, AAFP (to name a few) have come out with very strong statements condemning things as they are, where are the bigwigs? I hope they are pondering where their membership has gone. And no, my current focus is not to be sucked into Maintenance of Certification, etc, it's to go out and deliver the best care possible while protecting my students, residents, staff, co-workers and my community. The amount of reading we are doing to keep up day to day should certify us forever, right?

The mental toll COVID-19 has taken on us will stick around for a while. My psychiatrist friends are busier than ever, the at-risk population is at heightened risk of abuse, self-harm, homicide and neglect, and my colleagues and friends are struggling. But maybe we are so used to hearing about these numbers that it's become another statistic. So, when I read about another fellow physician's suicide, I die a little more. And how, just how, can I be doing okay?

So, the next time you give me a look when I am wearing a mask or trying to create a space between you and I, PLEASE try to show empathy and understanding. Behind that mask is a doctor who dies a little every time their child has a scratchy throat or their tummy hurts because they think they gave their child COVID-19. Behind that mask is a mother who is exhausted from working and homeschooling. Behind that mask is a father who has been camping out in the garage for months because he works with COVID-19 patients daily. Behind that mask is an immunocompromised person who will not survive this disease if they get it. Behind that mask is a two-year-old who has the decency to do the right thing when they have to be out with their dad/mom because of lack of day care!

Yes, while we are still waiting for masks, COVID 19 surely unmasked who we truly are!

Missouri Contestants Recognized at the National ACP Poster Competition

Missouri ACP is very proud of our contestants that participated in the National ACP's Virtual Poster and Abstract Competitions. Two of our contestants excelled:

Morgann Madill won in the student 2020 Virtual ePoster Competition, Clinical Vignette

“When To Think Zebras, Not Horses: A Case of Delayed Care in anti-NMDA Receptor Encephalitis”

St Louis University School of Medicine, St Louis, MO

Farzana Hoque, MD, participated in the Early Career Physician competition and was a Poster Finalist and awarded Young Achiever recognition.

Councilors and Elections

The Missouri ACP Governor's Council comprises members voted in by our membership, student and resident members voted in by their peers, past Missouri Governors, chairs of our committees (ex-officio), and the residency program directors for internal medicine programs and medical pediatrics programs (ex-officio). Each elected Councilor can serve two consecutive three-year terms. We want to thank two Council members that will be completing their second terms at the end of the calendar year, Raj Patel, MD, FACP, and Wade Schondelmeyer, MD.

We want to welcome our newest ex-officio Council member, Alexandre Lacasse, MD, the new residency program director at St. Mary's in St. Louis.

If you are interested in learning more about the Governor's Council, or are interested in running for the Council, please contact the MO ACP Executive Director by email. The election cycle begins this fall, and nominations will be accepted through September.

Committee Updates

Wellness Committee

The wellness committee is discussing a wellness webinar series for members over the next 18 months. We would love feedback from members on what they are interested in hearing about, be it mental health, physical health, relaxation tips, etc. Please take a minute and complete this short form so we know your areas of interest and if you would like to join the Wellness Committee.

Hospitalist Committee

The hospitalist committee is working on many projects right now including the development of a mentorship program, a Hospitalist Day event, and resources for the hospitalist section of www.missouriacp.org. The committee has been hard at work, so look for additional information on their efforts in the coming months. If you are interested in getting involved in their committee, here is a poster that outlines more information. Ready to join the committee, then sign up here. The committee has an active survey out now to determine areas needed for those interested in a mentorship program. You can complete the survey by clicking here.

Nominations Committee

Selecting the Laureate Award winner is always a difficult task each year with so many members that excel at what they do. The award winner this year stood out for his involvement in our chapter and we are pleased to present the award to Ernie-Paul Barrette, MD, FACP. Though the presentation will be different in 2020 from normal years, we will be sure to give recognition where recognition is due, and share it with as many people as we safely can.

Additionally, it's that time of year for the nominations committee to begin asking those interested in joining the Missouri Governor's Council to please announce themselves so we may add you to the ballot. If you are interested in serving on the Council, please email the executive director and let her know of your interest.

Membership Committee

The membership committee has been planning events and working to reach out to new members, lapsed members and cancelled members. We have developed a recruitment and retention plan to help with our membership numbers, but also to fulfill our Chapter Excellence Award criteria.

We had an event planned at the Saint Louis Zoo at the end of May, but had to postpone it due to the pandemic. If you had signed up to attend the event, or were planning to attend, please take a minute to complete this survey so we can plan to continue with the event, or decide to postpone until next spring.

Health and Public Policy Committee

The HPPC held another successful Advocacy Day earlier in the year and we appreciate all those that attended. We were lucky to get our event in before the pandemic shut the Capitol building down for several weeks. We will plan to hold an Advocacy Day in 2021, but this will be dependent on the current health status of the state. Medicaid Expansion will be on the ballot in August, and the HPPC will be receiving a presentation on this issue in late June to help the committee better understand the ballot measure.

Poster Committee

The committee is working on redeveloping the poster competition as a virtual event. The event will run similarly to the national event this spring. We are still in need of judges and poster contestants. If you would like to judge virtual posters, please send an email; if you would like to participate in the competition, please check with your medical school or residency program, as all submissions come through the school/program and are not submitted on an individual basis. Additional information will be sent to the medical schools and programs soon.

Racism and Discrimination

The Missouri chapter stands with national ACP on racism and discrimination. ACP Condemns Racism, Discrimination and Violence by Public Authorities and Others - The American College of Physicians (ACP) is gravely concerned whenever any person is subject to discrimination, racism, harassment and violence, whether it's by police and other public authorities, or by private individuals discriminating and committing violence against others because of their race or other characteristics. It is evident that African-Americans in particular are at risk of being subjected to discrimination and violence against them because of their race, endangering them and even costing them their lives. This should never be acceptable and those responsible must be held accountable. ACP has long held that hate crimes, prejudice, discrimination, harassment and violence against any person based on race, ethnicity, religion, gender, gender identity, sex, sexual orientation, or country of origin is a public health issue. View the complete statement here.

DHSS Launches Comprehensive Cancer Survivorship Campaign

The Missouri Department of Health and Senior Services recently announced the launch of a Comprehensive Cancer Survivorship Campaign. The campaign will be released statewide in July on radio, Facebook, Instagram, Snapchat, YouTube, Google, telephone on-hold messages and online.

The comprehensive educational awareness effort includes three components:

Survivorship

Promotes thriving while surviving and self-care with messages tagged as ‘Cancer Survivors Self Care Tips' encouraging healthy behaviors, active lifestyles and wellness.
Encourages individuals to upload photos and share positive survivorship stories through ‘Honor a Cancer Survivor’.

Prevention

Urges Missourians to lower their risk of developing cancer by informing them of prevention methods such as the use of sunscreen, eliminating tobacco use, increasing physical activity, and eating a healthy diet tagged as ‘Reduce your Risk of Developing Cancer’.

Screening

Educates Missourians about the early detection of cancer through screening for the top incident and mortality cancers in the state tagged as ‘COVID-19 Didn't Cancel Cancer – Get Screened’ and ‘Cancer Screenings Save Lives – Get Screened’.

The graphics, messages, public service announcements, tip cards, fact sheets and the link to Honor a Cancer Survivor. Please feel free to use this content with your patients, clinics, hospitals, etc.

Congrats to our Executive Director

Congratulations to our executive director, Sarah Luebbert on completion of her year serving as President of the Missouri Society of Association Executives.