Fentanyl is now the leading cause of accidental overdose deaths in people aged 18-45. The Centers for Disease Control and Prevention (CDC) report that Fentanyl deaths have surpassed deaths from motor vehicle accidents, gun violence, heart disease, and COVID-19. In 2021, 71,000 Americans died from synthetic opioid abuse, i.e., Fentanyl.

At the end of 2022, the FDA seized over 50.6 million Fentanyl laced fake prescription pills and over 10,000 pounds of Fentanyl powder. The DEA further estimates that 379 million of those seizures contain potentially dangerous doses of Fentanyl. Most of the Fentanyl is mass-produced in the United States and is manufactured in Mexico and China

The Theory of Three

Looking at the growing number of opiate-related deaths, you may ask yourself, “Where did it all begin?” The author Cicerone has come up with the “Theory of three” overlapping waves, which will help explain how the opioid crisis began:

• Wave One: The opioid crisis kicked off the first wave in 2000, with doctors overprescribing painkillers, leading to mass addiction.
• Wave Two: overlapping opioid deaths involving heroin intensified in 2007 and exceeded opiate deaths by 2015.
• Wave Three: illicit synthetic opioids, which include Fentanyl

A fourth wave is on the horizon and further complicated by stimulants.

Dr. Paul Janssen, The Father of Fentanyl

In Sam Quinones’s book “The Least of Us, True Tales of America and Hope in the Time of Fentanyl and Meth,” he describes Dr. Paul Janssen as ‘obsessed with chemistry and finding new painkillers. Dr. Paul Janssen is the founder of Janssen Pharmaceuticals and the inventor of Fentanyl. “The Least of US” chronologically details how Dr. Paul Janssen obsessively studied the molecular structure of morphine and other opiates. He was trying to create a drug that penetrates the blood-brain barrier at a faster rate.

The image of a ‘mad scientist’ may pop into your head as you read more about Dr. Paul Jansen in Sam Quinones book. A typical non-conformist, Dr. Paul Janseen believed that “good scientists do not need to be supervised.” The author Sam Quinones further explains that “Dr. Paul Janssen was able to envision three-dimensional images of the molecules he was struggling to modify. He would often doodle chemical structures on napkins during meetings.” If you’ve ever watched a science fiction horror movie, the ‘mad scientist’s protagonist is always a genius of some sort, like Dr. Frankenstein in ‘Frankenstein’ or Dr. Emmet Brown in ‘Back to The Future.’ They are all eccentric-looking men working with fictional technology, crossing boundaries while trying to play God.

A Potent Painkiller

Dr. Paul Jansen discovered that when drugs like heroin cross the blood-brain barrier, once in the brain tissue, the drug eventually converts into morphine, slowing the absorption rate. The new molecule crossed the blood-brain barrier more effectively and did not convert into anything other chemical. Fentanyl binds to the body’s opioid receptors controlling pain and emotions. The brain tends to adapt to the drug after chronic use. The euphoric high eventually diminishes, decreasing Fentanyl sensitivity and making it hard to feel pleasure outside of drug use.

A more potent painkiller than morphine, Fentanyl allows a patient to be rapidly sedated for surgery and then walk away post-op with lesser aftereffects. Fentanyl changed surgical anesthesia forever. Before Fentanyl’s anesthetic intravenous use in 1960, anesthesiologists used flammable gas for various surgeries like coronary bypass surgeries. Though Fentanyl is short-acting, it can be reversed quickly with Naloxone.

Fentanyl Addiction and Overdose Symptoms

Fentanyl is 50 to 100 times more potent than heroin. Actiq, Duragesic, and Sublimaze are the prescription names for Fentanyl. A Doctor or healthcare provider typically prescribes Fentanyl in an injection form, a transdermal patch, or oral tablets. Drug dealers mix Fentanyl with heroin, cocaine, methamphetamine, and MDMA. Synthetic Fentanyl sold illegally is found in a powder form and sold in eye drops, blotter paper, nasal sprays, and pill format.

Symptoms related to Fentanyl overdose include:

• Euphoria
• Nausea
• Drowsiness
• Decreased level of consciousness
• Constipation
• Confusion
• Sedation
• Respiratory problems
• Loss of consciousness

When a person overdoses on Fentanyl, their breathing slows down and stops. The person can then become hypoxic. Naloxone can treat Fentanyl overdose and is available as an injectable needle and nasal spray (NARCAN). Unfortunately, many drug dealers mix Fentanyl with other drugs, increasing its potency; in these cases, Naloxone may or may not work.Naloxone should be monitored for at least 2 hours to make sure they do not stop breathing. Healthcare providers or anyone administering a dose of Naloxone to a person who remains hypoxic after administration  should call 911 and start CPR. Patients who are receiving

FDA Alerts Regarding Xylazine aka “Tranq,” The “Zombie” Drug

Used primarily for animal anesthesia, Xylazine is a pharmaceutical drug that increases sedation and relaxation in cattle, horses, and other non-human mammals. Veterinarians also use Xylazine as an antiemetic for cats.

Xylazine also goes by the street name “Tranq” and is called the “Zombie drug.” The drug goes by the nickname “Zombie Drug” because it slows down breathing, and the person influenced by the drug takes on a “Zombie,” like the appearance of being zoned out or in a trance. Xylazine lengthens the Fentanyl high, which can lead to a person’s demise.

There have been increasing reports to the FDA regarding the inclusion of Xylazine into heroin, Fentanyl, and other illicit drugs. The FDA further warns healthcare professionals to be aware of the possible overdoses in patients due to Xylazine inclusion because it is unknown if the side effects are reversible with Naloxone. Toxicology screens do not detect Xylazine.

Healthcare providers are encouraged by the FDA to continue to treat suspected drug overdoses with Naloxone. If the patient does not respond, it’s best to question Xylazine exposure and provide appropriate measures. Signs and symptoms of Xylazine use include chronic and severe skin ulcerations.

Although the FDA continues to investigate whether Xylazine is produced illegitimately, it is unknown if the Xylazine taken is illegal or if it comes from the animal drug supply.  

Rainbow Fentanyl

Rainbow Fentanyl debuted in August of 2022 as multicolored pills, chalk, and blocks. The DEA suggested that the drug cartels and traffickers use “rainbow-colored” tablets to mask Fentanyl and lure young children and teenagers into drug addiction. Two milligrams of Fentanyl, equal to 10-15 grains of table salt, is considered a lethal dose.

Teenage Fentanyl Deaths

In 2021, overdose deaths for teenagers from 14-18 years old increased to over 94%. With Fentanyl overdoses at an all-time high in California and responsible for almost all drug overdoses in teenagers, Governor Gavin Newsom has signed a budget proposal of 3.5 million dollars to supply middle and high schools with Naloxone. Currently, schools can get Naloxone for free through public health grants.

Some young teens buy pills from drug dealers on social media thinking they are oxycodone, Adderall, or Xanax, laced with Fentanyl. The main problem is not more teens using drugs; the problem is that the drug supply is much more potent.

Solutions To a Growing Problem

Proposals for legislation are to curb the sale of ‘fentapills’ to young adults on social media sites. Republicans have introduced bills to extend sentences for traffickers and sellers who violate the proposed legislation. Schools also need to start educating students regarding Fentanyl. Lawmakers are also seeking laws allowing all amusement parks, stadiums, concert venues, and universities to have Naloxone available in case of an overdose.

Much like how Dr. Frankenstein lost control over his creation “Frankenstein,” this drug has become lethal and dangerous, turning some people into ‘zombies.’ Dr. Paul Jansen probably never considered that his pain killer, Fentanyl, would be addictive or for sale as a street drug and cause people to overdose. Nor did he ever conceive young adults and children would be consuming the drug recreationally.

Perhaps we need go back in time with Dr. Emmet Brown from “Back to the Future,” to bring Dr. Janssen into the present moment. What would Dr. Paul Janssen think about the current Fentanyl crisis? What would he think about the thousands of people who have lost their lives due to Fentanyl overdoses? Would he have gone back in time to make any changes to his invention Fentanyl? Would he offer any solutions? We’ll never know.

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TikTok, the most downloaded social media platform in the world, is potentially facing a ban due to privacy concerns over its data collection practices. On March 23, 2023, Shou Zi Chew, TikTok’s CEO, testified before Congress about the various allegations the app is facing.

The proceedings were harsh. Many congressional representatives were aggressively stating, “TikTok should be banned.” As I was watching the hearing on the TikTok app, it reminded me of the trial at the end of “Alice in Wonderland,” where the Queen of Hearts keeps screaming, “Off with your head!”

Where Did TikTok Come From?

TikTok officially launched in 2016 through a Chinese company called ByteDance. Known initially as Musical.ly and was used as a lip-synching app. ByteDance acquired the company in 2016 and changed its name to Tiktok. Due to the COVID-19 pandemic, TikTok grew in popularity and became a connecting tool for people worldwide.

The app is available in over 150 countries and boasts over 1 billion users worldwide. In the United States alone, TikTok downloads equl total of 210 trillion. According to a survey conducted in 2022, Gen X and millennials aged 25-54 spend an average of 45 minutes per day on the app. Many people worldwide use the TikTok app for various purposes, including education, entertainment, and a platform for branding and sales.

Healthcare Hot Topics Discussed During the Congressional Hearings

1. Data Collection: there are national security concerns over how TikTok handles a user’s data. The RESTRICT ACT includes increased protections for sensitive health-related data. The United Kingdom has fined TikTok 16 million dollars for illegally processing data containing children under 13 years of age.
2. Dangerous Medical Misinformation: several state representatives accused TikTok of medical Misinformation. They accused the medical that appears o Tiktok of being ‘extreme.’ An example shared included a search done for medical abortions that would show false claims regarding papaya seeds for “herbal aborts.” A study also showed a hydroxychloroquine tutorial on TikTok claimed the drug could be manufactured through grapefruit to treat COVID-19.
3. Telehealth Providers and Advertising: concerns regarding TiikTok’s algorithm preying on vulnerable people with mental health issues, especially those with addiction and eating disorders. There were also allegations stating that TiikTok received information from third parties like BetterHelp and Cerebral regarding a patient’s browsing history and mental health diagnosis.
4. Children and Mental Health: Rep. Kim Schrier, M.D. questioned the effects of TikTok on the mental health of children and teenagers. She states, “The constant scrolling takes young people away from meaningful relationships and pushes back bedtime, which may lead to issues of depression and potential academic failure.” “Is your app designed to keep children addicted?” Rep Shirer questioned Shou Zi Chew, the CEO of TikTok if psychologists were employed to evaluate the mental health effects TikTok has on children. He replied, “We worked with the Digital Wellness Lab, Congresswoman, at the Boston Children’s Hospital, and we came up with a 60-minute default limit for any users under 18,” Mr. Chew added, “We were the first to do it in our industry.” Mr. Chou also stated that the platform had a family-safe tool that families could use when children use the app.

Is TikTok Really That Bad?

Many healthcare providers and patients use the TikTok platform as a teaching and learning tool. Healthcare-related businesses also use the platform for advertising their brands and services. TikTok offers healthcare professionals and patients an innovative way to share information.

The use of ‘hashtags’ makes it easier for users to find specific types of media with healthcare-related topics. The TikTok algorithm will then customize topics and content based on the user view history and continuously send the user media based on those topics.

The hashtags “doctor” and “medicine” each received 1.4 billion and 6.4 billion views. Most videos are 60 seconds long, making it easy for learners to quickly review techniques like ultrasound or other procedural training. Shou Zi Chew also stated that the hashtag “booktok” is one of the most popular hashtags used on the platform. It has gotten more children interested in reading. The hashtags allow users to post multiple videos in a row, making learning a task convenient.

Causing More Harm Than Good

As seen through the Congressional hearing, there is much debate regarding the educational value of healthcare topics. For example, a recent study found that videos related to diabetic education may not meet the academic standards or contain valid peer-reviewed research data a typical diabetic patient needs. The study further suggested that diabetic patients seeking information on diabetic-related content and diet should exercise caution when using TikTok for diabetes education.

Pediatric movement disorder centers across the U.S. reported an influx of teen girls with tic disorders. One of the common factors in all the cases of teen girls with tics was that they all were watching TikTok. Specifically, all the girls watched videos of TikTok influencers with Tourette’s Syndrome. Since their algorithm customizes topics based on a user’s viewing history, the teen girls watched endless hours of influencers and their Tourette’s Syndrome tics and symptoms of involuntary movements. However, many specialists speculate that there could be various contributing factors other than TikTok causing the tics, like anxiety, depression, and stress.

Ten Helpful Tips on How To Educate Your Patients About TikTok Health-Related Content

At the end of 2021, I asked my teenage patients where they got their healthcare information. Mostly all my patients responded, “TikTok videos.”

Before starting my mini-verbal survey, I was opposed to using the Tiktok app. My patients made me curious about the health-related content they were watching. And if you’ve been on it, there’s a little bit of everything on there. Scrolling through the endless sea of content is overwhelming. And yes, very addicting.

Some critical questions you should ask your patients, especially if they are teenagers, when assessing for healthcare literacy regarding TikTok include:

1. Where are they getting their healthcare education from?
2. If they answer TikTok, what type of healthcare-related content are they watching? Is it from a healthcare provider, patient influencer, or healthcare/ telehealth organization?
3. How much time are they spending on the platform per day? Is it interrupting their bedtime schedule?
4. Do they feel anxious or depressed after using the app?
5. Are they feeling addicted to the app, or are they having trouble putting the app down?
6. Are they having face-to-face relationships with friends and family members?
7. Do they have friends, a best friend, or a romantic dating relationship?
8. Are they involved in other in-person social activities that do not include TikTok or social media?
9. What did they learn from the healthcare information on TikTok? Did it trigger any symptoms?
10. Are they also sharing personal content? What kind?

It’s essential to have open conversations with patients, especially if they are teenagers, about their TikTok and social media. Healthcare providers must also educate their patients on using discernment when watching health-related videos on TikTok and sharing personal information. Parents must be encouraged to monitor their children’s social media consumption and use parental control options when needed.

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AI and Chatbots and ChatGPT, oh my! Technology is transforming healthcare at warp speed. It seems like these days; you need a degree in Computer Science or “Science Fiction” to understand all the new lingo that’s being branded as the ‘future’ of healthcare.

Here are ten popular healthcare tech terms and definitions that all healthcare providers should know:

1. AI: Artificial Intelligence that gives computers and machines the advantage of mimicking the problem-solving and decision-making talent of the human brain. 
2. Chatbots: computer programs that simulate and process written and or spoken human conversations. Humans can have conversations and interact with digital devices as if communicating with another human being. The first chatbot in history was created in 1994 by Joseph Weizberg at the Massachusetts Institutes of Technology (MIT) and named “ELIZA.” 
3. Machine Learning: a section of AI that spotlights the use of data and algorithms to imitate the learning capabilities of a human being. 
4. Natural Language Processing: a subfield of AI that helps machines to understand and process human language to perform repetitive tasks. Some examples include spell check, machine translation, and ticket summarization. 
5. Turing Test, also known as the “imitation game,” developed by Alan Turing in 1950 as a test of a machine’s ability to exhibit intelligent behavior. 
6. Deep Learning AI: used to help detect and diagnose diseases faster, personalize patient treatment plans, and automate drug discoveries and diagnostics. 
7. ChatGPT: is an AI “chatbot” that uses natural language processing which allows you to have human-like conversations and much more with a machine. Elon Musk helped to develop OpenAI (creators of ChatGPT). Microsoft is now controlling ChatGPT. 
8. ChatGPT-3.5: stands for Generative Pre-Trained Transformer 3. It’s the third version of the ChatGPT tool to be released. It generates texts using pre-trained and programmed algorithms with the data to carry out their specific task. 
9. ChatGPT4: more advanced than ChatGPT-3.5. Better at understanding context by giving more straight answers to questions. It can also interpret images and provide ideas for recipe lists of ingredients located in your refrigerator.
10. ChatGPT5: advanced form of AI which could achieve artificial general intelligence (AGI) and become identical to a human.

Better Healthcare Delivery to the Masses

Healthcare Tech and AI are committed to revolutionizing the healthcare system. Many hospitals around the world already use AI and ChatTGPT platforms. The value of AI comes from increased cost-effectiveness and more efficient workflows to decrease provider burnout. 

Prevention

The government in Singapore has mined the data of 5 million citizens to identify pre-diabetic people. These people will benefit from using AI and ChatGPT platforms to manage their pre-diabetes diagnoses better, preventing full-blown diabetes. Part of the program includes giving people daily nudges on how they can lower their blood sugar. So far, this program has been successful in decreasing the advancement of pre-diabetic patients. 

Robotics

The United States has been utilizing AI robotics in surgery for several years. Robotic-assisted surgery is minimally invasive, and research shows that patients experience decreased post-surgical complications. 

Robotic mitral valve repair patient done yesterday discharged home today! Likely the first postoperative day 1 discharge after surgical mitral repair in the southern US and in Georgia! @GaHeart_NGHS@myNGHS @ACC_Georgia@GeorgiaAHA pic.twitter.com/7hlD9a6eRI

— T. Sloane Guy, MD, MBA (@sloaneguy) February 28, 2023

One of AI and machine learning’s superpowers is pattern recognition and the ability to make predictions. Some examples of how healthcare organizations use AI and machine learning technology include predicting patient hospital admissions to provide safer staffing ratios, more precise diagnostic abilities on rare cancer cases, improving the interpretation of patients’ radiology scans, and further advancing the work of radiologists. 

A Second Pair of Eyes

In a recent interview in Forbes magazine, Tom Lowery, National Director of AI for Health & Life Sciences at Microsoft, states:

“When a radiologist looks at a scan, they’re typically looking for one thing, which is why you have that image done. But many times, in the background, there’s something else that can be seen. So as radiologists are dictating, natural language processes are being used to call out these secondary issues for follow-up, where previously those things might go unnoticed…so it’s a preventive way of trying to get out ahead of a future health problem.”

AI Benefits in Hospice Care 

Late referrals and the difficulty in accurately predicting patient death within six months are just some obstacles to getting a patient admitted into hospice care. As a matter of fact, AI and machine learning have the potential to predict which patients have a high probability of expiring within the next six months, allowing for quicker admission into hospice care and improving a patient’s quality of life. 

ChatGPT Transforming the Future of Healthcare Tech

As soon as ChatGPT launched in November of 2022, it became the fastest-growing platform in the world, gaining 100 million users in 60 days. Social Media entrepreneurs are creating automated business plans business. In fact, high school and college students are using the platform for homework and writing essays. Some of the ways ChatGPT will revolutionize healthcare include:

• Development of virtual assistants to book patient appointments
• Aid in patient management
• Patient health education
• Medical record keeping and streamlined EMRs
• Improved healthcare systems 
• Automatically monitoring patient vital signs and signaling warning signs to patient deterioration
• Healthcare professionals dictating to ChatGPT with better-streamlined details
• Real-time patient translation services of technical terms and medical jargon
• Better patient understanding of health, wellness, and disease process 
• Identifying patients who meet inclusion criteria in clinical trials. 
• Development of more accurate symptom checkers
• Medication management
• Medical writing
• Patient triage
• Predictive maintenance of hospital equipment
• Quick detection of atrial fibrillation in cardiac care
• Patient data collection at home
• Integration of information across many platforms like radiology, EMR’s and genomics
• Better and more efficient patient diagnosis
• Better image analysis

Should ChatGPT Be Used for Mental Health?

Recently, Rob Morris, the founder of Koko, a complimentary therapy program, admitted on Twitter that his service used ChatGpt-3 chatbots to respond to over 4,000 users seeking mental health advice. When users were told a machine was counseling them, they did not like it. “Simulated empathy feels weird,” states Rob Morris. 

We provided mental health support to about 4,000 people — using GPT-3. Here’s what happened 👇

— Rob Morris (@RobertRMorris) January 6, 2023

More and more people are using ChatGPT platforms for mental health to deal with social isolation, anxiety, depression, and relationship breakups. According to an article in the Indian Express, “chatbots monitor and analyze human emotion and then use machine learning to track and record a person’s mood, acting like a person’s virtual therapist.” There is also conflicting dialogue regarding a machine’s ability to analyze and respond to human emotion accurately. 

Of course, if a machine were to diagnose a patient inaccurately, the outcome could be fatal. There can also be a false sense of acceptance, especially among young adult patients. It’s important to realize that AI and machine learning platforms are driven by practicality and not based on real human emotions. 

Healthcare Providers Trusting the Process

A research study of 11,004 U.S. adults finds that only 38% agree that using AI to diagnose disease and recommend treatments would lead to better outcomes, while 33% said it would lead to worse results. 

One of the main problems with more significant AI usage in healthcare facilities is physicians’ and healthcare providers’ understanding of what AI implementation could represent. Not to mention, to have more healthcare providers adopt AI and machine learning systems, they must be able to trust and understand the predictions the machines are giving them. Researchers recently put ChatGPT through the U.S. Medical Board 3-part Licensing Exam to to see if it could pass. ChatGPT could perform at or near the passing rate on all three exams without training or added cheat sheets. 

Should We Fear ChatGPT?

In a recent interview Sam Altman ChatGPT CEO, states, “AI will reshape society,” and he’s “a little bit scared of this.” With the new ChatGPT5 having qualities identical to humans and the ability to process data above and beyond what the human mind can, we should all be afraid. 

There’s a scene in the movie 2001: A Space Odyssey where a computer by the name of HAL is in control of most of the operations on the spaceship Discovery. Hal makes an error that he blames on human error. When the ship’s captain keeps giving HAL orders, HAL responds, “I’m sorry, Dave, I’m afraid I can’t do that.” Hal then starts to take over the spaceship, killing most of the crew who are asleep in suspended animation. 

Even though 2001: A Space Odyssey is just a science fiction movie, it gives humanity something to think about regarding ethics when it comes to healthcare tech making decisions. AI and machines having too much power over life-and-death decisions is a scary thought. It’s important to understand that no matter what outcome the AI spits out, humans and healthcare providers must always be able to make the final call on all patient care decisions. On balance, let’s hope that machines will only partially replace humans in healthcare. 

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No matter what type of specialty you practice, a strong and healthy therapeutic relationship is essential to gaining patient trust and compliance, hence leading to positive health outcomes for your patients. Nonetheless, there are many days when due to unpleasant doctor-patient interactions and rude patients, the workday may feel like a struggle and drain our energy and enthusiasm. Unfortunately, this scenario is not uncommon and can sometimes feel like the norm. According to the American Academy of Family Physicians, https://www.aafp.org/PUBS/FPM/issues as many as 15% of patient physician encounters are rated difficult by the treating Physician.

The Disconnect

As it turns out, many patients have also come to feel their healthcare provider is not showing the expected kindness, caring, and courtesy they once enjoyed. Patients go to their doctors wanting to be heard and expect their doctor to understand their particular situation. According to statistics put forth by United Healthcare, most doctors only listen to their patients for 11 seconds before interrupting them. Many times, patients receiving their diagnosis, feel anxious because they perceive they have little or no control over their care plan. They also feel that at the end of the visit, they have not understood their diagnosis, often reporting that their healthcare provider explained the diagnosis and plan too fast. Virtual healthcare can also make patients feel helpless and scared, because often patients will receive their test results through their patient portal before a provider can review their significance with them.

First Impressions Count

According to the AAFP, http://www.aafp.org./PUBS/FPM/issues/2017/0900, an otherwise pleasant patient may behave rudely and become angry by the time they see a physician due to how they are treated by front office reception staff.

They may become annoyed because the waiting room is too cluttered or noisy. Patients may be short with their provider because of having to wait in exam rooms that may be too cold or too hot. They may feel overly nervous due to language or literacy concerns. Therefore, it is crucial to review important points of contact within the practice and anticipate any possible environmental factors that may make patients feel uneasy and affect the therapeutic experience.

The Types of Difficult and Rude Patients

While all difficult patients can make getting through the day an arduous task, they are not problematic for the same reasons. There are many facets that can contribute to the patient becoming rude, pushy, and even potentially aggressive and violent.

So, Who Are the Players??

The Manipulative Patient

They may threaten legal action if they do not get their way. Some will bribe or threaten their physician with good or bad reviews based on getting what they want. They may even threaten to harm themselves. They tend to struggle with personality disorders. The key here is to remember that they are actually playing on your emotions.

Therefore, it is important to keep calm and remain self-aware when dealing with these types of patients. Often written forms that patients can read and sign may set healthy boundaries and establish expectations in writing.

High Utilizers

These patients are known to everyone in the office or clinic due to their frequent visits. These patients, although no more or less important than others, will take up multiple appointment slots to discuss medication questions, or to consult on occasional symptoms, or to find out if the medical information they were given by other healthcare providers, or their friends and family is correct. They likely suffer from anxiety or loneliness or both and may have somatization disorder.

The Somatizing Patient

As mentioned above, they can require multiple visits, calls, or emails to address an ongoing array of vague signs and symptoms. They have likely seen several other physicians in multiple settings and report having “fired” them because the urgent care, emergency room, and other primary care providers they consulted did not agree with them and did not take them seriously.

The key to maintaining a therapeutic relationship with these rude patients comprise of the three C’s: a) compassion, b) a calm demeanor on the part of the healthcare provider, and above all c) a caring attitude that addresses their concerns.

It may be helpful to set up  regularly scheduled visits and address concerns that will inevitably arise. Confronting patients with a dismissive attitude and telling them not to worry or it is all in their head never works.

The Angry or Defensive Patient

There are, definitely, a variety of factors that may contribute to making a patient angry or defensive. They may be angry about waiting too long to be seen, or perhaps with a friend or a co-worker prior to their visit. Anything may have gone wrong in their day, and they lack the emotional maturity to remain courteous to you or your staff. They may feel they have been mistreated over the phone or by the front desk staff. But, whichever the cause, you can become the person they direct their anger toward.

The good news is in most instances there are many ways to address the situation, and hopefully steer the visit toward a satisfactory outcome. There are ways in which  to respond to such patients that can calm them and help staff and physicians maintain an optimistic and resilient attitude as they continue their work. Keep in mind that even though you are their preferred target for the moment, you may not be doing anything wrong.

The Non-Compliant Patient

These rude patients tend to suffer chronic diseases, such as hypertension, heart disease, diabetes mellitus, hyperlipidemia, etc. You may spend many visits listening to them, educating them, and motivating them. Your staff may spend time and effort working on prior authorizations to help these patients avoid high co-pays. Your staff may even spend hours on authorizing multiple specialty referrals. All of this, only to find out on a follow up visit that they have not even picked up the much-needed medications and have not followed up with the appropriate specialists that should have been an integral part of their medical care.

They will cancel and will no-show for many appointments, arrive late, and go as far as to claim no one told them their prescription was ready or their imaging order was authorized. These patients typically claim they have “lost” the mammogram order, the x-ray order, or their lab order, and hence have not completed their needed studies. They may place blame and responsibility on their medical provider and office staff. All of this can be very frustrating and lead to multiple duplicative work.

Unfortunately, there is no medical practice that is spared. The key is to remain aware and avoid becoming emotionally involved in the outcome when it comes to the non-compliant patient. Instead, employ multiple automated reminders and document when the patient has been informed about their care plan. Utilizing email, text reminders, handouts, visit, summaries, and other forms of communication can really help. Remain calm and be ready when the patient decides to face their illness and take responsibility for their health.

How to Create a Therapeutic and Respectful Alliance with Patients

The above-described patients can sometimes baffle the most seasoned physician. Therefore, it is best to always refer to the code of medical ethics. Below is the list put forth by the American medical association. https://code-medical-ethics.ama-assn.org/ethics-opinions/patient-rights.

Physicians must serve as patients advocates and represent patients’ rights which include:

1. The right to courtesy, respect, dignity, and timely responsive attention to his or her needs.
2. To receive information from their physicians and to have an opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including risks, benefits, and costs of foregoing treatment. Patients should be able to expect that their physician will provide guidance about what they consider the optimal course of action for the patient based on the physicians’ objective professional judgment.
3. To ask about their health status or recommended treatment when they do not fully understand what has been described and to have their questions answered.
4. To make decisions about the care the physician recommends and to have those decisions respected. A patient who has decision making capacity may accept or refuse any recommended medical intervention.
5. To have the physician and other staff, respect the patient privacy and confidentiality.
6. To obtain copies or summaries of their medical records.
7. To obtain a second opinion.
8. To be advised of any conflict of interest their physician may have in respect to the care.
9. Patients should have the right to continuity of care and should be able to expect that their physician will cooperate in coordinating medically indicated care with other healthcare professionals and that the physician will not discontinue treating them when further treatment is medically indicated without giving them sufficient notice and reasonable assistance in making alternative arrangements for care.

The Last Resort

There will be times that the inevitable may happen despite all the effort put forth to maintain a mutually respectable and therapeutic relationship. 

In such situations, maintaining a courteous and professional demeanor and remaining calm without allowing patients to trigger any inappropriate behavior on your part is crucial. 

It is best to inform the rude patient that you will be discharging them from the practice in person with an office manager present. Additionally, informing patients in writing that you will be discharging them from the practice is mandatory. Let them know that you care about their health and will be available for a period of 30 days for any emergencies that pertain to their care plan until they find a new medical provider to care for their needs.

 At times, the most therapeutic decision can involve discharging the rude patient from the practice to allow them to seek care with an alternative medical provider that the patient may prefer over you.

In the end, knowing how to respond to each patient and trying to deliver personalized care with an understanding and compassionate attitude can go a long way in preventing a break in the therapeutic bond.

It is important to keep in mind that discharging a rude patient does not reflect on your ability to deliver excellent medical care.

As the saying goes, there are times that patients make us feel contented and happy when we see them in our offices and there are times that we feel equally happy when they depart from our office.

If you are ready for a change of pace from your current practice, give locum tenens a try for a little more freedom! Click here to see what we have available, or to speak to our great recruiters, fill this out

Fun? FUN!!! I remember years ago when I worked for a pharmaceutical company as a Nurse Marketer, I would get in trouble all the time. The job was dull. A huge change from working in Pediatrics for the last 15 years.

Why was I getting in trouble you ask? For one thing, I had a habit of telling jokes in front of my colleagues and pranking my former boss. At the time, I was also performing stand-up comedy and comedic storytelling on various stages in Hollywood, California.

I felt like a fish out of water in the pharmaceutical world. I was a Pediatric Nurse Practitioner working with a bunch of people wearing suits who talked like robots. It was no fun!

Hiring me to work in the pharmaceutical industry is kind of like hiring a clown to perform at an old folk’s home. I really didn’t fit in. To this day, I’m not sure why my former boss, a pharmaceutical sales manager and not a nurse, hired me. Perhaps he hired me because I was ‘fun!’

Having Fun Makes Us Happy

Of course, we all could use more fun in our lives! Americans are constantly in pursuit of happiness. Catherine Price, the author of the book “The Power of Fun. How to Feel Alive Again,” suggests that having and incorporating more fun in your life will produce more happiness. She further suggests that having fun will increase the likely hood of feeling good in the future.

Depression Is an Epidemic

Overall, depression in the United States is on the rise. At least 10 % of Americans currently suffer from depression. Additionally, researchers are claiming that depression has now reached epidemic levels equivalent to the flu. Surprisingly, from 2015 to 2020, depression was ranked the highest in adolescents aged 12 and older. The cause of depression has been blamed on the increased feeling of helplessness and economic distress. Furthermore, many researchers speculate the cause of depression is an increased use of screen time and a lack of human social interaction.

Technology and Infinite Distractions

Our brains have been hijacked with a variety of meaningless distractions. Many people are addicted to their smartphones and devices. In essence, technology has taken over as a main source of entertainment and distracts us from life leaving many to feel dull and dead inside. Catherine Price writes in her book refers to this in her book as being ‘fake fun.’

Fun Helps Us Flourish

Catherine Price interviewed many researchers when she wrote “The Power of Fun.” She found that “When humans flourish, they are in a state of optimal human functioning in which we feel engaged, open, purposeful, self-accepting, resilient, robust, motivated and satisfied. “

When humans are in ‘survival mode,’ fight or flight, or working to live, we tend to get stressed which may lead to depression. We are not in flow. And that’s when our bodies may start to break down in a state of ‘dis-ease.’

Maslow’s Pyramid

According to Maslow’s Hierarchy of Needs Pyramid, the basic human needs, located at the bottom of the pyramid, are physiological requirements and safety which include food, water, warmth, adequate rest, security, and physical safety. When many people are in work mode, all they can do is stay stuck at this level.

Undoubtedly, to climb up Maslow’s Hierarchy of Needs pyramid and achieve ‘self-actualization’ achieving one’s true potential, we need to include friendships, belonging, love, and increased self-esteem to allow us to grow and flourish.

Making True Fun A Priority

In Stanley Kubrick’s “The Shining” protagonist Jack Torrance, a burnt-out writer, sits at a typewriter and obsessively types out the same phrase over and over again, “All work and no play makes Jack a dull boy.”

What makes the average working adult not have fun and become dull? Catherine Price states that she had succumbed to what she calls a ‘time value paradox,’ only placing priority and value on activities that brought in money or were productive. Once Catherine started to treat ‘True Fun’ as a priority in her life, she felt like she was flourishing.

What is True Fun?

“The times we feel most alive, those that make up our best memories are moments of play,” states Stuart Brown, founder of the National Institute for Play. For children, the art of play and having fun is normal and necessary for their brain development. But as we grow up to be adults, for some reason play and having fun are no longer seen as important. Brown describes ‘play’ as anything that can be absorbing and purposeless.

Price describes ‘True Fun’ as a mood-boosting and energizing state. Some signs to watch for include:

• Laughter
• A sense of release/ freedom/letting go
• Feeling like you’re having a special shared experience
• Losing track of time
• Feeling free from self judgment and self-consciousness
• Feeling like you’ve stepped out of the normal
• Being fully absorbed into the present moment
• Not caring too much about the outcome
• A feeling of childlike excitement and joy
• A positive boost in energy
• Feeling yourself

How to Add More Fun to Your Life

The best thing to do is take a self-inventory and evaluate what your passions, interests and hobbies are. Whether it’s playing with Legos, painting, taking guitar lessons, enrolling in a  storytelling class, or experimenting with standup comedy, you should be having FUN.

When you pick up a new hobby and or passion, make sure you are doing it for fun. I have picked up many exciting interests. In the beginning, they were fun, and I even found myself in that ‘true fun’ state. But over time some of these activities were no longer fun. I gave myself permission to drop them or take a break. Sometimes, I explore another type of fun which helps to evolve and expand my creativity.

Are you looking to add more fun and excitement to your career? Are you looking to add travel and adventure to your life? MedCare Staffing has a variety of long-term and short-term locum tenens assignments. Click here for more information.

Are you in the process of quiet quitting? Unfair staffing ratios and productivity paranoia getting you down in the healthcare workplace? Are you looking more flexibility and adventurous travel? Working Locum Tenens could be the answer to all your healthcare job woes with the perks of:

• Greater Flexibility
• Travel Opportunities
• Work-Life Balance
• New and Exciting Work Environments
• Greater Compensation
• More Diversity
• Less Administrative Responsibilities

Locum Tenens Providers vs. Non-Locum Tenens Providers

Multiple healthcare facilities around the United States employ locum tenens providers. As placeholders, locum tenens providers temporarily fill the space of another. Hospitals, Federally Qualified Clinics, Urgent Care facilities, Dental clinics, rural healthcare clinics, and correction facilities all employ locum tenens healthcare providers.

Recent studies show that patients treated by locums’ providers exhibited shorter hospital stays, decreased hospital costs, and no increase in readmission or mortality. According to another study published in World Neurosurgery, there were no differences between locum and non-locum neurosurgeons related to short-term complications, lengths of hospital stays, or costs.

Healthcare Labor Market Trends

The healthcare job market in 2022 has been tumultuous with unpredictable staffing ratios, a looming recession, and more healthcare providers complaining about workplace burnout. Hot healthcare job postings have shown a slight trend of cooling down compared to previous years.

 According to research done by The Indeed Hiring Lab, healthcare job postings on the Indeed website have been flat. However, Physician and Surgeon job postings are up 15.8 % while Nursing job postings have been on the decline by 0.07%.

Although, the United States Board of Labor Statistics is estimating that over 500,000 nurses will leave the profession in 2023 resulting in a nursing shortage of over one million nurses.

Healthcare facilities are still using locum tenens providers to fill various staffing gaps

Approximately 88% of healthcare facilities stated they used locum tenens advanced practice providers to fill staffing gaps in 2021. Many facilities are utilizing locum tenens advanced practice providers to address rising patient demands, provider burnout, and supplementary staff while looking for permanent staff replacements.

The Gig Economy

The gig economy has been slowly creeping into the healthcare workforce for many years. The COVID-19 pandemic further opened more opportunities for gig work in healthcare. Gig work offers alternatives that include flexible options to retain advanced healthcare providers and nurses, flexible work schedules, and the ability to achieve financial independence.

What to Expect When Speaking with A Locum Tenens Healthcare Recruiter

You’ve probably been bombarded with emails from various locum tenens companies. Perhaps you’ve gotten several unsolicited text messages from a locums’ recruiter offering you a job with the opportunity to travel somewhere new and exciting.

 When you’re first treading into the unknown waters of the locum tenens job market, things can be confusing.

Finding the right locum recruiter is key to navigating the best locum assignment.

Locum recruiters are free of charge and can connect you with potential job offers. Many have established relationships with highly regarded facilities. It’s best to work with a recruiter who is connected to a locum’s company that is affiliated with NALTO, the National Association of Locum Tenens Organization.

Sheila Samuelson, the Managing Director of Recruitment and Marketing for MedCare Staffing states:

“A locum tenens healthcare recruiter acts on the candidate’s behalf. The main role of a locums’ healthcare recruiter is to communicate and connect clients with candidates as well as act as a liaison between the two parties.”

The recruiter’s main job is to make sure that the healthcare provider candidate is a good fit for the client. A good locum recruiter communicates directly with the facility and helps to advocate for safe staffing parameters. The recruiter will also help you to negotiate pay and benefits on your behalf.

Questions to Ask Your Recruiter When Considering a Locums Assignment:

• Pay rate
• Rest breaks and length of meal breaks
• How many patients per hour
• Type of charting
• Paid orientation
• Malpractice coverage
• What type of job support will you have?
• Is there a lab onsite at the facility you will be working at?
• How often is payday?
• Length of contract
• Cancellation policy
• Sick days
• Travel logistics, parking, and lodging

Clarify Job Responsibilities

Not all advanced healthcare providers and nurses are alike. The locum tenens recruiter should clarify the healthcare providers’ or nurses’ responsibilities before accepting and or arriving at the assignment.

Credentialing

When starting a new locum tenens assignment, all providers must go through a credentialing process. A recruiter may ask you for copies of your CV and all required documents which may include diplomas, licensing information, malpractice insurance, work references, and NPI number.

The credentialing process for advanced healthcare providers is a regulated process that evaluates and assesses their specific qualifications. Subsequently, the verification of education, training, and licensing is an important safety check that doctors, dentists, nurse practitioners, and other advanced healthcare providers must go through the ensure that they can perform adequate patient care.

Sheila Samuelson further states that “Each facility is different when assessing a provider for credentialing. Smaller clinics move fast with their processes whereas government, FQHC’s and hospitals last 30-90 days on average. Our internal credentialing is complete in 24-48 hours.”

Medical Malpractice Insurance

Many healthcare providers and nurses carry their own malpractice insurance. The locum tenens company should offer all healthcare providers some type of malpractice coverage with every locum’s assignment. The healthcare provider should ask for clarity on whether the coverage includes all incidences or is limited to the assignment location.

Travel and Lodging

Traveling to a new location on a locum tenens assignment can be an adventurous ‘workcation.’ Locums’ contracts can be short or long-term. They can be located in both touristy or rural areas.  Local travel in your home city or state can also be an option. Travel and lodging opportunities as well as accommodations may vary depending on the contracting facility.

Are you ready to start your new locum tenens assignment? MedCare Staffing has many exciting long- and short-term locum assignments. Click here for more information.

The holiday season is in full swing. It’s the “most wonderful time of the year.” A time for parties and getting together with family and friends. It’s a time for having fun.

Although, for some people, the holiday season can be dreadful. The mere scent of nutmeg and pies baking in the oven can trigger a person’s mood. Feeling blue during the holiday season is a normal phenomenon.

What Are the Holiday Blues?

There’s a high expectation placed on being happy during the holidays. It’s not just a song that Elvis Presley made famous. The added stress of shopping, attending social events, baking the perfect holiday cookies, and decorating your home along with planning family dinners can make people feel uncomfortable.

The American Psychological Association states that 38% of people surveyed complain of increased stress during the holidays, which can lead to increased physical illness, anxiety, and substance abuse. The number of alcohol fatalities increase during the holiday season.

Approximately 64% of people who suffer from diagnosed mental health issues state that their symptoms worsened around the holidays.

In most cases, symptoms caused by the holiday blues can be temporary.

SAD

Seasonal Affective Disorder (SAD) is a natural health disorder caused by a lack of sunlight. In parts of the world that experience decreased sunlight during winter months, approximately 10 % of the population is affected by SAD and presents with symptoms.

The body’s natural circadian rhythms and the internal clock are upset due to decreased sunlight. Symptoms can start in adolescence and are more common in women than men.

Some signs and symptoms of SAD include sleeping too much, increased appetite, weight gain, decreased energy, low concentration levels, loss of interest in work and other activities, slow movement, social isolation, unhappiness, and irritability.

Symptoms can improve with light therapy. A lamp with a very bright light that mimics the sun works well. Treatment starts in November and the early winter months before symptoms manifest. Some side effects of light therapy include eye strain, headache, or mania. Et Symptoms usually get better when the seasons change.

Although there is a risk for self-harm during the holidays, according to NAMI, it’s a myth that suicides increase during the holiday season.

Common Stressors

-Family and social dynamics
-Unreasonable expectations
-High pressure to be in the ‘holiday spirit.’
-Overeating
-Ability to maintain diet and exercise routines
-Taking off time from work
-Financial Stress-Spending more money than usual
-Working too much
-Intense travel plans
-Getting sick
-The economy

Pay Attention to the Signs and Symptoms

Signs and symptoms can begin in November and last until the beginning of the New Year.

-Feeling irritable
-Feeling overwhelmed
-Trouble concentrating
-Lethargy
-Trouble sleeping
-Lack of joy during happy times
-Impulsive behavior
-Procrastination
-Self-isolation

Loneliness and Social Isolation

The holidays are full of scenes of people spending time with loved ones drinking eggnog by the fire and singing holiday songs. Loneliness during the holidays is common. Many older people tend to isolate themselves or may suffer the loss of a loved one. Lack of support or feeling loved can also lead to social isolation.

Certain things like seasonal songs, various holiday movies, or even certain aromas can trigger people who experience loneliness during the holidays. People remember past partners, children, or careers. Thoughts and feelings can also trigger unpleasant moods.

Kids Also Experience the Holiday Blues

Children may have high expectations around the holiday season. Movies and social media advertise picture-perfect holidays. A child’s mental image around the holidays may not match their reality, potentially causing a depressed mood.

Setting realistic goals and making holiday plans while incorporating children in the decision-making for the season can help parents deal with possible mood changes. Establishing family budget expectations for the holidays and having open conversations with children can help.

Parents need to differentiate when their children feel a little blue versus having a depressive episode. The darker days of winter can also increase gloomy moods in kids. The highest rate of child psychiatric admissions occurs in the winter months. If a child is feeling sad or withdrawn for more than two weeks and the child or teen is having problems concentrating in school, it’s best to seek the help of a healthcare professional.

Conquering Sadness

A recent study on sadness during the holidays came up with a quirky and creative way to deal with uncomfortable feelings. The study uses the Disney-Pixar movie ‘Inside Out,’ where the feelings from Joy to Sadness of a little girl become personified. Much like the movie, study participants picture their sadness as having human traits. The study participants were able to alleviate their symptoms and have more self-control. When sadness becomes a ‘person,’ participants could easily detach from the feeling.

Reframing an experience can also be a powerful technique to help harness your coping skills. Exploring how interpreting specific experiences and finding that your interpretations are problematic can help you shift them for a more positive experience. Reframing the experience to a more positive one can help you move your mood and current external reality.

Take Charge of Your Moods and Shake Off the Holiday Blues

-Put yourself and your mental health first
-Reach out and watch out for each other
-Talk to someone verbally instead of texting
-Create new holiday traditions
-Permit yourself to go somewhere where there are no triggering memories
-Take a walk outside
-Reread greeting cards
-Look forwards to the future instead of looking backward into the past
-Be patient
-Keep expectations low and realistic
-Set realistic boundaries with family members
-Take short-term mental health problems seriously
-Set healthy boundaries with friends and family when needed
-Avoid drinking alcohol when feeling depressed or down

MedCare Staffing: Travel and Add Some Spice to Your Life

Are you looking to add more diversity to your career? Have you considered making a temporary or long-term shift that can help you transform into something better? MedCare Staffing has many long-term and short-term locum tenens assignments. Click here for more information.

Happy National Nurse Practitioner Week! November 13-19, 2022

It’s National Nurse Practitioner Week. Nurse Practitioners are a vital resource to the healthcare community, with over 355,000 currently licensed to practice in the US.

A Nurse Practitioner is a nurse with a master’s degree and who completed a graduate-level education at a university. All NP’s are registered nurses who the Board of Registered Nursing licenses in the state where they may be practicing. NPs have an expanded scope of practice over the traditional registered nurse role and may vary from state to state.

NP’s bring clinical expertise, leadership, and robust solutions to the challenges experienced in the healthcare universe. One of the main focuses of the NP profession is to reduce healthcare disparities with patient-centered care at the heart of the practice.

Bridging the Gap

The COVID pandemic revealed many cracks in an already fragile healthcare system. The disease burden was high, while medical equipment, hospital beds, and personal protective equipment resources were low. A lack of fairness regarding healthcare accessibility was found to exist primarily in the lower socioeconomic populations and rural areas. Once these patients were diagnosed with COVID, morbidity, and mortality rates were higher due to a lack of accessable healthcare.

Several policy changes emerged during the COVID pandemic. This catapulted the advanced practice role of the NP forward into more extraordinary evolution. Legislative changes were made allowing NPs to work to the full extent of their training and licensure.

Full Practice Authority

Nurses should practice full extent of their education and training. A recent study found that the main barriers in the practice guidelines for NP’s are in states with limited practice authority, further restricting patient’s access to healthcare.

Full Practice Authority (FPA) authorizes nurse practitioners to evaluate patients, diagnose, interpret, order diagnostic labs, and initiate and manage treatment. Prescribing medication is also included in the FPA under the board of nursing in each state. (For a complete list of FPA States, please click here)

Quality and Cost-Effective Healthcare

NP’s have a unique approach when it comes to healthcare. Care focuses on the well-being of the whole person, with particular attention on disease prevention, health promotion, and health education.

Various studies show NPs provide a 29 % reduced cost to patients compared to physicians. The same survey found that NPs are more inclined to refer and recommend patients for health education, counseling services, and smoking cessation counseling as compared with patients seen by physicians.

Specialties of Practice with Primary Certification

According to the American Academy of Nurse Practitioners, specialties with primary certifications can be found in:

• Family Practice
• Adult Medicine
• Adult-Gerontology- Primary Care
• Geriatric disorder Adult Gerontology-Primary Care
• Gerontology
• Psychiatric-Mental Health
• Women’s Health
• Pediatrics
• Neonatal
• Pediatric Acute Care.

A Valid Asset in Long-Term Care Facilities

Long-term care facilities were hit hard during the COVID pandemic. A recent study revealed that many Medical Directors in LTC facilities worked virtually to reduce the risk of transmission while NP’s saw their patients in person. The study also found that NP’s were pivotal in containing the spread of COVID in LTC facilities, helping out where there was a need, extending support to patients and families, and acting as liaisons in fragmented areas.

High Demand for Psychiatric NP’s

Mental and behavioral health disorders are on the rise. On average, 70% of primary care patient visits are for mental health issues. Approximately 13-20 % of children in the United States are diagnosed with emotional, behavioral, or mental health disorders daily.

Psychiatric Nurse Practitioners are in high demand, especially in lower socioeconomic areas and Federally Qualified Clinics. Psychiatric NP’s have advanced degrees in psychiatric mental health nursing and apply the nursing process to patients and families with behavioral health and psychiatric disorders. Many studies show that integrating behavioral health services like substance abuse and mental health services has drastically decreased anxiety and depression.

Netflix Promoting NPs

The Netflix show ‘Virgin River,’ now in its 4th season, is the perfect example of NP’s servicing rural areas of the United States. The protagonist is a nurse practitioner searching for a fresh start who moves from Los Angeles to a rural part of California to practice as an NP.

The Outlander series, also on Netflix, features a nurse as the main protagonist who time travels back 200 years. At one point, she also becomes a doctor. Perhaps you can say she was a modern-day nurse practitioner.

The Future of Healthcare Sustainability

According to the United States Bureau of Labor Statistics, the role of the Nurse Practitioner will grow by 40% by 2031. NPs are not only healthcare providers; they are mentors, educators, researchers, and administrators. They possess a dynamic knowledge base that spans from academia to clinical practice.

According to The American Academy of Nurse Practitioners, over 1.6 billion visits are made to NP’s every year. Post-visit, patients report an extremely high level of satisfaction with their care.

NPs are in a unique space to help mold healthcare policy and take positions as leaders to help guide elected political officials in the event of future pandemics. The ICAN (which stands for improving care and access to nurses ) act has been introduced into legislation which will allow for greater patient access to nurses.

Psychiatric NPs are in high demand and can teach FQHCs and community clinics to integrate behavioral health services into primary care.

Further legislation of Full Practice Authority needs to occur in all 50 states with nationwide approval of the APRN Compact Legislation. More Nurse Practitioners are valuable in underprivileged and rural areas of the United States where healthcare access is difficult.  

Travel and Explore the United States: Give Locum Tenens a Shot

You may not be able to time travel on a locum tenens assignment, but you can explore new and rural places across the United States. If you’re looking to make a temporary or permanent change in your healthcare career, MedCare Staffing offers a variety of locations and assignments. Click here for more information.

It is a typical day for Dr. Green, as she arrives at her large institution’s urgent care department. She has decided to arrive an hour early, 7:00 AM instead of her usual 8:00 AM, to finish her charting from last night’s shift. Normally, she tries to keep up with her charting on EMR (Electronic Medical Record), but last night was especially hectic as two doctors called out sick. The last minute acute abdominal case and sickle cell crisis patients who arrived three minutes prior to closing kept her working well past midnight. Since she lives 110 miles away from work, she ends up spending many nights at hotels, as she is too exhausted to drive back home to her family. This morning, she is on a mission to finish charting and responding to outstanding emails, not to mention her administrative tasks. She is happy because she will finally be able to return the two missed calls from her husband. He should be up by now, she thinks, and cannot wait to say good morning to him and wish him a good day.

The Pressure Cooker

Before she has a chance to place coffee and breakfast on her desk, she is met by a triage nurse frantically explaining how a patient walked into the triage booth with bloody clothes requesting help after being stabbed during an altercation. Dr. Green drops her coat, scarf, and breakfast and springs into action. By the time the stabbing victim is stabilized, and hospital bound, she has nine patients on her queue who need medical attention. Three patients are already roomed, one of which swings the exam door open and begins yelling ,cursing, and threatening to sue “the incompetent doctor that doesn’t give a damn about sick people.” Dr Green checks all three patient charts, reviewing their past medical histories and their reason for today’s visit. The patient yelling obscenities has checked in for migraine treatment. Her list of medication allergies include six non-narcotic medications used to treat pain and migraine headaches. Also, there is an eight-year-old child in the adjacent room with complaints of vomiting, fever, and abdominal pain.

Dr Green takes a deep breath and springs into action.

Meanwhile, in the 3rd exam room sits a twenty-nine year old woman with her four year old daughter, who has checked in to have her child examined for signs of child abuse, after spending the weekend with her father two weeks ago. She did not seek care sooner because she did not have time to make an appointment. She also requests a full written report that she can show her divorce attorney.

Tired from having slept only five hours and hungry from having skipped breakfast, Dr. Green decides to evaluate the eight-year-old patient suspected of acute appendicitis. As she walks past the migraine patient’s room who is shouting into her cell phone, she hears the patient say, “be careful in the parking lot tonight.” Dr. Greene suspects the patient is referring to her. She feels tension build-up in her temporomandibular joints.

Before she can attend to her first patient of the day, she has been shouted at, cursed at, and threatened.

Her charts from last night are still not done and a myriad of emails have not been answered, despite cutting back on her sleep to arrive early to complete her administrative tasks. She works in a department dubbed “the trenches” or “the pressure cooker” by other departments in her large organization because daily life for her and her colleagues often feels like a battle in the trenches. During the years she is worked there, multiple staff members have taken medical leave due to stress, depression, heart palpitations, and a host of gastrointestinal and musculoskeletal illnesses. A colleague has decided to apply for permanent disability due to health issues. Another previously well accomplished and respected doctor in the department is in rehab for prescription drug abuse and dependence. Many doctors have simply quit.

Unfortunately, Dr. Green’s experience is not uncommon and days like these have become the norm, leading to a never-ending cycle of emotional and physical exhaustion. This never-ending occupational stress has resulted in an epidemic of physician and medical provider burnout.

What Constitutes Physician Burnout?

To understand this occurrence better, we must know what “Burnout” actually means. According to the World Health Organization, burnout is an occupational syndrome where the medical provider suffers from emotional and physical exhaustion. Typically, there is a sense of cynicism or negativity related to his/her job. Physicians experiencing burnout will often grapple with a lack of personal sense of accomplishment. They will distance themselves from the offending cause, in this case, their work and, most likely display a marked loss of interest in their work to avoid further stress.

Additional Signs of Burnout

1. Feeling drained and exhausted even when not working.
2. Fatigue that does not respond to adequate rest, sleep, or even time off.
3. Feelings of helplessness.
4. Feeling trapped in one’s current circumstances.
5. Changes in appetite and sleep.
6. Procrastination and loss of motivation.
7. Withdrawing from, and isolating from, work functions, family, and friends.
8. Physical manifestations, such as increased muscle aches, headaches, gastrointestinal disturbances, and even lowered immunity.

Who Is at Risk?

In a word, everyone, given the current environment. Burnout does not spare physicians in training either. In a survey, 25% of medical residents said they would choose a different career if given the chance. Almost half of Gen X physicians report experiencing burnout. Another survey revealed approximately 46-50 % of physicians exbibit at least one of the symptoms of burnout. Unfortunately, this malady has not improved since the World Health Organization defined burnout in 2018.

In 2020, 42% of physicians reported suffering from burnout. That number rose to 46% in 2021. To elaborate, the Medscape 2021 Physician Burnout and Suicide Report exposed an increase in this problem. Medscape surveyed 12,000 physicians across different specialties.

The results were tallied and reported in various statistical breakdowns with the six most significant findings described below:

1. The highest rates of burnout were reported among Critical Care, Pulmonary Medicine, Neurology, Infectious Diseases, Rheumatology, Internal, and Family Medicine.
2. Female physicians reported higher rates of burnout. Not surprising, since most female physicians carry added childcare and domestic responsibilities. Additionally, female physicians often end up caring for elderly and sick parents.
3. Work settings can often contribute to burnout. According to the National Institute for Health Care Management Foundations, medical providers who work at hospitals, large integrated systems, outpatient community clinics, outpatient academic settings, and multispecialty group practices report the highest rates of burnout.
4. Burnout is not due to Covid! In the 2021 Medscape survey, 79% of the physicians surveyed said their burnout started before the pandemic. The remaining 21% of physicians who reported experiencing burnout as a result of the pandemic cited factors such as lack of adequate PPE, stressful work conditions due to Covid cases and watching their patients die alone without their families to comfort them. Of those surveyed, only 8 % reported treating Covid patients a source of burnout, compared to 58 % citing too many bureaucratic tasks as a burnout source.
5. Sources of burnout are not a result of treating patients. Top causes of burnout included bureaucratic tasks, as mentioned previously. Long hours at work, 37%. Lack of respect from administrators/employers, 37%. Another top cause of burnout was insufficient compensation, 32%. The next common source of burnout was the lack of autonomy or control over physician medical decision making, 28%. Next in the survey results was the everlasting increasing computerization of the medical practice, 28%. Lack of respect from patients was another cited source, 17%. Yet another source of burnout was increasing governmental regulations pertaining to healthcare delivery, 14%. Out of all the cited causes, only 8 % of those surveyed cited stress from patient treatment.
6. The causes of burnout have remained constant year to year. Regardless of the pandemic, physicians have cited the ever-increasing bureaucratic tasks as a top contributing factor. This is not to say that the pandemic did not worsen this problem. But the cracks in the system were already there; Covid-19 just deepened the already existing angst and hopelessness among health care providers.

The Mental Health Toll of Burnout

Ongoing helplessness and frustration on the part of overwhelmed, underpaid, and disrespected physicians have led to increased rates of depression. Unfortunately, medical professionals tend to feel inadequate if they ask for help. Other factors keeping affected physicians in an endless cycle of depression, depersonalization, and guilt, are the fear of being judged harshly by peers and superiors if
they seek mental health services. Some even fear retaliation and damage to their reputation and careers
if they are found to be suffering from depression and anxiety. Unfortunately, the consequences of not
seeking help can lead to self-medication and even suicide. In fact, physicians are more than twice as
likely to fall victim to suicide than the population at large.

The Wide-Reaching Impact of Physician Burnout

The ability to care for and cure what ails our patients is a source of great personal satisfaction and joy for medical providers. However, regardless of good intentions, it has been shown repeatedly that burned out providers become less effective in their communication with their patients. When information exchange between patients and doctors is compromised, the quality of care given to patients also suffers. What is more, burnout coupled with the pressure of time constraints has been shown to jeopardize patient safety and increase unintentional errors in the delivery of care. It stands to reason that when doctors keep “a stiff upper lip” and push past their fatigue, they can ignore patients’ feelings and wishes in the process.

The adverse effects of burnout on quality medical care has been demonstrated in other countries as well

According to the Canadian Medical Journal, physician burnout decreased productivity, as more physicians call out sick, forcing remaining colleagues to treat a higher number of patients in a shorter amount of time, which led to an increase in medical errors.

Given this unsustainable scenario, one of two things happen. Either more physicians experience burnout and mental health problems, rendering them unable to provide the quality care patients deserve, or the remaining physicians choose to change jobs or careers in order to avoid burnout. Neither scenario is good for health care and will harm the overall health of our communities.

It would not be an exaggeration to say that our health care system needs help!

One way of improving health care is to start focusing on the wellbeing of healthcare providers. For example, if multiple surveys have shown that bureaucratic tasks take time away from the physician’s ability to focus on quality health care, shouldn’t administrators be held to task with regard to simplifying said tasks? Similarly, if long hours on EMR impact the time a medical provider has to interact with patients, shouldn’t we enable EMR to be user friendly and intuitive? In short, when we make physician health and wellbeing a priority, solutions can and will emerge.

Until positive changes occur in the delivery of care, medical providers ought to keep a few things in mind:

1. Remember who you truly are. Who you were before you became a medical provider and where you’d be in life if you didn’t possess the knowledge and credentials you have today.
2. On your worst days, try and remember why you chose your profession and know even the worst days are only 24 hours long.
3. Remember that one of your greatest super-powers is remaining calm. Practice this elusive skill and you will immediately notice the positive impact on your patients, your team, and your wellbeing.
4. Keep in mind, that on your worst days, you still possess the power to treat an asthmatic child who is gasping for breath, you have the power to safely lower your patient’s high blood pressure and high blood sugar. You have the power to calm nerves and to treat pain. You have the power to change the trajectory of your patients’ lives.
5. Remain hopeful that many advances in medicine are headed your way which may be a game changer in how easily you can diagnose and treat a particular disease.
6. Practice self-compassion. It is perfectly OK to set aside time to try new hobbies, make exercise a priority, plan for time away from work, and even time just to be alone and rest. Start planning before experiencing any symptoms of burnout.
7. Incorporate diversity into your medical practice. Consider a salaried part time position while you scale back from private practice. Consider a sabbatical in order to branch out into non-clinical projects, such as teaching or research. Look into an interesting locum assignment either in your area or in another state or country. Locum assignments allow for a great deal of freedom and flexibility, while providing a chance to practice medicine in settings that are new to you.
8. Consider stepping down from a leadership position that no longer gives your life meaning. Conversely, step up to a leadership role.
9. Complete your CME requirements in other states and countries if feasible.

Above all, value your peace of mind and your health.

There is no one else quite as remarkable as you are.

To all health care superheroes, thank you for all that you do.

Ela Grigorian 

Check out my blog at www.thevitaminchannel.com !!

Several media outlets predict that 2022 will be the worst flu season since before the pandemic. Covid cases are slowly up ticking in many cities. RSV cases in children are also on the rise. Are we headed into a winter ‘tridemic?’

The Main Concern: Healthcare Staffing Shortages

Hospital and healthcare systems are still trying to recover from the pandemic and COVID surges. Many hospitals around the country are experiencing a nursing shortage. Physician’s covering emergency rooms are also in short supply. A pending ‘tridemic’ poses a great threat to the already ailing healthcare system.

What’s New About the Flu?

The CDC states that while the overall flue activity remains low, early increases in cases are being reported all over the country. The southwestern and southcentral areas of the United States report significantly high levels of activity.

Flue trends in California are particularly rising compared to five years ago. According to Cal Matters, 6.6% of flu tests came back positive. Even Harry Styles had to postpone his California tour due to being sick in bed with the Flu.

The CDC recommends a flu vaccine for all people over the age of six months. Flu vaccines for the 2022-2023 season are quadrivalent and will protect against four types of flu viruses, including two types of influenza A and two types of influenza B.

For people between the ages of 65 years and older, the CDC recommends Fluzone, High Dose Quadrivalent, and Fluad quadrivalent vaccines.

The effectiveness of the flu vaccine can vary from season to season. Pregnant women, infants, and the elderly are particularly at high risk for flu illnesses during the winter months.

Do Onions Help Prevent the Flu?

If you’re on Tiktok, you’ve probably heard about ‘Poshmamma’s’ onion recommendations against the Flu that have won her over 2.3 billion views. But do onions combat the Flu and other viruses?

Believe it or not, people have used onions to combat viruses for centuries.

Perhaps this tale stems from a story from 1919 about a farming family who placed onions around their home to combat the Spanish Flu. The legend states that none of the members of the family became ill. Although to date, there is no scientific evidence to support onions combating the flue or any other viruses. It is considered a ‘wives’ tale’ that is passed on from generation to generation and tends to go viral every winter.

RSV: The Most Common Virus to Infect Children Worldwide

If you work in Pediatrics, you know about RSV. Typically, RSV season begins in mid-September and lasts till mid-November. Respiratory Syncytial Virus (RSV) is the most common virus affecting children and some older adults worldwide.

RSV presents in children as an upper respiratory infection. Common symptoms include cough, runny nose, sneezing, fever, or wheezing. Most children recover without worsening symptoms. If symptoms do worsen, inflammation can cause bronchiolitis and pneumonia, which may result in hospitalization.

The Origins of RSV

In 1956, RSV was first discovered in a group of chimpanzees suffering from colds and upper reparatory infections resembling hay fever. Once the virus was isolated it was called the chimpanzee coryza agent. RSV was later detected in children who had bronchopulmonary pneumonia.

Who’s at Risk?

The CDC reports that each year RSV leads to 58,000 to 80,000 hospitalizations in children younger than five years old. Elderly adults are also at risk for contracting RSV. Infants who are immunocompromised, born premature, or have cardiac issues are at the most significant risk of contracting RSV. Infants and young children under the age of 2 years old cannot clear their mucus secretions which makes them susceptible to upper airway obstruction causing difficulty with respirations.

Treatment of RSV

Supportive care includes lubricating and suctioning of the nasal airway to relieve nasal congestion, along with fever relief and adequate hydration. If a child is experiencing increased respirations and low oxygenation, they need oxygen and ventilatory support. Doctors might recommend hospitalization.

RSV Prophylaxis and Vaccines

The American Academy of Pediatrics recommends palivizumab be given as an immune prophylaxis to premature infants less than or equal to 29 weeks gestational age, born with chronic lung disease, congenital heart disease, or neuromuscular disorders.

Pfizer has just released data from their phase 3 trial for their RSV vaccine that was tested on pregnant women. The vaccine is 82% effective. Pfizer plans to submit their data to the Food and Drug Administration towards the end of the year.

COVID Updates

COVID cases and hospital admissions are rising for the first time in several months. In the past two weeks, Nevada, Utah, and New Mexico have reported a 50% increase in COVID cases. Various hospitals around the United States report a 20% increase in COVID admissions.

Variants

The latest COVID-19 variants BQ.1, BQ.1.1, XBB, and XBB.1which, are all derived from Omicron and are highly transmissible. However, they also evade vaccine-derived immunity and infection-derived immunity. According to the National Institutes of Health treatment guidelines, only one monoclonal antibody treatment exists, and BQ.1 and BQ.1.1 are most likely resistant to Bebtelovimab. The drug is only recommended if people cannot take Paxlovid or Remdesivir. Although the virus can evade these treatments, they remain the first defense against severe SARS-CoV-2.

Tips to Survive a Tridemic

Get vaccinated

Practice good hand washing

Boost your immune system

Stay hydrated

Get adequate sleep

Exercise in moderation

Stay home from work or school if you are sick

Wear a mask in heavily populated places

Practice social distancing

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