Year End 2010

Celebrating our many gifts and family. Wishing you and yours Peace in the world and contentment in your heart in the New Year 2011.

IMG00787-20101114-1441 Masha continues at Hunter College of the City University of NY where she's been on the Dean's List. She lives in Bohemian Bushwick with her rabbit, George, shown here with our "Jack Russell in Sheep's Clothing" mixed breed, Leo.

 

Zoey graduated from University of Pennsylvania followed by a three-week European tour with schoolmates. He returned to the same lab where he had worked as an undergraduate, blogs irregularly and is applying for graduate programs in condensed matter physics which he expects to start in Fall 2011.

Simone is without a BMW for the first time since 1973 having sold her 525 in August, replacing it with an orange Honda Element–but, if you know of a 1973 BMW 2002, she's interested! Simone has devoted herself this year to helping a friend maintain her North Fork of Long Island farm and to the menagerie and gardens in Brooklyn while serving on the Prospect Park South Neighborhood Association Board, as a Site Coordinator for the Cobble Hill CSA and on the board of the GSR-SP.

Steve stepped down as Chairman of Emergency Medicine in June and after 35-years in Emergency Medicine has moved into a physician-executive role as Maimonides' first Chief Medical Informatics Officer. Shortly after he stepped down, the New York Times featured a lengthy story, photo essay and video about the Maimonides ER. He's enjoying the shift from 24 hour, 365 day operational responsibility to staff support for the Enterprise Medical Informatics efforts.

  
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Comment on Bob Wachter’s “Letter From London”

Wachter's World is a somewhat irregularly posted, always thoughful, sometimes provocative blog that Bob Wachter, Chief of Hospital Medicine at UCSF maintains.Reading it is a great pleasure for me as Bob's posts elicit both reflection and responsive comment. I commonly wait until I can use my computer to read his posts, rather than read on my blackberry or iPad as I do with so many others. For me, the pleasure of consideration and reflection is enhanced by Bob's fine job of eliciting dialogue–which he clearly seeks to accomplish and engage. Writing a responsive comment on a Bob Wachter post brings me pleasure.

Unfortunately, for the last several months his site hasn't accepted my comments. Let me be clear, Bob does moderate comments to his site, but his site hasn't allowed me to enter a comment to the site for moderation. He and his technical team are aware of a problem and have been working on it. Given that I've tried three different browsers on two different Windows7 computers, I don't think it's on my end, yet it persists. Today, I wrote a comment evoked by Bob's recent post, Letter from London" and since I can't post on his site, I thought I'd post it here with this explanation. Though many fewer will see it here than if it had been part of his site's comments–the text below, somewhat satiatiates the urge to usefully comment on Bob's post.

Slightly more than two years ago @KentBottles and I had a conversation in multiple parts about trust and the physician relationship with patients and the public more generally. Somewhat later the June 2009 issue of HBR in Rethinking Trust provoked consideration of the question more broadly. Given the greater political malaise and active diminishing of trust through various political antics, including perhaps some of those mentioned by the commentator @Cory on Wachter's original post, it seems most useful to focus on the profession and local efforts at raising trust.

So I ask, "Is improving patient safety a good way to do that, Bob–raise trust between physicians/clinicians and patients?" For Bob's post tells us he is off to London for a sabbatical, June-December 2011.

Don't get me wrong, I'm in awe (and envious!) of Bob's planned sabbatical with Charles Vincent who I've followed since meeting at the AEMJ Sponsored Consensus Conference in 2000 and Vincent's subsequent published contribution.

Bob's blog posting as always looks to the substantive as does his planned sabbatical. Yet I wonder if that's enough. Today's NY Times Magazine in "The President and the Passions" makes the case:

 "The lesson to be drawn is that the art of politics must be the art of engaging the passions, first by exciting them, then by moderating and directing them to a worthy end, one that reason may reveal but cannot achieve."

 

So too do Solomon & Flores in Building Trust which @KentBottles introduced me to. They make the case that it's less what goes on in the exchange and more about how engaged, interested and compassionate the exchange with another is conducted.

Thus, if I were to submit my contribution to that decade past consensus conference AEMJ issue today, I think I'd likely add a fourth area of comment: communication, particularly the use of social media in expanding connections between providers and patients and thereby hopefully rebuilding trust among them.

It's not just the science we bring to bear and how we explain it; it's also how we show the patient that they are safe and their concerns and interests are valued.

A feature the decade younger me hadn't yet grasped.

Thank you, Bob, for sharing your thoughts and experiences through your blog postings and your encouragement of the subsequent commentary and dialogue. Oh, and I look forward to the correction of the technical difficulty that prevents me from commenting on your site.

"The problem with communication is the illusion it has occurred." –G.B. Shaw

Report to the Maimonides Board on Stepping Down as Chair of EM

Thank you for the opportunity to address you once again. Last September 2009 when I presented a status report on the Department of Emergency Medicine, little did I expect to find myself here again so soon.

15 years ago at a board meeting very much like this one you created a new Department of Emergency Medicine for Maimonides. I was fortunate to be selected as the Founding Chairman of that new department. I’d like to spend a few moments recounting a chronology of the department’s physical and program development and then share another aspect of the department’s development–one perhaps less apparent to you, yet a facet of the department’s development I hope you’ll come to view as significant as facilities and program.

The first step towards the construction of the Weinberg Emergency Department took place in May 1996 with the move of the Ambulance Department from a trailer on the corner of 49th and Ft. Hamilton parking area to a garage on 39th Street. Maimonides operated 6 tours daily in the NYC EMS System. At about the same time, the Department moved into its administrative home at 965 48th St.

June 1997 brought the opening of the adult ED in the newly constructed Weinberg Emergency Department and the following month, residents from the Kings County/Downstate Emergency Medicine Residency began rotating with faculty in our ED.

March 1998 brought the opening of the Sephardic Friends Pediatric ED and the Bruce Birnbaum Administrative Suite where our department leadership was housed through 2001 until the Cardiac Cath lab expanded in 2002. In 2000 we had our own CT scanner installed in the suite on the main hallway.

In late 2000 we began developing an application for our own Emergency Medicine Residency, an application that was approved in 2002, leading to the graduation of our first class of EM residents in 2005. In February 2004, the MMC Ambulance department moved to its present location on 38th Street operating 12 (8ALS/4BLS) tours daily in the FDNY EMS System.

The Department initiated both a 3-year Pediatric Emergency Medicine Fellowship and a 1-year Emergency Ultrasound fellowship training program in 2008. Our sixth class of EM Residents graduates tomorrow evening.

As a capstone, the hospital opened the new ED in January 2009 and installed a 64-detector/dual-source CT scanner in August of 2009.

I’d like to turn to the other development that I mentioned earlier. Over the past 15 years the staff of the Department of Emergency Medicine have truly incorporated the many communities we serve as partners in improvement and incorporated improvement into the daily work of patient care.

The staff of the department, whose roles as clinician, technician, administrative and operational support are centered on individual patient care, have also incorporated into their core work improving how patient care is delivered at the bedside. Particularly in this latter role, the hospital’s community partners have been invaluable for their ready advice. Partnering with community representatives hasn’t always been easy and neither we nor our community partners have always gotten it right in our initial efforts, yet much of the improvements accomplished can be attributed to the interdisciplinary team in the department of EM and to effective collaboration with the community and its representatives.

I’ve experienced a thrilling and challenging 15 years.  As your steward for the department of emergency medicine I’ve done my utmost to fulfill your vision for program development supported by the facilities and resources you’ve invested. I trust you can equally value the extant culture of the department of EM which fully engages the necessity of continuous improvement in caring for patients as a fundamental element of daily work. The creation and existence of this culture is a source of considerable satisfaction to me.

Year End 2009

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Hello from Brooklyn where as I write cookies are baking and some
hens are laying—though molting hens reduce egg production. This past January, the
family winter vacation plan took us all to Costa Rico with some friends for the
warmth and explorations. The environment was warm, the beach and the Pacific
were a bit farther away than perfection would argue for, yet the stay was
marvelous for the rest, adventures in organic farming and (the kids) zip-line
canopy touring along with the untimed sleep, good grub and rum drinks.IMG_1073_crop DSC_0670
IMG_1113_crop
  The tour
of the mangroves along the coast was early in the trip and one of the
highlights as we were swarmed by capuchin monkeys, but also saw less disturbed
examples of the local flora, fauna and their ecological interactions. Our
guides in the mangroves and the national park were young men who impressed us
with their ingratiating personalities, knowledge of the environment and generous
storytelling.

DSC_0114
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In late spring Steve’s ER was nearly overwhelmed by a doubling of daily patient volume as the H1N1 “Swine” Flu moved through New York. Our year over year growth continues and we’ll finish the year having seen well over 100,000 patients, more than a doubling from the time of Steve’s arrival in 1995. Amazing to realize how long Steve’s been at Maimonides.

 

Masha made the move to an apartment share over the summer
while continuing at Hunter where she’s full-time in the fall session. She’s happy to be out of the parent’s house, though came home to bake cookies with Mom. Zoey imported his Mom for cookie baking this past weekend to his better this year West Philadelphia apartment where he’s living with three close school friends. He’s in his senior year at Penn and uncertain as to what’s next which seems like a normal state of affairs for this time of his life.

 

This past summer, Simone and Steve enjoyed a month of long weekends around NY and on LBI with Grandma Claire and a full week with friends Bill and Peggy on the North Fork of Long Island. Zoey joined us for several of those days driving over from Brookhaven National Labs where he spent a few weeks working at the end of the summer.

 

Simone again served as a site coordinator with the Cobble
Hill Community Supported Agriculture program that supports local farmers and supplies us with fresh produce. She continues the Brooklyn branch of the German Shepherd Dog Rescue, just celebrating its tenth anniversary, that she helped establish when we were in Philadelphia. Our old GSD Hillary finally died at nearly age 14 early this summer and so after more than a year of not doing so, we’ve recently taken in a foster German Shepherd dog, Alma, a long-legged female ~2-year-old named for a longtime friend of Simone’s. Leo, our terrier mix in sheep’s clothing is not entirely thrilled with the new addition.P1000323_crop

 

We’re fortunate that our mothers remain active and mostly
well though not without some of the challenges of great age. These family
tidings remind me of friends who are struggling with their health and life
itself. I hope you are taking care of yourselves and enjoying the world around
you. We would love to host your visit to New York in 2010.

Year End 2009

P1000315

Hello from Brooklyn where as I write cookies are baking and some
hens are laying—though molting hens reduce egg production. This past January, the
family winter vacation plan took us all to Costa Rico with some friends for the
warmth and explorations. The environment was warm, the beach and the Pacific
were a bit farther away than perfection would argue for, yet the stay was
marvelous for the rest, adventures in organic farming and (the kids) zip-line
canopy touring along with the untimed sleep, good grub and rum drinks.IMG_1073_crop DSC_0670
IMG_1113_crop
The tour
of the mangroves along the coast was early in the trip and one of the
highlights as we were swarmed by capuchin monkeys, but also saw less disturbed
examples of the local flora, fauna and their ecological interactions. Our
guides in the mangroves and the national park were young men who impressed us
with their ingratiating personalities, knowledge of the environment and generous
storytelling.

DSC_0114
DSC_0573_crop

In late spring Steve’s ER was nearly overwhelmed by a doubling of daily patient volume as the H1N1 “Swine” Flu moved through New York. Our year over year growth continues and we’ll finish the year having seen well over 100,000 patients, more than a doubling from the time of Steve’s arrival in 1995. Amazing to realize how long Steve’s been at Maimonides.

Masha made the move to an apartment share over the summer
while continuing at Hunter where she’s full-time in the fall session. She’s happy to be out of the parent’s house, though came home to bake cookies with Mom. Zoey imported his Mom for cookie baking this past weekend to his better this year West Philadelphia apartment where he’s living with three close school friends. He’s in his senior year at Penn and uncertain as to what’s next which seems like a normal state of affairs for this time of his life.

This past summer, Simone and Steve enjoyed a month of long weekends around NY and on LBI with Grandma Claire and a full week with friends Bill and Peggy on the North Fork of Long Island. Zoey joined us for several of those days driving over from Brookhaven National Labs where he spent a few weeks working at the end of the summer.

Simone again served as a site coordinator with the Cobble
Hill Community Supported Agriculture program that supports local farmers and supplies us with fresh produce. She continues the Brooklyn branch of the German Shepherd Dog Rescue, just celebrating its tenth anniversary, that she helped establish when we were in Philadelphia. Our old GSD Hillary finally died at nearly age 14 early this summer and so after more than a year of not doing so, we’ve recently taken in a foster German Shepherd dog, Alma, a long-legged female ~2-year-old named for a longtime friend of Simone’s. Leo, our terrier mix in sheep’s clothing is not entirely thrilled with the new addition.P1000323_crop

We’re fortunate that our mothers remain active and mostly
well though not without some of the challenges of great age. These family
tidings remind me of friends who are struggling with their health and life
itself. I hope you are taking care of yourselves and enjoying the world around
you. We would love to host your visit to New York in 2010.

Trust and the Serendipity Engine: Twitter


In this wonderful, 10 minute video done at the NYC Web 2.0 Conference in mid-November 2009, Chris Brogan opines on the value of Twitter, especially search on Twitter. He tells of his experience with discovering the Roger Smith Hotel, just down the way from the Four Seasons which is losing business to the Roger Smith. Why? Because colleagues responded to his twittered question about where to stay and then so did a live communicating voice (through Twitter) from the Roger Smith.

However, don't be distracted by the forgoing narrative as it's the deeper message that Brogan speaks to a commercial world using the web for commercial business that resonated for me. I've written about Brogan before, elsewhere, and urge you to read that post and Brogan's Trust Manifesto, for it is the loss of trust that so many clinicians experience–perhaps not so much with their patients–in working with all of the components of the health care system that support clinicians in the care of their patients. Brogan in this video, once again speaks to building trust, using the contemporary tool of relationship development: Twitter.

Brogan recommends using your @replies much more than most users do to this point. 80% of his tweets are replies–he suggests that users reply to others 12 times for every one original tweet and addresses many other aspects of using Twitter.

He goes on to raise a series of questions:

How do we share?
How do we extend experiences and relationships?
How do we collaborate?
How do we make new distribution?
How do we develop relationships that yield?

"The difference between an audience and a community is which way we turn the chairs."

Brogan closes with this quote from Ralph Waldo Emerson, "Do not go wherever the road may lead, but go where there is no road and leave a trail."

I'm proud to have done that in my work in Emergency Medicine; I'm just warming up for the next act.

HealthCamp Philadelphia–Less than a month to go

The BarCamp movement of self-produced intense conferences reminds me of the charrettes I'd hear about from my close friend and college roommate when he was in architecture school. HealthCamp has grown out of BarCamp and on Saturday, March 28, 2009 HealthCamp Philadelphia begins at 8:00 AM in the Hamilton Building on the Thomas Jefferson University at 11th and Locust Streets. The slide show summarizes the day and its goals.