CHARITY BEGINS AT HOME
SIU Medicine tops leaderboard in annual SIU Day of Giving
Southern Illinois University Carbondale held its third annual Day of Giving on Wednesday, March 6. The 24-hour fundraising campaign raised more than $909,000 for scholarships, programs and other SIU priorities. The School of Medicine raised more than 16 percent of that total, bringing in more than $150,000. The participation at the school also increased from 250 donations to 395.
Thanks to the generosity of employees, retirees, alumni, learners and community members, the School of Medicine won the coveted SIU Day of Giving traveling trophy for the most dollars raised by an academic unit. The school also earned the trophy for most individual gifts.
Hal Smith joins SIU Medicine as executive director of development
The Foundation Office at SIU School of Medicine welcomed new leadership in February. Hal Smith, who has served in senior staff roles for members of the US House of Representatives and the Senate, brings more than 40 years of public and private sector experience to the Springfield Foundation office.
Smith, a Springfield native, has previously worked in development, first at Springfield College in Illinois and more recently at Lincoln College. Over the years he has also served in various roles in state government and spent nearly 30 years as a marketing consultant for Arthur Young (now EY) Consulting Services, Scientific Games, Inc., IGT Corporation and Jonathan Goodson Productions.
Smith has a passion for working in partnership with organizations to improve the local community. “Springfield is my hometown,” said Smith. “After many years of traveling elsewhere to earn a living, I am now focused on efforts to help strengthen this community. It is my honor to join the very capable staff at the SIU School of Medicine Foundation to support the institution’s ongoing mission of providing improved health care and educating medical providers for the 2.2 million residents and communities of central and southern Illinois.”
To connect with Smith, visit the Foundation Office at 409 W. Calhoun Ave. in Springfield, or reach out at 217-545-6447 or firstname.lastname@example.org.
NOW SERVING CHRISTIAN COUNTY
Family Medicine partners with Taylorville Memorial Hospital
SIU School of Medicine opened the Center for Family Medicine - Taylorville inside Taylorville Memorial Hospital on January 15.
Janet Albers, MD, along with physician assistant Christine Albers and nurse practitioner Airn Etherton will see patients three half-days per week. Services provided at the clinic include: well child care, chronic illness management, women’s health, geriatrics and behavioral health.
Taylorville Memorial Hospital is a 25-bed critical access hospital with a mission to improve the health of the people and communities they serve. The hospital is fully accredited by the Joint Commission and is an affiliate of Memorial Health System.
The SIU Department of Family and Community Medicine now serves patients in 10 sites in central and southern Illinois.
SIU Medicine presents 'The Vagina Monologues'
On February 15, faculty, staff and learners, including Brittany Idusuyi, Class of 2019, presented “The Vagina Monologues,” by activist and playwright Eve Ensler. Proceeds benefitted The Phoenix Center, Central Illinois’ LGBTQ community center, and Sojourn Shelter and Services, which provides housing and resources for domestic violence victims, supporters and the community.
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.
Breast cancer survivor walks at New York Fashion Week
Two-time breast cancer survivor and SIU Institute for Plastic Surgery patient Susan Danenberger strutted the AnaOno Intimates runway at New York Fashion Week on Feb. 10 in Manhattan. Danenberger, owner of Danenberger Family Vineyards in New Berlin, was one of 24 models, all of whom are living with or are in remission from stage IV, metastatic breast cancer.
AnaOno Intimates, which specializes in apparel for breast cancer patients and survivors, is in its third year at New York Fashion Week. The show aimed to shine a light on those living with metastatic breast cancer and raise funds for METAvivor Research and Support, Inc., a nonprofit organization that funds research to benefit people with stage IV breast cancer. According to METAvivor, only 2-5 percent of money for breast cancer research is dedicated toward metastatic breast cancer or finding solutions to extend the lives of MBC patients.
Danenberger used the platform to raise awareness not only about metastatic breast cancer and breast reconstruction, but also about the quality of care available in her own backyard of Central Illinois. After an out-of-state reconstructive surgery left her with dented, asymmetrical breasts, Danenberger returned to Springfield where fellow-ship-trained plastic surgeon Nicole Sommer, MD, FACS, ‘96, director of SIU Medicine’s Cosmetic Clinic, performed three reconstructive surgeries.
I learned from my sisterhood that it’s okay to be strong and sensitive, brave and scared. I learned that I am never alone and that it’s important to both lean on others and be the person holding someone else up. -Susan Danenberger
Danenberger first battled breast cancer in 2014. Two years later, she was diagnosed with metastatic breast cancer and underwent a double mastectomy. Now Danenberger says she is ready to move from cancer patient to cancer survivor. “I made it,” she said. “I made it through all of this. This show was a celebration.”
Sommer joined Danenberger on her trip to Fashion Week along with Maria Ansley, photo-grapher at the SIU Medicine Institute for Plastic Surgery, and Nicole Florence, MD, Danenberger’s primary care doctor from Memorial Physician Services, who is also a 1996 graduate of SIU School of Medicine.
Senior medical students in the graduating Class of 2019 at SIU School of Medicine received results from the National Resident Matching Program Friday, March 15, at the same time other U.S. medical students learned their matches to postgraduate training programs. Sixty-three SIU seniors secured residency positions.
Match results also were announced for SIU’s residency programs in Springfield, based at the school’s two affiliated hospitals – Memorial Medical Center and HSHS St. John’s Hospital. Seventy-eight starting positions in Springfield were filled. The first-year residents will join more than 200 senior residents and fellows already in training at SIU programs in Springfield.
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.
REMEMBERING DR. TAMARA O'NEAL
By Anneke Metz, PhD, Interim Director of MEDPREP
All of us at MEDPREP (Medical/Dental Education Preparatory Program) were heartbroken to learn of the death of one of our own, Dr. Tamara O’Neal, who was a MEDPREP student from 2007-09. After MEDPREP, Tamara went on to complete her MD at the University of Illinois at Chicago, followed by a residency in emergency medicine. She was working as an emergency department physician at Mercy Hospital in Chicago at the time of her death.
Dr. O’Neal, who was affectionately known at “TO” by her colleagues and friends, was beloved for her smile, her kindness, and her generosity of spirit. She had a passion for helping her community and wanted to be a physician to help the people of Chicago, particularly the south side. Her love for her community was evident in all she took on in life. Tamara entered college to study child psychology, and completed her bachelor’s degree from Purdue University in 2002. She then worked for several years as a case manager for troubled adolescents. She was proud of the role she played helping many of the youth she worked with to become more open and trusting, and even complete high school and attend college.
Despite her success in social work, Tamara knew medicine was her calling, and she returned to school to fulfill that dream. In applying to MEDPREP, Tamara expressed a desire to save lives in underserved communities, because those individuals’ medical care was often overlooked due to poverty. She dedicated herself to a grueling course of medical study, not to become rich or famous, but because she wanted to be a leader for change in her community, to right the wrongs, and to reach out to those who needed a helping hand. It wasn’t going to be easy, but Tamara was all-in.
Even as an aspiring medical student, she was tenacious and strong, and it was clear that Tamara had what it took to become an outstanding physician. She often spoke about experiencing many setbacks in her own life, which might encourage someone to give up. However, she always also said that she refused to give up on herself, and as a physician, would not do so on her patients, either. With that tenacity and dedication, she tackled MEDPREP, and medical school, and residency, and made it every time.
For her hard work, her great tenacity, her infectious enthusiasm, and her big, ready smile, she will never be forgotten.
Breanna Taylor, MD, who attended medical school with Dr. O’Neal, recalled how Tamara was the driving force behind organizing her fellow black medical students into a study group that would ensure they all succeeded. They came to call themselves the “One-Hitter Quitters”—for any test, they would do it right the first time—no failures, no repeats. Tamara was driven to get there herself, but it was also important for her to mentor others along the way. This is the Tamara that MEDPREP faculty remember; someone who did not just think about herself, but always made sure everyone around her was lifted up, too.
Tamara had as a personal goal to not only be a good physician, but to be a caring role model as well. As a MEDPREP student, in medical school and a successful physician, she continued to hold that goal in her heart, and lived every day of her life with that promise. She chose emergency medicine to help those that needed her the most: the underserved who often end up in the emergency department as a last resort when they have nowhere else to turn. Dr. O’Neal was a loving and generous soul, and a tenacious advocate for the least fortunate among us.
Although she was taken from us too soon, Dr. O’Neal more than made good on that promise made those years ago as a MEDPREP student, to serve as a role model and to help others as a good physician. She made every difference to those whose lives she touched, and she made this world a better place. For her hard work, her great tenacity, her infectious enthusiasm, and her big, ready smile, she will never be forgotten. Dr. O’Neal, we celebrate all that you accomplished, and keep your passion for service, your devotion to others, and your joy for life close to our hearts. Rest in peace, and may you serve as an example to us all.
Tamara O'Neal Scholarship
Dr. Tamara O’Neal holds a special place in the hearts of MEDPREP classmates like Kamilah C. Banks-Word, MD, MA. To honor her memory and carry Dr. O’Neal’s legacy forward to future generations of MEDPREP students, Dr. Banks-Word and a committee of MEDPREP alumni have started the Dr. Tamara O’Neal MEDPREP Scholarship.
To endow this scholarship and provide support to bright and motivated students for years to come, we need your help. Preserve Dr. O’Neal’s legacy by making a gift today.
#THIS IS OUR LANE
By Richard Austin, MD, '14
“Someone should tell self-important anti-gun doctors to stay in their lane….” On November 7, 2018, the NRA, in response to a position paper from the American College of Physicians, tweeted that doctors should stay in their lane when it comes to gun violence research. This tweet led to a massive response from not just physicians, but health care workers of all types as well as the general public. The majority felt that gun violence research was firmly in the lane of physicians.
The fact is that gun violence is responsible for 36,000 deaths every year. Unfortunately, this year it hit home for the SIU family. Dr. Tamara O’Neal, a graduate of the SIU MEDPREP program, was murdered while working as an emergency physician in Chicago by her ex-fiancé. Victims of domestic abuse are five times more likely to be killed if their partner owns a firearm, and over half of intimate partner homicides are committed with a firearm. Despite these facts, federal funding for gun research continues to be restricted, largely due to the Dickey amendment, which was passed after a study showing gun ownership was independently associated with an increased risk of homicide.
Setting aside the contentious nature of any debate surrounding firearms, there is common ground between most Americans on much of this topic. By almost every objective measure, more people die in the U.S. from guns than anywhere else in the developed world. Gun violence is a common thread linking deaths from suicide, homicide, mass murder and domestic violence. Similar to motor vehicle accidents, SIDS, HIV, or any other public health crisis, studying and attempting to reverse trends in morbidity and mortality is firmly within the lane of physicians and public health experts.
Researching gun violence is too often assumed to mean increasing gun control or restricting second amendment rights. Researching gun deaths is often combated with emotional appeals to a Second Amendment right, but that doesn’t have to be the case. Cars weren’t banned when we studied seatbelts and sex wasn’t banned when studying HIV. The successes came from safer practices that prevented injuries and transmission, and not for removal of rights.
Injury prevention of any kind is well within our scope, and we should be leading the charge to study ways in which we can improve the lives of those within our community. The beauty of this being in our lane is that more than advocacy groups on either side of the debate, we are well equipped to provide unbiased interpretations of objective data that can potentially save lives. The alternative is to continue to sit idly by, treating a growing number of increasingly devastating injuries and mourning alongside families, wishing we could’ve done more.
This is our lane.
Richard Austin, MD, is an assistant professor of emergency medicine and the assistant emergency medicine residency program director. His interests include medical education, public policy and simulation. He is a lifelong resident of Springfield and a graduate of SIU School of Medicine’s Class of 2014, and the SIU Emergency Medicine Residency. He practices clinically at Memorial Medical Center, an Academic Level 1 trauma center.
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.
Trauma-informed care (TIC) uses an ecological framework that encourages culture and infrastructure changes at the institutional level, combined with individual-level practice change. Best practices in TIC are coalescing around an institutional-level response that includes the following:
- Creating a safe and welcoming physical environment; using welcoming language on signage
- A clinic environment that conveys a message that the patient can address violence and trauma with the provider; brochures and posters; perhaps a video playing in the waiting room addressing themes of trauma and health
- Universal education for all patients regarding the relationship between trauma and health, combined with an interdisciplinary team approach that provides seamless provision of services to high-risk patients (e.g., integrating primary care and behavioral health)
- Training providers to sensitively and safely ask high-risk patients about current violence and to recognize high-risk situations (for example, bruising, suicide threats, access to firearms by a perpetrator)
- Training all staff (clinical and nonclinical) upon hire and at regular intervals to facilitate TIC with both patients and one another
- Creating and encouraging a culture of staff wellness and educating staff members about vicarious trauma, burnout and the importance of self-care
- Creating policies and procedures for patient emergencies (such as a suicide threat) and shielding confidential information from the perpetrator
- Building partnerships with community-based agencies to facilitate “warm” referrals to domestic violence advocacy and other social services
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.”
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, email@example.com; 217.747.0849
- Christine Todd, MD, Chair of Medical Humanities and SIUSOM Center for Human and Organization Potential Wellness Leader; firstname.lastname@example.org; 217.545.4261
- Jan Hill-Jordan, PhD, Center for Clinical Research and Department of Psychiatry, email@example.com; 217.545.7626
In 2020, SIU School of Medicine is turning 50! Celebrate a half century of patient care, research, education and community service by nominating an outstanding alumna or alumnus. Medical student, resident, fellow, physician assistant, graduate student and MEDPREP alumni are eligible. Select nominees will be featured in digital campaigns and print publications throughout 2020.
Submit your nominations by July 31, 2019.
The Distinguished Alumni Award recognizes the MD alumni who have made an outstanding commitment to the health and welfare of their patients and community, as well as humanitarian activities (community setting), or who have made outstanding contributions to medicine and distinguished service to mankind (academic/research medicine).
Submit your nominations for this annual award by Sept. 1, 2019.
Alumni in Springfield and Carbondale invited medical students to dinner and conversation in March. These dinners provide rich opportunities for the students to learn more about life in medicine and outside the clinical arena.
Pictured: Max Hammer, MD, ‘76, with students David Forgas, Tom Pumo and Warren Skoza
Larry Jones, MD, ‘76, with students Elizabeth Wieland, Matt Mannion, Logan Grubb and Cody Bailey
Sierra Higginson, Treshawn Anthony, Amanda Mulch, MD, ’03, Barra Madden, and Yvette Igbokwe
Michael Pick, MD, ‘76, with students Ryan Bowman, Kristen Cecil, Brett Nelson and Kyle Whittington
John Benitez, MD, MPH, ’81, completed the military tropical medicine course at Uniformed Services University in Bethesda, Maryland, as well as six years of service on the American Academy of Clinical Toxicology Board of Trustees.
Thomas Diller, MD, ’83, is the Blue Cross and Blue Shield of Louisiana Vice President of Population Health and Quality Transformation.
David Dahl, MD, ’85, (pictured) summited Granite Peak, Montana, his 49th state highpoint.
Wesley McNeese, MD, ’86, director of diversity initiatives for the SIU System, received the 2019 Equity Award at the Third Annual Alonzo Homer Kenniebrew, MD, Presentation on Health Inequities and Disparities at the Memorial Center for Learning and Innovation in February.
Brian Dossett, MD, ’87, maintains his solo medical practice in Vandalia, providing both outpatient and hospital care. Three nurse practitioners keep his sanity and his work week short.
Patrick O’Donnell, MD, ’92, opened a satellite branch of his private clinic, BALANCED CARE Mental Health Services, in Belleville.
Susan Schaberg, MD, ’97, and her husband, T. Michael Ward, adopted a daughter, Caroline Grace Ward, in May 2017. Susan is president of Schaberg Dermatology in Glen Carbon, named the EdGlen Chamber of Commerce Business of the Month in February 2018.
Ronald Gotanco, MD, ’00, relocated to Carmel, Indiana, to be near family, including Ray Gotanco, MD, Class of 1999, and joined Riverview Anesthesia in Noblesville, Indiana.
Quinn Bensi, MD, ’05, a pediatrician in Zionsville, Indiana, manages the blog “Opening Up with Dr. Quinn Bensi” to discuss parenting and health care issues from a pediatrician mama’s perspective. She wrote an article published on KevinMD offering an intimate look into life’s transitions and how we can find enlightenment in our struggles. https://www.kevinmd.com/blog/2019/02/a-physician-leaves-her-practice-and-finds-beauty-in-the-struggle.html
Amanda (Wemlinger) Hahn, MD, ’08, joined University of Maryland Community Medical Group and practices general surgery and wound care. Amanda and her family live in Stevensville, Maryland.
Brandon and Jennifer Snyder, MDs, ’09, welcomed Connor Michael Snyder in September 2018. Connor joins his brother and sister who are “over the moon” with their little brother. Brandon is a radiologist with Clinical Radiologists, Springfield Clinic, and Jennifer is a pediatrician with Memorial Health System. The family lives in Springfield.
Holly Steiner, MD, ’09, married John C. Wright on November 11 in Red Bud. Holly practices OB-GYN at Washington University School of Medicine.
Tabatha Wells, MD, ’09, was selected to the American Academy of Family Physicians Commission on Education, a four-year position. Tabatha is faculty in the Department of Family & Community Medicine at SIU Medicine.
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.
PENNY TIPPY, MD
Written by Dean and Provost Jerry Kruse, MD, MSPH
I first met Penny Tippy in Springfield in 1984. I had just joined the faculty of the SIU Department of Family & Community Medicine at its site in Quincy. Dr. Tippy had joined the Department two years earlier, in 1982, as a faculty member in Carbondale, and had just been promoted to the position of family medicine residency program director.
I recall Penny’s great enthusiasm, her cheerful smile and her most perfect laugh. She had a precise understanding of the importance of the type of care delivered by family physicians—comprehensive, longitudinal, coordinated care, accessible. She was totally invested in the mission of meeting the health care needs of the people and communities of southern Illinois by training physicians who would stay and practice in the region. She had a vigor that wouldn’t stop.
Penny said something that day that I still remember. She said, “You won’t see me often in Springfield. I’m going to spend my time in Carbondale. That’s where I can do the most good.”
With time, I learned that Penny meant that she could have the greatest impact by being a residency program director for a long duration in the same place. And a long duration it was – Penny was the program director for SIU Carbondale for 28 years.
Penny knew, as program director, that she would have an impact on her own patients; on the careers and lives of her resident physicians; on the communities of Carbondale, West Frankfort and the surrounding area; on the state of Illinois; and on the nation. I’ll start at the national level.
The Association of Family Medicine Residency Directors (AFMRD) was special to Penny. She was on the founding Board of Directors of AFMRD in 1990 as secretary-treasurer. Her personal mission at AFMRD was to help develop many family medicine residency programs of excellence – to work with colleagues to provide support and advice on a national level.
Penny became the sixth president of the AFMRD in 1995. She was instrumental in the founding of NIPPD – the National Institute for Program Director Development, a program that has provided a fellowship to train the next generation of program directors. More than 900 family physicians have completed the fellowship in the past 20 years. NIPPD was Penny’s national pride and joy. She also held key positions with the AFMRD Residency Program Solutions program and the Family Medicine Review Committee for the Accreditation Council for Graduate Medical Education. For both positions, her mission again was to support and help, and to move the now more than 600 family medicine residency programs to positions of excellence.
Penny Tippy was a force of nature at the national level for family medicine residency programs. Fittingly, she was named the Outstanding Program Director in the nation by AFMRD in 2003.
Penny’s influence at the state and institutional level was no less. I’ll give you one example of many.
In 2006, Penny had arranged a total of about $500,000 in grant funding from the Illinois Healthcare Children’s Foundation and from the Office of the Lt. Governor for a new mobile medical office, the Care-A-Van, to provide medical services to the high school students in Benton and West Frankfort.
A news conference was held in the waiting room of the West Frankfort clinic, and was attended by a number of dignitaries, including Lt. Gov. Pat Quinn himself. I was in the audience that day, and had the privilege to be seated next to Penny’s father, Goebel Patton, who was brimming with joy. He said to me, “You know, Jerry, the Patton family motto is this: ‘Service is the rent we pay for the space we occupy here on earth.’ My daughter really gets that.”
The program began, and Lt. Gov. Quinn took the podium. During his address, he said this: “Penny Tippy is Illinois’ North Star shining brightly in the South!” Goebel and I looked at each other, and a tear came to Goebel’s eye. Then Penny took the podium. Among other things, she said, “Service is the rent we pay for the space we occupy here on earth.” More tears flowed. A program was born that would break down long-standing barriers to access and communication with adolescents who needed care the most.
In one of her presentations to the Residency Program Solutions group, Penny stated that a residency program director wore too many hats – those of “physician, administrator, teacher, politician, mentor, colleague, friend and disciplinarian.” All true indeed, and Penny loved every one of these roles.
As program director, she cared for a large number of her own patients as their personal physician. They loved her, and she loved them. She was a great clinician, because she knew her patients in the context of their family and their community.
She was directly responsible for the training, competence and excellence of the family medicine resident physicians – three years of training for each, six per year, for 28 years – more than 160 residency graduates altogether.
This is the role Penny loved the most. She was the residents’ mentor, role-model, leader, teacher, critic and consoler. A very high percentage of these graduates have stayed in the Carbondale region, the highest percentage staying in the local area of any of the SIU programs. They are the heart and soul of health care in southern Illinois.
As program director, Penny was also a great politician, exerting influence that many elected officials would envy. This work involved procurement of funding and the development of policies for new programs, to be ahead of the game. Penny always had a new and better idea.
An example is the SIU Physician Assistant Program. The PA program was established more than 20 years ago. Penny was a driving force for the development of that program. She had a vision for systems of interprofessional care – for teamwork – long before it became an accepted concept in medicine.
Penny left an indelible stamp, and her influence will live on.
How did she accomplish this? She did it with a smile on her face, and with infectious enthusiasm. She did it by recognizing talent, and building the members of her team. She did it through her personal values and expectations of others. Penny never flagged in zeal for her work. She took a real interest in every person and in the everyday part of their lives. She smiled, had fun, and laughed. This is what Penny instilled in others.
Today, we mourn the loss of Penny.
Today, we celebrate the life of Penny.
Penny Tippy – A champion for what is right in medicine and what is right in life. We will miss her.
This eulogy was written and delivered by Dr. Jerry Kruse at the memorial service for Dr. Tippy on December 29. It has been edited for length.