Alumni Corner

Filmmaker, MD: Interview with Award Winning Documentary Filmmaker and CIR Alum

Pg 12 - Alumni Corner - RMheadshotThe film Code Black is a thrilling glimpse into the work of the Emergency Department at Los Angeles County Hospital. The documentary centers on the legendary C-Booth, the hospital’s trauma bay and the birthplace of emergency medicine. Dr. Ryan McGarry, the filmmaker, began shooting footage of the C-Booth when he was a medical student and then captured the transition to a new facility when the hospital was forced to upgrade its facilities to comply with seismic standards in 2008.

Code Black, which received Critic’s Pick reviews from the New York Times and Los Angeles Times, introduces viewers to a talented and passionate group of resident physicians, attendings, nurses and other team members as they grapple with unwieldy patient loads, excessive wait times, and ever-increasing paperwork burdens. The film raises questions about how to balance patient privacy and accountability from providers with the loss of intimacy and teamwork that accompanied the transition away from C-Booth when the hospital’s facilities were upgraded.

CIR Vitals had an opportunity to interview Dr. McGarry at reception and screening co-sponsored by CIR in Los Angeles on June 28, 2014.

What inspired you to make this film?

It was the idea of a C-Booth, which was one of the first things I saw when I started my rotation as a medical student. I saw that it was a 16 by nine-foot space, almost a theatrical ratio, and with all this drama. You see all facets of the human condition coming in every two minutes, plus amazing characters, and then this idea that the C-Booth was going to pick up and move during the upgrade. Well, those are three things that would make an incredible film, in my mind, and so I thought, “This trifecta may never happen again. I’d better get on this!”

Were you active with CIR during residency? Were you aware of the union?

I was definitely a member of CIR and most of my class was. During the second half of the film I was a resident there, so of course I was a CIR member, which we all thought was pretty cool.

What themes do you hope people will take away from the film? 

The first is that we have to protect and value our county public hospitals. The other is that it’s always better to discuss healthcare in a disarmed fashion. Audiences seems to leave less polarized [than when they came in].

What most surprised you during the shooting of the film?

I was shocked at just how difficult it is… when you’re directing a documentary, your instinct is to have a vision for the story, and of course your expectation as an artist is to be true to that vision. But really, the greatest skill in documentary filmmaking is flexibility, the ability to see what the story is, not what you want the story to be.

Did it take turns you weren’t expecting?

I thought the whole film would be confined to the old county hospital. I never thought I’d be a character in the film, for example. But narratively we found that the bridge between the old and new place had to come from someone who had seen both, and my voice had to be included in that, although reluctantly.

What advice would you give to resident physicians who have a story to tell?

The biggest thing that our patients need right now is for physicians to take back control of the patient-doctor interaction. Doctors should be policing ourselves, evaluating regulations, deciding if it’s in the patient’s benefit. If it is, great; I’m for that regulation. If it’s not, why are we doing it?

The public should see the physician voice as the commanding one again as far as who’s leading healthcare. Right now we’re not leading it, at least in the media. Our voices are drowned out by politicians, by lobbyists, and by insurance executives. And those people didn’t drop $300K to go to med school. They didn’t lose their 20s to residency.

Have you found that the film has opened people’s eyes to the role of residents?

People leave the film feeling a bit more informed about what the front lines are like. Residents are the front lines, and in many ways that was the ultimate task for us in telling the story without getting into politics. Residents are effectively pulling the weight, and it’s hard to argue with that. We didn’t choose what society has given us at the front door, but we’re the ones literally dealing with it.

Anything else you’d like people to know?

What was really encouraging to me was how good an experience it has been to actually step up and say something. People are listening, and for change to happen, you have to speak up first.

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Empowering Patients Who Are Victims of Violence

Page 13 Thea James Alumni Corner

Dr. Thea James

If ever there was a physician who understood the humanistic and therapeutic importance of connecting to the lives of patients, it is emergency medicine physician Dr. Thea James. Dr. James trained at Boston City Hospital and was an active member of the House Officers’ Association, an independent union that affiliated with CIR in 1993. Today she is associate professor of Emergency Medicine and assistant dean for the Office of Diversity and Multicultural Affairs at the Boston University School of Medicine.

At the CIR convention in Boston this year, Dr. James ran a workshop on Treating Urban Violence: Transforming Vulnerable Moments into Opportunity, Impact and Positive Outcome. She is a a founding member of the National Network of Hospital-Based Violence Intervention Advocacy Programs. At Boston Medical Center Dr. James runs this innovative emergency department‒ based program that helps guide victims of community violence through recovery from physical and emotional trauma. Using a trauma-informed model of care, the program empowers clients and families and facilitates recovery by providing services and opportunities that bring hope and healing to victims and their families.

Dr. James spoke to CIR Vitals recently about physician activism.

What made you become a physician activist? 

I haven’t thought about it much, but I guess it was instinctive. My father always taught me to reach out and help people— and not to be judgmental. If he took me to the Burger King and the cashier was unfriendly, and I made a comment about it, he would say, “you have no right to judge—you don’t know that person’s life.”

This particular hospital—Boston Medical Center—nurtured my activism. There is a culture of it here. As an intern we were taught that we could make a difference. We couldn’t discharge a patient until we made sure they had a place to go, that they had their meds and a follow-up appointment. We were taught to care. And to put a mirror up to ourselves and ask—what would we want for our loved ones or ourselves? Why would we accept a standard of care that was lower than that for other people?

CIR grew me—this union helped me be the person I am today.

What advice would you give to residents who want to become activists? 

Many times I was told that I needed to choose one thing, I needed to focus on one area to make a difference or to be successful, but I’ve never been able to do that. And yet—if I look at every single thing I’ve done (and there are so many different things!) I see them as a Venn diagram with 3 basic tenets: social justice, advocacy and peace; peace in peoples’ lives so they can hopefully thrive.

I also found with people that it’s best to listen and find out what they need or want, not what I think they need or want. I sometimes just say to my patients: What could we do today to make you feel satisfied when you leave here? Medicine is so doctor-centered that we forget to ask. For example, we’re looking to expand our outpatient care, but have we thought about evening and night clinics? We’re told—oh, there are so many no-shows during the day, but did anyone think that might be because they needed to come at another time?

Learn more about Dr. James’s work.

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Post-Residency Contracts 101

At a recent post residency life workshop in New York, guest speaker Robert Stulberg, Esq. said, “Through your residency you have had excellent employment protections. The reason you’ve had those protections is that you are represented by CIR, which has negotiated a collective agreement for you. When you step out of your residency, all that will end.

“Although your bargaining strength may not be equal to the bargaining strength of your potential employer, don’t forget that you also come to the bargaining table with strengths. Some of these strengths include medical knowledge and training, your expertise in a field of research that can be used to attract government or corporate grants, and your ability to serve in high-need communities and build long-lasting relationships with patients.” 

Are you negotiating your first contract after residency? Mr. Stulberg offers tips below:

CONTRACT ESSENTIALS:

A contract is a bilateral agreement that contains a legally enforceable promise that is supported by consideration—the legal term that refers to any bargain—for advantage or disadvantage given by one party to the other. A valid employment contract for physicians should answer the following:

  • Who are the parties to the contract?
  • What are the duties of the employee/what position is he or she going to occupy?
  • What compensation will be provided to the employee? That includes wages, salary and benefits.
  • What is the duration of the contract and under what circumstances can it be terminated?

OTHER PROVISIONS:

Physician employment contracts are likely to contain other provisions, such as non-compete agreements or restrictive covenants, malpractice insurance, and termination clauses.

Whether or not you will be able to negotiate changes to these provisions, you should at least be sure you understand what they mean so you can make an informed decision as to whether to accept the terms of the contract offer.

TIPS:

  • Speak to other physicians about the hospital or medical institution you are considering.
  • Find out what you can about the financial stability of the employer.
  • The potential employer is going to be represented throughout this process by an attorney; therefore, it would be to your benefit to consult with an attorney before engaging in negotiations and/or signing a contract.

 


Click here for more in the post-residency employment video series.

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CIR Alumni Couple Reflects on Service Trip to Haiti

“Since I heard about the earthquake I had wanted to go there, but I never got a chance because of work and resources,” said Dr. Samina Azam.

“Then my husband saw an ad on the CIR [website] about volunteering through Project Medishare, and we jumped on the opportunity.”

Dr. Samina Azam did her internal medicine residency and geriatrics fellowship at New York Methodist Hospital in Brooklyn,, while her husband,

Dr. Asif Azam, completed his family medicine residency at Jamaica Hospital in Queens. The couple shared their experience after a week spent volunteering at Hospital Bernard Mevs in Port-au-Prince through CIR and Project Medishare.

“My first one to two days, I was somewhat overwhelmed by the new culture, new people, new atmosphere with a totally different way of working,” said Samina.

While Asif worked night shifts, his wife worked days, and they saw each other in passing as they signed out to one another at the start and end of each twelve-hour shift.

“There was limited space for patients, but we made do with what we had,” he said. “If not a bed, then a stretcher, if not that, a wheelchair, if none of those then a bench or a chair.”

Samina found Hospital Bernard Mevs to be a good facility, well-stocked with medical donations. “But some things were scarce,” she said. “So we had to use things very wisely.”

The couple noticed some distance between permanent staff and the volunteers at first, but they were able to build relationships as the week progressed.

“Once we got to know each other, I should say that they were the most wonderful and kind people I have ever met,” Samina said. “I realized how difficult it must be for them to see every week new faces, to get to know them, like them, and to say goodbye.”

“When we were leaving, they were asking over and over again when we are coming back again,” she said.

One of the more difficult aspects of the experience was the lack of long-term care for patients, as incomes and literacy rates remain low in the years since the earthquake. “It’s challenging, not knowing if the patient can or will follow up,” said Asif, “. . . knowing that some things need to be done, but cannot because the patient can’t afford the test.” Samina agreed, recalling patients who had to be transferred out for a CT scan. “In American dollars it would cost them $7 with transport, CT scan, and a CD to bring back – yes! Only $7, but the sad thing was that some of them could not afford even that.”

When asked if they would encourage others to volunteer in Haiti, both doctors gave a resounding yes, noting that the experience is an incredible eye opener and a way not just to help those in need in Haiti, but to reflect on life in the United States as well.

“I feel people need to see and be able to compare how wasteful we as Americans can be,” said Asif.

“Even though I left Haiti, I left part of my soul there,” said Samina, “And every time I think about the Haitian people I keep remembering all the smiling faces and their song for me – ‘Samina mina OO waka waka AA’.”

Drs. Samina and Asif Asam applied for funding to work in Haiti through the CIR Alumni Network and the CIR Policy and Education Initiative. For information on Haiti and other programs available to former CIR members, please visit www.cirseiu.org/alumni.

RECRUIT CIR ALUMNI Is your practice short a specialist? Are you starting a new clinic and looking for primary care physicians? Know a hospital administrator looking for new faculty? You can now share opportunities with current CIR members and alumni on our website at www.cirseiu.org/job-opportunities. Submit job descriptions to communications@cirseiu.org.

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Then and Now: Former CIR President Reflects on Physician Activism from the 1960s to Today

Dr. Eugene Thiessen

Dr. Eugene Thiessen has spent his career expanding the definition of physician service. After earning his MD at the University of Chicago, he trained as a surgical resident at Bellevue Medical Center in New York, served as president of CIR from 1960-1962 and continued as a welfare administrator while starting
his general practice. Dr. Thiessen was an Associate Professor of Surgery at NYU for 20 years, and later practiced in emergency medicine. He also founded SHARE, the first peer support group for women with breast cancer and ovarian cancer.

CIR Vitals spoke with Dr. Thiessen about how he became a physician activist and how he sees physicians’ roles today.

WHAT WERE CIR’S GOALS WHEN YOU WERE PRESIDENT?

We certainly were addressing the inequities of salaries and working conditions of interns and residents. We negotiated to get a better contract. But at the same time we were advocating for nurse services, better lab services, we went beyond. . . . We were interested in the health care of the patients in the hospital.

Ever since its founding in the late 1950s, and during my tenure as President in the early 1960s, “patient welfare” has been one of the core principles underlying the efforts and activities of CIR. For me—and I believe for CIR also—“patient welfare” encompasses more than just the quality of care given to the hospitalized patient. Among other principles, I believe it also stands for both universal access to affordable health care, and health care as a universal human right.

WHAT DO YOU THINK OF TODAY’S HEALTHCARE SYSTEM?

Health care is a right, not a privilege. It should be taken out of the hands of
profit-making entities. The application of health care is as much the responsibility
of physicians as the individual practice of medicine. I would like to see physicians active in the political process—not necessarily running for office but lending their professional expertise to politicians. I help my district representative in Long Island whenever I can by sending him information on health care. Physicians should be advocates not just of their own patients but of the system of health care.

WHAT DO YOU TELL A DOCTOR WHO WANTS TO GET MORE INVOLVED IN HIS COMMUNITY BUT ISN’T SURE WHERE TO START?

It’s hard to imagine that anybody who seriously considers getting involved in advocating for patient care would have difficulty finding something. Open your eyes, look around where you are, listen to the news broadcasts and what’s being said—pick out what interests you and you feel confident in.

About a month ago I heard on NPR that a group in California organized their
practice with an emphasis on prevention. They had a clinic and they would go out to their diabetic patients to make sure they didn’t have any lesions or infections on their feet—they’re really making preventive medicine an essential part of the practice. They were able to cut down on expensive hospitalizations resulting from lack of care and come in under budget.

My big complaint is that politicians don’t want to cut the cost of health care delivery; they want to reduce the amount that the government pays out. So the costs will stay the same if the system continues as it is now and there will be a shift on the payment from the government to the individuals. What we really need to do is figure out how to reduce the cost of health care delivery.

HOW DO YOU SEE THE OCCUPY MOVEMENT?

It is my belief that the OWS movement’s most important contribution is not the
development of a policy or political agenda; it is the raising of awareness and
discussion about fundamental political, economic and social relationships and inequities in our society. The “movement” isn’t providing answers—it’s asking questions; it’s asking the “whys”.

After retiring from clinical medicine in 1999, Dr. Eugene Thiessen continued as a lecturer in the Department of Preventive Medicine at SUNY-Stony Brook. In 2008, Dr. Thiessen received the “Distinguished Service Award” from the University of Chicago in “recognition of honor brought to the University through teaching, research, and community service.”

RECONNECT WITH CIR
We’re building an alumni network of all CIR past members going back to our founding in 1957! Connect with CIR and former colleagues by visiting our alumni center.
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In Implementing Electronic Records, Don’t Forget the People

The most valuable thing about EHR is the data and the control it gives you. I can see all of my patients, filter for diabetics, filter for those who are uncontrolled and focus on getting them in for screenings. We have easy access to data that was unimaginable with paper but none of it matters if I can’t even get my password to work.

Dr. Nailah Thompson

Having completed residency training in a largely paper-based hospital, former CIR Executive Vice President Dr. Nailah Thompson reflected on transitioning to her new position in Internal and Preventative Medicine in the fully electronic Kaiser Permanente in Oakland, CA.

When we speak of EHR, we extol its virtues in creating a safer, more efficient patient care setting. Yet one of the greatest barriers to creating this more efficient system is the providers themselves. In addition to cost and technological hurdles, hospitals face the challenge of training physicians and healthcare workers to adopt and be proficient in an entirely different work flow. We asked Dr. Thompson to share her experiences working in a fully electronic health records system. Kaiser Permanente is an industry leader in health IT, recognized by the Healthcare Information and Management Systems Society for its implementation of EMR.

Vitals: Why did you choose to work at Kaiser?

NT: I wanted to work at Kaiser because the position I have now blends primary care and preventative medicine. Its focus on public health provided opportunities to do a lot of community work.

Vitals: Kaiser Permanente has a fully electronic medical records system. What does that look like on the ground?

NT: Kaiser’s EMR is very intergrated. I can have a patient come from any other Kaiser hospital in California and have their information. Everything from the patient’s chart to notes from specialists are all immediately available. The entire hospital — radiology to pharmacy to physical therapy — uses the same system.

Vitals: How does EHR improve your day-to-day work?

NT: During residency [in Internal Medicine at Alameda County Medical Center in Oakland, CA] and at a small community hospital I worked at in Northern California, we were still using paper charts. What really sets my work apart now is the access I have to data. I can look at all my patients, filter for diabetics and for how many of them are controlled. If only 20 percent are, I can focus on getting those patients in for check ups and screenings. That’s not possible with paper charts. Not only can you not get these kinds of measures, you often don’t even know how many patients you have. It also makes the doctor’s work much more streamlined. You can include prompts for all sorts of measures: blood pressure screenings, mammograms, colon screenings. And the physician doesn’t have to commit these to memory. In fact, other staff can be sure to prompt patients for preventive measures as well. You can have reminder messages automatically sent to patients and you can communicate with them through the health net [the hospital’s online patient communication system].

Vitals: How did you adjust to working with EMR?

NT: There was definitely a learning curve but what’s really helped me adapt quickly is learning from my colleagues. You can’t be afraid to ask questions. The hospital has implemented programs like a physician mentorship program and a year-long physician orientation program that create a supportive environment for continued learning.

Vitals: What factors do you think are most important in creating an efficient EHR system?

NT: Training. We received one full week of training on the system. It’s so important because learning on the job just doesn’t work. We ran through everything—logging in, checking patient charts, checking email—with the hospital’s IT staff. We were able to troubleshoot many of the inevitable problems, so you are not unable to access a patient’s medical history because you are sitting in front of your computer trying to get your password to work.

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