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And lots of them, were the featured guests at Supervisor Sean Elsbernd’s Fifth Annual Crab Fest last Friday night, held at the Irish Cultural Center in the Outer Sunset. The evening itself was perfect: warm air, no wind, and clear skies featuring Jupiter, Venus, and the crescent moon lined up in the western sky above the ocean.
Supervisor Sean Elsbernd and Katie Albright, Director SF Child Abuse Prevention Center
Each year, Sean calls pretty much everyone he knows to ask for a contribution to a charitable cause that matters to him. Even better, many people say yes. This year, the event was a benefit for the San Francisco Child Abuse Prevention Center and the place was jam-packed with hungry San Franciscans.
The program itself was mercifully short, consisting of a two-minute introduction by the Supervisor, followed by an even briefer thank-you from Katie Albright, the Center’s director. Then it was on to the main event: crab, which I heard was excellent. I wouldn’t know—I’m allergic to all types of crustaceans (shrimp, crab, lobster), though mollusks (clams and oysters) are just fine. So I had salmon.
Why am I blogging about this? Because the evening represented why I love San Francisco: physical beauty, combined with human kindness and a good time.
…is where I’ve been. Though I like to travel, I don’t recommend a visit*. The food is tasteless; everything sounds like you’re underwater; your voice seems to belong to someone else; your forehead pounds to your heart beat; and the locals speak in a dialect with words like “inspissated” and “occluded.”
I managed to make it to work every day, but I’m sure I wasn’t too pleasant to be around. The evenings, which are when I normally write for the blog, passed in a semi-fog. Good thing that watching the Giants on TV does not exactly require one’s full intellectual capabilities.
So I spent last Thursday mid-day at our Cal campus, having my inner passages rerouted and flow restored. I got excellent care and I’m hopeful that all will be well soon.
*I’m grateful to my friend Paul Staley for his KQED Perspective on his trip to Illville: I stole his metaphor.
Unless you’ve got a really common name, I suspect you’ve Googled yourself once or twice, or maybe more. According to one poll, about 40% of Americans have “ego surfed”, but I think there’s been some systematic under-reporting.
If you’ve got uncommon first and last names, like mine, ego surfing provides an unfiltered “virtual” view of yourself. Plus some surprises, like pictures that friends and relatives have posted (if they’ve labeled them) or even copies of your signature!
View the reviews
Go on, Google yourself
If you’re a practicing physician, then Googling yourself can turn up some real surprises, like on-line evaluations of your practice. More and more, the massive numbers of users of Facebook (almost half a billion these days), Yelp, and Twitter are using the Internet to read and write reviews of physicians.
I admit: I selected the company who fixed the roof of my house on Yelp, and they did a phenomenal job. But I’d be reluctant to select a physician or dentist or lawyer the same way. Why not? Because a professional’s “virtual” reputation can be compromised by one or two unhappy–or even vindictive–clients. The same is true, of course, for roofers, but few people have unrealistic expectations about their roofs, personality conflicts with their roofer, or an ax to grind with the whole profession.
Good news, bad news
The good news about online reviews is that they reach a large audience and live in cyberspace indefinitely. But that’s also the bad news: Catch 22. Positive reviews are great and can encourage patients to seek a physician’s expertise. But negative reviews, whether valid or not, scare people away. To complicate matters, on most sites, reviews can be posted by anyone, at any time, from anywhere, and say just about anything.
So what’s a physician (or anyone else who’s been reviewed on the internet) to do? Start by Googling yourself! If there’s nothing posted, spend a little time building your virtual reputation. Encourage patients to post reviews. If you already have a virtual reputation, ask your staff to keep an eye out for reviews. In general, most people write reviews if they’re extremely happy or unhappy with service.
Fight back, write back
Please, Yelp yourself
If you’ve gotten a negative review, try to identify the unhappy patient so you can make amends if it’s reasonable to do so. (But only if it’s reasonable: some people can never be appeased, no matter what you might do.) Importantly, most reputable sites will allow you to post a response or rebuttal. So stand up for yourself and defend your reputation. It’s our responsibility to help people make informed decisions about whom they choose to provide their health care.
And though it’s tempting to be cleverly critical, those of us who post reviews have the responsibility to be objective and fair. Lest we write a review that blames the hotel because it was foggy every day.
It’s never easy being accused of doing something illegal, or foolish, or unethical. But there’s a special sting when an accusation involves discrimination. Which is what happened to us this week, when the CNA accused CPMC of discriminatory practices against hiring Filipino nurses. You may have seen the story in Friday’s Chronicle.
Let me begin by saying that nothing could be further from the truth. We are an equal employment opportunity employer; we cherish the diversity of our staff; and we encourage people from all walks of life to work here. More to the point, we have hired more than 150 Asian nurses in the past three years (we don’t keep track of who’s Filipino—that would be illegal!). Just take a walk on any of our campuses and you can see the panoply of people who have chosen CPMC.
This is personal
If I take the accusation personally, there’s a good reason. I learned much of what I know about medicine from a group of outstanding Filipino nurses on unit 5R (the respiratory and medical intensive care unit) at San Francisco General Hospital. They took me under their wing when I was a medical student and intern, and tried their best to keep me from making mistakes. They taught me how to recognize who was really sick and needed immediate attention, and who could wait. They showed me how to quickly resuscitate someone in hypovolemic shock (“Lift his legs, Warren. Both of them. High!”). I learned how to start IV’s in patients who had no visible veins and how to place an NG tube in a jiffy.
I loved working on 5R, so much so that I volunteered for extra months in the unit during the second and third years of my residency. (OK, maybe that was partially because of the lumpia at midnight.) I will never forget Amor, Edith, and Lily and the rest of the nursing staff. Amor in particular stood out—it seemed like she was always around to keep me and the rest of the house staff out of trouble. Only later did I learn that she worked so much overtime because she was paying the hospital bills for her sister, who had leukemia.
I remember one episode as if it happened yesterday. One of my fellow interns (let’s call him Gerry) was taking care of a patient with end-stage liver disease (back then, we just called it cirrhosis). The patient was deeply comatose, and Gerry wrote an order to treat him with lactulose in an attempt to wake him. But Gerry didn’t quite get the dose right (he was off by a factor of five or ten). Amor, in her good-natured way, came up to us and said “Gerry, you ordered a 5000 cc lactulose enema. Gerry, Gerry—the BED will wake up.”
After my residency, I spent a year traveling around the world, including a glorious month in the Philippines, visiting the places that Amor and her colleagues had talked about, like Baguio and the Pagsanjan falls. I never did garner the strength to try balut (if you don’t know what one is, Google it), but I did get to see the rice terraces of Sagada and the white sand beaches of the outer islands. To this day I regret not buying a hand-carved chess set from a remarkable man in Banawe who had been in Apocalypse Now, which was filmed in the Philippines.
Being the target
I’ve lived in San Francisco long enough to know that CPMC is going to be a prominent target as we go through the entitlements process with the City for our new hospitals at Van Ness and Geary and St. Luke’s. Sometimes I just wish it wasn’t so. That way, we could sooner join our colleagues at San Francisco General in breaking ground for our new facilities
I’ve been reading “The Brain and the Meaning of Life” by Paul Thagard, who is a professor at the University of Waterloo in Canada. The ambitious title reflects the author’s desire to explain how our brains (i.e., our minds, AKA ourselves) understand reality, feel emotions, and make decisions.
In an interesting chapter called “Needs and Hopes,” Thagard cites research suggesting that we have three psychological needs: the needs for competence, autonomy, and relatedness. The idea is that the feeling of being competent, for example, triggers a pattern in our brains that satisfies us, similar to the way that filling a physiological need, like hunger, does. (As someone who derives a ridiculous amount of satisfaction from successfully tackling a crossword or Ken-Ken puzzle, I can relate.)
The need to feel
Paul Thagard
Thagard defines competence as our need to feel effective; autonomy as our need to feel that we choose what we do; and relatedness as our need to feel close to others. This idea got me thinking: if we need to feel competent, autonomous and related, then the opposites—feeling incompetent, trapped, or isolated—should be states we avoid. Strongly.
Why am I blogging about this? Well, for most of us, work is a prime opportunity to fill our needs to be competent, autonomous, and related. (Love and play are the other two major arenas for meeting these needs.) But sometimes work fails to do so, or even worse, leads to the opposite states.
Autonomy at CPMC
So how do we provide opportunities to feel autonomous at a place like CPMC? On the surface, it seems like a Catch 22. The medical center can’t be safe, effective, and efficient if everyone who works here can be autonomous and decide what to do. If people don’t follow our policies and procedures, we’ll have chaos. (“Scalpel.” “Nah, I’d rather hand you a root beer float.”)
So if autonomy is a fundamental human need, and CPMC (and other organizations, especially big ones) needs policies and standard procedures, what are we to do?
I think there are a few strategies to increase autonomy in an organization like ours. First, we (meaning CPMC’s leaders and managers) have to make CPMC a place where staff and physicians choose to work. That’s why we pay so much attention to what employees tell us on the EOW survey. Doing so will help us make sure that everyone acknowledges their fundamental autonomy: that you have, in fact, chosen to work CPMC. It sometimes may not feel that way (particularly in a tough economy), but the reality is that we all could choose to work somewhere else.
Second, we need to make it clear that if you think you have a better/safer/faster/easier way of doing something, you have the green light to suggest the improvement. And that if you see something that is dangerous or wrong, you should put up a red light and stop the process immediately.
Finally, I think we should strive for a tight-loose-tight management philosophy when it’s appropriate. By tight-loose-tight I mean that we are tight about setting and agreeing to expectations and policies, and tight about holding people accountable for meeting them, but loose about exactly how people do so. As an example, if a unit consistently provides high-quality care to patients who rave about their care, then we can be loose about exactly how that unit achieves those goals.
I intentionally said, however, that tight-loose-tight is a state to strive for: we can’t get loose in the middle until we’re tight about expectations and accountability. Right now, we’re not uniformly tight about expectations and accountability, so being loose in the middle would just make us loosey-goosey.
Competence and Relatedness
So far, I wrote mostly about autonomy, not about competence and relatedness. In part, that’s because nearly everyone I’ve met at CPMC is trying hard to be competent in what they do, and most often succeeding. Most of the time, when we do find a lack of competence, it’s because we’ve got a system problem, like a failure to train or communicate. As to relatedness, we need to feel like we’re part of something larger and that we’re all working together. Campus-specific or perhaps even unit-specific relatedness is probably easier—it’s more like a community when you know your co-workers. But we all can take pride in the accomplishments of the entire medical center, even as we celebrate the unique qualities of the campus and unit where we usually work. I’ll write more about competence and relatedness, and how these needs might fit with our QD system, in the future.
If you made it this far, and want to read the book, let me know and I’ll send you a copy! And if you’ve got ideas about how we can increase people’s sense of autonomy at work, while we continue to provide high-quality safe and compassionate care, let me know.
We had some very sad news recently at CPMC. Brian Friedman, MD, the medical director of the Emergency Department at our Davies Campus, died suddenly while running in Palm Springs.
Brian Friedman, MD
I went to the memorial service for him in the Davies gazebo, and was moved by the outpouring of emotion among his colleagues. Brian had worked at Davies for more than 20 years, including the difficult early years of the AIDS epidemic. He started as a family practitioner, and then gradually spent more and more time in the ED, where he was soon appointed medical director in recognition of his skills, experience, and commitment. His dedicated leadership turned the ED, including the staff and patients, into a true family practice.
Colleagues at the service spoke touchingly about him. One remembered the time that Brian had congratulated him for being a good doctor—for the first time in his career. Nursing staff spoke about his energy, compassion, and joie-de-vivre. I was especially moved by the words of his longtime partner, who recognized and appreciated how much Brian cared about the work that he did. Indeed, Kevin recalled how often Brian would tell him about the patient satisfaction scores for the ED; fortunately, they were usually very high.
As the Bay Area Reporter said: “Brian was the heart and soul of the Davies E.R., and he dedicated his life to making absolutely certain that each and every member of our community was treated with the utmost dignity, respect, and compassion while receiving the highest quality medical care.”
We have lost a fine physician, a treasured colleague, and a very good man.
Like many of you, I’ve spent a good deal of time the past few weeks watching the World Cup. I caved in and got a DVR so I could record the games to watch in the evenings, warning people all day long not to tell me the scores. I had a few favorite players (Michael Bradley, the U.S. coach’s son; Diego Forlán of Uruguay). And I enjoyed listening to the ESPN announcers, whose pithy phrases and exotic accents made the usual sports commentary seem loud and pointless.
Soccer and Americans
Americans, of course, are notorious for our relative lack of interest in soccer. We moan about the flopping, the lack of scoring, the shirt- and shorts-pulling, and the apparent witlessness of having a single referee try to see the entire pitch while sprinting. Perhaps most of all, we’re not fans of ambiguity. We like fair play, instant replay, and lots and lots of scoring. We like games where the better team wins most of the time, and sometimes by a lot. Those 1-0 games are OK every now and then (especially if Lincecum is pitching), but not as regular fare.
What has any of this got to do with health care? That’s a good question. As I see it, there are a bunch of traditional differences between the U.S. and the rest of the (developed) world.
| Characteristic | Rest of world | U.S. |
| Favorite sport | Soccer | Not soccer |
| Health care | Universal | Trying (finally) |
| Politics | Multi-party | Two-party |
| Measurements | Metric | Yards and pounds |
Signs of change
But the gap is closing. Lots of us watched the World Cup; we’re making progress in health care; and every now and then a third political party gains some traction. Can meters, kilograms, and degrees Celsius be far away? (For the record, I’m 1.82, 79.4, and 37.)
Pacific Campus Group 1
For the past several years, California Pacific Medical Center had participated in Take Our Daughters and Sons to Work Day, which is always a delightful, inspiring and educational experience for those involved. We invite the children and grandchildren of our staff for a “behind-the-scenes” look at our four medical campuses. Thanks to the generosity of the CPMC Foundation, we were able to host 130 kids this year.
The event is a great opportunity to encourage them to consider careers in the medical field. It’s also a way to thank staff for the hard work they do every day.
The kids visited many departments, including the Intensive Care Unit, Surgical Services, Engineering, Radiology, and Ophthalmology. Some even saw our EVS team demonstrate the device we use to process medical waste, which may not seem very thrilling unless you picture it as a child might: as a giant machine that opens with a loud hiss and a dramatic cloud of steam.
Our dedicated staff showed how a patient’s heart rate and blood pressure are monitored, why hand washing is critical to infection control, and how we care for moms and babies. Our visitors also learned about the precautionary steps that staff would take if there were an incident involving hazardous materials, tested some of the unique tools used in physical rehabilitation, and received firsthand experience with guided imagery and expressive arts.
It’s inspiring to see our employees’ passion for their jobs as they “show off” their department and their skills. It’s hard not to feel proud of our organization when you see kids react with such enthusiasm to the laundry cart hydraulic lift or the oxygen mist used in respiratory therapy.
Taking a fresh look at our jobs through the eyes of a child can re-energize us to remember why we chose healthcare careers in the first place.
Taking the stairs – one flight if you are going up, two if going down – may not sound like much in terms of physical activity, but it’s certainly a start. Not just because it reduces energy consumption (it does, but not by a whole lot; see Fat Knowledge to find out just how much) ). Because it’s good in other ways. 
Why? For a few reasons. For one, there’s a report in the Journal of Physiology about the benefits of short bursts of exercise. The benefits of taking the stairs may require walking up 3 to 4 flights, but we’ve got to start somewhere.
Second, unless you can wait patiently without becoming anxious and irritable, it’s also good for your mental health. You never have to wait for a stair.
Also, the fewer people who use elevators when they don’t need to, the less time that people who do need to use them have to wait. So taking the stairs is altruistic.
Any others?
WB
Last Sunday night, our Institute for Health and Healing held its annual awards dinner, honoring Jerry Mapp, the President Emeritus of the CPMC Fountain, and Matt Sanford, a leader in the disability movement in the U.S. I’ll write more about Jerry in another post. For now, I’ll just say that he was a lot funnier that night than I’ve ever heard him before.
Matt Sanford was honored for his innovative approach to people with disability, especially those with spinal cord injuries. 
He became paraplegic at the age of 13, in a car accident that took the lives of his father and sister. After many years of being told to ignore the lower part of his body—that he was feeling “phantom” signals—he made the decision to pay attention to them. Since that time, he has become a yoga instructor, specializing in teaching others how to connect their minds and bodies. He’s written a book about his experience, called “Waking.”
What I found interesting about his presentation (along with his invitation for everyone at the event to take off their too-tight shoes and let the dogs bark!) was his simple message that “reconnecting” his mind and body has enriched his life immeasurably.
Downward-facing dog, anyone?
