Speaker, guests spark authentic conversations about race, health care

Racial inequalities are pervasive within our systems of education, criminal justice and health care, said invited speaker Dave McIntosh, PhD, and need to be recognized and addressed for America to achieve its promise. McIntosh delivered “Authentic and Critical Conversations on Race, Health and Patient Care” at the Third Annual Alonzo Homer Kenniebrew, MD, Presentation on Health Inequities and Disparities at the Memorial Center for Learning and Innovation on February 12. Discussions continued the next day as Dr. Wendi Wills El-Amin welcomed panelists to the Alonzo Homer Kenniebrew, MD, Forum on Health Inequities and Disparities. Panelists shared stories of encounters where they felt “minoritized” because of system practices that impede racial understanding. Guests also discussed their own experiences, sparking authentic conversations that can lead to changes in behavior, attitudes and policies within their personal and professional spheres.

McNeese presented with inaugural Equity Award

Wesley G. Robinson-McNeese, MD, was awarded the 2019 Equity Award in recognition of his “legacy, devotion and commitment to health equity, diversity, and inclusion at SIU School of Medicine and the surrounding community.” Associate Dean for Equity, Diversity and Inclusion Wendi Wills El-Amin presented the award at the Third Annual Alonzo Homer Kenniebrew, MD, Lecture on February 13 (photo at top).

Dr. McNeese serves part time as the SIU System’s executive director of diversity initiatives. Previously, he worked as SIU School of Medicine’s associate dean for diversity and inclusion.

Over a 15-year span, Dr. McNeese created and organized numerous initiatives to promote and expand the culture of diversity and inclusion at the school. Most notably, he launched “P4”—the Physician Pipeline Preparatory Program—to encourage high school students to pursue careers in medicine. He also spearheaded Diversity Week, the Eastside Health Initiative, the Metro-East Healthcare Elective, and the Alonzo H. Kenniebrew Lecture and Forum.

TYLER FULKS, MD

As chief resident physician in the Department of Emergency Medicine, Tyler Fulks, MD, Class of 2016, has made it his life's mission to provide the best care to patients having their worst days.

ASPECTS: What was your childhood like?

Dr. Tyler Fulks: I grew up not far from here in Chatham. As a boy, I knew I wanted to be either a rock star, a racecar driver or a doctor. I’m glad at least one of those seemed to pan out.

I used to race go karts. My dad’s whole side of the family races to this day. I retired from racing in middle school, but at the time I was actually pretty good.

What made you choose medicine?

There was never really one ‘defining moment’ that inspired me to pursue a career in medicine. My mom’s brother is a physician and from an early age I always felt like his job sounded fun and exciting. After high school I was lucky enough to land a job as a tech in the emergency department at Memorial Medical Center. I always consider that my first true experience with the world of medicine and from there, I was hooked.

What attracted you to emergency medicine?

I was drawn to the exciting, fast-paced style of practice that occurs in the emergency department. It works well with my short attention span. In med school I began to better appreciate the wide breadth of knowledge emergency physicians must have in practice. I can remember one of my mentors explaining that in emergency medicine we are not only resuscitationists, but it is our duty to know how to manage the first 30 minutes of every specialty in medicine.

Now that I have been doing this a while, I believe the most gratifying aspect of my job is the ability to have a positive effect on people during what is often one of the worst days of their lives.

And because I’m from here, the ability to provide care for the community that raised me is very rewarding.

What are your plans after residency and beyond?

I will enter a one-year, out-of-hospital care fellowship at Indiana University in Indianapolis. In fellowship I will be immersed in the world of prehospital care and will come out with the training and experience necessary to serve as a successful emergency medical services (EMS) physician.

After fellowship, I will be double-boarded in the practice of both emergency medicine and EMS. From there I plan to fulfill my ultimate career goal of becoming an EMS fellowship-trained academic emergency medicine provider.

What might we find you doing outside of work?

My fiancée and I have been remodeling our house for what feels like an infinite amount of time. There isn’t really a clear end goal to it either. It seems like each project we complete inspires two additional projects. Outside of that I like to play basketball and golf, weather permitting.

And I love karaoke. What I lack in talent, I attempt to make up for in sheer passion. I’ll sing all genres, but my go-to song has to be ‘Shameless’ by Garth Brooks. A couple years ago my family got me a karaoke machine for Christmas and I don’t think my dog, Finnley, will ever forgive them for that.

What’s your motto or favorite quote?

“If you work really hard and you’re kind, amazing things will happen.” My mom used to say this to her fifth graders (she was a teacher), but I think it originally comes from Conan O’Brien. Nevertheless, the sentiment is all the same.

CRITICAL CONDITIONS

TRAINING FOR TRAUMA & VIOLENCE AT WORK

Written by Steve Sandstrom | Photography by Sara Way

On an early Monday morning in March 2018, James Waymack, MD, was on his way to work at Taylorville Memorial Hospital. Waymack is the director of the emergency medicine residency program within SIU’s Department of Emergency Medicine, and on Mondays he accompanies a team of residents on a rural service rotation to a hospital 30 minutes east of Springfield. Nearing his exit, he was suddenly passed by three ambulances. Approaching the hospital, he found the parking lot teeming with police vehicles. Inside, emergency medicine director Rich Jeisy, MD, Waymack’s former SIU School of Medicine classmate, was providing care for the three gunshot victims who had just been transported from a nearby domestic violence crime scene. The law enforcement presence was there for protection, because the shooter was still at large.

That afternoon, officers spotted a man they believed to be the perpetrator driving on a rural Taylorville road. He had attempted to rob a convenience store in the interim. With the police in pursuit, the man drove into town and headed for the hospital. His truck struck the curb in front of Taylorville Memorial’s main entrance and came to a stop. The man got out carrying a pistol and headed toward the hospital door. When multiple officers confronted him and told him to drop his weapon, he shot himself in the head.

Dr. Waymack then found himself treating the man in the same nine-room ER where his victims had been receiving care earlier. The trio of victims—a man, a woman and a 13-year-old child—had been stabilized and transported to Memorial Medical Center in Springfield. With a life-threatening injury, the attacker was also stabilized and then sent to Springfield, where he died the following day.

SIU physicians, staff and hospital partners all receive training to prepare for active shooters and other threats. According to the Illinois Health and Hospital Association (IHA), physicians and clinical staff at hospitals across the state are trained in the “Run, Hide, Fight” response and use “plain language” and “color codes” to notify patients and staff of an incident. In addition, the IHA coordinates an annual Emergency Preparedness Exercise, giving hospitals the opportunity to rehearse for these harrowing incidents.

On Nov. 8, 2018, nearly 1,000 individuals participated in the IHA’s most recent statewide simulation. Different active-threat scenarios prompted teams to think through ways to keep patients and employees safe. Eleven days later, a domestic argument escalated into a triple homicide at Chicago’s Mercy Hospital and Medical Center, taking the lives of a doctor, a pharmacist and a police officer.

Both the Taylorville Memorial and Mercy Hospital tragedies demonstrate that no amount of preparation can guarantee total safety from workplace violence. But trained clinicians can help improve the odds of a safe environment for all.

TRAINING FOR LEARNERS

Violence against health care workers—including verbal and physical assault—occurs in practically all care settings, with the highest number of recorded incidents taking place in psychiatric wards, emergency departments and visitor waiting rooms.

The Bureau of Labor Statistics classifies incidents of workplace violence as “intentional injury by other person” in its list of occupational injuries causing days away from work, and reported nearly 18,670 such injuries across the United States in 2017. People working in service occupations made up about half of the incidents (9,110). Health care practitioners and technical occupations reported the second-most: 3,130.

One of the ways SIU medical students are taught how to deal with aggressive and potentially dangerous patients is through clinical simulations with standardized patients (SPs). Since 1981, SPs have been used in Springfield’s Professional Development Lab to simulate real-life medical encounters students may one day face as physicians.

SIU medical students see their first SP during the first week of medical school. It emphasizes the importance of becoming comfortable with taking patient histories, performing examinations and polishing communication skills. As the clinical skills curriculum builds each year, the SP encounters become more complex.

A Doctoring Physician Attitude and Conduct session in year 2 centers on intimate partner violence (IPV). It includes information on the demographics of IPV in society, how doctors encounter it, and methods used to interact with and treat patients. Following the didactic, the students are split into small groups and exposed to one of two standardized patient encounters involving IPV.

In the current SP scenarios, a woman presents with persistent headaches and makes no mention of domestic violence. In the second, a loud and domineering spouse accompanies a female patient to her clinic visit. The student-physician has to figure out how to treat the patient for what could be IPV while the abuser is literally in the room. The second-year SP cases require the learner to discreetly navigate from suspicion to action.

When appropriate, a faculty observer will call a time-out and discuss ways to address the volatile situation. The students are also coached with techniques to de-escalate aggressive behavior. This includes choosing verbiage and empathy for how the patient is feeling, and ways to openly acknowledge the patient’s frustrations and fears.

In addition to skills learned through SP scenarios, SIU’s Departments of Family and Community Medicine, Medical Humanities, Pediatrics and Psychiatry offer Year 4 electives that address aspects of violence. Topics include vulnerable patients, biological terrorism response, health care responses to violence, the role of community service agencies, the criminal justice system and health disparities. The school also hosts frequent educational opportunities to spotlight concerns related to violence and trauma-informed care.

TRAINING FOR FRONTLINE STAFF

Training nurses to deal with aggressive patients is a challenge which varies across clinics and departments. Jessica Barney, a nurse administrator in internal medicine, says that under very stressful conditions, “It’s important to try to stay calm, keep the patient calm and go find who’s in charge to take care of them. I tell my nurses ‘if it’s truly dangerous, just try to get yourself out of the room quickly and call Security. Then come find me.’”

Catie Myers, an SIU charge nurse in the Department of Cardiology says, “For a new nurse, any kind of confrontation with a patient is overwhelming. Through the years, I’ve found that de-escalation is the key to getting the situation under control, whether it’s on the phone or in the clinic.”

Nurse educator Leslie Montgomery and the nurses interviewed for this article all see the value in a debriefing conversation when a traumatic episode or death occurs in a “code session.” This gives the care providers time to reflect and acknowledge what they experienced. Connecting with other care providers afterward and talking with nurse managers was a standard operating procedure mentioned within the group. “You can lean on your peers,” Montgomery says. “After that, I would go home and talk to my family. Venting to my husband was my usual debriefing.”

She recommends debriefing sessions be made mandatory under certain circumstances, so nurses wouldn’t have the option of toughing it out and regretting it later. It could remove some of the stigma from requesting the counseling opportunity. “Our days are so busy,” she says. “Sometimes you won’t even know how much something has affected you until much later.”

EMERGENCY ROOM TRAUMA

When a critical incident occurs, an otherwise healthy individual’s coping skills can be shaken. After providing care, it is vital for clinicians to have the space to process their emotions about violence.

Dr. Rich Jeisy remembers the shock and trauma that he felt after treating patients in the triple shooting at Taylorville Memorial Hospital’s Emergency Department in March 2018. Afterward, he was simply staring at his computer. “I needed to chart but didn’t feel like I could focus,” says Jeisy. “All of the emotion of the last two hours seemed to come crashing down.”

Jeisy had been working an overnight when the countywide EMS radio went off, calling for response to a gunshot wound. While examining a patient for a general illness, Jeisy recalls the traumatic scene and sequence of events:

I was examining the patient when there was a commotion at the ambulance door. One of the nurses opened the door, and a firefighter walked in with two patients with gunshot wounds. They were immediately taken to our two trauma rooms with nurses taking each one. I quickly left the patient I was seeing and attended to the more seriously wounded patient. When I determined that patient was stable, I moved to the other. As I bounced back and forth between the two rooms, we received a call from EMS. They were on the scene and had a patient with a gunshot wound to the head. Amazingly, that patient was alert and responsive. I knew that we would need one of the trauma rooms, so we quickly moved one of the other patients. At the same time, our charge nurse and I declared a mass casualty event.

Jeisy says he could not be more proud of the nurses and techs who were in the ED that day.

“They did an amazing job of focusing on patient care and keeping the patients calm during a hectic situation,” he says. “They were all business and did a great job of ignoring the emotional aspect of this until everything else was done.”

Jeisy says he felt fortunate he was able to discuss the incident with his colleague and SIU classmate, Dr. James Waymack—“someone who understood the situation from a physician standpoint”—at the shift change. He then headed home to explain everything to his wife.

“Talking about it with someone who knows me so well was equally helpful,” he says.

With the nature of the work and long hours, emergency care faculty are especially watchful for how post-traumatic stress affects staff, Waymack says. Whenever necessary, a huddle or debrief will be called to capture the team that experiences a critical incident, so they can talk about everything and do immediate post-processing.

John Sutyak, MD, associate professor of surgery and director of the Southern Illinois Trauma Center, appreciates that residents have counseling available. “And we make certain they have a support system in place and encourage them to take time to care for themselves,” he says.

In addition to counseling and conversations with coworkers and family members, other popular stress relief options for health care employees include:

• listening to music
• getting sufficient sleep
• eating with nutrition in mind, minimizing sugar and caffeine
• avoiding alcohol and drug use
• exercise, especially when alternated with relaxation

Both Waymack and Sutyak endorse exercise as a practical prescription. “When your mind’s not right, focus on your body,” Waymack said. But the crucial element is for the healer to recognize that he or she needs healing, and then to actively pursue it.

PLANTING THE SEED

USING TRAUMA-INFORMED CARE

By Jan Hill-Jordan, PhD

“Start where you are. Use what you have. Do what you can.” - Arthur Ashe

If an audience standing in a conference room is asked, “If you or anyone in your family was a victim of child abuse, sit down,” a few people would sit down.

“If you know someone who was a victim or perpetrator of domestic violence, sit down” – a few more people would sit down.

“Did a friend or family member commit suicide? Please sit down.”

“If someone you know was murdered, sit.”

Eventually, nearly everyone would be sitting. Experiences with violence are widespread and the impacts can devastate individuals and even entire communities.

What we can achieve through trauma-informed care is to plant the seed that no one deserves abuse and that help is available when the person is ready.

Violence that culminates in death represents the furthest point along a continuum from verbal abuse and abusive behaviors to threats of violence to physical battering. However, approaches to prevention and intervention have traditionally been piecemeal and address a specific form of violence, such as mandatory child abuse reporting laws or anti-bullying school programs. Most health care professional ethics promote or require a proactive response to intimate partner violence (IPV). Under Illinois law, “Any person who is licensed, certified or otherwise authorized by the law of this State to administer health care in the ordinary course of business or practice of a profession shall offer to a person suspected to be a victim of abuse immediate and adequate information regarding services available to victims of abuse” (750 ILCS 60/401). However, efforts within health care systems to incorporate screening and services for patients experiencing violence have met with well-documented challenges at the institutional and provider levels. Research suggests that a multifaceted, systems-level approach produces the best outcomes for survivors.

Trauma-informed care (TIC) offers a holistic response to violence and trauma, building on research related to individual risk factors (particularly the Adverse Childhood Experiences studies), research on IPV screening, and the hard lessons learned from 50 years of victim advocacy. TIC is marked by a fundamental paradigm shift from “What is wrong with you?” to “What has happened to you, and how can we help you heal?” It is the individual’s experience of the event, not necessarily the event itself, that is traumatizing.

TIC recognizes that trauma is common across providers and patients. This can affect both the extent to which patients engage with treatment, but also how providers approach patients who disclose trauma. Our trauma experiences can also affect how we interact with colleagues who may be experiencing a violent event or traumatic memory.

Screening for specific trauma experiences, such as domestic violence, can be uncomfortable for both providers and patients. When asked in a way that sounds judgmental, the patient can feel pushed away or embarrassed. Alternatively, the provider can assume a history of trauma and provide universal education regarding the relationship between trauma and physical and emotional health. Universal education is designed to educate patients about trauma, relationship red flags, activities to help healing, and basic safety planning, in a nonthreatening manner. This approach, offered by Futures Without Violence, provides an opening for the patient to engage in further discussion, if they wish. Thus, universal education is integrally linked to an institutional infrastructure that facilitates meeting patients where they are with regard to their psychological and physical safety.

Health care professionals enter their professions with the goal of helping people achieve better health. In the case of survivors of violence, the “goal” of having the patient leave a violent situation may not be feasible at that moment. What we can achieve through trauma-informed care is to plant the seed that no one deserves abuse and that help is available when the person is ready. Changes in institutional culture and changes in practice revolve around each other in a complex dance. As individual providers change their practice, the culture changes. As the institution invests in infrastructure and training, individual practice changes. The goal is to create a safe space for both patients and colleagues to confront their trauma experiences and move toward a healthier future.

STRESS MANAGEMENT TEAM OFFERS CARE FOR FIRST RESPONDERS

When critical incidents occur, it is the firefighter, police officer or emergency service driver who is called to the scene. Their willingness to confront dangerous situations and aid people in distress is “just part of the job.” Unfortunately, so is the post-traumatic stress that can sometimes result.

A group of volunteers in central Illinois have organized to help the people who help others. They are coordinated by Kathy Martin, LCPC, a Springfield police officer who has been doing personal and family counseling for a decade. The 11-member Sangamon Valley Critical Incident Stress Management (CISM) team is comprised of volunteers from SIU School of Medicine, other health care organizations, law enforcement, EMS and dispatchers. The team offers debriefings, counseling, education and more by appointment.

“Everyone is welcome, so individuals won’t feel singled out if they are struggling,” says Martin. “We’ll talk about the incident together. Maybe you’ll say something that can help someone else, or you’ll hear something that helps you.”

RESOURCES

Critical Incident Stress Management

• Contact the stress management team at SangamonValleyCISM@gmail.com.

SIU School of Medicine

• Meghan Golden, LCSW, SIU representative on CISM team, mgolden49@siumed.edu; 217.747.0849
• Christine Todd, MD, Chair of Medical Humanities and SIUSOM Center for Human and Organization Potential Wellness Leader; ctodd@siumed.edu; 217.545.4261
• Jan Hill-Jordan, PhD, Center for Clinical Research and Department of Psychiatry, jhill2@siumed.edu; 217.545.7626

Larry Jones, MD, ‘76, with students Elizabeth Wieland, Matt Mannion, Logan Grubb and Cody Bailey

Michael Pick, MD, ‘76, with students Ryan Bowman, Kristen Cecil, Brett Nelson and Kyle Whittington

2010s

Bethany Burge, MD, ’11, and her husband, Nick, welcomed twin girls, Evelyn and Blair, in May 2018. Bethany is an attending physician for Northwest Community Hospital in Arlington Heights.

Marshall Holland, MD, ’13, and his wife, Farrell, welcomed a son, Taeden Gideon Holland, in September. Marshall is halfway through the chief year (6 of 7) of a neurological surgery residency at the University of Iowa Hospitals & Clinics.

Kevin Simon, MD, ’15, received the NIDA-AACAP Resident Training Award in Substance Use Disorders (SUD) to support the development of SUD expertise through mentored experience and a project that utilizes existing evidence-based treatment science. He’ll be recognized at AACAP’s annual meeting in Chicago, October 14-19.

Dax Volle, MD, ’16, (pictured with family) is a third-year resident in geriatric psychology at UCLA-Resnick Neuropsychiatric Hospital, Semel Institute for Neuroscience and Human Behavior. Next year, he will serve as chief resident. Dax and his wife, Laila Abdo, welcomed a daughter, Amira Nassima Volle, in October.

Evyn Neumeister, MD, MPH, ’17, received the SIU Department of Surgery Teaching Award.

Sean and Jacque Murray, MDs, ’17, were featured in the February 12 AAMC News regarding how romance can soar amid the intense demands of medical school. In 2019-2020, Sean and Jacque will serve as chief residents in their respective departments, emergency medicine and family medicine, at Carolinas Medical Center in Charlotte, North Carolina. https://news.aamc.org/medical-education/article/match-made-medical-school/

T. L. Newsome, MD, ’17, published “Rapid complete atrioventricular heart block reversal due to Lyme carditis” in the Journal of Community Hospital Internal Medicine Perspectives.