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Reducing Physician Burnout Focus of New Study at UAB

Reducing Physician Burnout Focus of New Study at UAB

BIRMINGHAM – A program to study and reduce physician burnout amongst residents will be introduced at the University of Alabama at Birmingham, along with three other hospitals around the nation. The five-year, $1.8 million grant is funded by the American Medical Association.

UAB’s Tinsley Harrison Internal Medicine Residency Program shares the grant with Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and Stanford University School of Medicine. The award supports the study of key factors that contribute to the well-being and clinical skills of internal medicine residents across different training programs.

“We are excited to be a part of this important study,” said Lisa Willett, M.D., professor of medicine at UAB and program director of the Tinsley Harrison Internal Medicine Residency Program. “The learning environment is critical to the professional development of physicians in training. With this study, we hope to identify the key elements of the learning environment that shape the professional development of residents, while ensuring they are able to spend meaningful time at the bedside caring for patients.”

Information gathered from the early years of the study will help educators better understand that training environment. Once factors that affect the residency training environment are identified, new techniques to reduce physician burnout and improve clinical skills will be tested. The final years of the study aim to improve resident wellness and clinical skills.

Working with the residency program to implement the AMA “Reimagining Residency” grant will be Stephen W. Russell, M.D., associate professor of internal medicine and pediatrics, and KeAndrea Titer, M.D., assistant professor of internal medicine.

“The Tinsley Harrison residency program is already taking steps to enhance the clinical skills of residents by offering formative skills assessments with real-time feedback,” Dr. Russell said. “The hope is that by collaborating with other leading universities, UAB will continue to investigate and implement the best practices of resident education and that knowledge can be generalized to other programs.”

Dr. Russell will represent UAB on the grant’s executive committee as well as oversee the outpatient formative assessments of clinical skills. As a recent chief medical resident at UAB and new faculty in the Division of General Internal Medicine, Dr. Titer will oversee the bedside rounding initiative at UAB as well as lead local resident engagement.

“This grant, along with graduate medical education leadership, will not only serve to increase wellness in our trainees,” Dr. Titer said, “but also continually improve upon the delivery of excellence in patient care that they provide each day.”

The Tinsley Harrison Internal Medicine Residency Program serves as one of more than 20 residency programs within UAB graduate medical education. The residency program comprises 116 categorical residents and 16 combined Medicine-Pediatrics residents, providing care at UAB Hospital and the Veteran’s Administration Medical Center (BVAMC). During training, residents acquire clinical acumen for the diagnosis and management of common acute and chronic medical illnesses as well as rare diseases that involve complex clinical reasoning. This grant will aid in the continual development of physicians who demonstrate excellence in clinical skills and compassion in patient care.

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Report: Overall Cancer Mortality Continues to Decline

Report: Overall Cancer Mortality Continues to Decline

The latest Annual Report to the Nation on the Status of Cancer finds that, for all cancer sites combined, cancer death rates continued to decline in men, women and children in the United States from 1999 to 2016. Overall cancer incidence rates, or rates of new cancers, decreased in men from 2008 to 2015, after increasing from 1999 to 2008, and were stable in women from 1999 to 2015. In a special section of the report, researchers looked at cancer rates and trends in adults ages 20 to 49.

The annual report is a collaborative effort among the National Cancer Institute (NCI), part of the National Institutes of Health; the Centers for Disease Control and Prevention (CDC); the American Cancer Society (ACS); and the North American Association of Central Cancer Registries (NAACCR). The report appeared in the Journal of the National Cancer Institute on May 30, 2019.

“We are encouraged by the fact that this year’s report continues to show declining cancer mortality for men, women, and children, as well as other indicators of progress,” said Betsy A. Kohler, executive director of NAACCR. “There are also several findings that highlight the importance of continued research and cancer prevention efforts.”

The special section shows a different picture of cancer incidence and mortality among men and women ages 20 to 49 than among people of all ages. In the main report, from 2011 to 2015, the average annual incidence rate for all cancer sites combined was about 1.2 times higher among men than among women, and from 2012 to 2016, the average annual death rate among men (all ages) was 1.4 times the rate among women. However, when the researchers looked only at men and women ages 20 to 49, they found that both incidence and death rates were higher among women.

The authors reported that, in the 20–49 age group from 2011 to 2015, the average annual incidence rate for all invasive cancers was 115.3 (per 100,000 people) among men, compared with 203.3 among women, with cancer incidence rates decreasing an average of 0.7% per year among men and increasing an average of 1.3% per year among women. During the period from 2012 to 2016, the average annual cancer death rate was 22.8 (per 100,000 people) among men and 27.1 among women in this age group.

The most common cancers and their incidence rates among women ages 20 to 49 were breast (73.2 per 100,000 people), thyroid (28.4), and melanoma of the skin (14.1), with breast cancer incidence far exceeding the incidence of any other cancer. The most common cancers among men ages 20 to 49 were colon and rectum (13.1), testis (10.7), and melanoma of the skin (9.8).

“The greater cancer burden among women than men ages 20 to 49 was a striking finding of this study,” said Elizabeth Ward, Ph.D., lead author of the study and a consultant at NAACCR. “The high burden of breast cancer relative to other cancers in this age group reinforces the importance of research on prevention, early detection, and treatment of breast cancer in younger women.”

In studying this age group, the authors also found that, from 2012 to 2016, death rates decreased 2.3% per year among men and 1.7% per year among women.

“It is important to recognize that cancer mortality rates are declining in the 20-to-49-year-old age group, and that the rates of decline among women in this age group are faster than those in older women,” said Douglas R. Lowy, M.D., acting director of NCI.

The authors also reported in the special section that the incidence rates of in situ breast cancer and nonmalignant central nervous system tumors among women and men ages 20 to 49 are substantial. They wrote that some of the most frequent malignant and nonmalignant tumors that occur in this age group may be associated with considerable long-term and late effects related to the disease or its treatment. The authors conclude that access to timely and high-quality treatment and survivorship care is important to improve health outcomes and quality of life for younger adults diagnosed with cancer.

This year’s report found that, among all ages combined, existing incidence and mortality trends for most types of cancer continue. Rates of new cases and deaths from lung, bladder, and larynx cancers continue to decrease as a result of long-term declines in tobacco smoking. In contrast, rates of new cases of cancers related to excess weight and physical inactivity—including uterine, post-menopausal breast, and colorectal (only in young adults)—have been increasing in recent decades.

Several notable changes in trends were observed in the report. After decades of increasing incidence, thyroid cancer incidence rates in women stabilized from 2013 to 2015. The authors wrote that this could be due to changes in diagnostic processes related to revisions in American Thyroid Association management guidelines for small thyroid nodules.

The report also shows rapid declines in death rates for melanoma of the skin in recent years. Death rates, which had been stable in men and decreasing slightly in women, showed an 8.5% decline per year from 2014 to 2016 in men and a 6.3% decline per year from 2013 to 2016 in women.

“The declines seen in mortality for melanoma of the skin are likely the result of the introduction of new therapies, including immune checkpoint inhibitors, that have improved survival for patients diagnosed with advanced melanoma,” said J. Leonard Lichtenfeld, M.D., M.A.C.P., interim chief medical officer of ACS. “This rapid change shows us how important it is to continue working to find effective treatments for all kinds of cancer.”

Other notable findings about cancer mortality from the report include that from 2012 to 2016:

  • Overall death rates decreased 1.8% per year in men and 1.4% per year in women.
  • Among men, death rates decreased for 10 of the 19 most common cancers but increased for 6 cancers, with the steepest increases for liver cancer, oral cavity and pharynx cancer, and non-melanoma skin cancer.
  • Among women, death rates decreased for 13 of the 20 most common cancers, including the 3 most common cancers (lung and bronchus, breast, and colorectal), but increased for 5 cancer types, with the steepest increases for cancers of the uterus and liver.

For cancer incidence, from 2011 to 2015:

  • Incidence rates for all cancers combined were stable in women and decreased 2.1% per year in men.
  • Among men, rates of new cancers decreased for 8 of the 17 most common cancers, increased for 7 cancers, and were stable for 2 cancers.
  • Among women, rates of new cancers decreased for 6 of the 18 most common cancers, increased for 9 cancers, and were stable for 3 cancers.

The report also shows continuing racial and ethnic disparities in cancer mortality and incidence. When data for people of all ages were combined and compared by sex, across racial and ethnic groups, black men and black women had the highest cancer death rates, both for all cancer sites combined and for about half of the most common cancers in men and women. Black men and white women had the highest overall cancer incidence rates, and Asian/Pacific Islander men and women had the lowest overall rates. Non-Hispanic men and women had higher overall incidence rates than Hispanic men and women.

“Major declines overall in cancer mortality point in the right direction, yet significant differences remain in cancer cases and deaths based on gender, ethnicity, and race,” said CDC Director Robert R. Redfield, M.D. “A better understanding of these discrepancies improves cancer diagnosis and recovery for all patients and is vital to our public health mission.”

For more about the report, see: https://seer.cancer.gov/report_to_nation/

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Study: Kids Distracted By Misleading Warnings in E-Cigarette Ads

Study: Kids Distracted By Misleading Warnings in E-Cigarette Ads

E-cigarettes and vape companies are courting smokers and non-smokers alike, and they have the advertising to match. Some of the ads from one company, Blu, included “fake” advisories like “WARNING: Contains flavor.” A new study published in the journal Tobacco Control found that boys who saw ads with that type of fake warning were less likely to recall information in the ad about possible health impacts.

“The ads we found from Blu in 2017 had these fake warnings at the top that really adhered to the warning messages requirements that are now required on e-cigarette ads by the FDA,” says Brittney Keller-Hamilton, the study’s lead and a researcher at Ohio State University’s College of Public Health.

“They said things like, ‘Important: vaping Blu smells good’ and ‘Important: less harmful to your wallet,'” she says. “And we know that these messages are likely to resonate well with adolescents,” she said.

But it wasn’t just that those messages would entice the boys. Keller-Hamilton and her team found that they also distracted the readers from the actual health advisories.

“Boys who were randomly assigned to view ads with fake warnings were less likely to recall the actual warning on the advertisement or to remember health risks conveyed in that actual warning,” she said.

The FDA now requires large warnings on the ads, which Keller-Hamilton believes will make this sort of campaign harder to replicate. But it could have implications for the rest of the industry.

“This is a really big concern for cigarette ads, for instance, because those still have smaller warnings,” she said. “And cigarette ads could put fake warnings at the top of their advertisements to even further reduce the impact of their actual warnings for adolescents.”

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New Study Inspires Researchers to Hit the Road

New Study Inspires Researchers to Hit the Road

A new $21.4 million RURAL study will examine rural, southern U.S. communities to find out why people there have more disease, shorter lives. Traveling in a mobile examination van, researchers will examine 4,000 study participants over the course of six years in 10 rural counties across Kentucky, Alabama, Mississippi and Louisiana.

Vasan Ramachandran, who leads the Framingham Heart Study at Boston University, is about to embark on the ultimate road trip with 50 other scientists. But this is not for adventure and sightseeing. The research team is part of a new study led by Ramachandran, called the Risk Underlying Rural Areas Longitudinal (RURAL) study, which has the goal of discovering why people in rural areas of the southern United States tend to live shorter, less healthy lives compared to the rest of the country.

With $21.4 million in funding from the National Heart, Lung, and Blood Institute, Ramachandran and his team plan to use their know-how from the Framingham Heart Study—the longest-running heart disease study in the country—to ask the question, “What causes the high burden of heart disease, lung disease and stroke in the rural South?”

To find out the answer, the researchers will travel by custom van, built as a “mobile examination unit,” to examine 4,000 study participants over the course of six years in 10 counties across Kentucky, Alabama, Mississippi, and Louisiana. Throughout the entire US, heart disease is the number-one killer of both men and women, but rates are even worse in southern states. People living in these areas also have higher rates of lung, blood, and sleep disorders compared to the national average.

“We hope that what we do [in RURAL] changes the lives of common human beings who live in these communities, who are robust individuals like you and me,” says Ramachandran, a BU School of Medicine professor of medicine and epidemiology and chief of preventive medicine and epidemiology. “The burden of [health] risk is high, in part because of geospatial characteristics that we don’t fully understand.”

The most crucial aspect of the study, Ramachandran explains, is going to be listening. Partnering with 16 institutions, including universities in all four states, the researchers will work with participating communities to organize active discussions, working groups, listening groups, and community advisory boards. Their plan is to take the “science to the people and study these health issues at their doorstep,” Ramachandran says.

The mobile exam unit will be constructed after carefully consulting with community partners and participants, long before the examination process begins. Ramachandran says this will ensure that the space will be comfortable, accessible, and customized to the needs of specific areas. The van, once fully operational, will spend time in each county over the next few years. Counties in Alabama will be the group’s first stop to conduct baseline examinations.

“We do hope to build relationships within these communities to understand them better beyond the 4,000 people [who will participate] in RURAL,” Ramachandran says.

Six years might seem like a long time, but this is only the first step toward a much longer process and larger goal. Once the RURAL van completes its trip through all 10 counties, the cohort will continue working with the communities through advisory boards and participant networks. After the data is collected and analyzed, the team intends to share the results with district health officials and provide health recommendations based on their findings.

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Can We Overhaul Our ‘Broken’ Health Data System?

Can We Overhaul Our ‘Broken’ Health Data System?

COLUMBUS, Ohio – Our system for protecting health data in the United States is fundamentally broken, and we need a national effort to rethink how we safeguard this information, according to three experts in data privacy.

“Data scandals are occurring on a regular basis, with no end in sight,” said Efthimios Parasidis, a co-author of the NEJM article and a professor at the Ohio State University’s Moritz College of Law and College of Public Health. “Data privacy laws for health information don’t go far enough to protect individuals. We must rethink the ethical principles underlying collection and use of health data to help frame amendments to the law.”

Parasidis wrote the article with Elizabeth Pike, Director of Privacy Policy in the Office of the Chief Information Officer at the U.S. Department of Health and Human Services; and Deven McGraw, chief regulatory office at Citizen, a company that helps people collect, organize and share their medical records digitally. Previously, McGraw was Deputy Director for Health Information Privacy at the Office of Civil Rights in the U.S. Department for Health and Human Services, and Acting Chief Privacy Officer at the Office of the National Coordinator for Health Information Technology.

Parasidis said a process analogous to the Belmont Report would be a good blueprint to follow today. The Belmont Report is one of the leading works concerning ethics and health care research. Its primary purpose is to protect subjects and participants in clinical trials or research studies. This report consists of three principles: beneficence, justice, and respect for persons.

The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research produced the 1979 Belmont Report, which resulted in Congress passing laws to protect people who participated in medical research.

“Indignities in human subjects research compelled the government to create a commission to propose ethical guidelines for new laws. We are experiencing a rerun of what was happening then, with the scandals involving use of health data now rather than the use of human subjects,” Parasidis said. “We need an equivalent response.”

Currently, the Health Insurance Portability and Accountability Act (HIPAA) is the main law protecting the data of patients. But it doesn’t apply to many of the new companies and products that regularly store and handle customer health information, including social media platforms, health and wellness apps, smartphones, credit card companies and other devices and companies.

“All of this data held by digital health companies raises a lot of ethical concerns about how it is being used,” Parasidis said.

For example, some life insurers are offering contracts that have policyholders wear products that continuously monitor their health, and the information can be used to increase a customer’s premiums.

Most regulations require only that consumers be notified about how their information is used and give their consent.

“That system doesn’t work. Very few people read the notice and most people just click agree without knowing what they’re agreeing to,” he said.

So how can health data privacy be fixed?

One idea would be to establish data ethics review boards, which would review projects in which health data are collected, analyzed, shared or sold, according to the authors of the NEJM article.

Parasidis said such boards could function as safeguards required in both public and private settings, from university medical centers to private life insurance companies.

These boards could consider the benefits and risks of the proposed data use and consider policies governing data access, privacy and security. Members could include project developers, data analysts and ethicists, as well as people whose data would be collected.

“Right now, everything is about compliance. Companies and institutions check the boxes, fill out the forms and don’t really think about whether they’re doing the right thing,” Parasidis said.

“Deliberations about use of health data should take the ethical obligations to individuals and society into account. The law should mandate that this occurs.”

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First Presumptive Positive Measles Case in Alabama for 2019

First Presumptive Positive Measles Case in Alabama for 2019

The Alabama Department of Public Health received notification of a case of presumptive positive measles the morning of May 2 in an infant in St. Clair County. Currently, this is the only presumptive measles case under investigation in Alabama.

The infant was considered contagious from April 23, 2019, through May 1, 2019. ADPH is working to confirm the diagnosis and to contact those exposed. The child is not in daycare and has had no out-of-state travel. So far in 2019, ADPH has conducted 174 investigations, including 32 open investigations, but this is the first presumptive positive case.

Measles (rubeola) is a notifiable disease in Alabama. The ADPH Immunization Division investigates reports of suspected measles. ADPH urges that all persons know their measles vaccine status. If never vaccinated and born after 1956, persons are strongly encouraged to obtain an MMR (measles, mumps, rubella vaccine) from their physician, healthcare provider or pharmacy. ADPH vaccine efforts primarily focus on children under 19 years of age. Free MMR vaccine is only available for children participating in the Vaccines for Children (VFC) Program and for persons who may qualify based upon local health department fee schedules.

ADPH has a very limited supply of MMR vaccine for adults and urges those with insurance and other coverage such as Medicaid to be vaccinated at their pharmacy or provider. About 95 percent or more of unvaccinated people exposed to a single case of measles will contract the disease.

For every single case of measles disease, 12-18 additional cases can be expected. The complication rate from measles is about 20-30 percent, especially in infants, children less than 5 years of age, and persons 20 years and older. Complications can range from ear infections and pneumonia to deadly encephalitis. For every 1,000 people with measles, one to two people will die.

Signs and symptoms of measles that occur before the rash are as follows:

  • Patients develop fever, sometimes as high as 105 degrees, followed by cough, runny nose, and red eyes (conjunctivitis).
  • Anywhere from 1-7 days after these symptoms begin, the rash develops.
  • The rash starts on the face and spreads across the body.
  • Patients may also have small white spots on the inside of the mouth on the cheek which may occur from two days before and up to two days after the rash.

From the time that a person is exposed to measles, it can take seven to 21 days for signs and symptoms to occur with an average of 10-14 days. People are contagious from four days before the rash develops until four days after.

For additional information, go to http://alabamapublichealth.gov/immunization/index.html

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SURVEY: Prior Authorization Obstacles Unnecessarily Delay Patient Access to Cancer Treatments

SURVEY: Prior Authorization Obstacles Unnecessarily Delay Patient Access to Cancer Treatments

ARLINGTON, Va., April 25, 2019 — Restrictive prior authorization practices cause unnecessary delays and interference in care decisions for cancer patients, according to a new survey of nearly 700 radiation oncologists — physicians who treat cancer patients using radiation– released today by the American Society for Radiation Oncology (ASTRO).

Nearly all radiation oncologists (93%) said that their patients are delayed from life-saving treatments, and a third (31%) said the average delay lasts longer than five days – a full week of standard radiation treatments. These delays cause added stress and anxiety to patients already concerned about their health, and they are cause for alarm given research linking each week of delay in starting cancer therapy with a 1.2% to 3.2% increased risk of death.

In addition to prevalent treatment delays, the ASTRO physician survey illuminates other ways prior authorization negatively impacts patient outcomes and takes physicians away from caring for their patients:

Added Patient Stress

  • More than 7 in 10 radiation oncologists (73%) said their patients regularly express concern to them about the delay caused by prior authorization.
  • More than 3 in 10 radiation oncologists (32%) have been forced to use a different therapy for a substantial number of their patients (>10%) due to prior authorizations delays.

Unnecessary Delay Tactics

  • Nearly two-thirds of radiation oncologists (62%) said most denials they receive from prior authorization review are overturned on appeal.
  • Radiation oncology benefit management companies (ROBMs) required 85% of radiation oncologists to generate multiple treatment plans, which require physicians and medical physicists to spend several hours developing alternatives to their recommended course of treatment.
  • More than 4 in 10 respondents (44%) said their peer-reviews typically are not conducted by a licensed radiation oncologist.

Wasting Physician Time

  • Nearly one in five radiation oncologists (17%) said they lose more than 10% of time that they could be caring for their patients focused instead on dealing with prior authorization issues. An additional 39% spend 5-10% of their average workday on prior authorization.
  • More than 4 in 10 radiation oncologists (44%) needed prior authorization for at least half of their treatment recommendations. An additional third (37%) needed it for at least a quarter of their cases.
  • Many radiation oncologists (63%) had to hire additional staff in the last year to manage the prior authorization process.

Disproportionate Impact on Patients at Community-Based Clinics

  • Patients treated at community-based, private practices experience longer delays than those seen at academic centers. For example, average treatment delays lasting longer than a week were reported by 34% of private practitioners vs. 28% of academic physicians (p=0.005).
  • Radiation oncologists in private practice are almost twice as likely to spend more than 10% of their day focused on prior authorization, compared to physicians at academic centers (23% vs. 13%, p=0.003)

“This survey makes clear that restrictive prior authorization practices can cause unnecessary, stressful and potentially life-threatening delays for cancer patients,” said Paul Harari, MD, FASTRO, Chair of the ASTRO Board of Directors and professor and Chairman of human oncology at the University of Wisconsin-Madison. “While the system may have been designed as a path to streamline and strengthen health care, it is in fact frequently harmful to patients receiving radiation therapy. In its current form, prior authorization causes immense anxiety and wastes precious time for cancer patients.”

“Radiation oncology and cancer patients have been particularly hard hit by prior authorization’s unnecessary burden and interference in care decisions,” said Vivek Kavadi, MD, Vice Chair of ASTRO’s Payer Relations Subcommittee and a radiation oncologist at Texas Oncology. “Radiation oncologists increasingly are restricted from exercising our clinical judgment in what is in the best interest of the patient, yet we are held accountable for the outcomes of treatments where decisions have been taken out of our hands.”

In the 2018 annual ASTRO member survey, radiation oncologists named prior authorization as the greatest challenge facing the field. The burden was especially prominent among private practitioners in community-based settings, where the majority of cancer patients receive care.

The findings from ASTRO’s new physician survey align with recent reports from the American Medical Association (AMA), American Cancer Society Cancer Action Network (ACS CAN) and others, demonstrating the pervasiveness of prior authorization obstacles throughout the American health care system.

ASTRO recently signed onto a letter with the AMA and other medical societies calling for CMS to require Medicare Advantage plans to align their prior authorization requirements with a Consensus Statement on Improving the Prior Authorization Process authored jointly by leading provider and payer organizations.

Survey Methodology

An online survey was sent by email to all 3,882 U.S. based, practicing radiation oncologists in ASTRO’s member database, and 620 physicians completed the survey online. Invitations were sent in December 2018, with one email reminder in January 2019, and the survey closed in February 2019. ASTRO staff also administered paper surveys at the ASTRO Annual Meeting in October 2018 and collected 53 responses. Findings reflect the combined total of 673 radiation oncologist responses. For more information about respondent demographics, view the executive summary.

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ABOUT ASTRO

The American Society for Radiation Oncology (ASTRO) is the world’s largest radiation oncology society, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. The Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals,International Journal of Radiation Oncology • Biology • PhysicsPractical Radiation Oncology andAdvances in Radiation Oncology; developed and maintains an extensive patient website, RT Answers; and created the nonprofit foundation Radiation Oncology Institute. To learn more about ASTRO, visit our website, sign up to receive our news and follow us on our blogFacebookTwitterand LinkedIn.

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National Health Survey Underway in Marengo County

National Health Survey Underway in Marengo County

The National Health and Nutrition Examination Survey (NHANES), the most comprehensive survey of the health and nutritional status of the U.S. population, is underway in Marengo County through April 20. This is an “invitation-only opportunity” in which randomly selected participants will receive a free and comprehensive health and nutrition evaluation. Respondents will be compensated for their time, travel and other expenses of up to $125.

“We encourage every eligible resident who has been selected for the survey to agree to participate,” said Alabama Department of Public Health’s Southwestern District Administrator Chad Kent. “All information collected is confidential, as required by law. If you are chosen, you will have been contacted by letter.”

A team of health professionals, nutritionists and health technicians ask respondents to first participate in a health interview in the respondent’s home followed by a health exam in the NHANES mobile examination center. Professionals will have a photo ID badge from the Centers for Disease Control and Prevention. While no medical care is provided directly, a report on physical findings is given to each participant along with an explanation from survey medical staff. All information collected in the survey is kept confidential and privacy is protected.

“NHANES serves as the nation’s ‘health check-up,’ by going into communities to collect health information throughout the country. The survey provides a wealth of important data about many of the major health and nutritional issues affecting the country,” according to the National Center for Health Statistics (NCHS) Director Jennifer H. Madans.

All counties in the United States have a chance to be selected for the NHANES, and Marengo County was one of the 15 counties chosen to be part of this initiative. NHANES provides important data on public health problems from a national perspective. Each year, 5,000 residents across the nation have the chance to participate in the latest NHANES, conducted by the NCHS, part of the Centers for Disease Control and Prevention.

“For the most part, people are very receptive,” George Dixon, study manager, said. “We may ask for some demographic information to determine if any people in the household are selected. We assist participants with transportation and even babysitting if needed.”

NHANES has had a prominent role in improving the health of all people living in the U.S. for the past 55 years. Public health officials, legislators and physicians use the information gathered by NHANES to develop sound health policies, direct and design health programs and services, and expand the health knowledge for the nation. NHANES findings provide critical health-related information on a number of issues such as obesity, diabetes and cardiovascular disease. In addition, NHANES data are used to produce national references and are used to create standardized growth charts for pediatricians across the country.

The comprehensive data collected by NHANES impact the everyday lives of the population of all ages, on everything from air quality to the vaccinations given by doctors, to the low fat and “light” foods now routinely offered in grocery stores.

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How Can Physicians Effectively Address Burnout?

How Can Physicians Effectively Address Burnout?

How many of your colleagues are complaining that they are doing more work and getting less for it? How many of them are experiencing ever-increasing levels of frustration brought on by outside influences: governmental regulation, insurance regulation, increased concern about medical malpractice, increasingly negative attitude by society towards physicians, and weakened physician-patient relationships?

Most individuals considering medical school know up front that a medical career inherently makes certain demands – they will be called upon to place their personal lives on hold financially as they study and train in the field of medicine. Competition is expected, as is delayed gratification, personal sacrifice, limited sleep, lack of free time, and intense pressure to be up on the latest medical knowledge. Upon completion of their residency or fellowships, they may be able to reclaim certain aspects – they will begin drawing a paycheck, they will have more control over their daily routine, some will even “man their own ship” in private practice – but not all of them.

Unfortunately, the characteristics that a make a good clinician may also lead the physician further and faster down the road to burnout. The field of medicine and often the physicians themselves set very stringent standards to be followed. These standards can be identified in the form of self-imposed limitations.

Physicians must…

  • Work until the work gets done
  • Not permit downtime, as downtime is time wasted
  • Handle everything that comes their way without complaint or assistance
  • Be highly conscientious
  • Try to be all things to all people – patients, staff, family, colleagues, etc.

On top of all that, the medical environment brings other components. Physicians are faced with repetitive tasks on a daily basis. While the diagnosis may change, the seeing of patients often becomes routine as physicians move from one room to the next. Physicians are often faced with problems that lack solutions, accompanied by demanding and chronically ill patients. Life and death issues are faced on a daily basis. In short, there is no time to emotionally recharge.

After several years of holding themselves to such high standards, a number of physicians are being forced to reevaluate their career, their life’s decisions. Many feel increasingly dissatisfied with their daily lives, and struggle to find a coping mechanism.

Symptoms of Burnout

There are many symptoms of burnout, some emotional, others physiological. Just as he or she would query a patient about the symptoms of an illness, the physician must stop and query himself or herself to identify common burnout symptoms. Examples of these include:

  • Negative perceptions of self
  • Negative practice habits
  • Lack of empathy with patients
  • Unhealthy lifestyle
  • Dissatisfaction with career
  • Sleep disturbances

Identification of the symptoms, and eventually the cause, is critical for two reasons. First, it is the only way the physician can work to overcome burnout and its significant effects. Second, failure to address burnout can foster an environment where the “it-just-doesn’t-matter“ attitude turns into a malpractice claim.

Preventing Burnout

Given the above situations and environments, is it possible to cope with burnout? Research indicates physicians who take charge of their lives and strive to ensure balance, are far more successful than most.

Prevention and/or mitigation can be divided into several areas.

Physical:

  • You should acknowledge that you, too, can get sick, and you should take normal steps to prevent it.
  • Have an annual physical to identify health concerns promptly.
  • If you can’t get motivated alone, hire a personal trainer so someone is expecting to see you at the gym.
  • Ensure you get enough rest.
  • Maintain a healthy diet.

Environmental:

  • Maintain control of your schedule.
  • Schedule non-patient appointments when they are convenient for you, and assign a time limit.
  • Evaluate your other commitments; be willing to say no when asked to serve on just one more committee or handle one more obligation.
  • Set priorities. Identify your daily tasks and divide them into one of four categories: urgent and important; urgent but not important; important but not urgent; and neither important nor urgent. Try to take a realistic approach and avoid lumping everything into “urgent and important.”
  • Meet with your staff on a regular basis. This helps prevent their burnout, and subsequently yours if you are not having to deal with staffing issues on top of everything else.
  • Chart throughout the day. Several sources agree charting at the end of the day allows a dreaded task to cut into personal time.

Emotional:

  • Volunteer
  • Find a hobby or leisure activity that does not pertain to medicine to give yourself an outlet.
  • You should get involved in your church or a community project that is important to you.
  • Spend time with friends or colleagues where you can be yourself.
  • Modify your perspective. Instead of saying, “There is no way I can get all this done today,” say “I will do only that which I can get to today.”
  • Learn to handle conflict. Resolving conflict instead of just living with it will improve your emotional outlook in a number of areas.

Financial:

  • Avoid overextending yourself financially. Stress over finances makes most individuals feel they have given up control of their lives – they must now work to meet their financial demands, and not just to achieve career goals or personal satisfaction.
  • Indebtedness may prevent someone from implementing other key steps to preventing burnout.

Is it hopeless? No. Is it easy? No. But today’s environment is highly stressful, and unfortunately, it is not likely to change for the good any time soon. This means physicians must either learn to cope with the forces battering at them on a daily basis or continue to feel ever increasing despair and frustration from their chosen career.

Article contributed by Sae Evans and Maddox Casey, Members, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

Posted in: Health

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