Rotations

Dawn Graham PhD is a wonderful person. She is one of the most hopeful colleagues that I know and so I enjoy working with her. I am also primed by a background in abnormal psychology so I tend to like psychologists. But in this series we are going to tackle the issues of burnout, resiliency, fear.

I think you will enjoy the episodes as much as I enjoyed recording them.

Dawn’s Bio at OU https://www.ohio.edu/uc/grahamd

Antifragility https://www.amazon.com/Antifragile-Things-That-Disorder-Incerto/dp/0812979680

Another reference which every medical student should be required to read is Michael Crichton MD’s incredible book, State of Fear https://www.amazon.com/State-Fear-Michael-Crichton-ebook/dp/B000FC2NQW/ref=sr_1_1?crid=ER34XPDD128P&dchild=1&keywords=state+of+fear+by+michael+chriton&qid=1604335974&s=books&sprefix=state+of+fear%2Cstripbooks%2C174&sr=1-1

This is perhaps all the more important in today’s current environment where people are scared of COVID, scared of the environment, scared of politics and everything becomes demonized and a crisis. When everything is a crisis, nothing is a crisis. It is not a healthy place to develop solutions that are enduring and compelling for a society to follow. Physicians, among all professions, should not live in a state of fear. They should learn to be comfortable with ambiguity and have the courage to lead in those circumstances without contributing to fear.

The Paw Paw Festival https://www.ohiopawpawfest.com/

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Intro and Outro Music: See Me by Jango

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Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is produced using (and we always accept donations from any gear folks):

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iMac

Tama mic stands

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

Well, because the nation has lost its mind, I think it is worthwhile to spend a little time getting you prepared for the discussion with Dawn Graham, PhD.

I am concerned about how a contingent of this nation is scaring the grandmas. I am concerned about medical students who are already stressed out wondering if they live in a good nation…that has any kind of future and I am concerned about a nation that is taking some pretty basic concerns (compliance with law and statute) and turning it into a hyperbolic projection of national castrophe.

So I am giving you some things to consider before we listen to Dawn.

With all apologies to Dean Burke (Bill) I present you with James. Understand that Dean “Bill” Burke has plenty of interesting things to say as well.

“The Big Short” by Michael Lewis https://www.amazon.com/Big-Short-Inside-Doomsday-Machine/dp/0393338827

“The Big Short” Directed by Adam McKay https://en.wikipedia.org/wiki/The_Big_Short_(film)

Neutron Bomb https://en.wikipedia.org/wiki/Neutron_bomb

James Burke, “Connections” https://en.wikipedia.org/wiki/Connections_(TV_series)

https://www.youtube.com/watch?v=XetplHcM7aQ

Certification of elections https://en.wikipedia.org/wiki/United_States_presidential_election

Loma Prieta Earthquake https://en.wikipedia.org/wiki/1989_Loma_Prieta_earthquake

German Citizens getting shot in the wire; https://en.wikipedia.org/wiki/The_Bridge_at_Andau

“The Bridge at Andau” by James Mitchener https://en.wikipedia.org/wiki/The_Bridge_at_Andau

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Intro and Outro Music: Seraph by Kiba

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Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is produced using (and we always accept donations from any gear folks):

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Rode NT1-A mics

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Kopul XLR cables

SanDisk media

iPhone 6

Final Cut Pro X

iMac

Tama mic stands

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

What about really sick kids? Since we are in the age of the COVID we need to understand that children can have some very serious , albeit thankfully very rare, complications with a SARS CoV2 infection. But that said the American Academy of Pediatrics is strongly behind reopening schools because of all of the other positive impacts on children that schools have on them.

Further the issue of dealing with hospitalized children and those with serious critical illness touches any rational person deeply. How do pediatricians deal with such things? What about the pediatricians who deal regularly with children who die from their illnesses. How do they cope with that?

Kawasaki-like disease (Multisystem Inflammatory Syndrome) https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e2.htm#:~:text=In%20April%202020%2C%20during%20the,in%20England*%20(1).

Kawasaki disease https://www.heart.org/en/health-topics/kawasaki-disease#:~:text=Kawasaki%20disease%20(KD)%2C%20also,vessels%2C%20particularly%20the%20coronary%20arteries.

School and Covid https://services.aap.org/en/news-room/news-releases/aap/2020/pediatricians-educators-and-superintendents-urge-a-safe-return-to-school-this-fall/

Clusters https://www.theatlantic.com/health/archive/2020/09/k-overlooked-variable-driving-pandemic/616548/

Health Systems Science https://www.ama-assn.org/education/accelerating-change-medical-education/teaching-health-systems-science

https://www.amazon.com/Health-Systems-Science-Susan-Skochelak/dp/0323694624

Fisher House https://fisherhouse.org/

Guess what? They do have a Fisher House at Elmendorf https://fisherhouse.org/programs/houses/house-locations/

CDC Vaccine Schedule https://www.cdc.gov/vaccines/schedules/index.html

Autism and Vaccinations https://autismsciencefoundation.org/what-is-autism/autism-and-vaccines/

For those of you willing to wear another type of uniform and leave medical school without debt, Neil discussed the HPSP program, his time at Joint Base Elmendorf Richardson and how we both like working with mid-levels.

HPSP https://www.goarmy.com/amedd/education/hpsp.html

https://www.health.mil/Training-Center/Clinicians-and-Healthcare-Providers

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Intro and Outro Music:

Tunnel Vision by Stanley Gurvich

Courtesy of Artlist.io

Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

This episode, number 2 in the queue, is focused for the sake of student’s success on a pediatrics rotation. We also spend some time on pediatric diseases.

Blueprints for pediatrics https://www.amazon.com/Blueprints-Pediatrics-Bradley-Marino-MSCE/dp/1451116047

First Aid for pediatrics https://www.amazon.com/First-Aid-Pediatrics-Clerkship-Fourth-ebook/dp/B075RQNKWR

Harriet Lane Handbook https://www.us.elsevierhealth.com/the-harriet-lane-handbook-9780323674072.html

For those interesting in the process of rapid vaccine development:

Operation Warp Speed https://www.hhs.gov/coronavirus/explaining-operation-warp-speed/index.html

Cystic Fibrosis Foundation https://www.cff.org/

Juvenile Onset Diabetes https://www.jdrf.org/ (which isn’t just about kids anymore)

Overall it is just a very pleasant continuation of the practice of medicine in the realm of little humans…

For those of you willing to wear another type of uniform and leave medical school without debt, Neil discussed the HPSP program, his time at Joint Base Elmendorf Richardson and how we both like working with mid-levels.

HPSP https://www.goarmy.com/amedd/education/hpsp.html

https://www.health.mil/Training-Center/Clinicians-and-Healthcare-Providers

Shoot me any comments or questions @TR Fredricks on Facebook

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Intro and Outro Music:

Walkabout-Australia by Hans Johnson

Courtesy of Artlist.io

Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

So here he is, after years of trying to find a pediatrician to opine about the specialty, Neil Copeland, MD; pediatrician. Neil is the first purposeful pediatrician on Rotations. If I sound gleeful it’s because I am. Pediatricians are notoriously hard to get to commit to interviews…

John does a really good job of sorting out the process of getting through a pediatric residency but his comments are germane to any medical specialty. He also gives a great intro to the things that pediatricians do and the things that all good physicians should be doing prior to referring to a pediatrician. That makes this interview highly relevant to Family Physicians as well.

Also, I hope you understand that the term “veterinary medicine” is an inside joke among physicians. It has nothing to do with our general love for managing children as patients. Babies can’t talk and so… …sometimes I find myself wondering why I have to explain this but we live in a hypersensitive time so there is the disclaimer.

I also imagine that I will ruffle feathers with my initial comments about disaster management but I will ask that you indulge me. A lot of "expert" opinions get shot out into social media and misinform people who look at physicians as “experts” in things. That creates chaos and is not aligned with the calling of academics.

I hope that a lot of young physicians consider going into administrative medicine after they get a decade or so of experience in actual clinical practice. You have to understand tactics and operations to become an effective strategic leader. The only practical way to gain that understanding is to spend a long-time practicing medicine.

I would encourage you to register and take courses with FEMA’s Emergency Management Institute. It will address some of the concerns that I mentioned in the beginning of this episode. https://training.fema.gov/

FEMA https://www.fema.gov/

For those of you willing to wear another type of uniform and leave medical school without debt, Neil discussed the HPSP program, his time at Joint Base Elmendorf Richardson and how we both like working with mid-levels.

HPSP https://www.goarmy.com/amedd/education/hpsp.html

https://www.health.mil/Training-Center/Clinicians-and-Healthcare-Providers

JBER Hospital https://www.jber.jb.mil/

USAF Surgeon General https://www.af.mil/About-Us/Biographies/Display/Article/466853/lieutenant-general-dorothy-a-hogg/#:~:text=Gen.-,Dorothy%20A.,Air%20Force%2C%20Arlington%2C%20Virginia.

To close out the episode Neil introduces us to the concept of Quality Improvement Fellowships in pediatrics.

Fellowship in quality improvement https://medpeds.org/residents/fellowship-guide/quality-improvement/

And hey! I found one at our own Children’s Hospital… https://www.nationwidechildrens.org/for-medical-professionals/education-and-training/fellowship-programs/quality-and-safety-leadership-fellowship

Finally, I want to leave you with this and highlight another great thing from Nationwide Children’s Hospital, Monarch 1… …flying things make me happy.  https://www.metroaviation.com/project/nationwide-monarch-1/

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Intro and Outro Music:

Pastor Dan’s Sermon-Final Speech by SPEARFISHER

Courtesy of Artlist.io

Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

So, we are between series and I anticipate giving you some Neil Copeland MD next week but in the meantime I thought it would be a good time to do a COVID-19 update. So we are going to talk about Flu Shots, Convalescent Plasma, Vitamin D, SARS CoV 2 Vaccine and then a little on suicide and Who Moved my Cheese? As always I am including links in these notes for you to pursue at your leisure…

Hedgerow cutter in WW II. https://en.wikipedia.org/wiki/Curtis_G._Culin

Red Cross Blood Donation https://www.redcrossblood.org/

Vitamin D. https://www.medicalnewstoday.com/articles/161618#sources-of-vitamin-d

Vaccines and Operation Warp Speed. https://www.hhs.gov/coronavirus/explaining-operation-warp-speed/index.html

Transverse myelitis https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/transverse-myelitis-fact-sheet

Who Moved My Cheese? https://www.amazon.com/Who-Moved-My-Cheese-Amazing/dp/0399144463/ref=sr_1_1?crid=1YKA8R7U2VDY0&dchild=1&keywords=who+moved+my+cheese+by+spencer+johnson&qid=1601488751&s=books&sprefix=Who+Moved+my+Cheese%2Cstripbooks%2C162&sr=1-1

The Movie. https://www.youtube.com/watch?v=OvYCLxqkfvY

Second Law of Thermodynamics. https://en.wikipedia.org/wiki/Second_law_of_thermodynamics

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Intro and Outro Music:

Kalahari Wind by SPEARFISHER

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Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Cohost:

Disclaimers:

Cut Clip

Rotations is produced using (and we always accept donations from any gear folks):

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Rode NT1-A mics

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SanDisk media

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Final Cut Pro X

iMac

Tama mic stands

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

This is the last of the episodes on Trauma Informed Care. Right up front, forgive the audio levels, that is on me, neither Lori or Jennifer like microphones and so it’s gonna be low levels. Had I been thinking I would have dropped my audio but hey, I am a family physician and not a genius audio engineer like one of my friends at OU who recently got married. Congratulations, Josh. I could have used you on this.

Anyway, Lori Brown LISW-S, LICDC and Jennifer Schwirian LISW-S are social workers who have a passion for looking at predictive outcomes in health care that center around childhood traumas. They are going to continue to talk with us about ACES and TIC. So, in this final episode we continue to address this topic and in the process I hope, sensitize those of you listening to the importance of considering ACES as part of your patient intakes and initial history taking. Helping patients to understand the impact of trauma on their long-term health may just help them live longer and healthier lives.

I think we all want that.

SETICC https://www.facebook.com/SETICCOhio/

ACES https://www.cdc.gov/violenceprevention/acestudy/index.html

Vincent Felitti MD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220625/

https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_Study

Trauma Informed Care https://www.nctsn.org/trauma-informed-care

By the way, Lori doesn’t like the mic so forgive the audio levels.

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Intro and Outro Music: Illusory Rhythms by Spearfisher

Courtesy of Artlist.io

Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is produced using (and we always accept donations from any gear folks):

Rode Podcaster Pro

Rode NT1-A mics

Polsen Studio Headphones

Kopul XLR cables

SanDisk media

iPhone 6

Final Cut Pro X

iMac

Tama mic stands

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

Lori Brown LISW-S, LICDC and Jennifer Schwirian LISW-S are back. This week on Rotations we continue ou r discussion about Trauma Informed Care. ACES is used as a predictive tool for future health issues. It is not a tool to identify mental or behavioral health problems and it was not designed to identify people who are somehow damaged. It is a tool that allows clinicians to help people understand what their long-term health risks may be.

ACES is not a tool to look at social-economic status of childhood.

We also discuss a little of the history of ACES and how Dr. Felliti moved from bariatric treatment and patients who dropped out of his program to identifying childhood trauma and correlating it with the propensity of overweight patients to leave bariatric treatment. It’s a good illustration of how humans are an interconnected system of mind, body and spirit and that injury in one system can reflect itself in problems in one of the other systems.

It’s also a very curious story about the confirmation bias inherent in medicine; something that can create a protective conservative position or actually interfere with the progress of medical science. It also gets into the very prevalent issue of childhood sexual trauma and the hidden nature of child abuse and its potential to harm its victims well into adulthood.

Soooooo, in this second episode we continue to discussion and talk about resiliency and how an understanding of ACES can help primary care physicians better understand their patients and how to guide them in their care.

Antifragile by Nassim Taleb https://www.amazon.com/Antifragile-Things-That-Disorder-Incerto/dp/0812979680

SETICC https://www.facebook.com/SETICCOhio/

ACES https://www.cdc.gov/violenceprevention/acestudy/index.html

Vincent Felitti MD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220625/

Robert Anda MD https://robertandamd.com/bio-2/

https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_Study

Trauma Informed Care https://www.nctsn.org/trauma-informed-care

By the way, Lori is still very quiet.

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Intro and Outro Music: Roots by I am Fowler

Courtesy of Artlist.io

I needed a little funk in my life and I think Austin Powers or Jackie Brown was floating around in the back of my head.

Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is produced using (and we always accept donations from any gear folks):

Rode Podcaster Pro

Rode NT1-A mics

Polsen Studio Headphones

Kopul XLR cables

SanDisk media

iPhone 6

Final Cut Pro X

iMac

Tama mic stands

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

Lori Brown LISW-S, LICDC and Jennifer Schwirian LISW-S are social workers. They are Licensed Clinical Social workers and they work with a population of patients who have significant mental illness. As part of their work they have developed a deep understanding of trauma. Not the crash your car into a bridge piling trauma, but trauma emotional trauma that occurs in childhood from neglect, un-met needs and other emotional insults that can significantly shape behavior in adulthood.

In this series we are going to look at the topic of Trauma Informed Care. This is a topic that is controversial. There are some people who think that trauma in this context is overplayed. There are others that don’t think enough attention is being paid to the impact of childhood and developmental trauma on adult behavior and mental health. So we tackle this with a discussion and let you have the opportunity to think about it and make some conclusions.

In this first episode we discuss what a Clinical Social Worker is and what a Psychologist is and also what a Counselor is as far as educational requirements and what they do. Then we dive into the various agencies and players in the realm of trauma.

SETICC https://www.facebook.com/SETICCOhio/

ACES https://www.cdc.gov/violenceprevention/acestudy/index.html

Vincent Felitti MD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220625/

https://en.wikipedia.org/wiki/Adverse_Childhood_Experiences_Study

Trauma Informed Care https://www.nctsn.org/trauma-informed-care

By the way, Lori doesn’t like the mic so forgive the audio levels.

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Intro and Outro Music: Toy Symphony by Nir Maimon

Courtesy of Artlist.io

Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is produced using (and we always accept donations from any gear folks):

Rode Podcaster Pro

Rode NT1-A mics

Polsen Studio Headphones

Kopul XLR cables

SanDisk media

iPhone 6

Final Cut Pro X

iMac

Tama mic stands

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.

I decided to give you a little teaser before I launch into trauma this week. When we speak of trauma for the next 3 weeks on Rotations we are not going to be thinking of the 70 MPH into a bridge abutment with a Lifeflight from the scene to the Level 1 facility for emergency care kind of trauma. We are going to discuss something else.

Trauma in the context of behavioral health concerns itself with things that happen in childhood and how they shape a person into adulthood. It is controversial and some people behind it get pretty passionate. But I will be honest, until I started learning about it, I wasn't all to entertaining of its impact. But after giving it a think I actually asked one of our psychologists to lead his class for our medical students during Veterans Health Week and discuss the topic.

It's important for us all to know about and to think about.

You can start your education here.

https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/

I also finish up with a brief discussion of concerns about cardiac health after COVID. I deal with it more aggressively on my You Tube channel but you can search that out for yourself.

In the mean time, I'm finishing up and hopefully by Thursday you will hear Lori and Jennifer start their conversation with me on trauma.

Intro and Outro Music: Mouthbeat Grooves

by J Stone

Courtesy of Artlist.io

Produced by: Todd Fredricks DO and Brian Plow MFA

Edited by: Todd Fredricks DO

Rotations is produced using (and we always accept donations from any gear folks):

Rode Podcaster Pro

Rode NT1-A mics

Polsen Studio Headphones

Kopul XLR cables

SanDisk media

iPhone 6

Final Cut Pro X

iMac

Tama mic stands

Rotations is part of the Media in Medicine family of medical storytelling and is copyrighted.

Rotations is made possible by the generous understanding and accommodation of our beloved institution, Ohio University and by the Ohio University Heritage College of Osteopathic Medicine and Scripps College of Communications. The comments and ideas expressed on Rotations are that of the content creators alone and may not reflect official policy or the opinion of any agency of the Ohio University.