by Catherine Colquitt, MD Tarrant County Public Health Medical Director
This article was originally published in the November/December issue of the Tarrant County Physician. You can read find the full magazine here.
With local hospitals and emergency responders struggling to meet the space and staffing challenges brought on by the COVID-19 Delta variant, monoclonal antibody infusions (and subcutaneous injections when applicable for REGEN-COV) are being used to treat early COVID-19 infections. These are effective options in persons who don’t require hospitalization for COVID-19, aren’t hypoxic (or, if chronically O2-dependent, aren’t needing to augment their percentage of supplemental O2), or even as postexposure prophylaxis for persons at high risk for severe disease and poor outcome if they contract COVID-19 after an exposure.
The science underlying the development of the three monoclonal products granted Emergency Use Authorization (EUA) by the FDA capitalizes on the importance of the COVID-19 spike protein as a means of host cell entry. When viral particles are tagged by SARS-CoV-2 monoclonal antibody therapies, the monoclonal antibody-tagged viruses can’t enter host cells and replicate.
The mRNA vaccines, encoded for the COVID-19 spike protein and currently in wide usage, target the same essential viral spike protein by stimulating the host to transcribe the spike protein mRNA. They mount an immune response to that transcribed viral spike protein which the host’s immune system will then remember and repeat (anamnestic response) when COVID-19 viral particles present the spike protein to the now-vaccinated host’s primed immune system.1
Three SARS-CoV-2 monoclonal antibody formulations have been granted EUA by the FDA, though the first monoclonal SARS-CoV2 product (the coformulation bamlanivimab and etesevimab) is no longer authorized in the U.S. because of the decreased susceptibility of Beta and Gamma COVID-19 variants to it.2 Two combinations remain in use— the coformulation monoclonal casirivimab and imdevimab (REGEN-COV), which binds to nonoverlapping epitopes of the spike protein, and sotrovimab (XeVudy). Both are given under EUA’s for mild to moderate COVID-19 infections in persons 12 years or older weighing at least 40 kg and at high risk for severe COVID-19 infection. REGEN-COV use in postexposure prophylaxis is also granted under its EUA for COVID-19-exposed persons not yet fully vaccinated and for persons who are vaccinated but regarded as unlikely to respond well to COVID-19 vaccinations.3 Locally, only REGEN-COV is in use at present.
Comorbidities to consider in deciding who to refer for SARS-CoV-2 monoclonal therapy after onset of mild to moderate illness (early is best but both products are approved through day 10 after symptom onset) include:
Age 65 and older
BMI over 25kg/meter squared
For 12 to 17 years old, BMI over 85th percentile for height and age
Pregnancy
Chronic kidney disease
Diabetes mellitus
Immunosuppressive disorder or treatment
Cardiovascular disease, including hypertension and congenital heart disease
Chronic lung disease, including COPD
Moderate to severe asthma
Interstitial lung disease
Cystic fibrosis
Pulmonary hypertension
Sickle cell disease
Neurodevelopmental disorders such as cerebral palsy or other conditions “conferring medical complexity such as congenital abnormalities and genetic or metabolic syndromes, and medical-related technology dependence such as tracheostomy, gastrostomy or feeding jejunostomy, mechanical ventilation, etc.”4
Data supporting the use of both SARS-CoV-2 monoclonal products currently in use is persuasive if primary outcomes of all deaths and hospitalizations through day 29 after administration of the products is the measure. For REGEN-COV there was an absolute reduction in death and hospitalization of 2.2 percent and a relative reduction of 70 percent in the treatment group versus placebo. For XeVudy, using the same primary outcome measures of all-cause mortality and hospitalization through day 29, the treatment group experienced a 6 percent absolute reduction and an 85 percent relative risk reduction compared with the placebo group.5
Some special considerations for the use of SAR-CoV-2 monoclonal products:
Variants: So far both products are rated as efficacious against variants available to test, including Delta and Mu, though this is a rapidly changing field of study.
Vaccinations Against COVID-19: Contraindicated in the 90 days following monoclonal administration due to theoretical concerns regarding a blunted immune response to COVID-19 vaccination.
Monitoring After Infusion: For one hour in a health care setting.
Drug Interactions: None so far identified.
Pregnancy: Monoclonals can be used in pregnancy and should certainly be considered when a pregnant woman has additional risk factors (beyond pregnancy alone) for severe COVID-19 disease.
Reactions to SARS-CoV-2 Monoclonal Products: Injection site reactions (pain, redness, swelling, pruritus, injection site ecchymosis) in approximately 1 percent and infusion related reactions such as urticaria, pruritus, flushing, pyrexia, shortness of breath, chest tightness, nausea, vomiting, and, rarely, anaphylaxis. In general, the REGEN-COV current dose of 600mg of casirivimab and 600mg of imdevimab is significantly better tolerated than the previously higher dosed formulations.
Lactation: No data yet available.
Hepatic impairment: No dose adjustment needed.
And please remember – COVID-19 monoclonal therapeutics are not a substitute for COVID-19 vaccination!
Locations of Tarrant County Infusion Centers:
JPS Urgent Care Center
1500 S. Main Street, Fort Worth , Texas 76104
Call 817-702 1451 for appt.
North Central Texas COVID-19 Regional Infusion Center
Additional Infusion Center resources are available at www.tarrantcounty.com or by phone at HHS Protect Public Data Hub (1-877-332-6585 in English and 1-877-366-0310 in Spanish).
This article was originally published in the September/October issue of the Tarrant County Physician. You can read find the full magazine here.
by Rachel Marie G. Felix, OMS-II
If everything I’ve learned in medical school thus far, my favorite realization has been that I love people. Given the fact that we live in a society rooted in individualism, becoming aware of this fundamental truth of mine was not as straightforward as it sounds. Especially when being part of the medical field, where there is constant pressure to compete, accomplish extremely taxing feats, and be the best all-around people we can possibly be at all times. From a young age, those who pursue medicine are conditioned to hyper focus on their individual accomplishments. However, through guidance from my extraordinary mom, support from my childhood loved ones, and interactions with my incredible classmates, I’ve come to truly understand my “why,” and it’s all for the community.
With a jam-packed schedule and overflowing course material, during the first few weeks of medical school I knew I had to take time to contemplate who I was and what I wanted from life, or else I would risk losing myself to the grind. And from deep reflection and unlearning during the Black Lives Matter movement, I realized that I thrive when I am able to contribute to the joy and wellbeing of those around me.
What came from living daily in this truth was life altering. I found myself soaking in every conversation shared with my mom and truly learning the depth of her selflessness. I challenged myself to go on a medical mission trip to help those with limited access to healthcare and was overwhelmed by both the support from my family and friends and the gratitude from those we were able to serve. I would even go to campus completely open to meeting new people and end up having such enjoyable conversations. This would lead to sessions of vulnerability and genuine connection, leaving me feeling enriched by the opportunity to appreciate the different sides of each classmate-turned-friend.
As I made a point to cherish each interpersonal opportunity, I realized just how fulfilling every day can be when we immerse ourselves in community. Yes, we can say we show appreciation for our communities through volunteering or even through our careers, but intentionally showing how much we care for one another as a regular practice is a lifestyle that I highly recommend. While there are many outside influences that can cause us to get caught up in our own worlds and participate in a zero-sum game, the truth is, there is abundance in the shared human experience. We are each beautifully complex and different beings with something unique to contribute to one another. So when one of us wins, we all win.
Conversely, we all hurt when one of us hurts. As made obvious by the pandemic, a flourishing community depends on the health of its people. So dear reader, I hope you are able to appreciate the unparalleled opportunity we have to positively impact those around us as healthcare professionals. Moreover, I hope you see how valuable both you and your patients are in creating a thriving community and allow every interaction—inside and outside of the clinic—to reflect that.
This article was originally published in the July/August issue of the Tarrant County Physician. You can read find the full magazine here.
I remember working as a medic in New York and New Jersey and loving what I did all day, every day (and many times all night). When I got “the call” to go to med school, I knew that it would be years before I could do anything clinical—at least eight years. My first procedure was at 14 years old at Southern Nevada Memorial Hospital (now University Hospital), when a surgeon let me round with him on a patient and told me to pull the tube straight back. I pulled out a chest tube at 14. Where do you go from there? Well, the day I went back to taking food trays to rooms and getting the nurse when a patient needed their bedpan to be emptied. After high school, I started taking dental x-rays, and I took great x-rays without even using the rings and film holders. I spent those moments in the darkroom praying and soaking in the blessing of the esteemed opportunity that I had been given as an almost dental assistant. Those x-ray skills thrust me into a career in dental and then oral surgical assisting.
When life brought me back to my home state of Texas, I got my first job as an oral surgical assistant. Dr. Robert Thomas Perry hired me after looking at my résumé, which was handwritten on a 11-by-14-inch sheet of legal paper. Full disclosure, when he asked for my résumé, I did not know what that meant; he explained that it was a list of my experience. I was just about 21 years old by then, so he was an early inspiration for me. We would drive to remote sites to perform oral surgeries and I would read board review material to him for hours and hours as we drove from College Station to Corsicana and Huntsville. I learned so much about oral surgery from these hours of drives, which always included a stop for Blue Bell ice cream.
Dr. Perry and his wife, a CRNA, were very well liked in the community, though he struggled to establish great referral patterns from the general dentists. While he was away doing his oral surgery training, two other oral surgeons, Garrett and Gray, had set up practice. Their winning personalities and ability to network between Bryan and College Station proved to be a barrier to Dr. Perry getting much business in this good ole boy country. Dr. McElroy did send us patients. Dr. McElroy is known to have left Thanksgiving dinner for an emergency; he even showed up at his office to meet a patient with a severe toothache one Christmas Day. That patient was one of my relatives (I got him on multiple holidays). Dr. Perry had me credentialed at both local hospitals and one in another town. At St. Joe’s in Bryan, I went through a week-long orientation in the OR, watching various cases so that I could assist Dr. Perry there—I knew all of the instruments he used and when he used them. I didn’t just see oral surgeries; I had a front-row seat for everything that was happening in the OR that week. I remember watching a vag hyst (in horror) and then a breast biopsy where they had to go ahead with a mastectomy right then, after the frozen section came back positive. I was a high school graduate dental assistant, and I was in the OR.
You think it’s difficult to get someone to take a statin? Try telling them you’re going to put a tube down their throat.
I first started assisting Dr. Perry in the OR when he performed orthognathic surgery that included down-fracturing a maxilla. I was so happy and fulfilled in my work. I had arrived. When the local hospitals stopped using CRNAs in the mid 80s, Dr. Perry had to move his family back to Ohio, where he had trained. Sue, his wife, was actually the breadwinner. Dr. Perry once had a farmer pay him with a side of beef (tractor accident). Another elderly woman paid him by making fabric holders for his surgical instruments. He was not the only oral surgeon that I worked for who depended on the income of their spouse to stay afloat. After crying every day for two weeks over having to leave Dr. Perry due to the imminent practice closure, I moved back to New York, where I had lived right after high school. I went to work for another oral surgeon there and I also joined my volunteer ambulance corps.
I was a trainee at the South Orangetown Ambulance Corps when I took my EMT course and then immediately followed with my medic course, which I studied at White Plains Hospital. I worked in Rockland County with my ambulance corps and in Westchester County as part of my medic class. I remember being in Yonkers, where the medics put on bulletproof vests at the beginning of their shift. I drove around White Plains looking for an address where there was a patient with a GI bleed. The police kept telling me to step it up (the patient was bleeding out from varices). Basic Life Support (BLS) transported the patient before I arrived as I was not familiar with White Plains, having lived in Rockland County and only commuting to Westchester. I remember once, when responding to a cardiac arrest, we found upon our arrival that the husband had coded, too. I had to decide which code we would care for, and which one would have to wait for the second unit to arrive.
One time I regretted having taken this career path—it was in the moments before arriving on-scene at an accident involving a train. Thank God for my partner, who also worked for NYC EMS at the time. He was a calm and reassuring voice as we worked with the PD to locate the body parts. This was important, because when daylight came there would be parents driving kids to school and the carnage would be seen in the light of day. There was the time that I dropped my partner at a call with the volunteers (we worked as a pair from a fly car, which is used to carry equipment, and would split up as needed). I arrived at a scene where the wife called about her husband, who was unresponsive. I had to speak to the wife in a calm, reassuring way as I dragged her husband by the feet from the foot of the stairs to the middle of the living room floor where I would intubate, put on the monitor, start an IV and work the code until another BLS unit arrived to transport him to Nyack Hospital. An awake intubation on someone in distress from severe congestive heart failure is an exercise in coaching a patient. You think it’s difficult to get someone to take a statin? Try telling them you’re going to put a tube down their throat.
I knew I wanted to go to med school, but it wasn’t to be in New York, and I didn’t apply anywhere else. While working in White Plains I met fellow medics George Kiss and John Brebbia. They were both students at Saint George’s University School of Medicine. I also knew Dr. Stuart Rasch, an ER doc at Nyack who was an SGU grad. I applied. I got in. I went. I continued to work as a medic per diem during my breaks from school. I worked for several companies at one time—Mamaroneck, Portchester Rye, and Larchmont, which were volunteer agencies with paid medics, and Rockland Paramedic Services and Clifton-Passaic MICU in Passaic, New Jersey. The relationships that I made still endure. The experiences that I had continue to keep the paramedic in me alive. I miss days when I would arrive at the home of an elderly person having an MI or pull up on the scene of an MCI (mass casualty incident). The other day I was talking to a close friend on the phone, and he mentioned in passing that his dad was short of breath. The last time someone mentioned that in passing (in the pulpit at a church), they ended up in the cath lab getting stents the following day. This time it was a friend, and I knew his dad. I calmly asked, “Do your parents mind if I come over?” Though it was late at night, they agreed. I got dressed and went over and did a medic questionnaire and exam which led to an ER visit and hospital stay. Though the family is thankful that I was there, I am even more thankful, because they allowed me the opportunity to remember life when I would wake up and be excited to go to work every day, all day (and many times all night).
Imposter syndrome and how the little monster brings us down.
by Ashley Brodrick, OMS-III
This article was originally published in the July/August issue of the Tarrant County Physician. You can read find the full magazine here.
“Am I really cut out for this?” A question most medical students have asked themselves time and time again. Imposter syndrome is this little monster in the back of our minds that tells us we are inadequate; it grows every week, with every test, and with every medical encounter. It tells us we are destined to fail. It tells us we are never going to make it, we are never going to learn, and we are never going to be good doctors. This little monster puts doubts into our minds about our ability to be successful physicians. If you are lucky enough never to have been visited by this little monster, I applaud you.
Medical school is this arduous four-year journey that tests us mentally, physically, emotionally, and sometimes even brings us to our breaking point. Why is medical training so taxing on our emotions, leaving us feeling empty, drained, and questioning if we are made for this career? Medical school is competitive by nature, with a national acceptance rate of 43 percent. This means you must be the “best of the best,” graduating with extraordinarily high GPAs, and performing well on the MCAT. Don’t get me wrong, being a doctor is no easy task. You are responsible for another person’s life, something that I consider to be a tremendous honor. However, at what point do we start to take a step back and reconsider this competitive atmosphere that we have fostered for so long and look at applicants on a holistic level and not just a statistic on a sheet of paper. I can tell you I would rather have a doctor that understands my concerns and listens to me than one who scored in the 99th percentile on their standardized exams but never questions their diagnosis. I would rather have a doctor that IS questioning their diagnostic and treatment decisions for me—not because they don’t know the proper protocols, but because they care about getting my treatment right for me as an individual. M
I am no stranger to imposter syndrome; however, this little monster did not visit me until my second year. My first year of medical school was the year I thrived, leading me to believe that maybe I could make it through without letting that little monster get the best of me. My grades were above average, I was making friends, and I was becoming more confident in my ability to talk to patients (even if it was standardized and following a script). The real challenge for me came during my second year, when my self-doubt started setting in. I was having difficulty connecting the dots and putting everything together. My classmates seemed to be following the right path, understanding how the different diseases connect across organ systems, whereas I felt like I was stumbling every step of the way. Each block presented a new challenge and fed that little monster even more. While I could understand the information and explain it flawlessly to my friends, it was just not coming together on the tests. This inability to perform well on exams did a number on my mental health. You don’t realize how deep into a hole you are until you turn around and realize you can no longer see any light, making it impossible to escape. Each day I would wake up with my heart racing, but you know what I did? I told myself this was normal; this is what medical school is supposed to be like. Stressful, hard, and exhausting, it takes everything out of you along the way, while proving to everyone that you are the “best of the best,” having the highest level of education, being in the top 0.29 percent of the population. The one thing I did not tell myself was that medical school did not have to be this way.
Medical school puts you in a bubble, one that is hard to escape. You are surrounded by medicine 24/7, and during my first two years I found it difficult to talk about anything other than medicine when I was with my friends and family. Every time I went home it was always, “How is school going? Any recent tests? What are you learning now? Making good grades still?” It was never, “How are you handling everything? Is there anything you need help with?” I knew they were trying to show an interest in my education, and genuinely wanted to know what I was learning, but I did not have the energy to go into detail. So, I found myself falling into the same routine of saying, “School is going well, just the same every day. I spend 10 hours in the library and when I get home I take Sadie on a walk, then sit on my couch and watch TV until I do it all over again.” This wasn’t always the case. I was hanging out with my friends, going to dinners, TV show watch parties, doing normal adult things, but whenever I would tell people about this, I would be hit with, “Shouldn’t you be studying? How do you have time for all of that?” I decided it was not worth it to try to please everyone and explain myself, so I shut down and didn’t tell anyone outside of medicine what was going on in my life. To some degree I felt this fed that little monster even more, because I was not sharing all the extraordinary things I was learning. I was not sharing how I was learning to properly perform a physical exam on patients. I was not sharing the complex pathology behind diseases and how to treat them. I was not sharing how I was developing my communication skills with our standardized practice patients. I was not sharing how I was constantly being uplifted and supported by not only my classmates and friends, but also my professors and faculty advisors. Looking back, I think the main reason I decided to suppress and not discuss was because of my imposter syndrome. I felt that if I started to talk about a subject and got one thing wrong, then my months of learning proved nothing, showing that I didn’t belong in this field.
I had this grand idea in my mind of what my clinical years in school would be like, but the pandemic added hurdles and setbacks, which further contributed to my imposter syndrome. I’ve spent most of my third-year rotations online— 60 percent, to be exact—which has left me questioning if I really am ready to begin my residency. I’ve never witnessed a code, never rounded on in-patient care, my note writing skills are lacking, and frankly, I just have not had the experience I feel is necessary to graduate medical school. Thus, imposter syndrome is in full effect for me right now. I made it halfway through my third year when I realized I was just getting to my first full in-person rotation. Thankfully it was OB-GYN, the field I have fallen in love with and will be applying for in the 2022 residency match. I felt comfortable taking a gynecologic history, performing PAP smears, delivering placentas, assisting in the OR, and even having the incredible opportunity of catching a baby. Now, as I am nearing the end of my third year, I realized I had the expectation that I would know so much; however, I feel like I know so little and find myself looking forward to the day when it will all come together. When I look around at my other classmates, I realize I am surrounded by people who were at the top of their class, and while I am one of those people, I still find myself feeling inadequate. I still find myself wondering how they can connect the dots on their rotations and see the big picture. I still find myself wondering how they know what questions to ask. I still find myself wondering simply how they make it look so easy. The one benefit of spending most of my clinical time online is it has allowed me to have time for self-reflection. This year has allowed me to foster relationships with my friends in ways that would not have been possible with a full work schedule. This year has allowed me to make myself and my mental health a priority. Most of all, this year has shown me the amazing support system I have cheering me on every step of the way, especially during the hard times.
So, while I try my best to contain this little monster, there are days when it breaks free from the room it is kept in, and I sometimes am still unable to contain my feelings of being inadequate. When these days come, I’ve learned how to work through them. I remind myself of how far I’ve come to get here. I remind myself of the years of education and knowledge I have gained on this journey. I remind myself of the countless individuals who have supported me, encouraged me, and helped me on this path. I remind myself of what lies ahead, and while it is a long and arduous road, it is one I am happy to be on. Sacrificing the best years of my life to being confined to the library, where I am studying and absorbing an overwhelming amount of information, has been worth it to me. Some might ask why, and the only answer I can give is that whenever I am asked what I would do if I wasn’t in medicine, I honestly do not have an answer. So, this is how I lure the monster back into its room—by reminding myself of my worth, my perseverance, my triumphs, and my successes throughout this journey.
Part of me is curious if it is the competitive culture of medicine that contributes to imposter syndrome, or if it is the self-doubt we carry in ourselves because of how difficult the road is to becoming a doctor. My biggest question going into my fourth year is how do we combat this? How do we tell medical trainees that it is okay to have these doubts; that they are normal, and that you are still learning and absorbing everything around you? How do we tell them that medical school is hard, but you don’t have to endure it alone? I think the answer to these questions is acknowledging that everyone experiences imposter syndrome at least once, and it is okay to have these doubts. It is okay to take a step back and say, “Wait a minute, was that the right call? Was that the right diagnosis? Should I have treated my patient’s condition in a different way?” Acknowledging this monster allows us to not become complacent in our careers, ensuring we are doing the best job that we can. This is a big part of the reason I chose to pursue medicine—the constant educational and learning opportunities, the inability to ever become complacent in your job. My time in medical school has opened my eyes to the type of physician I want to be. I want to encourage and reassure the medical students I will one day work with that it is okay to not know the answer to everything. It is okay to ask questions out of curiosity, even if the answer is something that I view as common knowledge. It is okay to be nervous, it is okay to be scared, it is okay to simply not know things. Medical students are exactly what they are called: students. Here to learn, here to observe, and here to take in everything around them. They should be able to do this without fear of humiliation or being deemed incompetent. I want to be the type of resident that shows my students that I too suffer from imposter syndrome right there with them, and that with the right tools and strategies, it is possible to cage the monster.
My challenge to this generation of physicians is to look back on your time in medical school and think of a resident or preceptor that showed an interest in your education and made you feel like you belonged. Do you think you could have survived that rotation without their help? If you find yourself answering “yes,” I give my applause to you, but if you find yourself answering “no,” hold on to that thought, remembering it for when you have students of your own.
We don’t have to be alone on this journey. We should work together to normalize the conversation around the mental exhaustion medical school creates in individuals. We should work together to lift and encourage our peers. We should work together to ultimately say it is okay to have imposter syndrome, but here is how we can deal with it before it becomes something greater than we can contain.
2021 Gold-Headed Cane Award Recipient Susan Rudd Bailey, MD
by Allison Howard
This article was originally published in the September/October issue of the Tarrant County Physician. You can read find the full magazine here.
When Dr. Susan Rudd Bailey reflects on her years of leadership in organized medicine, she says there has been a consistent truth.
“Every organization, whether it’s Tarrant County Medical Society, whether it’s TMA, AMA—they always seem to have the right person in office at the right time.”
When the allergist and immunologist began her term as AMA president in June of 2020 in the midst of a global pandemic, she wondered why she was the right person for that moment. The self-proclaimed extravert has a leadership style that emphasizes relationship building and the importance of community, and she was facing a year of virtually leading the United States’ largest medical association at a critical moment for medicine. It was a daunting situation at best.
Despite that, Dr. Bailey had the perfect set of experiences to prepare her for that moment.
“Having been the Speaker at TMA and AMA—I spent basically 16 years doing that—and having a lot of media experience, along with immunology credentials, working with the media and the public was a relatively easy transition,” she says. “I was able to do a lot more and reach a lot more people because I wasn’t traveling. Traveling is a real time waster. Instead of doing two or three events a week, I could do two or three events a day.”
Thinking about the past year, the culmination of over 40 years of advocacy on the behalf of doctors and patients, Dr. Bailey is humbled and honored by the opportunities that she has been awarded. “What a privilege,” she says, as she smiles and shakes her head. “What a privilege.”
Dr. Bailey has practiced in Fort Worth her entire career, but it took her a while to get here. Though her family has lived in Tarrant County for generations, she was raised in Houston—“in the shadow of the Texas Medical Center,” she says, remembering a childhood where many of her friends’ parents were physicians.
That coupled with the influence of Dr. Bailey’s allergist, who treated her severe allergies and asthma with compassion and excellent care throughout her adolescence, propelled her toward her future.
“The quality of care we give our patients doesn’t just happen in the examining room. It happens in Austin, it happens in Washington, D.C.”
“I have been so blessed to know what I wanted to do very early on in my life,” Dr. Bailey says. “I mean, I put on my college scholarship applications that I wanted to be an allergist; not just a physician, but an allergist.”
She was in the charter class of the A&M College of Medicine and loved every moment of her medical training. At times, it was an adventure to participate in the then-new program; the first two years of classes were housed in the basement of the computer sciences building. The small class of 32 students built strong bonds that turned into lifelong friendships.
She graduated in 1981 and began her residency at the Mayo Clinic. It was a complete shift from her tight-knit medical school; this program is one of the largest in the country and housed over a thousand residents at the time. Despite the completely different setting, Dr. Bailey says that this is an experience she has valued throughout her career.
Dr. Bailey completed her residencies in pediatrics and allergy and immunology by 1987 and joined Fort Worth Allergy and Asthma Associates (FWAAA) in 1988. By then, she was a mother of two young children, trying to find a balance between her career and her family. She wanted to work part time but was concerned about finding a position that fit her needs.
Dr. Bob Lanier, who hired her, and the rest of the partners at FWAAA were supportive of her position, so she joined the group and has stayed there her entire career. The unique setup of their clinic, which is an expense sharing partnership, gives her the flexibility Dr. Bailey needed to focus on her family and be involved in groups like TCMS, TMA, and AMA.
Her longtime partner at FWAAA, Dr. Robert Rogers, feels she is an integral part of their clinic. “Her patients thrive under her care,” he says. “Sue has an unwavering sense of fairness, which has created a perfect environment for the business side of our practice. I have been fortunate to share so much of my life with this excellent physician and close friend.”
She anticipated she would find a good fit with the Tarrant County medical community, and that hope was confirmed before she even got here. In February of 1988, just a few short months before the move to Texas, she went to the AMA’s Winter Conference, an event that executives and presidents from state and county societies around the country would attend. She brought her youngest son with her, who was only two months old at the time.
“The two people at that meeting from TCMS were the late Leo Benavides, who was the executive director then and just such a wonderful man, and the president of the society at that time, who was Dr. John Smith,” Dr. Bailey says. “I had my son, Stephen, in his stroller, and at one point in time he got kind of fussy. So John picked him up and started soothing him and then kind of started dancing with him as we were listening to the music, and I thought to myself, oh yes, these are the people I want to be with. I had found my family.”
Dr. Bailey has a recommendation for doctors and medical students everywhere: get involved in organized medicine and learn to say “yes.”
“There are opportunities available – the county medical society needs good people, the TMA needs good people, your specialty society needs good people,” she says, sharing the passion from her own career. “For me, it was the importance of physicians being involved in advocacy, and in helping other physicians practice medicine in a better environment. The quality of care we give our patients doesn’t just happen in the examining room. It happens in Austin, it happens in Washington, D.C.”
This is something Dr. Bailey has practiced her whole career. She joined TMA and AMA during her years of medical school and began to attend meetings. As a resident, she was elected to chair the AMA’s advisory panel on women in medicine. As her career progressed, she served as speaker of the house for both TMA and AMA, and as president for TCMS, TMA, and now, AMA. She has been involved in countless committees and groups, assisting with policy, advocacy, and education.
She has brought many physicians to join her along the way. Dr. Melissa Garretson, who has referred some of her most challenging allergy patients to Dr. Bailey, has often been inspired by her. “Sue Bailey is a phenomenal allergist,” she says. “But her greatest gifts are as a mentor and friend. Sue has guided many of us on our journey of service to organized medicine.”
Leading and participating in groups has always fascinated Dr. Bailey, but her commitment goes beyond her affinity for working in a team.
“I think of being involved in organized medicine as a professional obligation. I really do,” Dr. Bailey says. “Things don’t happen organically. We have to be intentional about making sure that everyone is represented, that everyone’s voice is heard.”
One area she has seen this in is the development of sections dedicated to female physicians. Though she was happy to be able to participate when she joined AMA’s advisory panel on women in medicine so early in her career, Dr. Bailey was concerned she was being pushed to the side to worry about women’s issues while other doctors worried about the “real” problems.
“My feeling about women in medicine groups has done a complete 180 from where I was when I finished my residency; now I think it’s incredibly important,” Dr. Bailey says. “Thirty-six percent of the physicians in the U.S. are female, but we still face significant pay inequities, and only 18 percent of medical school deans and 25 percent of tenured faculty are women. There is obviously still work that needs to be done.”
Looking back at what has been done, and the many things that still need to be accomplished, Dr. Bailey says that she has learned two important lessons about leadership. Good leaders sometimes step back to give someone else a golden opportunity, and good leaders always support their team. She had the chance to practice this when she first planned to run for TMA president.
“The late, wonderful Ladon Homer called me and took me to lunch,” Dr. Bailey says, remembering that day with a smile. “He had said all along that he didn’t want to be TMA president, that he would be happy to be chair of the board and then he would be done, but I always felt that he needed to be TMA president. So he took me to lunch and asked me if I would mind if he went ahead and ran for TMA president in the year that I was going to run.
“It was a no-brainer for me. I said, ‘Yes! Do it. We need you.’ Some people asked me later if I was resentful of that. No! I’m so glad, because Ladon was an amazing TMA president. He was the right person at the right time for us.”
Dr. Bailey had her opportunity to serve as TMA president from 2010 to 2011, and with the implementation of the Affordable Care Act, she grew greatly as a leader as she navigated the different opinions and positions of the organizations and people she worked with.
“Leadership means that you will not always be advocating for your personal cause,” says Dr. Bailey. “There are times you have to take one for the team. A team, whether it’s a small group in an operating room or it’s thousands of physicians working together.
“You can have your arguments, you can have your disagreements and grind out policy, but when the decision is made, you all work together and leave your differences behind you. In the end, the credibility of the team far outlasts individual policy implications. If you lose your team, it doesn’t matter if you win.”
Dr. Bailey says so much of what she has done has been possible through the support of her loving husband, Doug; her two sons, Michael and Stephen Wynn; her daughter-in-law, Hannah; and her grandson, 11-year-old Jackson. She loves to spend time with them, and one benefit of completing her time in leadership is that she is now able to do that more often.
When not in the midst of a pandemic, Dr. Bailey also enjoys expressing her love of music by singing in her church choir at University Christian Church. She has had unforgettable experiences with her choir members, many of whom are her closest friends. A top highlight has been being able to sing at Carnegie Hall—six times.
Though Dr. Bailey loves organized medicine, she is ready to step back and focus on her practice and her family. She looks toward the possibilities of the future with anticipation as she limits her role at TCMS, TMA, and AMA to that of an “interested observer.”
“I have had 40 years to make a difference,” she says. “If I haven’t done what I needed to do in 40 years, said what I needed to say, accomplish what I needed to accomplish, then it’s nobody’s fault but mine. It’s time for younger people to occupy those committee chairs, to be the delegate, to get a chance to run the meeting. I’ve had my turn, and it’s been glorious, but now it’s someone else’s.”
As Dr. Steve Brotherton puts it after spending many years as her colleague in organized medicine, “Dr. Bailey has been an exemplary physician at all levels.” With great appreciation for her many years of selflessly serving the patients and physicians of Tarrant County and beyond, we congratulate Dr. Bailey— the Doctor’s Doctor.
This article was originally published in the September/October issue of the Tarrant County Physician. You can read find the full magazine here.
I will remember Project Access forever because not only did it save me, but it also helped my family.
I am twenty-eight years old. I have been married for seven years and I have a son and a daughter. Five years ago, I was diagnosed with rheumatoid arthritis. Doctors were shocked. They had never seen a patient my age with such severe rheumatoid arthritis.
My condition has affected everything. It has been the cause of my depression. I felt like giving up on life. I could not be a mom or a wife. My husband would always see me sick and in pain. I could not take my kids to the park. My son would ask me to kick a ball with him, but I could not do simple things.
It has been a major setback in my life. Since being diagnosed, I have had to quit three jobs because of my arthritis, especially in my knees.
This year has been hard because my pain has increased so much. It has been hard on me physically, emotionally, and mentally. One day, the pain was so unbearable that I went to the emergency room. After many tests, I was told that I needed an orthopedic surgeon. I knew that it was going to cost so much money. My husband told me that he did not care if he had to give up his whole paycheck for me to go to the doctor but that I was going to get the care I needed. That was when I started seeing Dr. David Brigati at Texas Bone and Joint. He immediately saw how bad my condition was and he told me he did not care what he had to do, that he was going to help me. He contacted Kathryn and that is when Project Access started helping me.
Dr. Brigati performed my double knee replacement at Baylor Surgicare. My life has changed so much since the surgery. I am 70-80 percent better. I can walk and get around on my own now, which is a huge accomplishment for me. I can finally drive and get in my car. I have been able to take myself to the grocery store. This past Sunday, my family and I went to the zoo. It was a big milestone for us because I was able to walk and go up and down the stairs. My husband kept asking me if I was okay because he couldn’t believe how much I was able to walk at the zoo.
Project Access also connected me to Baylor Community Care Clinic, where I have been seeing a therapist, and that has helped my mental health so much. The fact that I am now able to move freely and be more independent has helped me mentally. I feel so much better knowing that my family is not so concerned about me because they know I am improving day by day.
I will remember Project Access forever because not only did it save me but it also helped my family.
I have been connected to a rheumatologist, and I plan on starting treatment soon. Eventually I hope to go back to work because I can finally walk.
I want Dr. Brigati to know that I am forever grateful for him. He listened to me, understood me, and validated me. He did not just help me. He helped my husband, my kids, and my whole family. He helped me come back to life. I just want to say “thank you.” I do not have words to describe my appreciation. We need more doctors like him.
For a long time, I dealt with so much pain that was contributed to my depression. It has been very hard for me to get healthcare. I just wanted to stop trying. I did not know there are resources out there that are willing to help. It’s amazing to me that there are organizations that want to help others. I have seen how much the surgery and physical therapy costs and I am so fortunate to not have to pay for these services. I am so grateful that PATC was able to help me. Diana and Kathryn were so helpful, and I am grateful for their patience. They have been a huge blessing in my life. I will remember this forever because not only did it save me, but it helped my family.
by Catherine Colquitt, MD Tarrant County Public Health Medical Director
This article was originally published in the September/October issue of the Tarrant County Physician. You can read find the full magazine here.
With healthcare systems, policy makers, and community partners preoccupied with the ongoing COVID-19 pandemic, other infectious diseases are percolating in the United States and across the globe, reminding us that Hamlet was right: “There are more things in heaven and on earth, Horatio, than are dreamt of in your philosophy.”1
Recently, the National Vital Statistics System (NVSS) issued a rapid release describing the effects of COVID-19 on U.S. life expectancy, which declined overall by 1.5 years between 2019 and 2020, from 78.8 years to 77.3 years.2 It is the sharpest decline in U.S. life expectancy since 1943, when World War II casualties were to blame for the decline from 1942 to 1943. Life expectancy decreased by 3.0 years for persons of Hispanic origin, and by 2.9 years for the non-Hispanic Black population over the same time period. The magnitude of the drop in life expectancy and the disparate effects of COVID-19 based on race and ethnicity are sobering.
In addition, many epidemiologists and public health experts are anticipating a busy influenza and other respiratory virus season after very low incidences of flu and other non-COVID respiratory infections in 2020 (attributed to COVID-19 shutdowns of schools, workplaces and businesses, masking requirements, and social distancing guidance). The CDC says to plan for “resumption of seasonal flu virus circulation” in the population with decreased “immunity due to lack of flu activity since March 2020” along with “co-circulation of flu, SARS-CoV-2, and other viruses like RSV” which may “place a renewed burden on the health care system.”3
The Texas Department of State Health Services attributes drops in vaccination rates to “stay-at-home measures, school and school-based clinic closures, and business closures” during the COVID-19 shutdown along with healthcare providers “suspending or postponing wellness visits including vaccinations in some cases.”4 From April 2019 to April 2020, vaccination rates through TVFC program decreased by 43 percent and remain well below 2019 rates even now. ImmTrac2, the Texas Immunization Registry, reported on July 1, 2021, that age-specific benchmarks for most VFC-supported immunizations (including pertussis, Hepatitis B, Hemophilus influenzae, rubella, measles, mumps, and varicella) remain well below benchmarks with schools soon to reopen for in-person classes.
Dallas County Department of Health and Human Services reported 100 cases of Hepatitis A in 2020 (an increase from an annual average of 19 cases for the prior 10 years) and has already recorded 52 Hepatitis A cases in the first three months of 2021.5 The outbreak in Dallas County is associated with drug use (both injection and non-injection) and homelessness. Tarrant County is working with the Tarrant County Homeless Coalition and John Peter Smith Hospital among other partners to offer homeless Tarrant County residents Hepatitis A vaccines (highly efficacious at preventing future Hep A infections).
And in July, the CDC issued a statement on Monkeypox in Texas.6 The infected U.S. resident had recently returned from Nigeria and traveled by air from Lagos to Atlanta and then to DFW International Airport. A contact investigation is underway; Monkeypox is rare in the U.S. The last large outbreak occurred in 2003 and was associated with transmission from pet prairie dogs to humans. Monkeypox can cause serious morbidity and is usually contracted through contact with infected animals (bites, scratches, or dressing wild game) but can be transmitted via respiratory droplets, body fluid contact, or fomite spread (via contaminated clothing or bedding). More information about monkeypox is available at https://www.cdc.gov/pox virus/monkeypox,index/html.
This article was originally published in the July/August issue of the Tarrant County Physician. You can read find the full magazine here.
After nearly a decade under the leadership of Dr. Jim Cox (and during a pandemic, no less), Dr. Stuart Pickell joined Project Access Tarrant County as the new medical director. He reviewed his first patient chart in December 2020 and made the transition seamless.
Dr. Pickell has long been involved in Tarrant County’s charitable network. He volunteered at Beautiful Feet (Christian Community Health Clinic) for over fifteen years and became involved with an informal gathering of clinic leadership, led by then-TCMS CEO Robin Sloane. In these meetings, attendees shared challenges and possible solutions regarding their patients’ barriers to care. Dr. Pickell says, “Access to specialists and surgeons was always at the top of the list.” As a member of the TCMS Board of Advisors and the current TCMS vice president, Dr. Pickell has stayed apprised and supportive of PATC’s activities over the past decade.
We are blessed with many gifted and generous physicians willing to donate their time and expertise to care for patients in need. Our next hurdle is to build and expand collaborative relationships with the entities we need to allow those physicians to do just that. David Capper, MD, long-time PATC board member, says, “Stuart Pickell carries forth from the superb foundation of medical direction and immense respectability established by Dr Cox. He also enriches the position with practical insights that benefit both patients and clinicians.”
While he was not surprised, Dr. Pickell was pleased to learn the number of physicians who volunteer with PATC. Because of his history of volunteering in a primary care clinic setting, he was well aware of the barriers clinics face with accessing specialty care. He also knew that many specialists want to give back but do not feel they have a mechanism to utilize their area of expertise. This connection, Dr. Pickell believes, is where PATC shines. “By creating networks of charity clinics, specialists, and surgeons, supporting personnel and outpatient facilities specialists and surgeons can treat as many patients as they want in their own clinics on their own time. It’s a win-win.”
Dr. Pickell recognizes the challenge that PATC faces in trying to provide care to as many patients as possible. “Leveraging the strength of many team members with unique skill sets and gifts, we can realize better outcomes for patients,” Dr. Pickell says. “Medical systems, which are the community’s greatest tangible resource for healthcare, value collaboration as well, but most of their energy is spent within their systems. They may share common goals and understand the community value of bridging silos, but they continue to function independently, competing rather than cooperating with the other systems.” Dr. Pickell sees this as a critical area of growth to sustain PATC.
When asked what his vision for PATC’s future is, Dr. Pickell says, “There are several priorities that I believe will help PATC continue to be strong and expand. The first is financial sustainability. Even though we offer charity care, there are still costs. We seek to minimize these, but they are an ever-present reality. The second is to expand networks – build a stronger team of partners willing to donate time, equipment, and facilities. Finally, we need to expand the specialty services we can offer. We already do well at this, but there is always room for improvement, and we still have needs in some specialties.”
“Fundamentally, my long-term vision is that Project Access Tarrant County would become a model for providing healthcare services to the underserved. We need to expand on the excellent foundation that has been laid by Dr. Cox and his team and expand our network so that patients who need specialty services will be able to access them.”
Dr. Pickell is a welcome addition to PATC leadership. “I am a strong advocate for teamwork in healthcare, for collaboration, and for cooperation,” he says. “Project Access is about improving the healthcare of our most vulnerable residents through collaboration. It seeks to create bridges between the silos in health care – the hospital systems, the physicians, the all-important ancillary staff – to improve the health of those who otherwise would be unable to afford it. Project Access seeks the common ground of shared values, those things that unite us in our human condition. This may be aspirational, but it is an aspiration worth striving for.”
This article was originally published in the July/August issue of the Tarrant County Physician. You can read find the full magazine here.
On the heels of the COVID-19 pandemic, pediatric suicide and mental health diseases are at all-time highs. According to the Centers for Disease Control and Prevention, suicide was the second leading cause of death for individuals between the ages of 10 and 34 in 2019.1 This research also noted that suicide rates have risen by 35 percent from 1999 to 2018 across the United States.1,2 With the arrival of the novel coronavirus pandemic and resulting social distancing, financial losses, and increased morbidity and mortality, we have seen an increase in the already high number of mood and anxiety disorders across all age groups. Children and adolescents have been especially impacted because of parental distress, social isolation, and difficulty adjusting to the virtual school environment. Many children with a pre-existing psychiatric diagnosis have experienced an exacerbation while others have experienced mental health symptoms for the first time, not knowing how to cope with the stress of their severely altered circumstances. Because the pandemic is currently ongoing, there is scarce research available to quantify the increase in mental health needs in the pediatric population due to COVID-19 and its restrictions.
Primary care providers and pediatricians have been on the front lines and often are the only point of contact for many patients before a suicide attempt. In 2015, researchers used National Institute of Mental Health-funded Mental Health Research Network data from 2009-2011 and found that 38 percent of patients who attempted suicide had made some type of healthcare visit within the week of the attempt, 64 percent within the month, and 95 percent within the year.3 This data shows us that primary care providers are integral in identifying and treating vulnerable patients that may not have access to psychiatric services.
Due to this urgent need for further pediatric mental health care services, the 86th Texas Legislature passed Senate Bill 11 in 2019, enacting the Child Psychiatry Access Network (CPAN), a telephone consultative service for primary care providers caring for children and adolescents with mental health needs. The caller will be greeted by a member of our team who will ask general questions about the call and can provide resources such as outpatient therapists, local partial hospitalization programs, and/or pediatric inpatient programs in the area if needed. If there are diagnostic questions or the need for support with treatment planning, consultation with a pediatric mental health provider can be arranged the same day.
Your local CPAN team wants to support you as you treat your pediatric patients’ mental health needs. The University of North Texas Health Science Center (UNTHSC) has partnered with John Peter Smith Health Network (JPS) to provide these services for Tarrant County and eight of the surrounding counties, including Parker, Wise, Cooke, Erath, Palo Pinto, Jack, Montague, and Clay. This service is free of charge with a response time of within five minutes for resourcing requests and 30 minutes for consultation with a child psychiatry provider. CPAN is ready to provide support to Texas primary care providers Monday through Friday from 8 am to 5 pm. Just call 1-888-901-CPAN, press 1 for North and North East Regions and press 1 again for the UNTHSC/JPS hub. You will be able to obtain needed resources or a consultation immediately. You can also contact the CPAN coordinator, Janet Thompson, at JThompso04@jpshealth.org to enroll, though enrollment is not required to make a call. We look forward to partnering with you to help your pediatric populations and their families.
2“Vital Signs: Trends in State Suicide Rates – United States, 1999–2016 and Circu stances Contributing to Suicide – 27 States, 2015.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, June 10, 2019. https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1_w.
By Susan F. Franks, PhD, David Farmer, PhD, and Janet Lieto, DO The University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic MedicineDepartment of Family Medicine and Osteopathic Manipulative Medicine, Department of Medical Education
Now more than ever, the most satisfying aspect of care—interacting with and helping patients—is overshadowed by the complexities of the modern-day practice of medicine. Your day may be more focused on interacting, coordinating, and making decisions with numerous ancillary people and various entities and stakeholders than the person before you who is seeking care. Coordinating your team and the administration of your practice demands independence, leadership, communication, and organizational skills. As the practice of medicine has evolved, you have progressively faced cumbersome EMRs, nuanced billing and coding expectancies, misinformation that patients get from the Internet, and varying organizational expectations. The on-going evolution of practicing medicine places further demands on the skills of flexibility and stress tolerance.
But perhaps the most subtle transformation in medicine is the increased necessity of creating and maintaining interpersonal relationships. The traditional circle and hierarchical approach of running a practice in the past has transformed into collaborative partnerships with patients, families, colleagues, consultants, administrators, and other key stakeholders. At times you are required to be a team leader, at times a team member. You must still attend to patients and provide expert counsel and education, all the while dealing with interruptions, personal agendas, and a vast array of different communication and personality styles. All your responsibilities are expected to be fulfilled with confidence, respect, professionalism, and above all, treatment effectiveness and a gracious attitude of sharing in successful outcomes, but while still bearing the burden of responsibility when things fall short. You must approach each day with an appropriate balance of assertiveness and impulse control, objectivity and optimism, and emotional expression and empathy.
The twenty-first century physician is immersed in a continually evolving interprofessional, team-based environment where medicine is delivered under an often-fragmented system of care.1 The traditional patient-physician dyad has expanded to encompass a wider net of individuals, all of whom must be integrated to meet clinical outcomes, patient satisfaction, and fiscal demands. Added to this is the increasing awareness of inequities in medical care, an explosion of public access to medical information and misinformation, cost-control strategies, and the politicization of medicine, adding enormous complexities to the primary task of simply caring for the patient sitting before you.
Never has the practice of medicine and the expectations of the people involved in every aspect of it been more dependent on the social and emotional skills of the physician than they are today. This is a world that the doctors of the future must be prepared to enter. A world where cognitive intelligence is not the only predictor of success. A world that depends on the emotional intelligence of the physician for the system to function effectively.
What is Emotional Intelligence?
Emotional intelligence (EI) is a set of social and emotional skills that collectively establish how well we perceive and express ourselves, develop and maintain social relationships, cope with challenges, and use emotional information in an effective and meaningful way.2 EI skills are also associated with the development of empathy, self-awareness, motivation, emotional control, and effective communication.3,4 Compared to people with low EI skills, individuals with high EI perceive, understand, and manage emotions better, are less likely to engage in problematic behavior, and have more positive social interactions.5 Individuals with high EI skills also report lower perceived stress, are highly adaptable, and are more successful in leadership.6
Never has the practice of medicine and the expectations of the people involved in every aspect of it been more dependent on the social and emotional skills of the physician than THEY ARE today.
Several models of EI have been introduced, but all are founded on four related fundamental skills: self-awareness, self-management, social awareness, and social management.7 To best manage your behavior, you must first be aware of your emotional states. People with low self-awareness may have difficulty distinguishing between the nuances of feelings, for example the difference between irritability and anger. They may display emotions that are out of proportion to the situation and have difficulty recognizing that their response may not be appropriate. This places them at risk of not being able to maintain mutually respectful relationships, tolerate frustration, be a collaborative member of a team, or create an environment of psychological safety expected from a good leader. Interestingly, 95 percent of people believe that they are emotionally self-aware, but only 10–15 percent are.8 In contrast to earlier beliefs, we now know that the skills of EI can be taught and improved.9
Emotional Intelligence in Medical Education
Many students entering medical school do not have mature development in interpersonal and communication skills (ICS), particularly in dealing with patients and interprofessional relationships. Competency in ICS is woven throughout Entrustable Professional Activities (EPAs) that are being taught in medical schools. As teamwork becomes increasingly important in medical care and decision-making, physicians of the future need to be poised to collaborate so they can achieve the best patient outcomes. Teams with high EI can create a shared vision and achieve results through mutual trust that is fostered through empathy, flexibility, and other key social and self-regulation skills. Furthermore, EI has been found to predict psychological well-being, life satisfaction, and success in collaborations and interpersonal relationships. It enhances higher level thinking through the development of advanced cognitive strategies used to understand and respond to others, thereby improving diagnostic and therapeutic decision making.3,10 Alarmingly, when unattended, EI may diminish throughout medical training, contributing to reduced resiliency and the increased number of residents entering the profession feeling burned out.11,12 EI is now more widely considered to be an essential skill set for medical student development.13
At the Texas College of Osteopathic Medicine (TCOM), we promote the progressive development of emotional and social self-awareness by having medical students reflect on their EI skills and establish targets for growth. They work with an accountability partner to identify progress and areas needing improvement. It is often during clerkships that the social, emotional, and behavioral skills associated with EI are most observable and can provide a deeper understanding of why a student might be experiencing difficulties. Preceptors and residents give feedback on professionalism, teamwork, and interpersonal communication, helping students explore their use of EI skills. For example, a student who is overoptimistic may miss preceptor comments and clues indicating a need for improvement. They are then caught off guard at the summative performance evaluation when they rate lower than they anticipated. Progressive guidance in targeted EI skill growth can help students manage pertinent skills effectively.
In the TCOM curriculum, we integrate educational activities to improve the skills of EI. We start with a baseline assessment during the first week of their Medical Practice class using a well-established self-report assessment of EI called the EQi-2.0.®14 A student’s results are explained, and the student is introduced to the basics of EI and given a framework that emphasizes how EI skills are applied to patient care, teamwork, leadership, and personal well-being.
Activities to develop EI are strategically integrated into our Medical Practice course curriculum, which teaches students to gather health information and perform appropriate physical examinations, acquire competency in Osteopathic Manipulative Medicine, and apply knowledge and skills to patient encounters. Topics begin with a focus on self-care and the use of the EI skills of flexibility, optimism, and stress tolerance to aid in adjustment to the rigors of medical school. Students later examine the role of emotional self-awareness, self-expression, and empathy as applied through standardized patient encounters. As students engage in small-group learning, EI skills of teamwork and leadership are introduced, and students rotate leading their team. In one particularly cogent activity, students each select a respected faculty physician as a model of emotionally intelligent leadership.
When students approach Year 2 board exams, we advance their stress management skills toward peak performance, and they evaluate their balance of optimism and reality. In the Professional Identity and Health Systems Practice Course, EI aids students in the development of professional identity and in management of that identity as they contemplate how they will fit into the healthcare system as an osteopathic medical student, a resident, an attending, and a life-long learner. EI is reassessed prior to the clerkship year to identify their progress and areas in need of further improvement. It is then revisited in the Family Medicine Clerkship, with a focus on patient care and interprofessional collaboration. Throughout the integrated EI curriculum, evidence-based principles of social learning and cognitive-behavior strategies help promote lasting change.
Conclusion
EI development can help physicians navigate the intra- and interpersonal complexities of the practice of medicine in areas not directly related to technical skill or medical knowledge.13,15 EI is a significant part of clinical competence and is tied to increased patient satisfaction, because it affects a physician’s ability to understand and relate to emotional barriers that patients experience.16,17 In support of the patient, EI can also increase the effectiveness of the healthcare team. In support of the healthcare team, EI can help reduce burnout through the development of resiliency, psychological safety, and mutual support. A focus on personal well-being can include EI development for improved resiliency, personal relationships, and work-life balance. With this understanding of the nature of EI, educational strategies are being utilized to prepare high EI physicians for the challenges of the twenty-first century.
4Orak, Roohangiz Jamshidi, Mansoureh Ashghali Farahani, Fatemeh Ghofrani Kelishami, Naima Seyedfatemi, Sara Banihashemi, and Farinaz Havaei. “Investigating the Effect of Emotional Intelligence Education on Baccalaureate Nursing Students’ Emotional Intelligence Scores.” Nurse Education in Practice 20 (June 23, 2016): 64–68. https://doi.org/10.1016/j.nepr.2016.05.007.
5Mayer, John D., Peter Salovey, and David R. Caruso. “Emotional Intelligence: Theory, Findings, and Implications.” Psychological Inquiry 15, no. 3 (2004): 197-215. http://www.jstor.org/stable/20447229.
6Chun, Kyung Hee, and Euna Park. “Diversity of Emotional Intelligence among Nursing and Medical Students.” Osong public health and research perspectives vol. 7,4 (2016): 261-5. doi:10.1016/j.phrp.2016.06.002
7Bradberry, Travis, and Jean Greaves. Emotional Intelligence 2.0. San Diego, CA: TalentSmart, 2009.
8Eurich, Tasha. Insight: The surprising truth about how others see us, how we see ourselves, and why the answers matter more than we think. New York, NY: Penguin Random House, LLC. 2001.
10Johnson, Debbi R. “Emotional Intelligence as a Crucial Component to Medical Education.” International Journal of Medical Education 6 (2015): 179–83. https://doi.org/10.5116/ijme.5654.3044.
11Dyrbye, Liselotte N., Colin P. West, Daniel Satele, Sonja Boone, Litjen Tan, Jeff Sloan, and Tait D. Shanafelt. “Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population.” Academic Medicine 89, no. 3 (2014): 443–51. https://doi.org/10.1097/acm.0000000000000134.
12Hansell, Maggie W., Ross M. Ungerleider, Courtney A. Brooks, Mark P. Knudson, Julienne K. Kirk, and Jamie D. Ungerleider. “Temporal Trends in Medical Student Burnout.” Family Medicine 51, no. 5 (2019): 399–404. https://doi.org/10.22454/fammed.2019.270753.
13Parks, Mitchell H., Chau-Kuang Chen, Christina D. Haygood, and M. Lisa McGee. “Altered Emotional Intelligence through a Health Disparity Curriculum: Early Results.” Journal of Health Care for the Poor and Underserved 30, no. 4 (2019): 1486–98. https://doi.org/10.1353/hpu.2019.0091.
14Multi-Health Systems, Inc. The Emotional Quotient-Inventory 2.0® (EQi-2.0®). MHS Beyond Assessments. https://mhs.com/.
15Coskun, Ozlem, Ilkay Ulutas, Isıl Irem Budakoglu, Mehmet Ugurlu, and Yusuf Ustu. “Emotional Intelligence and Leadership Traits among Family Physicians.” Postgraduate Medicine 130, no. 7 (2018): 644–49. https://doi.org/10.1080/00325481.2018.1515563.
17Wagner P.J., Ginger C. Moseley, Michael M. Grant, Jonathan R. Gore, ChristopherOwens. Physicians’ emotional intelligence and patient satisfaction. Fam Med. 2002 Nov-Dec;34(10):750-454. PMID: 12448645.
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