Tag Archives: Physician

Physician Fired After Slurs, Including 'Cannibalism,' Against Israel

Fidaa Wishah, MD, a pediatric radiologist at Phoenix Children’s Hospital in Arizona, has been fired after the hospital reviewed evidence that included her anti-Israel comments on social media, according to the hospital’s statement.

On May 26, Wishah posted, “We will uncover your thirst to kill our Palestinian children. … We sense your fear. The fear of your collapse. A state based on atrocity, inhumanity, racism and cannibalism never last long! Hey #israel…your end is coming sooner than you think.”

Phoenix Children’s Hospital did not respond to Medscape Medical News‘ request for comment, but said in a statement to the Jewish News Syndicate : “After a thorough review of the facts related to this matter, this individual is no longer providing care at Phoenix Children’s. All children in the care of Phoenix Children’s receive hope, healing and the best possible health care, regardless of race, color, disability, religion, gender, gender identity, sexual orientation or national origin.”

Wishah’s profile has been removed from the hospital website. Her LinkedIn profile indicates she had been a pediatric radiology fellow at Stanford University in California, specializing in advanced magnetic resonance imaging and fetal imaging and had been a senior staff pediatric radiologist at Henry Ford Health System in Detroit, Michigan.

It wasn’t the first time antisemitic comments have led to the firing of a physician. Medscape Medical News wrote last year about Lara Kollab, DO, a first-year resident fired for her antisemitic tweets. She was subsequently barred from medicine.

In the same post from May 26, Wishah also wrote: “We will not be #censored anymore ! Bomb our media buildings and we have the phones[.] Bribe the mainstream media and we have our small #socialmedia platforms[.] From our windows.. from our streets .. next the rubble we will expose you to the world[.] We will expose the #massacre and #genocide you #zionists are proud of[.]”

Today, CAIR-AZ, a group whose mission is to “enhance understanding of Islam, protect civil rights, promote justice, and empower American Muslims,” according to its website, announced that it, along with three private law firms, will represent Wishah in what they referred to as “her wrongful termination case against Phoenix Children’s Hospital.”

The announcement, which mentions that Wishah was born and raised in Gaza, said, “Dr. Wishah has been a medical doctor since 2010 and has spent the vast majority of her career as a pediatric physician. Despite caring for thousands of children, many of whom are Jewish, she has never been accused of discriminating against any of her patients or colleagues.”

The statement added, “PCH’s decision to terminate Dr. Wishah is shameful and an attack on freedom of speech.”

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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This post originally appeared on Medscape Medical News Headlines

Physician warns Tokyo Olympics could spread variants

The chairman of the Japan Doctors Unions says the IOC and the Japanese government are underestimating the risks of the Olympic Games.

TOKYO, Japan — A physician representing a Japanese medical body warned Thursday that holding the postponed Tokyo Olympics in two months could lead to the spread of variants of the coronavirus.
Dr. Naoto Ueyama, chairman of the Japan Doctors Union, said the International Olympic Committee and the Japanese government had underestimated the risks of bringing 15,000 Olympic and Paralympic athletes into the country, joined by tens of thousands of officials, judges, media and broadcasters from more than 200 countries and territories.
“Since the emergence of COVID-19 there has not been such a dangerous gathering of people coming together in one place from so many different places around the world,” he said, speaking in Tokyo at the Foreign Correspondents’ Club of Japan. “It’s very difficult to predict what this could lead to.”
Ueyama continually likened the virus to a “conventional war” situation, and said he was speaking from his own experience as a hospital physician who works just outside Tokyo. He has not been involved in any of the Olympic planning.
“I think the key here is if a new mutant strain of the virus were to arise as a result of this, the Olympics,” he said.
The IOC and local organizers say they have been relying on the World Health Organization for public-health guidance. They say the Olympics and Paralympics will be “safe and secure,” focused on extensive testing, strict protocols, social distancing, and keeping athletes largely isolated in the Olympic Village alongside Tokyo Bay.
The IOC has said it expects more than 80% of the people living in the village to be vaccinated. This contrasts with a very slow rollout in Japan where less than 5% of the public has been vaccinated.
Ueyama, who is the chairman of a body that represents 130 physicians, joins other medical experts in Japan in voicing opposition to holding the Olympics. On Wednesday, Japan’s mass-circulation Asahi Shimbun newspaper called for the Olympics to be canceled.
Earlier this week, the New England Journal of Medicine said in a commentary: “We believe the IOC’s determination to proceed with the Olympic Games is not informed by the best scientific evidence.”
It questioned the IOC’s so-called Playbooks, which spell out rules at the games for athletes, staff, media and others. The final edition will be published next month.
“The IOC’s Playbooks are not built on scientifically rigorous risk assessment, and they fail to consider the ways in which exposure occurs, the factors that contribute to exposure, and which participants may be at highest risk,” the publication wrote.
The British Medical Journal last month in an editorial also asked organizers to “reconsider” holding the Olympics in the middle of a pandemic.
Ueyama said strains of the virus found in Britain, Brazil, India and South Africa could find there way to Tokyo. He repeated that PCR testing and vaccines are not foolproof.
“Such a decision (to hold the Olympics) is not something to be made only by the IOC or only by the one host country,” he said. “I am an Olympic fan. However, I don’t think they should go ahead while pushing many people into danger or calling on many people to make sacrifices in regard to their lives in order for them to take place.
“It is dangerous to hold the Olympic Games here in Tokyo,” Ueyama added.
He stressed what others have said — holding the Olympics will place Japan’s medical system under more strain. Tokyo, Osaka and other parts of Japan are under emergency orders that are likely to be extended past the May 31 expiration.
“It will not be possible for hospitals to provide any special treatment for those involved in the Olympics,” he said. “They will be having the same treatment under the same rules that are available to the Japanese people.”
More than 12,000 deaths in Japan have been attributed to COVID-19, good by global standards put poor compared to other parts of Asia. Many of those deaths have occurred in the last few months as new cases have spread quickly.
Japan has officially spent $ 15.4 billion to organize the Olympics, although government audits say it may be much higher. All but $ 6.7 billion is public money.
The IOC depends on selling broadcast rights for 75% of its income. It stands to generate an estimated $ 2-3 billion from TV rights in Tokyo no matter if fans are allowed to attend or not.
So far, fans from abroad will be banned, and next month organizers will say if any local fans can attend.
Senior IOC member Richard Pound of Canada has been speaking out almost daily, focused on convincing Japanese — and a global audience — that the Olympics will not be canceled. He told the Japanese magazine Bunshun this week that games the games will be held.
His interview was translated from English to Japanese.
In an interview this week in London’s Evening Standard, Pound said: “Organizers have now changed gears and they’re in the operational part of it. Barring Armageddon that we can’t see or anticipate, these things are a go.”
Ueyama bristled at the comments.
“The Olympic Games are not something that should be held even to the extent of Armageddon,” the doctor said. “The question is for whom are the Olympics being held and for what purpose? I don’t think that someone who could make such statement has any understanding of these questions.”

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This post originally appeared on CBS8 – Sports

Less After-Hours Work on EHRs Linked to Less Physician Burnout

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This post originally appeared on Medscape Medical News Headlines

Physicians who spend less time charting after-hours and those who have better organizational support for their electronic health records (EHRs) are less likely to report that they feel burned out, according to a large-scale study published April 23 in the Journal of the American Medical Informatics Association.

Among the physicians who responded to the surveys used in the study, doctors who spent 5 hours or less a week on after-hours charting were twice as likely to report lower levels of burnout than those who charted after-hours for 6 or more hours per week.

The same was true for respondents who said their healthcare organizations had done a great job with EHR implementation, training, and support.

The researchers used data from the KLAS Arch Collaborative, which was started in 2017 to measure and establish a benchmark for the clinician EHR experience. (KLAS is an independent health information technology firm that publishes survey results on various types of software.)

Since then, more than 200 healthcare organizations have participated in the Arch Collaborative. About two thirds of the 25,000 physician respondents in the study were affiliated with academic medical centers or large healthcare systems, and less than 5% were physicians in ambulatory care practices.

In 2018, Arch added a question about physician burnout to its survey. It also measures after-hours charting by asking how many hours per week physicians spend on this activity.

In the study, the likelihood of experiencing symptoms of burnout became more common with each increase in time spent on after-hours charting. The largest jumps occurred between 0-5 hours (57% of the sample) and 6-15 hours (35%).

Just more than one third (35%) of the respondents agreed that their organization provided excellent EHR support, and 9% strongly agreed. The correlation with lower burnout in this cohort was independent of how much after-hours charting the respondents did, the study shows.

Overall, 30% of the physicians reported symptoms of burnout — a considerably lower number than the 42% of doctors who reported burnout in a recent report on the problem by Medscape. The researchers said this disparity could have been related to differences in the burnout measurement and study design.

The researchers did not look at how burnout was correlated with the type of EHR used. More than two third (69%) of the respondents used the Epic EHR, followed by Cerner at 15.8%. Nearly 52% of the respondents had been using an EHR for at least 5 years.

Although no demographic data was available on the respondents, the study used the length of time a doctor had been in practice as a proxy for age in adjusting the data for confounding factors. A third of the respondents had been practicing medicine for 25 or more years; 28.6%, for 15-24 years; 31%, for 5-14 years; and 5.3%, for 0-4 years.

Big Differences Among Specialties

There were significant differences among specialties in reported burnout, after-hours charting, and organizational EHR support.

The specialties with the highest levels of burnout were family medicine (34%), hematology/oncology (33%), internal medicine (32%), neurology (31%), cardiology (30%), and pediatrics and pulmonology (28%). The specialties with the lowest levels of burnout were psychiatry (22%), anesthesiology (24%), and orthopedics (25%).

Among doctors who charted after-hours for 5 or fewer hours per week, most specialties reported lower levels of burnout than did doctors in the same specialties who charted longer outside the office. This was especially notable for ob/gyns and pediatricians. Among the doctors who said their healthcare organizations had done a great job of implementing and supporting their EHR, all specialties had lower levels of burnout, particularly cardiology and neurology.

Forty-three percent of the physicians did 6 or more hours of weekly after-hours charting. There were large differences among specialties. At the high end were hematology/oncology (60%), pulmonology (56%), and family medicine and internal medicine (53%). At the low end were radiology (12%), anesthesiology (14%), hospital medicine (34%), and psychiatry (37%).

Forty-four percent of all respondents approved of their organization’s EHR support. The leaders in this area included hospital medicine (54%), pediatrics (50%), anesthesiology (49%), and family medicine and internal medicine (47%). The specialties least satisfied with their organization’s EHR performance included radiology (35%), orthopedics (37%), cardiology (38%), and pulmonology (39%).

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Physician Support for Open Notes Grows Over Time, With Caveats

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This post originally appeared on Medscape Medical News Headlines

Although most physicians surveyed expressed doubt about sharing clinical notes with patients before having done so, a new longitudinal study finds that their outlook has shifted dramatically with experience.

The findings, which come just weeks after federal legislation began requiring physicians to share notes with patients, were published online on April 22 in the Journal of General Internal Medicine.

James Ralston, MD, MPH, and his team at Kaiser Permanente Washington Health Research Institute, in Seattle, Washington, analyzed responses from 192 physicians (119 in primary care, 47 in medical specialties, and 26 in surgical specialties). Patients were invited to view their visit notes online in 2014 and again in 2018, 15 months after an open notes program was widely implemented in the Kaiser system.

Before implementation, 29% of physicians agreed or somewhat agreed that making notes on clinical visits available online benefited patients overall. After implemnation, that percentage grew to 71% (P < .001). In addition, 44% of physicians switched from thinking it was a bad idea to thinking it was a good idea. Only 2% switched from thinking it was a good idea to thinking it was a bad idea (P < .001).

Attitudes shifted after implementation across all clinician categories.

“I think the overall message is positive: It’s likely going to have less impact on your practice than you think,” Ralston told Medscape Medical News.

Number Who Worried About Time Demands Drops

The proportion of physicians concerned that office visit time would increase dropped from 47% before implementation to 15% after. The percentage of those who thought more time would be needed for patient questions dropped from 71% to 16%. Similarly, before implementation, 57% thought it would take more time to produce the notes; after implementation, 28% thought so.

Beliefs that patients would have more control of their care were strong to start with and increased slightly, from 72% to 78%. By contrast, beliefs that patients would worry more if they could see the notes decreased slightly, from 72% to 65%.

Both before and after implementation, most clinicians said note sharing led to their notes being less candid (65% vs 52%).

The authors report that the pattern of change was similar across primary care, medical specialty, and surgical specialty physicians.

Shifting Landscape

Ralston and colleagues note that responses of patients have been consistently positive. For example, patients report being better prepared for clinic visits, having better understanding of their care plan, particularly medications, and feeling more in control of their care.

But few studies have assessed physicians’ views over time, and there is still considerable work to be done to make open notes valuable and effective.

In some areas, confidence in note sharing dropped significantly.

Before implementation, a higher percentage of clinicians reported that patient satisfaction and safety would improve (40% and 33%, respectively). After implementation, 17% and 11%, respectively, felt that way.

“To realize its potential to improve safety, quality, and experience of care, open notes may need to be coupled with additional interventions,” the authors write.

Mental Health Clinicians Not Included

Among the limitations of the study, the authors note that they did not include mental health clinicians, who may have more concerns about open notes.

Steven Reidbord, MD, a psychiatrist in private practice in San Francisco, California, said adding mental health experts may have altered the outcomes of this study.

“Mental health clinicians have more to be concerned about ― not only the motivation of patients looking at their notes but also what they’re apt to conclude from them,” he said.

Reidbord, who blogs for Psychiatry Today, told Medscape Medical News he doesn’t think that note sharing is bad and that patient engagement is always good. “I just don’t think it helps anything. It’s a feel-good measure,” he said.

Reading clinical notes isn’t the best way to engage patients in their care, he said. He pointed out that clinical notes are often technical and typically are filled with jargon.

More helpful, he said, would be more patient-directed literature to help patients ― “not the work product of the doctors who are trying to get the work done.”

He continued, “Transparency is good. It’s just that this is a poor tool to do that.”

Open notes likely are best suited to primary care, he said. He agrees that it’s good to know from this study that most physicians were reassured that open notes do not increase their workload or visit time.

When asked about the drop in physicians’ belief that open notes would improve patient safety or satisfaction over the study period, Ralston said the likely explanation is that the number of patients who read notes was smaller than they had expected.

“We had 10% to 11% of our notes being read,” he said. “We waited until we had 11 continuous months where 10.5% of the notes were being read, and that occurred only after we started sending patients an email notification that they had a note ready for review.”

That may undermine one of the purposes of open notes, in that if patients aren’t reading the notes, they won’t be pointing out errors and asking questions that might improve safety and quality.

Reidbord said that if patients aren’t reading the notes, it fuels the question of the value of open notes.

Additionally, 74% of physicians surveyed reported that the value of their notes to other clinicians remained the same before and after implementation, “with a quarter (25%) reporting much less or somewhat less value,” the authors say.

“It’s one more thing doctors have to do that doesn’t really help healthcare,” Reidbord said. “The notes aren’t for public consumption, particularly. You don’t go to a restaurant and ask the chef to see their recipes. It’s not a secret, it’s just not part of the experience.”

The survey was funded by The Group Health, Robert Wood Johnson, Gordon and Betty Moore and Cambia Health Foundations. The authors and Reidbord have disclosed no relevant financial relationships.

J Gen Intern Med. Published online April 22, 2021. Full text

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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