Physician Suicide: Sounding a Mental Health Alarm

By Ruchi M. Fitzgerald, MD

The life of a physician is incredibly challenging. Hours and hours of training and patient care with inadequate emotional and mental health supports built in to balance out chronic stress levels. It’s a labor of love, but it takes its toll.

Sept. 17, 2020, is National Physician Suicide Awareness Day. A staggering number of physicians and others working in the medical field die each year by suicide. In fact, the number is an estimated 300 physicians, with rates continuing to rise, according to a report in Missouri Medical, The journal of the Missouri State Medical Association.

This startling data that has not changed since 2003, when it was presented at the national American Psychiatric Association by researchers in 2018, which urges all of us to consider implementing more preventive strategies in our workplaces to address emotional supports for health care workers.

National Physician Suicide Awareness Day is a day that allows us to remember those in the medical field who have died by suicide. For me, it is a stark reminder to pause and make sure I am doing my part to continue to break the stigma surrounding depression, substance use/misuse and emotional distress that are at play for so many people in the medical field. It’s also a great time to review some specific action plans on how to help a colleague in distress by reviewing the resources available here at Rush and nationally.

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Corneisha Fowler: #IAmTheWestSide

Corneisha Fowler, 23, is a guest relations associate from West Garfield Park, known for her warm smile and ability to put anyone she meets at ease.

She came to Rush through the CARA program, a Rush employment partner that helps get community members back to work.

“When I found the Rush job on Indeed and applied, I practiced for two weeks straight,” Fowler says. “I did mock interviews with volunteers, and I prayed for someone who worked at Rush. And then when I did my mock interviews, I worked with someone who just happened to work at Rush.”

She added, “When I looked at the Rush mission statement, it was like it my prescription.”

‘It changed my life’

Fowler started her job on Feb. 4, 2019.

Her CARA program allowed her to really show and prove what West Siders can do and what opportunities exist for community members.

“People don’t feel like they have a chance or that they have other options,” Fowler says. “Programs like this can help get them gainfully employed. Oftentimes if you see no other opportunities, it leaves you feeling stuck. But if more community members knew about programs like CARA and others at Rush, it would change people’s lives. It changed my life.”

Fowler has ideas for other ways the lives of Garfield Park residents could be improved as well. She advocates for more funding for programs like after-school clubs and education in her neighborhood.

“So many schools got shut down a couple of years ago and a lot of the safe havens have been shut down because of lack of funding,” she says. “Instead of putting money into things like newer police cars — because they’ll probably be flying in a minute — whoever is in power, whoever is in power needs to fund the West Side so we can build back up like we used to be.”

‘More than your surroundings’

And if Fowler had limitless amounts of cash, she’d like to open up a program for kids who have experienced trauma firsthand. “We’re taught to hold that stuff in, and we really don’t have an outlet. It’s dangerous to keep all of that emotion bottled up inside; it can really affect your health,” she added.

Despite its challenges, Fowler, like many other Rush West Siders, knows the West Side to be “the best side.” Its pre-COVID-19 lively social scene is just one of many reasons. “You can have so much fun on the West Side,” said Fowler. “Barbecues, block club parties, it’s just so much positive energy and so many people who want to just enjoy life.”

The advice she’d like to offer to her fellow West Siders is sage for such a young age: “Give yourself a chance,” she says. “Don’t be afraid to ask for help. Life is more than your surroundings. Open your mind up to something different.”

Patient Care Navigators Help Make Health Care Journey a Success

Calisa Williams provides navigator services through the Medical Home Network.

Imagine traveling abroad by yourself, but you’re not fully equipped with the information you need to make the trip successful. It would feel pretty overwhelming and confusing, right? This is what the health care system can feel like for patients who are unfamiliar with how it works.

Patient care navigators answer that need. These non-licensed people come from the communities we serve and help connect patients to the appropriate resources and places of care as they wind their way through the health care system.

“Health care is often referred to as a journey,” says Michael Hanak, MD, associate chief medical officer for population health. “If you think about all the things that have to go right to travel to a new place, knowing when the plane leaves is essential. But what if you needed help planning, packing, getting to the airport, understanding how to check in and find your gate, and after landing — ​making your way to your final destination?

“Our navigators make complicated things simple and dedicate themselves to ensuring all patients are successful in their journey,” adds Hanak, who also is an associate professor in the Rush Department of Family Medicine​​.

Patient care navigators may schedule appointments, arrange transportation, perform health risk assessments for frequent hospital and emergency room use, and connect patients to care management or navigate insurance and in-network providers. They are often the first point of contact for many patients and can serve as a significant support for patients who aren’t otherwise familiar with the health care system.

The role of patient care navigators also varies according to what areas of care they support. The following are just six types you may find at Rush University Medical Center and a broad overview of what support each role provides:

  • Ambulatory Quality Team Navigators: These navigators identify Rush University Medical Group (RUMG) patients with outstanding care gaps, such as hypertension, diabetes, colorectal screening and breast cancer screening. They also schedule the necessary appointments so patients can get much needed preventive care measures met, identify patients who qualify for an annual wellness visit and schedule the necessary pre-visit and provider visits to get Medicare patients access to care.
  • Medical Home Network CountyCare/Medicaid Accountable Care Organization (ACO) Navigators: These navigators support nurse and social work care managers with managing the care of at-risk CountyCare/Medicaid Accountable Care Organization ​(ACO) patients, complete health risk assessments, coordinate transportation and assist patients with renewing insurance, scheduling appointments and connecting patients to community resources.
  • Medical Home Network Post-Acute Care Navigators: These navigators provide transitions of care for all CountyCare patients who belong to the Medicaid ACO (known as MHN ACO​), and who are admitted to a skilled nursing facility, long-term acute care or rehabilitation. These individuals visit all admitted Medicaid ACO patients in the facility and connect the facility providers with providers from the patient’s medical home to facilitate a smooth discharge and transition process once the patient is discharged to their home. This includes ensuring the primary care physician understands the facility’s discharge instructions and has the latest medication list, and that the providers and outpatient care managers are informed of the care plan.
  • Oncology Care Model Navigators: These navigators support the nurse and social work care managers with care managing at-risk Medicare cancer patients who are on chemotherapy. These individuals assist with helping patients sign up for Medicare (Senior Health Insurance Program counseling), follow up on recently discharged patients, introduce them to the care management program, address social determinants of health and play a crucial role in the Rush University ​Cancer Center ​advanced directives initiative.
  • Rush@Home Navigators: These navigators receive referrals for home-bound RUMG patients who meet criteria to enroll in the program, identify patients who may qualify, schedule appointments according to their proximity to one another, follow up on home health orders, are the first points of contact for all patients and coordinate with Rush ​University Internists​ and Rush Senior Care to align clinic and Rush@Home schedules.
  • Transitional Care Program Navigators: These navigators support the patient’s discharge plan by assisting the patient in scheduling post-discharge hospital follow-up appointments for all patients admitted to designated units at Rush, identify in-network providers for patients both in and out of network with Rush, navigate uninsured patients to accessible and affordable care, connect patients to the appropriate care management team and follow up on social determinants of health needs. They also follow up on Adverse Childhood Experiences (ACE) screenings that indicate ACE events occurred in pregnant women and new moms ​with positive adverse childhood events screens, and they connect new mothers to appropriate home visiting agencies and community resources.

It’s clear that without patient care navigators in place, the health care journey for many would be incredibly difficult. It’s easy to overlook these small details, yet the results of their efforts can be life-changing. They take care of so many details behind the scenes it almost looks effortless. 

“The patient care navigators are essential to every population health initiative we have at Rush,” adds ​Vidya Chakravarthy, MS-HSM, director, Population Health. “Their dedication to our patients and the communities we serve is inspiring and evident in each of their interactions with patients and staff. Our navigators form the bridge between the hospital and our communities and connect us closer to the patients we serve. Thank you for everything you do.”​ ​

Racism, Health and Rush’s Commitment to Equality

Leaders at Rush shared the following message Friday with the Rush University Medical Center staff:

Along with our leaders across the Rush system, we are deeply saddened to be writing to acknowledge the death of George Floyd in Minneapolis. This tragedy is all too familiar and has once again shocked the nation and our community here at Rush.

Floyd’s death sadly echoes those whose lives were taken before, like Breonna Taylor, Ahmaud Arbery, Laquan McDonald and so many more. This is not an issue for only black Americans. This is an attack on all humanity.

At times like these, we often offer thoughts and prayers as a show of support. However, thoughts and prayers will never be enough to address this pattern of losing men and women in our communities. We need more than just words. We must show by our collective actions that we are willing to dismantle racism — a system of oppression that produces poor health outcomes and premature mortality and affects all of us. 

We have witnessed in our own community how COVID-19 has disproportionately taken its toll on black and brown lives. People have lost family members, and in areas throughout our community, many have lost jobs. The murder of George Floyd just adds to the collective pain and strain that our communities, including those in our community here at Rush, are feeling.  

‘We must work together’

Rush has a mission of improving the health of communities. Four years ago, we made health equity a strategy and identified structural racism as the root cause of poor health and death gaps in our neighborhoods. We formed West Side United, a racial equity health collaborative aimed at reducing by 50% the life expectancy gap between the Loop and the West Side by the year 2030 by addressing the structural determinants of health.

Violence in any community tears at its very fabric. Such violence cannot be tolerated, and we must work together to guard against it. We commit to doubling down on our existing efforts and to building a stronger foundation to support them. We must continue to stand united against racism in all its forms.

“Returning hate for hate multiplies hate. Adding deeper darkness to a night already devoid of stars. Dark cannot drive out darkness; only light can do that. Hate cannot drive out hate. Only love can do that.”

— Martin Luther King, Jr. 

Today, hate is thriving in the light, on our TV screens, through social media, in public speeches, in random police stops, during casual walks in the park while bird watching. It’s so important for the light of justice, peace and equity to shine even brighter, and we do this by calling out the darkness. By facing it head on and refusing to give into it. What’s happening now in our nation and communities is not normal. It is not acceptable. We cannot sit by and tolerate it, because our silence equals complicity.

At Rush, we do everything we can to save lives. Rush is a place of hope, health and healing. We honor people’s lives here. We care for each other. Our culture is to heal, to connect, to support, to serve, to give back, to invest in communities and to provide opportunities. We believe in respect for all, and Rush stands with those looking for peaceful change and an end to such unnecessary brutality. We know we are so much stronger together.

Sincerely,

Dr. Omar Lateef, CEO, Rush University Medical Center
Dr. Sherine Gabriel, President, Rush University, and Chief Academic Officer, Rush University System for Health
Dr. Ranga Krishnan, CEO, Rush University System for Health  

A Second Chance at a Healthy Heart

By Hussam Suradi, MD

I was in medical school when my dad suffered from a heart attack that required an emergency procedure. It made me realize that sheer minutes can make a difference in treating cardiac patients. I wanted to make that difference for people like my father; I wanted to save lives in the minutes that mattered most.

One thing I love about my job is being able to tell patients that they have more options — that it’s not the end of the road. And frankly, this is the heart of our work as interventional cardiologists as we can provide minimally invasive treatments for structural heart diseases.

Every day, we see people who think nothing can be done for their heart problems, but most of the time, they’re willing to do whatever it takes to improve their quality of life. Perhaps they’re older, or maybe they’re dealing with illness or birth defects that limit their possible treatments. The good news is, there are always more options.

Alternatives to open-heart surgery

Structural heart intervention is a relatively new field in cardiology, treating patients with heart valve problems such as tight or leaky valves, or those born with birth defects. In the past 10 years especially, technology and devices for treating structural heart conditions have changed dramatically. Today, patients are treated for these conditions through minimally invasive procedures rather than open-heart surgeries, regardless of how old or sick they may be.

One of the biggest innovations we’ve seen is the treatment of valvular heart disease through minimally invasive catheter-based procedures. One of these procedures is called TAVR (transcatheter aortic valve replacement), which involves replacing the aortic valve without needing open-heart surgery.

With TAVR specifically, patients recover much faster. In fact, they can usually go home the very next day. Additionally, they typically don’t need cardiac rehab after the procedure and they surely don’t endure as much pain — whereas, open-heart surgery patients typically go through cardiac rehab and need several months of recovery before feeling “normal” again.

Aside from a faster recovery, data has now shown that TAVR is as effective and safe as open-heart surgery. Only recently, but fortunately, TAVR was expanded to low-risk patients after initially only being for high-risk patients who were not candidates for surgery.

Another similar treatment option is MitraClip, specifically for those with severe leakage in their mitral valve. Using a catheter, the interventional cardiologist attaches a small clip to the valve to enable it to close more completely without leaking. Given the minimally invasive nature, this is another ideal treatment option for those not eligible for traditional surgery.

A better solution and quality of life

At least 30% of the people we care for have had some sort of heart procedure before — whether it’s a stent procedure or bypass surgery. When they come to us, they not only gain a more hopeful outlook, but they experience the full “heart team” approach. They’re evaluated by an interventional cardiologist and a cardiac surgeon who, together, evaluate their data and tests to recommend the best treatment options available — including some of our latest clinical trials.

It’s so rewarding to be able to tell patients they have another shot at life, and it’s even more powerful to feel their gratitude. If you ever feel it’s the end of the road, know that there are always more options.

Hussam Suradi, MD, is a fellowship-trained structural/interventional cardiologist at Rush.

Tips for Working From Home, From Us

MicrosoftTeams-image (2)Even if you’ve done it before, working from home for an extended period of time comes with unique challenges. And many of us have been doing it for a while now thanks to COVID-19.

While Rush’s health care workers still head to our hospitals every day to treat patients and save lives, many other staff members — including most of our marketing and communications team — are working remotely.

So we’ve learned a few things along the way that are helping us maintain work efficiency and well-being — sometimes even our sanity — and we’ve decided to share them. Here goes:

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ER Nurse: Don’t Panic, ‘Take Care of Each Other’

This is an excerpt from a message Georgia Orchowski, RN, a nurse in the Emergency Department at Rush University Medical Center, recently shared with friendsGeorga Orchowski

First and most importantly, I cannot thank everyone enough for everything. I have been completely overwhelmed by the love and kindness I have been shown over the past few weeks. Every single gesture — a call, message, gift, coffee, meal, etc., is appreciated. I don’t feel worthy of any of it because nursing is something I have been doing for 12 years. It’s a part of who am. I would never think twice about being a part of the movement to care for America as more and more of us fall ill. It’s honestly an honor to know I can make a real difference in such a time of despair.

A couple thoughts as I reflect on what I’ve seen over the past few weeks for anyone reading.

  • No. 1 is please, please don’t panic. Fear gets you nowhere. We all know what we need to do to stop the spread — stay at home, wash your hands, etc. But your mental health is also so important. Stop reading so much COVID news. Take time for your mental health. Find something that brings you joy each day. Read for pleasure, meditate, exercise, have a glass of wine, watch Netflix. Get outside every single day. Stop reading so much COVID news! The world is not ending. This too shall pass.
  • Be kind to one another. It’s OK to still smile and wave when you pass people (six feet away) when you’re out walking the dog. Send a note in the mail to someone who might appreciate it. FaceTime friends or family members every day. Think about someone who might be lonely and reach out to them. Donate to a local food bank. If you’re reading this, you are probably in a lot better position than a lot of our country right now. So many have lost their jobs, are without paychecks, or have children home without food to eat. Let’s give what we can. Let’s take care of each other.
  • Do your part to not overwhelm our medical centers. Things are escalating quickly, and soon we will all be overrun with critically ill patients. Call your doctor if you think you have symptoms of coronavirus. If you think you do, honestly at this point you probably do. We have extremely limited testing supplies. They need to be saved for the elderly, immunocompromised, homeless and pregnant. If you have are having trouble breathing, come to the emergency room and we will help you immediately. If you have a fever, cough, sore throat or fatigue, you can probably help yourself at home.
  • Lastly, practice gratitude. Think about all that you have to be thankful for: a warm home, family, children, food to eat. Each day that I wake up and don’t feel sick I consider a gift. Each day that I get to work with the most incredible team of nurses and doctors, I feel beyond grateful. Thank you for reading, and take care of yourselves.

‘Social Distancing Actually Works’

By Mia Levy, MD, PhD

I know there’s a lot of fear right now with the increase in the number of COVID-19 cases in the United States, and there’s even more fear when we start talking about shutting down schools and closing restaurants and taking a lot of measures to do social distancing.

But I think that should be our message of hope today. Social distancing actually works, and it is our best defense right now against this rising epidemic in our country.

Many people feel like we’re overreacting by closing schools and restaurants and not going to the movies, but actually it is our best hope for really making a change in the curve of acceleration of this illness in our country.

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