Welcome to the Clinical Center Grand Rounds,
a weekly series of educational lectures for physicians and
health care professionals broadcast from the Clinical
Center at the National Institutes of Health in
Bethesda, MD.
The NIH Clinical Center is the world's largest hospital totally
dedicated to investigational research and leads the global
effort in training today's investigators and discovering
tomorrow's cures.
Learn more by visiting us online at http://clinicalcenter.nih.gov
OUR SPEAKER TODAY IS Dr. SANSEA
JACOBSON FROM PSYCHIATRY AT
THE UNIVERSITY OF PITTSBURGH
MEDICAL CENTER WHERE SHE'S THE
PROGRAM DIRECTOR FOR CHILD AND
ADOLESCENT CHILD PSYCHIATRY
FELLOWSHIPS AND THE TRIPLE BOARD
PROGRAM.
SHE RECEIVED HER BACHELOR OF
ARTS IN ENGLISH FROM DARTMOUTH
COLLEGE.
SHE THEN RECEIVED HER MEDICAL
DEGREE FROM THE UNIVERSITY
PITTSBURG SCHOOL OF MEDICINE.
SUBSEQUENTLY SHE TRAINED IN
GENERAL AND CHILD SIGH COULD PSE
PREVENTION OF YOUTH SUICIDE
THROUGH HER WORK A LOT THE
SERVICES FOR TEENS AT RISK OR
STAR CENTER WHERE SHE HAS BEEN A
CORE MEMBER OF THE TEAMS SINCE
2007.
SHE IS RECOGNIZED FOR CREATING
AND IMPLEMENT INNOVATIVE,
EDUCATIONAL INITIATIVES TO HELP
SUPPORT VULNERABLE YOUTH EXPOSED
TO TOPICS IN THE MEDIA.
Dr. JACOBSON IS ALSO AN
ADVOCATE FOR PHYSICIAN WELL
BEING THROUGH HER ROLE AS
CO-CHAIR FOR THE UPMC, GME
WELLNESS ENVIRONMENT LEARNING
AND LIVING COMMITTEE WHERE SHE
HELPS OVERSEE WELLBEING
INITIATIVES TO SUPPORT THE
NEARLY 2,000 RESIDENTS AND
FELLOWS ACROSS A UPMC
HEALTH-CARE SYSTEM.
SHE IS THE CHILDCARE OF THE
ADOLESCENT TRAINING AND
EDUCATION COMMITTEE AND
COLLABORATES WITH THE ACMAAA
SCHOSCHOLAR AND SHE HAS CREATEDE
WELL TOOLKIT CURBSIDE AND
THRIVE.
SHE'S AUTHORED PEER REVIEW
ARTICLES AND BOOK CHAPTER AND
BEEN THE RESILIENT OF SEVERAL
TEACHING AWARDS.
OF NOTE, PRIOR TO A EMPLOYING TO
MEDICAL SCHOOL SHE WAS A FORMER
NIH INTRAMURAL RESEARCH TRAINING
AWARD RECIPIENT AND WORKED AT
NCI UNDER EILEEN JAFFY SO
WELCOME BACK TO THE NIH AFTER A
LONG ABSENCE.
THE TITLE OF HER PRESENTATION
TODAY IS "PHYSICIAN WELL-BEING."
WHICH NEED NOT ALWAYS BE HEROES.
PLEASE JOIN ME IN WELCOMING
TODAY'S GRAND ROUNDS SPEAKER
Dr. SANSEA JACOBSON.
>>THANK YOU SO MUCH, THAT WAS A
LOVELY INTRODUCTION AND IT
REALLY IS SO SPECIAL BEING BACK
HERE AT THE NIH EVEN IN ONLY
VIRTUALLY BUT I DO HOPE THAT
PERHAPS I GET TO COME AND VISIT
YOU ALL IN BUILDING 10 AND VISIT
IN-PERSON WHEN THINGS NORMALIZE
WITH THE PANDEMIC.
SO, I WANTED TO START BECAUSE
THE WORK THAT I DO REALLY IS A
PRIORITIZE CONNECTEDNESS AND
COMMUNITY WITH TRYING TO GET TO
KNOW YOU A LITTLE BIT IN THIS
VIRTUAL SPACE.
SO, IF YOU COULD, I'M GOING TO
SHARE WITH YOU, MY SCREEN.
SO THAT YOU CAN SEE HERE A QR
CODE HOPEFULLY AND IF YOU HAVE A
PHONE, YOU CAN GO AHEAD AND JUST
SCAN THE QR CODE WITH YOUR
CAMERAS AND I'M GOING TO DO IT
MYSELF AS WELL.
AND THEN, GO AHEAD AND HIT THAT
LITTLE HEART BUTTON TO LET ME
KNOW YOU GUYS ARE STARTING TO
JOIN.
IF YOU ARE ON YOUR COMPUTER AND
YOU PREFER TO JOIN ON THE
LAPTOP, GO TO MENTI.COM AND USE
9-1-1 03700.
IT WILL BE FUN TO SORT OF GET TO
KNOW WHO IS IN THE ROOM BEFORE
WE GET STARTED SO THAT I CAN
MAKE SURE THAT I AM INCLUDING
YOU IN THE CONVERSATION THAT WE
HAVE GOING FORWARD ON THIS
REALLY IMPORTANT TOPIC, OF
PHYSICIAN WELLBEING.
SO LET'S JUST DO A LITTLE FUN
QUIZ.
IF YOU ARE HAVING LUNCH RIGHT
NOW WITH SOMEONE OTHER THAN ME,
WHO WOULD YOU CHOSE TO BE HAVING
LUNCH WITH TODAY?
>> THAT'S GREAT.
YES, I HAVE TO SAY I'M LISTENING
TO TREVOR NOAH'S AUTO BUY OT RA
FEE RIGHT NOW BUT DEFINITELY NOT
SURPRISED THAT MICHELLE OBAMA IS
LEADING IN THIS POLL.
THANK YOU FOR PARTICIPATING.
WE'LL GO AHEAD TO THE NEXT
SLIDE.
SO, WHO ARE YOU OUT THERE?
AND I REALLY WISH I COULD SEE
YOU AND INTERACT WITH YOU IN THE
AUDITORIUM.
TELL ME, ARE YOU A STUDENT, ARE
YOU A RESIDENT OR FELLOW,
ATTENDING, FACULTY, ADMIN OR
STAFF?
WHO DO WE HAVE IN THE ROOM
TODAY?
IT LOOKS LIKE WE HAVE A
COMBINATION HERE.
TRAINING, ATTENDING, ADMIN/STAFF
AND OTHER.
WONDERFUL.
COMING IN NOW.
THANK YOU FOR JOINING.
I APPRECIATE THE INTERACTIVE
TEE.
THERE'S A STUDENT HERE.
WELCOME!
IT'S GREAT.
I HAVE TO SAY NIH IS WHERE I
STARTED MY CAREER AND I COULDN'T
BE MORE GRATEFUL, I'LL TELL YOU
A LITTLE BIT MORE ABOUT THAT AS
I BEGIN MY TALK.
YOU MIGHT FEEL LOW PEOPLE ON THE
TOTUMPOLE RIGHT NOW AND YET WHAT
A BEAUTIFUL EXPERIENCE YOU HAVE
BY BEING PART OF THE NIH
COMMUNITY RIGHT NOW.
LET'S GO AHEAD.
THIS IS COMPLETELY ANONYMOUS,
HOW WOULD YOU DESCRIBE YOUR OWN
WELLBEING?
I HAVE TO BE HONEST, AS A SINGLE
MOTHER AND A FULL-TIME ACADEMIC
ADMISSION AND WHATEVER ELSE I
DO, MY MONTRA WITH MY TWO BOYS
AND WORE HOLDING IT TOGETHER
WITH SCOTCH TAPE SO THAT'S MY
VOTE.
I LOVE TO SEE THAT SOME OF YOU
ARE WAXING AND WANING SO IT'S
NOT SURPRISING THAT THIS STAGE
OF THE PANDEMIC AND WHERE WE ARE
IN THE WORLD RIGHT NOW, THAT OUR
BELL CURVE HAS SHIFTED, ISN'T
IT.
LOOKS LIKE WE HAVE SOME
WELLBEING CHAMPIONS IN THE ROOM
POSSIBLY.
AT LEAST TWO OF THEM.
ALL RIGHT.
THANK YOU, AGAIN FOR VOTING.
LET'S GET REAL A LITTLE BIT.
I'D LOVE TO HEAR WHAT YOU THINK
THE BIGGEST WORK-RELATED
STRESSORS ARE RIGHT NOW IN YOUR
POSITIONS.
WHATEVER ROLE IT IS THAT YOU
HAVE RIGHT NOW AND WHETHER IT'S
RESEARCH, WHETHER YOU ARE
TRAINING, WHETHER YOU ARE DOING
CLINICAL WORK, WHETHER YOU ARE A
LEADER OR ADMINISTRATOR, WHAT
ARE THE BIGGEST WORK-RELATED
STRESSORS, GO AHEAD AND THROW A
COUPLE OF THEM IN THERE AND
MULTI TASK.
YEAH.
WORK ITSELF.
VERY FUNNY.
THANK YOU FOR BRINGING SOME
HUMOR TO A VIRTUAL ROOM, WHOEVER
THAT WAS I'M GRATEFUL.
SELF, YEAH, RIGHT.
WE ARE THE WHOLE MALE ADAPTIVE
PERFECTIONISM AND WITHIN OUR
FIELD OF MEDICINE IS REAL, RIGHT
SOLVE, WE, OURSELVES, ARE PART
OF THE PROBLEM.
TOXIC WORK ENVIRONMENTS,
PERSONNEL, THERE'S NOT ENOUGH
PEOPLE NOT ENOUGH TIME.
NOT ENOUGH SPACE.
TOO MANY DEMANDS.
MICRO MANAGEMENT.
RIGHT.
FEELING OF CONDENSE, TEAM
DYNAMICS WHICH IS PART OF THE
MAGIC AND ALSO BE PART OF THE
PROBLEM.
DEADLINES, DEADLINES.
OVER SCHEDULED.
WORK-LIFE IMBALANCE.
BUDGET.
MONEY, JOB IS STUPID.
YOU GUYS ARE GREAT, I REALLY
WISH I COULD BE WITH YOU
IN-PERSON.
A PERSONAL QUESTION THAT YOU
DON'T HAVE TO ANSWER BUT HAVE
YOU GONE AND GONE YOURSELF ANY
PSYCHOTHERAPY.
I HAVE, YOU WILL HEAR ABOUT
THAT.
BUT YOU KNOW, ONE OF THE THINGS
WE ARE GOING TO TALK ABOUT TODAY
IS MAYBE SOME OF US REALIZE THAT
WE COULD HAVE USED ADDITIONAL
HELP AT DIFFERENT TIMES WHETHER
BY PROFESSIONAL MENTAL HEALTH
PROVIDERS ARE JUST SUPPORT BUT
THERE ARE EXPECTATIONS OF
PERFECTIONISM IN OUR FIELD AND
SO HOW CAN WE DECREASE THE
BARRIERS SO PEOPLE CAN GET HELP
WHEN THEY NED IT SO IT'S LOVELY
TO SEE SO UM PEOPLE THAT HAVE
SOUGHT HELP FOR MENTAL HEALTH
BUT IT LOOKS LIKE UNSURPRISING
LOW A LOT OF YOU HAVE NOT.
ALL RIGHT.
SO, IN THE MIND SET OF THE
APPRECIATIVE INQUIRY WHICH I
WILL TALK TO YOU ABOUT LATER,
WHICH IS A POSITIVE-NODES BASE
ASSESSMENT, WHAT IS GOING WELL
FOR WELLNESS IN YOUR WORK
ENVIRONMENT OR YOUR TRAINING
ENVIRONMENT RIGHT NOW?
WE TALKED ABOUT STRESSORS, BUT
THERE HAS TO BE SOME THINGS THAT
ACTUALLY YOU ARE FINDING
HELPFUL, YOU ARE FINDING
MEANINGFUL, LECTURES ON LOVE.
WHEN I SEE A WELLNESS LECTURE I
WONDER IF IT'S A GO A GOOD USE R
TIME SO I'M HAPPY YOU ARE HERE
AND PARTICIPATING.
WORK FLEXIBILITY.
LOOK AT THAT.
SO WE NO FROM THE WELLNESS
RESEARCH THAT IS RELATED TO
PHYSICIANS THAT FLEXIBILITY HAS
AN EVIDENCE-BASED INDICATION FOR
IMPROVING WELLNESS IN DECREASING
BURNOUT.
I LOVE -- THERE'S A LOT OF YOU
TALKING ABOUT COMMUNITY
CONNECTIVENESS.
COFFEE SHOPS.
FINDING TIME TO DO LUNCH AND BE
OUTSIDE AND FINDING MENTORSHIP.
THE WELLNESS CULTURE, RIGHT.
AT LEAST WORE TALKING ABOUT IT
NOW.
THIS DIDN'T EVEN EXIST BEFORE.
GENERAL SUPPORTS AND SUPPORT OF
SUPERVISORS AND YEAH, AND THEN
YOU KNOW, PERSONAL VIDEO
INTERACTIONS, RIGHT.
SOMETIMES A VIDEO INTERACTION
CAN BE NICE AND I DO A LOT OF MY
OUT PATIENT WORK WITH
ADOLESCENTS ONE-ON-ONE IN A
VIRTUAL SPACE AND IT FEELS
INTIMATE BUT IT DOESN'T ALWAYS
FEEL INTIMATE SOMETIMES IT FEELS
LIKE WE'RE REBOTS IN THESE
STRANGE VIRTUAL REALM.
SO LET'S GO AHEAD, I'M GOING TO
STOP THE MENTEE, THANK YOU SO
MUCH FOR DOING THAT.
I KNOW JOYCE SAID WE WOULD IT
WILL BE CHALLENGING FOR ME TO BE
ABLE TO SEE THEM COME UP BUT I'M
GOING TO COUNT ON THE OTHER
AMAZING FOLKS IN THE ROOM FROM
NIH TO INTERRUPT ME AND ASK ME
QUESTIONS IF THEY COME UP AS
THEY COME UP IF IT FEELS LIKE
SOMETHING WE SHOULD TAKE CARE OF
BEFORE THE END OF THE SESSION.
SO, BUT MAKE IT AS INTERACTIVE
AS YOU LIKE IT AS I DO LOVE
MAKING MY TALKS AS USEFUL TO THE
COMMUNITY I'M TALKING TO AS
POSSIBLE.
ALL RIGHT, SO, MY BROTHER WORKS
FOR PIXAR SO IT'S A PICTURE OF
ME WHEN I GO TO VISIT HIM ON
CAMPUS.
I DON'T HAVE ANY FINANCIAL
DISCLOSURES SPEAKING OF
GRATITUDE AND COMMUNITY, CAN YOU
BELIEVE THIS, 23 YEARS AGO, I
WAS IN IRDA UP THERE IS Dr.
STEPHANO AND ELAINE JAFFEY WHO
REALLY TREATED ME WITH THE
UTMOST RESPECT.
I WASN'T A MEDICAL STUDENT, YET,
RIGHT AND THEY WERE INTERESTED
IN WHO I WAS AND THEY NURTURE ME
AND MY INTEREST AND SURE, I'M
NOT A SPECIALIST ANYMORE BUT I
AM HUGELY GRATEFUL FOR THEIR
MENTORSHIP AND BELIEF IN ME AND
I WOULDN'T BELIEVE WHERE I AM IF
IT WEREN'T FOR THEM AND SO AND I
WANT TO SAY THANK YOU TO ALL THE
OTHER IRTA AND FELLOWS, IT WAS
SUCH A TIME TO BE TOGETHER AND I
HOPE THAT YOU ALL AT THE NIH ARE
EXPERIENCING THAT EVEN IN THE
MIDST OF A PANDEMIC, I'M SURE IT
FEELS VERY DIFFERENT THAN IT HAS
IN THE PAST.
THE OTHER THING I WANTED TO
MENTION IS THAT I HAVE SOUGHT
THERAPY FOR MYSELF.
THIS IS A SAFE PLACE TO TALK
ABOUT THAT OBVIOUSLY.
ALSO, EVEN THOUGH I'M A HUGE
WELLBEING CHAMPION THE WORD
WELLNESS MAKES ME CRINGE AND
BURNOUT IS SOMETHING AS I
MENTIONED TOO, THE FACILITATORS
YESTERDAY, I THINK I MADE RITA
CHUCKLE IS THAT BEEN OUT IS
BORING, RIGHT.
YOU GUYS DON'T WANT TO HEAR
ABOUT BURNOUT, WE'RE ALL BURNED
OUT ON BURNOUT.
OVER THE NEXT 40 MINUTES, LET'S
KEEP IT REAL, RELEVANT AND I
HOPE I'M GOING TO GIVE YOU SOME
LOOSE THAT'S YOU CAN WALK AWAY
WITH AND THINK ABOUT WELLNESS IN
YOUR COMMUNITY DIFFERENTLY AND
THIS IS ANOTHER DISCLOSE YOUR, I
AM A CHILD SIGH PSYCHIATRIST AY
SON WILDER.
SO FIRST I'LL TELL YOU A LITTLE
BIT ABOUT MYSELF.
THE CHAPTER I CALL A BEAUTIFUL
MESS.
AND THEN WE'LL DO A LITTLE BIT
OF TERMINOLOGY ON BURNOUT AND
LANGUISHING AND MORAL INJURY AND
ALL THE REST.
REALLY, I WANT TO SPEND THE
MAJORITY OF THE TIME TALKING
ABOUT PERSPECTIVES AND HOPES.
SO, WHAT CAN WE DO TO IMPROVE
PHYSICIAN WELL BEING RELATED TO
MENTAL HEALTH AND ALSO WHAT
KINDS OF SYSTEMS-LEVEL CHANGES
CAN WE BE MAKING TO IMPROVE THE
ENVIRONMENT AROUND US TO
FACILITATE WELLNESS FOR OUR
PHYSICIANS AND TRAINEES.
SO THESE ARE MY TWO LITTLE BOYS.
AND AS YOU CAN IMAGINE, THAT WAS
A BEAUTIFUL MESS WITH THAT MUCH
PINK CHALK.
SO WHO AM I?
WELL, YOU HEARD FROM THE
INTRODUCTION AND I DON'T WANT TO
BELABOR MY OWN CV BUT I'M HERE
PRIMARILY BECAUSE I'M SOMEONE
WHO REALLY CAN'T HELP MYSELF
WHEN SOMETHING IS WRONG AND I
TEND TO STAND UP AND SPEAK MY
MIND WHETHER IT COMES TO SUICIDE
PREVENTION, SOME OF YOU MIGHT
KNOW ME FROM THE ADVOCACY WORK I
DID AROUND 13 REASONS WHY AND
WHERE ABLE TO WITH THE HELP OF
RESEARCHERS AND THE FIELD AND
ADVOCACY EDUCATION WITH NETFLIX,
GET THEM TO REMOVE TH THREE-MINY
FICTION OF SIGHS I'D.
SUICIDE.
IT WAS GETTING ME OUTSIDE AND A
WONDERFUL RIDE IN TERMS OF
ADVOCACY AND IT MADE ME REALIZE
THERE ARE OTHER THINGS I WANTED
TO ADVOCATE FOR AROUND THE
CULTURE OF WELLNESS WITHIN THE
COMMUNITY THAT I WORK BUT ALSO
NATIONALLY AND THEN MORE
SPECIFICALLY I'VE BEEN WORKING
TO BECOME A PHYSICIAN COACH
WHICH HAS BEEN FUN, A LITTLE
OUTSIDE OF THE TOPIC TODAY, BUT
I THINK IT DOES HELP US THINK
ABOUT PERSPECTIVES AND IDENTITY
THAT MIGHT BE DIFFERENT IN YOUR
OWN CAREERS.
SO WHILE THAT WAS HAPPENING WITH
MY CAREER, I HAD WRITTEN AN
IDYLLIC PERSONAL EXPERIENCE IN
MY LIFE AND IN MY FAMILY LIFE.
THIS IS US ARE FROM GOSH, I
GUESS MY OLDEST SON IS 13 SO
THIS IS LIKE A DECADE AGO AND
EVERYTHING SEEMED SO GREAT BOTH
TO ME AND TO OUTSIDE OBSERVERS.
AND YET ON MAY 29th, 2016, I
WAS UP IN VERMONT AT A
CONFERENCE AND IT ALSO HAPPENED
TO BE FATHER'S DAY WEEKEND AND I
WAS VISITING WITH MY FAMILY OVER
THE WEEKEND AND I REMEMBER
SAYING TO MY MOTHER, EVERYTHING
SHOULD BE SO GREAT AND YET
SOMEHOW I FEEL ALONE.
I FEEL LIKE MY PARTNER IS NOT
AROUND, LIKE TO RIDE THIS SORT
OF CHALLENGING RIDE OF HAVING
YOUNG KIDS AND HAVING THESE
AMBITIOUS CAREER AND WHAT HAVE
YOU.
I REMEMBER HER SAYING, WELL, DO
YOU THINK HE IS HAVING AN
AFFAIR?
MEANING MY HUSBAND AND I THOUGHT
ABSOLUTELY NOT.
IT PLANTED A SEED.
I WENT BACK TO PITTSBURG AND
AFTER MANY, MANY, MANY
CONVERSATIONS AND AFTER MANY,
MANY HOURS OF THERAPY IN MARITAL
COUNSELING, IT BECAME QUITE
EVIDENT THAT BOTH OF OUR LIVES
WERE NOT GOING TO BE GOING
TOGETHER.
AND THAT IN FACT I WAS GOING TO
BE A SINGLE MOM.
VERY DIFFERENT THAN THE CAREER I
THOUGHT I WAS GOING TO HAVE.
AND SO, THE MONTHS PROGRESSED
AND WE SEPARATED AND I CONTINUED
TO FEEL PRETTY SAD.
PEOPLE WOULD ASK ME AT WORK, HOW
ARE YOU DOING, AND I WOULD BURST
NO TEARS.
I HAD BEEN A VERY LONG TIME AT
THAT POINT.
IT TOOK MY STAR PHYSICIAN WHERE
WE WERE ACTUALLY TRYING OUT SOME
APPS FOR ME TO SEE THAT IN FACT
I WAS SAD FROM THE EXPERIENCE
THAT I WAS GOING THROUGH WITH
THE DISSOLVING OF MY MARRIAGES
BUT THAT I WAS ACTUALLY STARTING
TO MEET SOME PRETTY SIGNIFICANT
CRITERIA FOR A MAJOR DEPRESSIVE
EPISODE.
SO, I GUESS THE POINT S. I ASKED
THESE QUESTIONS EVERY DAY AND
FRANKLY, IT WAS A HUMBLING
MOMENT TO REALIZE THAT I WASN'T
SEEING IT FOR MYSELF.
TRUTH OF THE MATTER IS, I'M NOT
A IMMUNE AND YOU ARE NOT EITHER.
IN FACT, PHYSICIANS HAVE HIGHER
RISK OF DEPRESSION THAN THE
GENERAL PERCENT OF 20% OF WOMEN
PHYSICIAN AND 12% OF RECEIVE A
MAJOR DEPRESSIVE EPISODE.
THE RATES OF SUICIDE ARE DEBATED
BUT THE MOST RESENT RESEARCH
SHOWS THAT ABOUT 119 PHYSICIANS
DIED BY SUICIDE ANNUALLY IN THE
UNITED STATES.
WHICH IS EXTREMELY HIGH.
THE SUBSTANCE USE DISORDERS, WE
DON'T EVEN LIKE TO TALK ABOUT
THAT RIGHT BUT IN FACT WE ARE AT
EQUAL RISK OF THE GENERAL
POPULATION BETWEEN 10% AND 12%
OF PHYSICIANS EXPERIENCE A
SUBSTANCE ABUSE ORDER.
I DID WANT TO HIGHLIGHT THAT
SUICIDE IS ACTUALLY VERY RARE
AND YET WHEN IT HAPPENS IT ROCKS
THE COMMUNITY AND IT'S
INTERESTING THAT ATTEND'S ARE
ACTUALLY AT THE HIGHER RISK WITH
MID-KA ROARCAREER TO LATER BEING
HIGHEST RISK BUT TRAINING
SUICIDE IS THE NUMBER ONE AND
NUMBER TWO CAUSE OF DEATH IN
MALE AND FEMALE RESIDENTS
BECAUSE THEY'RE HEALTHY AND THEY
TEND TO NOT DIE FOR OTHER
REASONS.
SO WHAT'S IS KNOWN.
BECAUSE I AM A ROOM HERE WITH
STUDENTS, RESIDENTS AND PEOPLE
WHO CARE ABOUT THEM AND WE NEED
TO LOOK OUT FOR THEM, RIGHT.
ESPECIALLY IF THOSE TIMES OF
TRANSITIONS AND SO I THOUGHT
THIS IS A REALLY INTERESTING
STUDY THAT SHOWS THERE ARE
TEMPORAL RISK FACTORS FOR
SUICIDE RISK IN TRAINEES AND
SPECIFICALLY EARLIER IN TRAINING
AND THE INTERN YEAR AND THE
FIRST AND THIRD QUARTERS.
WHILE PHYSICIANS SOMETIMES HAVE
AWARENESS THAT THEY'RE
STRUGGLING, THIS STUDY OF NEARLY
8,000 SURGEONS SHOWED THAT WHILE
ONE AND 16 OF THEM ADMITTED TO
HAVING SUICIDAL THOUGHTS, ONLY
ONE IN FOUR OF THEM SOUGHT
PROFESSIONAL HELP.
AND WHY?
WHEN PHYSICIANS ARE ASKED GIVE
ALL SORTS OF REASONS WHY THEY'RE
NOT SEEKING TREATMENT.
MORE THAN 80% OF DEPRESSED
INTERNS DIDN'T GET MENTAL
HEALTHCARE AND YOU CAN SEE HERE
CONFIDENTIALLY, AND STIGMA AS
WELL AS TIME AND OTHER REASONS
CHART THE COURTS AS A PHYSICIAN
CHAMPION AT THE UNIVERSITY OF
PITTSBURG, SOMETIMES I TALK TO
PHYSICIANS AND TRAINEES WHO ARE
TRULY, TRULY STRUGGLING AND IN
CRISIS EVEN.
I SPOKE TO ONE RESIDENT WHO WAS
SORT OF TURNED INTO ME BECAUSE
HER COLLEAGUES WERE CONCERNED
ABOUT HER MAKING SUICIDAL
STATEMENTS AND I WAS HAPPY TO
TALK TO HER AND SO HAPPY TO
CONNECT HER TO CARE AND IT FELT
REALLY MEANINGFUL TO DO SO AND
YET WHEN I TALKED TO HER YEARS
LATER AND NOW SHE'S A VERY
SUCCESSFUL ATTENDING IN PER
FIELD AND SHE SAID TALKING TO
YOU MADE ME FEEL IT WAS THE END
OF HER CAREER.
SHE WAS CERTAIN BECAUSE SHE WAS
TURNED INTO ME, SHE WASN'T GOING
TO BE ABLE TO RELISH IN ALL THE
HARD WORK SHE PUT IN UNDERGRAD
AND MEDICAL SCHOOL AND THERE I
AM WITH MY RESIDENTS ATTENDING
DOING AMAZING THINGS IN THE
WORLD.
IT'S EASY TO HELP SOMEONE WHO IS
HAD THE UNHAPPY TRIAD AND TORN
EVERYTHING IN HER KNEE TRYING TO
TAKE CARE OF HER WELLNESS IN A
SOCCER MATCH WHEN SHE'S PROBABLY
TOO OLD TO DO SO BUT IT'S NOT AS
EASY TO RECOGNIZE WHEN SOMEONE
IS STRUGGLING EMOTIONALLY AND
PSYCHOLOGICALLY.
SO WHAT IF PEOPLE LIKE OURSELVES
WHO ARE A LITTLE FURTHER ALONG
IN OUR CAREER MODELED
VULNERABILITY AND HUMILITY SO WE
CAN BE PART OF THE CHANGE
TOWARDS CHANGING PERFECTIONISM
IN MEDICINE AND OUR FRIEND IN
YALE AND HIS COLLEAGUES HAVE
DONE SOME RESEARCH ON THIS AND
THEY DID FIND THAT STUDENTS WHO
NEW ONE OF THEIR MENTORS HAD
SOUGHT TREATMENT FOR MENTAL
HEALTH THAT THEY WOULD BE 91%
MORE LIKELY TO SEEK TREATMENT
FOR THEMSELVES.
PHYSICIANS NEED TO KNOW HOW TO
ACCESS HEALTH AND UNDERSTAND THE
PRACTICAL IMPLICATIONS OF DOING
SO.
ALL RIGHT.
BEFORE WE TALK ABOUT PRACTICAL
IMPLICATIONS OF DOING SO, WE'RE
GOING TO FLY THROUGH THIS
SECTION BECAUSE IT'S A LITTLE
BIT LESS INTERESTING BUT I THINK
IT'S IMPORTANT AND FOUNDATION.
THAT'S MY SON, YES, BOTH OF HIS
PARENTS ARE PSYCHIATRISTS SO
WHEN HE WAS THREE OR
FOUR-YEARS-OLD HE WAS NEEDING TO
WRITE DOWN ALL OF HIS FEELINGS.
WE HAVE UNIQUE STRESSORS.
I DON'T NEED TO TELL YOU THIS
BUT BOTH ACUTELY AND
CHRONICALLY, PHYSICIANS'
WORK-LIFE IS DIFFERENT WHETHER
IT'S MORBIDITY AND MORTALITY OF
OUR PATIENTS, MALL PRACTICE
LAWSUITS, MEDICAL I REMEMBERERS
CAN BE VERY PRICE ETEN
ESPECIALLY EARLY ON IN ONE'S
CAREER AND SO
HERE IS THE TRIAD.
EMOTIONAL, LOW SENSE OF PERSONAL
ACCOMPLISHMENT OF WORK.
THERE'S STARTING TO BE SOME GOOD
LITERATURE LOOKING AT BURNOUT
AND WE DO KNOW THAT THESE
SYSTEMS-LEVEL CONTRIBUTORS SUCH
AS THE BUREAUCRATIC PAST, THE
ELECTRONIC MEDICAL RECORDS
SYSTEM AND ALL THE REST DOES
SEEM TO BE READING PERCENTAGELY
AND PROFESSIONALLY RADIO LATED
TO BURNOUT AND SO BROKEN
RELATIONSHIPS, ALCOHOL AND
SUBSTANCE USE, DEPRESSION, AS
WELL AS IMPACTS OUR SYSTEMS, OUR
PATIENTS AREN'T AS HAPPY WHEN
WE'RE BURNED OUT AND WE MAKE
MORE MEDICAL ERRORS AND OUR
CONCENTRATION ISN'T AS GOOD.
IT'S NOT JUST A HUMANNESS ISSUE,
THIS IS A SYSTEM'S ISSUE AND
IMPORTANT TO LEADERSHIP OR AT
LEAST IT SHOULD BE.
ONE THING AS A SUICIDE
PREVENTION SPECIALIST I DO LIKE
TO HIGHLIGHT, HOWEVER, IS IT
DOES APPEAR THAT THERE'S NOT A
CORRELATION BETWEEN BURNOUT AND
SUICIDE THAT WHILE BURNOUT HAS
MANY NEGATIVE POTENTIAL OUTCOMES
INCLUDING INCREASING RISK FOR
DEPRESSION AND WHAT HAVE YOU,
THERE'S NOT AT THIS POINT SEEM
TO BE A DIRECT CORRELATION
FORTUNATELY.
SO WHO IS AT RISK?
WELL, FIRST AND FOR MOST ALL OF
US.
BUT SOME OF US ARE AT HIGHER
RISK SO SPECIFICALLY WE KNOW
THAT RACIAL AND ETHNIC
MINORITIES RELATED TO A VARIETY
OF FACTORS ARE AT HIGHER RISK
FOR BURNOUT WHETHER IT'S
DISCRIMINATION THAT IS HAPPENING
THE MINORITY TAX THAT WE PUT
UPON AND UNDER REPRESENTED
COLLEAGUES AND THERE ARE SEXUAL
AND GENDER MINORITY FACTORS THAT
PLACE WOMEN IN SEXUAL MINORITIES
AT HIGHER RISK FOR BURNOUT
FACTORS AND ESPECIALLY EMOTIONAL
EXHAUSTION AND PERSONALIZATION
AND RELATED TO A VARIETY OF
DIFFERENT INEQUALITIES THAT
HAPPENED STILL IN OUR WORK
SETTINGS.
AND WE KNOW THAT THIS VARIES AND
INTERESTINGLY THESE MEDICINE
SCAPE SURVEYS HAVE VARIED
DRASTICALLY DURING THE PANDEMIC
BUT THAT PHYSICIAN BURNOUT
CERTAINLY DOES VARY BY MEDICAL
SPECIALTY AND INTERESTINGLY
EARL' IN THE PANDEMIC BUT THERE
WERE SIGNS WE WERE LESSED BURNED
OUT WE WERE STRESSED,
OVERWORKED, SCARED AND LESS
BURNED OUT.
THERE'S SOME INTERESTING
LITERATURE OUT THERE TO SUGGEST
YEAH, OF COURSE, BECAUSE WE WERE
DOING WHAT WE SET OUT TO DO,
RIGHT.
WE WERE TAKING CARE OF PATIENTS
AND VALUED BY OUR COMMUNITY MORE
THAN EVER.
THE HUGE BANNERS OF PHYSICIANS
HEROES WORK HERE.
I DROVE UNDER IT EVERYDAY,
RIGHT.
IT'S NICE TO BE CALLED A HERO ON
THE WAY TO WORK, OR AT LEAST IT
IS FOR A LITTLE WHILE.
SO WHAT ABOUT COVID-19.
AS I MENTIONED, YOU KNOW, WE
HAVE OUR UNIQUE STRESSORS BUT
EVEN MORE STRESSORS WHEN IT CAME
TO THE PANDEMIC RELATED TO PPE
AND ALL THE RISKS AND BE IT THE
JUGGLE THAT WE HAD TO DO WITH
OUR OWN FAMILIES AROUND
CHILDCARE AND JUST FRANKLY THE
PROCEDURE BOUNDARIES AND FEELING
LIKE WE WERE WORKING ALL THE
TIME.
HERE IN THE UNIVERSITY OF
PITTSBURG, WE DID SOME RESEARCH.
WE DIDN'T MEAN TO DO IT DURING
THE PANDEMIC BUT OF COURSE WE
CAN'T BACKOUT JUST BECAUSE OF A
PANDEMIC IS HAPPENING BECAUSE
THE TRUTH OF THE MATTER IS, WE
WERE FEELING LIKE BURNOUT WASN'T
CAMTURING WHAT OUR RESIDENTS AND
FELLOWS WERE EXPERIENCING AND IT
WAS EARLY IN THE STAGES OF
TALKING ABOUT MORALE INJURY
WHICH IS MORE, LESS OF A
STRESS-RELATED RESPONSE AND MORE
OF A TRAUMA MODEL.
THAT WE SET OUT WITH VERY HIGH
EXPECTATIONS MORE ALS AND VALUES
TO DO THIS WORK OF BEING A
PHYSICIAN.
AND WE'RE NOT ABLE TO ACCOMPLISH
WHAT WE WANT TO ACCOMPLISH
BECAUSE OF THE BUREAUCRATIC
TASKS BECAUSE WE CAN'T DELIVER
THE CARE WE FEEL LIKE THE
PATIENTS SO DESPERATELY DESIRE
AND NEED, THIS CAN LEAD TO
SOMETHING CALLED DISENCHANTMENT.
HOLD THIS SPACE BECAUSE I THINK
THE RESEARCH ON THIS WILL BE
REALLY INTERESTING.
I'M SPEAKING OF THE NIH SO I HAD
TO HAVE A BRAIN MODEL ON ONE OF
MY SLIDES, RIGHT.
I INCLUDED THIS HERE BECAUSE
TRULY ALL OF THIS STRESS, NOT
JUST THE ACUTE STRESS BUT THE
CHRONIC STRESS OF YEARS OF
PANDEMIC IN A MEDICAL
ENVIRONMENT MEANS THAT WE'RE
JUST IN A DIFFERENT SPACE NEURO
BIOLOGICALLY IN TERMS OF HOW OUR
BODIES ARE RESPONSING AND
RESPONDING TO WORK AND FAMILY
AND EXPECTATIONS AND FRANKLY THE
WORLD.
AND WE'RE SEEING IT SO I'M A
ADOLESCENT SUICIDE PREVENTION
SPECIALIST IN MY CLINICAL WORK
AND BOY, BUSINESS DIDN'T
SHOWDOWN THIS YEAR AND USUALLY
IT DOES IN THE SUMMER BUT KIDS
ARE REALLY SICK AND FRANKLY,
EVERYONE IN THE WORLD IS AT
SLIGHTLY HIGHER RISK RIGHT NOW
IT SEEMS AND ONCE AGAIN
PHYSICIANS AREN'T IMMUNE TO THIS
SECOND PANDEMIC OF MENTAL
ILLNESS.
ALL RIGHT.
WE GOT THROUGH THAT PRETTY
QUICKLY.
SO THIS IS MY SON WILDER.
HE IS PHYSICALLY VERY CAPABLE SO
HE IS ABLE TO LIVE UP TO HIS
NAME.
BUT I WANT TODAY HIGHLIGHT THAT
THIS IS SORT OF DOOM-TYPE TALK
BECAUSE OF HIGHWAY WE TALK ABOUT
IN TERMS OF BURNOUT, SUICIDE AND
DEPRESSION BUT I'M OPTIMISTIC
AND I WANT TO BRING US TO SOME
SOLUTIONS-FOCUSED CONVERSATIONS.
SO, LET'S DO THIS.
HOW WE HELP EACH AND FRANKLY HOW
DO WE HELP OURSELVES?
ALL RIGHT.
SO, I ALREADY MENTIONED THIS --
WE NEED TO KNOW HOW TO ACCESS
HELP BUT EVEN MORE IMPORTANTLY,
PHYSICIANS NEED TO UNDERSTAND
WHAT IS GOING TO HAPPEN IF THEY
DO THAT.
SO, YOU ARE ALL I'M SURE
FAMILIAR WITH THE AMERICANS WITH
DISABILITIES ACT, RIGHT.
UNDER THIS IT SAYS THE EMPLOYERS
REALLY AREN'T ALLOWED TO ASK
ABOUT CURRENT IMPAIRMENT AND SO
SPECIFICALLY AROUND HIRING AND
ALSO WE WOULD PREFER TO NOT SEE
THAT IN MEDICAL LICENSURE,
HOSPITAL PRIVILEGING AND THE
REST AND THIS RECENT 2021JAMA
STUDY THAT WE HAVE SOMEWAY TO
GO, RIGHT.
SO, THE FEDERATION STATE MEDICAL
BOARDS MADE RECOMMENDATIONS BACK
IN 2018 RELATED TO DECREASING
THE AMOUNT OF QUESTIONS AND TYPE
OF QUESTIONS THAT WE ALL WERE
BEING ASKED BY THE MEDICAL BOARD
SYSTEM AND MEDICAL LICENSING.
AND SO, FSMB SAID THAT YOU KNOW,
PLEASE, IF YOU ARE GOING TO ASK
THESE QUESTIONS, AND IT NEEDS TO
BE ONLY IF IMPAIRED ONLY CURRENT
AND IF THERE'S SEEKING HELP
THROUGH A STATE PHYSICIAN HEALTH
PROGRAM, THEN THEY DON'T EVEN
NEED TO REPORT BECAUSE WE
ALREADY KNOW ABOUT THEM, RIGHT,
SO THEY DO NEED TO DISCLOSE SO
THAT'S THAT SAFE HAVEN NON
REPORTING.
AND THEN, THEY ALSO ENCOURAGE
THAT FRANKLY YOU DO NEED TO ASK
THESE QUESTIONS AND YOU SUPPORT
OF LANGUAGE NORMALIZES THE FACT
THAT MENTAL HEALTH IS IMPORTANT
FOR ALL AND SO YOU CAN SEE HERE
THAT THE DARKER COLORS ON THE
MAP REPRESENT WHERE THIS STATES
ARE BETTER MEETING THESE
RECOMMENDATIONS AND CRITERIA AND
THE LIGHTER COLORS ARE THE LOWER
NUMBERS ARE WHERE WE REALLY HAVE
A LOT OF WORK TO DO.
WHAT CAN YOU DO?
SO, ANOTHER FRIEND AND COLLEAGUE
FROM YALE, JULIE CHILTON HAS
CREATED A WONDERFUL WEBSITE TO
HELP ANYONE WHO IS INTERESTED IN
THIS KIND OF PHYSICIAN WELLBEING
ADVOCACY WORK, TO FIGURE OUT HOW
TO WRITE LETTERS TO YOUR
CONGRESSPEOPLE AND HOW TO BE
WELLNESS EMBASSADORS LOCALLY AND
ON THE NATIONAL LEVEL.
SO WHAT CAN INSTITUTIONS DO?
WELL, WE CAN LIST THE ACTUAL
QUESTIONS SO PHYSICIANS KNOW
WHAT THEY'RE FACING BEFORE THEY
GO AND FILL OUT THESE FORMS.
WE CAN DESCRIBE THE
CONFIDENTIALALITY PROCESS BEFORE
A DOCTOR SEEKS HELP SO IF YOU
KNOW YOU HAVE TO TAKE TIME OFF
TO TAKE CARE OF YOUR MENTAL
HEALTH, WHO NEEDS TO KNOW.
DOES YOUR PHYSICIAN ASSISTANCE
PROGRAM NEED TO KNOW, DOES HR
NEED TO KNOW?
DOES YOUR BOSS NEED TO LOW.
WILL IT BE REPORTED ANYWHERE.
THESE THINGS, DOCTOR REALLY WANT
TO KNOW ABOUT AND SO RELEVANT
POLICIES REALLY NEED TO BE
AVAILABLE AND UP-TO-DATE.
SO HERE IS AN EXAMPLE IN
PITTSBURGH, I PRESENT THIS ALL
THE TIME TO TRAINEES AND FACULTY
MEMBERS AND JUST SO YOU KNOW,
THESE ARE THE ACTUAL QUESTIONS
ON THE HOSPITAL PRIVILEGING
QUESTIONNAIRE AND THE TAKE HOME
IS FORTUNATE LOW FOR MY STATE
AND FOR MY INSTITUTION, ONLY
CURRENT MENTAL HEALTH CONDITIONS
THAT CAUSE IMPAIRMENT ARE ASKED
NOTHING ELSE.
WE ALSO CREATED THIS COOL AND
VERY OVERWHELMING ALGORITHM BUT
YOU CAN IMAGINE IT WOULD FEEL
VERY, VERY OVERWHELMING IF YOU
ARE A PHYSICIAN HIDING WITH A
SUBSTANCE USE DISORDER THAT WAS
UNDISCLOSED AND YOU KNEW YOU
NEEDED HELP BUT YOU WERE
FRIGHTENED AND CONSEQUENCES TO
LEAD TO THE END OF YOUR CAREER
SO WE WORKED VERY HARD WITH
SPECIALIST WHO'S WORKED WITH
PHYSICIANS WHO HAD HAD SUBSTANCE
USE DISORDERS TO BETTER
UNDERSTAND WHAT WOULD HAPPEN IF
A PHYSICIAN SELF-DISCLOSED
VERSUS BEING SUSPECTED OR
RECORDED AND THE STEPS THAT
HAPPENED SO THOSE PHYSICIANS CAN
KNOW HOW THAT COULD RESULT IN
THEM REMAIN EXAMINING PHYSICIANS
AND REMAINING PROFESSIONALS AND
REMAINING PEOPLE WITHIN OUR
COMMUNITY WHO WE TRUST, WHO WE
KNOW AND WHO WE NEED.
AND ANOTHER THING WE'VE DONE
HERE IN PITTSBURGH IS WE'VE
CREATED ONE-PAGE FLYERS.
I'M FORTUNATE, I MEAN, WE HAVE
UNOF THE LARGEST GMEs AND WE
HAVE 2,000 RESIDENTS AND
FELLOWS, WE HAVE A LOT OF
PEOPLE.
WE HAVE A LOT OF RESOURCES AND
MORE THAN MOST PLACES.
SO, WE CREATED THESE FLYERS THAT
I UPDATE, I FEEL LIKE, EVERY
OTHER MONTH NOW.
IN FACT, WE JUST UPDATED IT WITH
THE NEW 9-8-8 SUICIDE CRISIS
HOTLINE NUMBER.
THERE'S ONE THING FOR ATTENDEE
AND ONE SPECIFIC TO RESIDENTS
AND FELLOWS AND IF YOU ARE
INTERESTED, YOU CAN GO TO THE
WEBSITE WHERE WE KEEP THESE
UPDATED BECAUSE I RECOMMEND
USING SOMETHING LIKE THIS SO
THAT PHYSICIANS AND RESIDENTS
DON'T HAVE TO ASK THE QUESTIONS.
THEY CAN FIND OUT WHAT IS
AVAILABLE BY READING AND DOING
THEIR OWN RESEARCH IF THEY'RE
FEELING LIKE THAT'S THE BARRIER
TO THEM UNDERSTANDING.
SO THIS IS MY BABY.
WE CREATED THIS ONE, GOSH, I
GUESS WE START TOUC WE START IN.
IT WAS CURBSIDE FOR BEHAVIORAL
HEALTH AND WE REALIZED THAT
PHYSICIANS WOULD CALL SOMEONE
LIKE ME A FRIEND AND PSYCHIATRY
AND MAYBE LIKE HEY, I NEED, YOU
KNOW, A MENTAL HEALTH PROVIDERS
LOCALLY AND I WOULD PREFER
SOMEONE OUTSIDE OF THE
INSTITUTION AND I HAVE, OCD OR
MY KID HAS ADH D AND THEY'RE
REALLY STRUGGLING DURING THE
PANDEMIC AND WHO DO YOU
RECOMMEND?
I WAS GETTING ONE OF THESE
E-MAILS OR PHONE CALLS OR TEXTS,
IT FELT LIKE EVERY WEEK AND I
KNOW SOME OF MY OTHER COLLEAGUES
WERE GETTING THE SAME.
WE THOUGHT, IT'S NOT BAD, HOW
ABOUT WITH THESE PRIVATE CURB
SIDES BUT YOU HAVE TO BE
PRIVILEGED TO BE COMFORTABLE
ENOUGH TO REACH OUT TO ME OR ONE
OF MY COLLEAGUES, RIGHT.
NOT EVERYONE HAS THAT IMMEDIATE
ACCESS TO BE ABLE TO DO THAT.
AND SO, WE REALIZED THAT WE
NEEDED TO CREATE A CONFIDENTIAL
MENTAL HEALTH REFERRAL SYSTEM
THAT WAS SPECIFIC TO DOCTORS.
BRANDING IS SO IMPORTANT.
PHYSICIANS DON'T LIKE TO GO TO
THE EMPLOYEE ASSISTANCE PROGRAM
AT OUR INSTITUTION.
WE DID RESEARCH ON IT AND WHEN
WE GRANTED FROM EAP TO PHYSICIAN
A EAST AS SOON AS PROGRAM THEY
REALIZED IT WAS FOR THEM AND
SAME THING WE CALLED THE RECEIPT
DEPARTMENT FELLOW ONE THE
RESIDENT AND FELLOW ASSISTANCE
PROGRAM.
THIS REBRANDING REALLY HELPS
NORMALIZE THERE ARE OTHER
PROFESSIONALS IN YOUR FIELD, WHO
NEED THESE SERVICES AND SO
CURBSIDE SPECIFICALLY IS NOT A
CLINICAL PROVIDING SYSTEM BUT
INSTEAD JUST A CONCIERGE
SERVICE.
YOU GET IN TOUCH WITH THEM AND
TELL THEM AS MUCH OR AS LITTLE
INFORMATION ABOUT THE CLINICAL
SITUATION THAT YOU ARE IN AND
THEN THEY CONNECT TO YOU TWO TO
THREE MENTAL HEALTH PROVIDERS
BASED ON YOUR REQUESTS AND NEEDS
WHETHER IT'S INSIDE THE
INSTITUTION, OUTSIDE OF THE
INSTITUTION, PRIVATE PAY AND
INSURANCE WHAT HAVE YOU.
YOU CAN SEE HERE, WE PUBLISHED
JUST THIS YEAR ON THE ORIGINAL
OUTCOMES AND ANXIETY AND STRESS
TOPPED THE CHARTS IN TERMS OF
WHY PEOPLE WERE CALLING CURBSIDE
AND WHO CONNECTED TO MENTAL
HEALTHCARE WHO MAY BE WOULDN'T
HAVE HAD CURBSIDE NOT EXIST
INSIDE THAT FIRST YEAR.
WHAT ELSE ARE WE DOING.
WE PAIRED UP WITH AMERICAN
FOUNDATION OF SUICIDE PREVENTION
AND YOU MIGHT BE FAMILIAR WITH
THE INTERACTIVE SCREENING
PROGRAM SO THIS IS A COMPLETELY
ANONYMOUS WAY TO ANSWER A MENTAL
HEALTH AND WELLBEING SURVEY.
ON PARAMETERS FROM SLEEPING,
EXERCISE AND DIET TO DEPRESSION,
SUBSTANCE USE AND SUICIDE AND
YOU ANSWER THE QUESTIONS BY
CREATING A UNIQUE I.D., A UNIQUE
PASSWWORD ON A UNIQUE SERVER SOO
ONE NEEDS TO KNOW YOU WERE THERE
AND YOU GO BACK INTO THE SERVER
WHEN YOU GET A MESSAGE IN THE
SERVER, TELLING YOU THAT ONE OF
THE ISP CLINICIANS HAS ANSWERED
EX THEIR PERSONALIZED SO IT
MIGHT SAY I NOTICED IN YOUR SUR
HAVE I HAVEA THAT YOU HAD A DEAE
FAMILY AND THAT PHYSICIAN CAN
CONNECT THROUGH THAT SERVER AND
CONTINUE TO KEEP THEIR ANONYMITY
OR THEY CAN CONNECT EITHER
VIRTUALLY OR IN-PERSON WITH A
CLINICIAN IF THEY FEEL THAT
WOULD BE HELPFUL.
WE HAVE A PEER-TO-PEER SUPPORT
PROGRAM FOR PHYSICIANS AND
PHYSICIAN TRAINEES AND IT'S
CALLED PHYSICIANS FOR
PHYSICIANS.
THIS IS DIFFERENT THAN MENTAL
HEALTHCARE.
THIS IS CHALLENGING OUTCOMES
HAPPEN AT WORK ALL THE TIME AND
YOU MIGHT BE REALLY STRUGGLING
WITH THE RELATIONSHIP WITH A
COLLEAGUES, ONE YOU SAID THAT,
RIGHT.
A TOXIC ENVIRONMENT ON YOUR
TEAM.
SO TALKING TO ANOTHER PHYSICIAN
IN A DIFFERENT DISCIPLINE IN A
CONFIDENTIAL ENVIRONMENT TO
VENT, GAIN SUPPORT, IDEAS, HAVE
SOME TRUST WITH SOMEONE WHO CAN
EXPERIENCED SOMETHING SIMILAR.
IT'S HELPFUL IF YOU HAVE NAMED
IN A MALPRACTICE LAWSUIT OR YOU
JUST HAD A REALLY CHALLENGING
CLINICAL INTERACTION OR OUTCOME.
I JUST WANT TO REMIND YOU THAT
THERE ARE AMAZING SERVICES AND
I'M SURE AT THE NIH, BUT ALSO
NATIONALLY AND SO THESE
BEAUTIFUL PROGRAMS LIKE THE
PHYSICIAN SUPPORT LINE, THE
EMOTIONAL PPE PROJECT AND THEY
ARE GEARED TWO PHYSICIAN AND
FRONTLINE WORKERS TO PROVIDE
MENTAL HEALTH SUPPORT AS WELL AS
THE NATIONAL SUICIDE PREVENTION
LIFELINE WHICH YOU CAN CALL,
CHAT OR TEXT AND NOW JUST THAT
9-8-8 NUMBER IS SO EASY TO
REMEMBER.
SPREAD THE WORD.
IT WILL SAVE SO MANY LIVES.
>> THE RESIDENT WHO HIT DISCLOSE
TO HER FRIENDS AND SHE WAS
HAVING SUICIDAL THOUGHTS AND SHE
GOT SENT TO ME.
SHE HAD A QUOTE.
THE HELP THAT I GAVE HER, SO I
CONNECTED HER WITH MENTAL
HEALTHCARE, SHE SAID, IT WAS
ABSOLUTELY NOT WHAT I WANTED AND
EXACTLY WHAT I NEEDED, RIGHT.
SO WE ALWAYS THINK AND I GUESS I
ALWAYS THINK, WHEN I'M HELPING
SOMEONE OUT IT'S GOING TO BE
THIS BEAUTIFUL MOMENT WHERE
THEY'RE GOING TO BE SO GRATEFUL,
THANK YOU SO MUCH FOR HELPING ME
CONNECT WITH THE THERAPIST AND
WHAT WOULD I DO IN THIS CRISIS
MOMENT IF IT WEREN'T FOR A
FRIEND AND PSYCHIATRY.
THE TRUTH OF THE MATTER, IT CAN
BE MESSIER THAN THAT AND YOU
MIGHT SEE A COLLEAGUE, A FRIEND,
A PEER, WHO IS STRUGGLE AGO THE
WORK AND YOU MIGHT VOICE THAT
YOU ARE CONCERNED ABOUT THEM AND
THEY MIGHT NOT BE AS WARM AND
ACCEPTING AS YOUR HELP AND
THAT'S OK.
WE'RE ON TO CHAPTER 4 AND IT'S
GREAT BECAUSE I WILL TIME FOR
QUESTIONS AT THE END AND
CERTAINLY AT THIS POINT JOYCE,
IF THERE ARE ALREADY QUESTIONS
IN THE CHAT, FEEL FREE TO
INTERRUPT ME.
THIS BEAUTIFUL LITTLE GOLDEN
OUTHOUSE HAS A LITTLE STORY AND
I'LL ONLY TAKE A MOMENT TO TELL
IT BUT MY GRANDFATHER TRAVELED
ACROSS EUROPE AND HE COLLECTED
LITTLE TRINKET FOR HIS WIFE, MY
GRAND MOTHER, DURING HIS TRAVELS
WHEN THEY WERE APART AND CREATED
BEAUTIFUL LITTLE CHARM BRACELET
THAT WAS GIVEN TO ME WHEN MY
GRANDMOTHER PASSED AND I
REMEMBER AS A CHILD PLAYING WITH
ALL THE LITTLE PIECES INCLUDING
A FERRIS WHEEL WITH ALL THE
PARTS THAT MOVED AND WORKED.
THIS WAS MY FAVORITE.
THE GOLDEN OUTHOUSE AND CAN YOU
OPEN THAT DOOR AND THERE WAS A
LITTLE GOLDEN MAN SITTING
INSIDE.
IT WAS JUST SO SWEET.
WHEN MY EXHUSBAND MOVED OUT OF
THE HOUSE, IT WAS JUST ME AND MY
BOYS AND I REMEMBER THAT WE CAME
HOME FROM THE POOL LATE ONE
EVENING AND I TOLD THE KIDS TO
RUN UPSTAIRS AND GET READY FOR
BED BECAUSE IT WAS LATE.
MY OLDER SON YELLED DOWN FROM UP
STAIRS, AND HE SAID, MOM,
SOMEONE STOLE MY PIGGY BANK
MONEY AND I WAS LIKE WHAT?
AND I CAME UPSTAIRS AND SURE
ENOUGH THE WHOLE UPSTAIRS WAS
RANSACKED.
THE JEWELRY BOX WAS TURNED OVER
AND EVERYTHING WAS TURNED OVER
SO SOMEONE WAS IN OUR HOUSE.
ANYWAY, TERRIFYING.
WE WERE SAFE, IT WAS OK.
SO SAD THOUGH.
I'M NOT MUCH OF A JEWELRY WEARER
BUT I LOST ALL OF MY GRAND
MOTHER'S JOWL RE JEWELRY GIVEN D
IT WASN'T UNTIL TWO WEEKS LATER
THAT MY SON WAS UNDERNEATH THE
BED IN THE BEDROOM AND HE SAID
MOM, LOOK WHAT I FOUND.
HE FOUND THE GOLDEN OUTHOUSE.
I DON'T KNOW HOW IT FELL OFF
DURING THE BURGLAR REBUT IT GAVE
ME HOPE AND I HOPE I CAN GIVE
YOU HOPE TOO.
THE TRUTH OF THE MATTER,
WELLNESS DOES MAKE ME CRINGE
BECAUSE IT DOESN'T FEEL
AUTHENTIC OR IT CAPTURES THE
EXPERIENCE WE'RE HAVING AS HUMAN
BEINGS.
IT DOESN'T HAPPENTURE THE FACT
THE MEDICAL CULTURE AND MEDICAL
SYSTEMS ARE JUST BROKEN.
THINK NOT BEEN MODERNIZED TO
MEET THE NEEDS THAT WE HAVE NOW
WITH ALL THE VIRTUAL
COMMUNICATIONS, WITH ALL THE
EXTRA NEEDS, WITH ALL THE EXTRA
DIAGNOSIS WE'RE STILL LIVING IN
THE VERY OLD SYSTEM.
SO WHAT CAN WE DO?
WELL, WE KNOW THAT EARLY STAGES,
IT LOOKS LIKE WELLNESS
INITIATIVES BOTH THE INDIVIDUAL
AND ORGANIZATIONAL LEVEL DO WORK
AND THEY CAN INCREASE WELLNESS
AND DECREASE BURNOUT IN THE
REST.
SO, FIRST AND FOR MOST, IF YOU
DO FEEL LIKE YOUR ENVIRONMENT IS
REALLY UNDERSTANDING HOW
IMPORTANT WELLNESS IS, FARCE AN
ADVOCACY EFFORT GO TO THE
WEBSITE AND I'LL SHOW YOU THE
URL AND THE BURNOUT SECTION ARE
THESE FLYERS AND THEY'RE
THREE-PAGE FOLD OUTS THAT WERE
MADE WITH CAROLE BERNSTEIN AND
SOME OTHER COLLABORATORS ACROSS
THE NATION TO HELP INSTITUTIONS
AND LEADERSHIP UNDERSTAND WHY
WELLBEING INITIATIVES ARE
IMPORTANT.
WE NEED TO GET OUR LEADERSHIP TO
BUY INTO PHYSICIAN WELL BE WELLO
WE HAVE A SYMPOSIUM EVERY WINTER
FOR FACULTY AND RESIDENTS AND
APPs AND FOR I GUESS NOW THE
THIRD YEAR WE'VE INVITED THE
EXECUTIVES TO COME TO THE TABLE
AND DISCUSS WITH OUR PHYSICIANS
THE ISSUES AT HAND.
I GET TO BE OPRAH AS IT WERE AND
TROY TO FACILITATE THESE
CONVERSATIONS BETWEEN THESE
PARTIES.
BY THINK YOU KNOW, IT'S REALLY
IMPORTANT AT LEAST TO FEEL HEARD
AND TO HAVE IMPORTANT
CONVERSATIONS AT LEAST BEING
HAD.
YOU ALREADY HEARD LAST GRAND
ROUNDS ON THE TOPIC OF WELLNESS
ABOUT BURNOUT AND HOW TO MEASURE
IT.
SO I'M NOT GOING TO BOW LABOR BE
POINT BUT WHERE IS YOUR
COMMUNITY IN TERMS OF WELL
BEING.
HAVING TEAMS, ADVOCACY CHAMPIONS
AND PEOPLE DEDICATE TODAY THIS
WORK HERE AT UPMC WE HAVE
SOMETHING CALLED THRIVE WHICH IS
FOR THE ATTENDINGS AND THE WELL
COMMITTEE AND AND WE'RE IN
CHARGE OF WELL.
PLEASE, IF NOTHING ELSE, TAKE A
SCREEN SHOT OF THIS URL.
IT'S JUST G.
>> Marie: WELLNESS AND YOU CAN
HAVE ANY OF MY MATERIALS FOR
FREE.
IT'S OUT THERE AND IT'S OUTSIDE
OF OUR FIRE WALL AND IT'S
ACCESSIBLE TO YOU.
A LOT OF THE SLIDES THAT YOU SAW
TODAY ARE AVAILABLE OUT THERE
AND INCLUDING SLIDES FROM THE
WELL TOOLKIT.
THIS WAS AN INITIATIVE THAT WAS
IN RESPONSE TO THE ACGME
REQUIREMENTS RELATED TO MAKING
SURE THAT PHYSICIANS KNEW HOW TO
SEE THE SIGNS AND SYMPTOMS OF
THESE SIX THINGS.
AND SO WE HAD EXPERTS FROM
ACROSS A VARIETY OF DISCIPLINE
PROVIDE BOTH PRESENTATIONS AND
AUDIO RECORDINGS AND RESOURCES
AND INTERACTIVE SESSIONS AND
FAQs AND BIBLIOGRAPHIES ON
FATIGUE BURNOUT, RISK FOR
VIOLENCE AND SUICIDE PREVENTION.
AND WE HAD A REALLY GOOD OUTCOME
SO WE DIDN'T START TRACKING
RIGHT AWAY BUT CAN SEE HERE,
SINCE JANUARY OF 2021, WE'VE HAD
MORE THAN 12,000 VIEWS TO OUR
WEBSITE AND HOPEF HOPELY YOU GUO
OUT AND CHECK IT OUT TODAY.
THERE'S PRACTICAL STUFF OUT
THERE.
FOR INSTANCE, DO YOU FEEL LIKE
YOU HAVE THE QUESTIONS TO ASK A
COLLEAGUE IF YOU ARE WORRIED
THEY'RE STRUGGLING?
WE BORROWED REALLY AMAZING
RESOURCES FROM ALL OVER THE
NATION.
FOR INSTANCE THIS ONE HERE.
LANGUAGE THAT YOU MIGHT WANT TO
USE FROM THE AMA RELATED TO HOW
TO HAVE A CONVERSATION WITH A
PHYSICIAN YOU ARE CURRENTLY
CONCERNED ABOUT.
WE HAD INTERESTING RESOURCES ON
THE APPRECIATIVE INQUIRY AND
IT'S A POSITIVE NEEDS BASE
ASSETMENT AND ACGME AND THE RRC
AND THE PSYCHIATRY STARTED
DISCUSSING THIS A LONG TIME AGO,
OF USING THIS ASSESSMENT TOOL TO
SECRETARY QUESTION LIKE, WHAT IS
WORKING WELL FOR WELLNESS WITHIN
YOUR WORK COMMUNITY?
HOW DO YOU BUILD ON THOSE
STRENGTH WITH THESE FOUR
DIFFERENT STEPS SO AT MY PROGRAM
WE DO THAT AS A HALF-DAY
WORKSHOP AND YOU CAN DO IT IN AN
HOUR AND TRY TO FIGURE OUT WHAT
CAN WE BE DOING ON A SYSTEMS
LEVELS TO IMPROVE WELLBEING FOR
OUR COMMUNITY.
AND SO HERE ARE JUST SOME SAMPLE
OUTCOMES OF AN APPRECIATIVE
INQUIRY WE DID WITHIN OUR
DEPARTMENT.
SO, FOR INSTANCE, SOME OF THEM
DON'T COST ANY MONEY.
THE INTERVENTION IS JUST MAKING
SURE THAT THERE ARE STANDARD
ROUNDING TIMES SO PEOPLE KNOW
WHEN TO DROP THEIR KIDS OFF AT
CAM AND WHEN THEY CAN GO AND
HAVE THEIR OWN MENTAL HEALTH
TREATMENT, RIGHT.
WE DID SOMETHING LIKE A
NUTRITION TASK FORCE THAT DIDN'T
COST MONEY BUT FOOD WAS BEING
CHOSEN THAT PEOPLE ACTUALLY
WANTED AT THE WELLBEING EVENTS.
SOME BIGGER THINGS LIKE HAVING A
WELLBEING CHIEF RESIDENT WITHIN
OUR RESIDENCY WAS A NEW
LEADERSHIP ROLE AND IT HAS BEEN
REALLY SUCCESSFUL FOR OUR CHAIR
AND SUPPORTED HIGHERING A NUMBER
PRACTITIONER BECAUSE THERE WERE
SO MANY HMPs OVERNIGHT AND WE
REALIZE AND WE DIDN'T JUST WANT
TO ACKNOWLEDGE THAT THE BLACK
LIVES MATTER MOVEMENT WAS
HAPPENING BUT WE WANTED TO
CREATE SOMETHING REAL AND
IMPORTANT AND WE CREATED A
FOUR-YEAR AROUND US AND ONE WAY
TO DO THAT EVIDENCE-BASED
INTERVENTION WISE AND IS TO GET
ACCESS TO PHYSICIANS AND WHO ARE
STRUGGLING AND OR STAGNATING IN
THE CAREERS AND COACHING, WHICH
IS DEFINITELY THAN THERAPY OR
MENTORSHIP AND INSTEAD REALLY --
THIS IS ME AND JOE WHO ARE IS A
DEAR FRIEND AND WELLBEING
CHAMPION AND ELSE THE HEAD OF
PHYSICIAN THRIVE HERE AT UPM
WITH CARDIOLOGIST AND NATIONALY
RENOWNED PLASTIC SURGEON AND
WEDS A CONVERSATION ON STAGE
PRE-PANDEMIC ABOUT HIM, ABOUT
BEING A DEAN AND A NATIONAL
PRESIDENT OF SEW ASSOCIATION AND
LGBTQ MINORITY FACULTY MEMBER WE
HAD A BEAUTIFUL NIGHT OF
PHYSICIANS AND TRAINING AND
GETTING TO KNOW EACH OTHER AS
HUMAN BEINGS.
WE'VE CONTINUED THE CONNECTION
SERIES AND IT'S VIRTUAL AND
FIGURE OUT HOW TO MAKE THEM
MEANINGFUL VIRTUALLY AS
IN-PERSON AND WE NEED YOUNG
INNOVATIVE MINDS TO HELP OUT
WITH.
SO, THIS IS MY LAST SLIDE IN
TERMS OF IDEAS AND IT'S ONE
THING THAT WE CAME UP WITH
THROUGH PHYSICIAN THRIVE AND THE
TRUTH OF THE MATTER IS,
PHYSICIAN WELLNESS CHAMPIONS, WE
DON'T HAVE ALL THE ANSWERS IN
FACT MOST OF THE REALLY GOOD
IDEAS COME FROM PEOPLE WHO DO
NECESSARILY HAVE THE TIME TO BE
WELL BEING CHAMPIONS AND SO THIS
IDEA OF THE PHYSICIAN WELLNESS
GRANTS FOR CHANGE WAS TO PUT
FOURTH A LITTLE INSTITUTIONAL
MONEY, $10,000 FOR LARGE GRANTS
AND UP TO $1,000 FOR SMALLER
GRANTS FOR PEOPLE WHO ARE NOT
NECESSARILY IN LEADERSHIP ROLES
TO PITCH THEIR WELLNESS IDEAS
VERSUS SYSTEMS LEVEL CHANGE AND
TO POTENTIALLY BRING NEW IDEAS
TO THE TABLE FOR WIDER
DISSEMINATION.
SO, THAT IS THE FORMAL END OF MY
TALK.
TO PUT A POSITIVE SPIN ON A
CHALLENGING FAMILY EXPERIENCE
AND I AM DIVORCED, MY TWO BOYS
ARE AMAZINGLY WELL AND THIS IS
ME WITH MY BOYFRIEND AND HIS
THROW KIDS IN OUR MODERN-BLENDED
FAMILY AND LIFE IS GOOD AND I
HAVE MUCH GRATITUDE FOR MY
PERSONAL LIFE, FOR MY
PROFESSIONAL LIFE AND FOR HAVING
HAD THE OPPORTUNITY TO SPEND
THIS TIME WITH YOU ALL.
SO, THANK YOU.
THANK YOU SO MUCH.
REALLY APPRECIATE THIS.
I JUST WANT TO HIGHLIGHT THE
REMINDER ON THE SLIDE THAT OUR
NIH CLINICAL CENTER GRAND ROUNDS
IS CONCLUDING FOR THE SUMMER
AND WE'LL RECONVENE ON WEDNESDAY
SEPTEMBER 7th IN THE MEANTIME
I'D LIKE TO RAISE A QUESTION
THAT WAS IN THE CHAT.
THIS ONE IS SOMEONE WHO ASKED,
CAN YOU COMMENT ON THE CURRENT
STATUS OF THE STIGMA/FEAR OF
GETTING A PSYCHIATRIC DIAGNOSIS
WHEN SEEKING THERAPY PROACTIVELY
FOR THINGS LIKE LIFE-WORK
STRESS.
SPECIFICALLY, THE FEAR WOULD BE
HAVING A DIAGNOSIS FOLLOW YOU
WITH REGARDS TO INSURANCE AND
THE EFFECT THIS WOULD HAVE ON
SEEING OTHER MEDICAL PROVIDERS
SUCH AS PRIMARY CARE OR NON
PSYCHIATRIC SPECIALISTS?
>> I MEAN, IT'S SUCH AN AMAZING
QUESTION, RIGHT.
FIRST AND FOR MOST, I THINK MORE
PEOPLE WHO ARE NOT PSYCHIATRISTS
IT'S NOT THAT SURPRISING TO HEAR
A SIGH SKY TERRORIST SEEKS
MENTAL HEALTHCARE AND Y DON'T
STIGMATIZE ME AS MUCH AS A
SURGEON.
SO HOW DO WE OVERCOME THIS
PARADIGM THERE'S STIGMA BECAUSE
THE TRUTH OF THE MATTER THE
REASON WHY I'M THRIVING AND
DOING WELL IN MY CAREER BECAUSE
AMAZING MENTORSHIP AND
OPPORTUNITY BECAUSE I DID SEEK
MENTAL HEALTHCARE AND MY
THERAPISTS HELPED ME OF
CHALLENGING TIMES AND SO
FIGURING OUT HOW TO DECREASE
STIGMA IS, I THINK, FIRST AND
FOR MOST BUT THEN SECONDLY,
CREATING AN ENVIRONMENT WHERE
PHYSICIANS REALLY UNDERSTAND
THAT ACTUALLY, THE IMPLICATION
OF HAVING A PSYCHIATRIC
DIAGNOSIS IN YOUR MEDICAL
PROFESSION EVEN SUBSTANCE USE
DISORDERS, FOR PHYSICIANS IN
TREATMENT AND THEIR SYSTEMS ARE
NOT IMPACTING THEIR CAREERS, CAN
HAVE AMAZINGLY FRUITFUL LIES AND
DO AMAZING THING TO NORMALIZE
THAT WE'RE ALL HUMAN AND AT
TIMES WE NEED SUPPORT AND SO I
THINK FOR THOSE WHO ARE STILL
FEELING UNNECESSARY FOR
THEMSELVES, WE NEED TO CREATE
ENVIRONMENTS LIKE VIRTUAL
WAITING ROOMS AND VIRTUAL CARE,
PARING OUT OF POCKET, SELF CARE,
THAT KIND OF THING SO PHYSICIANS
WHO STILL AREN'T REALLY BUYING
INTO BEING OPEN WITH THEIR
DIAGNOSIS AND CONFIDENTIALLY AND
KNOWING THAT WHAT IS MY HOSPITAL
AND WHAT DOES MY STATE SAY AND
YOU MIGHT BE FORTUNATE ENOUGH IN
AN ENVIRONMENT WHERE YOU DON'T
HAVE TO DISCLOSE ANYTHING TO
ANYONE AND IF YOU ARE TAKING
CARE OF YOURSELF PROACTIVELY.
>> SO, ON THAT NOTE, CAN YOU
COMMENT ON THE STATE PHYSICIAN
HEALTH PROGRAMS.
A LOT OF PEOPLE ARE NOT FAMILIAR
WITH THEM AND IT WAS ON YOUR
SLIDE BUT IT WAS NOT REALLY
TALKED ABOUT.
I THINK IT'S A RESOURCE OR
SOMETHING THAT PEOPLE NEED TO
KNOW ABOUT.
>> YEAH, ABSOLUTELY.
IF YOU ARE INTERESTED GO TO THE
WELL TOOLKIT SUBSTANCE USE
DISORDER SECTION.
THERE ARE ARTICLES ON THAT.
THE PHYSICIAN HEALTH PROGRAMS
ARE A LOT OF TIMES DREADED AND
FEARED BECAUSE A LOT OF TIMES
THEY'RE UTILIZED RELATED
PROBLEMS THAT HAVE GOTTEN THEM
AND LEGAL AND PROFESSIONAL
ISSUES THAT NEED TO BE TRACKED
OVER TIME AND INTERESTING THOUGH
IF YOU LOCK AT THE RESEARCH, THE
PEOPLE WHO A, VOLUNTEER GO DO
MAR RUSSLY BUT EVEN THE PEOPLE
WHO RELUCTANTLY HAVE TO GO DO
MARVELOUSLY AND MUCH BETTER THAN
THE GENERAL POPULATION.
PHYSICIANS HAVE HUGELY WONDERFUL
OUTCOMES AND WE'RE RULE
FOLLOWERS AND LIKE WE WANTED TO
REALLY WELL AND SO WHEN WE'RE IN
TREATMENT, WE DO REALLY WELL AND
SO IN FACT, BEING PART OF LIKE A
MONITORED STATE PROGRAM AND IF
FOR INSTANCE AND IF YOU HAVE
COLOMBIAISALCOHOLISM YOU HAVE TK
INNS AND BE MONITORED TO KEEP
PRACTICING IF YOU HAVE HAD
CHARGES AGAINST OR WHAT HAVE YOU
BUT THE TRUTH OF THE MATTER IS
YOU CAN BE A DOCTOR AND TAKE
CARE OF YOUR FAMILY AND YOU GET
THE REALLY IMPORTANT HELP THAT
YOU NEED AND SO THAT'S A LITTLE
BIT ABOUT THAT AND I'M GLAD YOU
BROUGHT IT UP.
>> I THOUGHT THE COMMENT OR THE
INFORMATION ON TRANSPARENCY AND
ABOUT LICENSURE ARE REALLY
IMPORTANT I DON'T KNOW HOW MUCH
PEOPLE -- FIRST OF ALL KNOW
ABOUT THAT AND DECIDED SOMETHING
THAT WE HAVE SOMEONE TO HAVE
MORE ATTENTION I SUPPOSE >> IN
PREPARATION FOR THIS TALK TO YOU
AND I AND I KNOW YOU HAVE DC AND
TO BE A LITTLE BIT MORE AND
ASKING QUESTIONS ABOUT
IMPAIRMENT AND AS OPPOSED TO
DYING SIS OF TREATMENT AND DON'T
QUOTE ME ON THAT IT'S JUST WHAT
I LOOKED AT.
IT'S WORTH WHILE FOR LEADERSHIP
WITHIN WELLNESS TO COLLECT THAT
INFORMATION AND CREATE YOUR OWN
SLIDES SETS AND WELL TOOLKIT IS
REALLY INTENDED TO HAVE PEOPLE
LIKE YOURSELF MODIFY THE SLIDES
AND TO MEET YOUR OWN COMMUNITY
NEEDS AND MAYBE YOU ALL WILL BE
SEEING Dr. CHUNG PRESENTING ON
LOCATIONS SPECIFIC WELLBEING
KNOWLEDGE.
>> SO WE REACHED THE END OF THE
HOUR.
REALLY WANT TO THANK OUR
SPEAKERS Dr. SANSEA JACOBSON
FOR AN INCREDIBLE TALK THAT
SPEAKS TO US IN THE DOCTORING
FIELD AND WE REALLY APPRECIATE
YOUR COMMITMENT AND
CHAMPIONSHIP.
THANK YOU.
>> THANK YOU.
IT WAS SUCH A PLEASURE TO BE
HERE AND I MISS SEEING ALL OF MY
FRIENDS AT NIH.
TAKE CARE AND BE IN TOUCH.
VERY GOOD.
THANK YOU.