April 25, 2024 • 20 mins
In an engaging episode of the TMA Practice Well podcast, we sample CME from TMA’s premiere conference TexMed. Guest speakers provide insightful discussion on essential aspects of maintaining a productive relationship with the Texas Medical Board, particularly important in light of telemedicine's post-pandemic boom. Dr. Mary Maness speaks on the growing issue of vaccine hesitancy. Then Dr. Mehta offers practical tips on using intense, non-judgmental awareness to foster physical health and psychological resilience. The compilation concludes with Dr. Kata, a successful mentor, offering advice on managing task load and burnout risks, emphasizing the importance of periodic career health evaluations to maintain a thriving work life. Registration today for TexMed 2024 and visit the TMA Education Center to find the full programs from this episode.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
Thank you for listening to TMA's Practice Well podcast. TMA,
helping you improve the health of all Texans.
Music.
TMA has a long, proud history of promoting patient rights, advocating for physicians,
(00:24):
and providing real solutions for your practice.
We can accomplish so much when we unite in one voice.
Call the TMA Knowledge Center at 1-800-880-7955 or visit texmed.org to find
out how you can join or renew your membership today day.
Music.
(00:55):
Hi, I'm Cheryl Kroviak. I produce the TMA Practice Well podcast,
and I'm the director of the TMA Education Center, where physicians can find
CME and training for a thriving practice.
In this episode, I will share with you a taste of CME from TMA's largest conference, TexMed.
TexMed is TMA's annual meeting where physicians can attend CME talks across
(01:17):
various specialties, all geared toward educating on new best practices and empowering
the physicians of Texas.
TMA members can attend the conference free by pre-registry.
Click the TexMed link in the episode description to register for our next conference.
We begin with Tony Bertolino and Troy Bower, two healthcare attorneys who have
(01:39):
years of experience helping physicians deal with complaints from the Texas Medical Board.
Tony and Troy discuss what's raising flags at the TMB now that many practices
have kept telemedicine services post-pandemic.
Is really three issues. Compliance, first with the minimum legal requirements
providing telemedicine services to patients, records retention that's required
(02:02):
by law, and compliance with prescription laws.
First, the standard of care. What are the expectations of the standards of care
required when employing a telemedicine or implementing a telemedicine kind of
procedure in your office?
Well, the standard of care is quite frankly the same. It is the standard of
what a reasonable, ordinary physician would do under those similar circumstances.
(02:26):
So that doesn't change whatsoever just by the use of telemedicine.
And of course, the process, procedure, and the practices that physicians have
in order and place to meet the minimum requirements is also what we'll discuss next.
The notice to the patients, you
know, what sort of notice obligation do physicians have to their patients?
And according to the administrative code, section 174.4, it requires the physicians
(02:52):
to comply with the HIPAA requirements, the privacy practices,
and the preservation of privacy.
And this is supposed to take place prior to the treatment, even if you are meeting
with a patient through telemedicine technology.
And there, of course, the complaint procedures must also be provided to the patient as well.
Going to be a need to provide notices of how to file a complaint to the Texas
(03:18):
Medical Board, and that needs to be be provided in the website,
for instance, or other written intake materials that you provide to your patient.
And of course, it's got to also be both in English and Spanish and 10-point type, at least.
And then, of course, the contact information to the Texas Medical Board must
be provided to the patient, or even at that point would be a potentially prospective patient.
(03:40):
Records retention. Again, you know, what we're going into is really discussing
the things that we're finding in this post-COVID world that is significant and
really uses a basis for an increase in medical board complaints.
And of course, record retention is very important, as you can imagine,
as practicing physicians.
The record retention is important to staying out of trouble.
And it's required not just by the board rules, but also by the statute itself.
(04:04):
A well-documented file, of course, minimizes your risk in the first place.
And it makes it easier to act quickly when you know where everything is located,
particularly if you You happen to suffer from receiving a notice,
a complaint from the medical board so that you can go and retrieve that information quick.
And then, of course, what we urge is that you invest in some type of cloud based
digital file management system or tool, particularly if you're going to be using
(04:26):
this kind of telemedicine technology.
And speaking as a as a former regulator, I can't stress enough how this issue of records comes up.
I saw it time and time in the area that I worked in for years.
And so taking the time, you know, sometimes you might get an illegitimate complaint
in terms of the actual substance.
(04:47):
But as the regulator is going through, they notice, oh, there is serious records deficiency.
So what might otherwise have been a dismissal ends up being some type of action,
because in the course of trying to see if there's, for example,
a standard of care violation, you determine, oh, there's a serious records issue here.
So it's really important to take that time, invest in that up front.
(05:08):
And it used to make all the difference in the world to me as a regulator when
I got a well-documented response that showed that license holder had their records,
what was required by law, and it was all there.
And it immediately put the relationship, you know, it's a difficult time for
the license holder, but it puts that relationship on a good footing to start off.
(05:28):
So I would just really stress and encourage taking some time.
I know physicians are extremely busy and overworked, but making that effort,
time up front and investing, whether it's in the staff, an IT provider,
whatever you need to do, that'll pay dividends in the long run.
So when you say well-documented records, what does that look like?
We're, again, guided by law, guided by Chapter 22 of the Texas Administrative Code, Section 165.1.
(05:53):
And it lays out what physicians are required to maintain in their records so
that they are, quote-unquote, adequate. And that's really what the standard is, is adequate.
You don't have to, you know, have extra, you know, extra perfect kind of documentation in your file.
This has to be, you know, adequate kind of information or at least meet the
minimum requirements under the law.
(06:14):
And those minimums include, of course, the documentation of the patient care
itself, the initial assessment of the patient, the past and the present diagnoses,
the rationale for and results of diagnostic and other ancillary services,
the patient's progress, including the response to treatments,
change in diagnosis, and patient's noncompliance, the relevant risk factors,
of course, associated with the treatment of that patient, and the written plan of care.
(06:37):
These are, for the most part, the minimal or what's deemed to be adequate.
Another popular talk at TexMed last year was using vaccine-informed practices
to navigate the new normal.
Dr. Mary Manis, a board-certified family medicine physician,
was part of a research team on vaccine hesitancy, and she shares findings and
techniques to improve vaccine adherence.
(07:00):
So who is the research team that I'm representing?
It's a multidisciplinary team, mostly from the College of Health Sciences at
Sam Houston State University.
We've been working on this grant for approximately a year and a half and have a fairly big team.
It's been very interesting and very enlightening and also very fun.
(07:20):
And I'm happy to share some of our results with you. Learning objectives after participating,
hopefully you will be able to list barriers to vaccine recommendation adherence,
to explain the components of vaccine-informed practice, and address barriers
to adherence in your own practices.
As part of having this presentation accepted, I needed to submit an abstract answering a question.
(07:45):
So that was, what is the practice-based problem TMA wanted to know?
So what I submitted was, in other words, what needs to be addressed?
And I thought that one of the important things to address, aside and even apart
from our research, is the gap in vaccination. And I think we've all been made
more acutely aware of those gaps over the last several years.
(08:06):
The gap between current and best practice in vaccination is fairly significant for our state.
For instance, rates in Texas for key vaccine-preventable diseases are either
below state public health goals or below U.S.
Vaccination rate goals set by public health experts.
(08:28):
So, for instance, pertussis. State vaccination rates in 2021,
and that's the latest data I could find to prepare for this presentation,
for kindergarten students.
So there are two groups that they track, kindergartners and seventh graders.
So for kindergarten students, 93.7% rate of vaccination for protests at seventh grade, 92.1.
(08:50):
Now, state's public health goals are 95%. And, you know, honestly,
when I first looked at those data, it doesn't seem so bad, right?
You know, 93.7 versus 95. But when you consider the numbers of kindergartners
in our state, that refers to a whole lot of children, tens of thousands of children
that are under or unvaccinated for pertussis.
(09:13):
Now, what can we do to overcome barriers? We know a little bit more,
perhaps, about those barriers in the state.
So what can we do to overcome them?
Broad literature searches and focus group interviews and expert consultations,
we came up with vaccine-informed practice.
Let me explain a little bit more about that. Based on our survey results,
(09:34):
it appears that we can address vaccine hesitancy in our patients by discussing
health benefits of vaccination, by discussing risk and safety associated with vaccines.
But I believe equally as important, discussing these in ways that promote their trust.
If we're number one in trusted source, we need to maintain that.
(09:55):
We need to make sure that we stay there and that the information that we present
as their trusted source is accurate, it, but it addresses their concerns and their hesitancies.
So vaccine-informed practice. That is using motivational interviewing to help
patients manage their mixed feelings, perhaps, about getting vaccinated.
(10:16):
I don't know that anyone walks in 100% and says, I am fully and completely confident.
Please give me my vaccination today and tell me when my next one is due.
Maybe your patients say that to you. I don't have any that say that to me.
When patients talk about out their views, though, especially about the benefits of vaccination.
It can help change the way they process their choices and move them forward
(10:37):
to use certain tools and techniques from motivational interviewing.
As a physician-led organization, TMA has many resources to help physicians with
the business side of medicine and with personal well-being.
This next snippet showcased Dr. Mehta, past chair of TMA's Committee on Physician
Health and Wellness, discussing Mindfulness in Practice.
(11:00):
When we decided as a part of Physician Health and Wellness Committee that we
want to talk to our physicians about how to get centered, how to balance life,
how to be more mindful in day-to-day basis,
everyone's question was, yeah, we hear that all the time, but how do we do it?
(11:22):
How do we learn to be actually mindful? mindful and it's a buzzword nowadays, right?
Mindfulness or a lot of different things has been talked about.
So we decided that, okay, let's go and see if I can put some information,
some practical tips to all of you from all the research and studies that has
(11:45):
been done over the the years and see if there is any one of it that work for any of you.
Mindfulness has become buzzword. Everyone talks about physician resilience,
physician mindfulness.
It's a $4 billion industry right now in our country.
There are more than 60,000 books on Amazon on mindfulness.
(12:07):
And there is all sorts of mindfulness, mindfulness for dogs,
mindfulness eating, Eating mindfulness, pets.
And I mean, it's amazing what that word mindfulness has taken to the next level.
You just add mindfulness in front of it and all of a sudden it becomes trendy and cool.
So that's not trendy and cool that we are talking about today.
(12:32):
Mindfulness, it's a type of meditation and it is a meditation where one focuses
on being intensely aware of what's happening,
what we are sensing at this very moment and not being non-judgmental about it.
So accepting whatever is we are sensing, feeling, acknowledging it that,
(12:57):
yes, this is what I'm sensing and this is what I'm feeling.
Feeling, but at the same time, not try to judge ourselves, not try to interpret
in any negative connotation, just feeling it, just acknowledging it.
So in last 10 years, there has been
a plethora of studies in all different universities about what this does.
(13:17):
So evidence suggests engaging in mindful meditation may influence physical health,
psychological habit of repeating dwelling or stressful that appears to intensify
physiological effect of the stressor.
Basically, that midbrain attenuation, decreasing limbic activity,
and increasing prefrontal lobe activities where the executive functioning is
(13:39):
the key, is the goal of this mindfulness practices.
Also, favorably influence immune system as well as inflammation.
And we all know that chronic inflammation or chronic health problems are one
of the the biggest ticket item when it comes to money being spent in our country.
So that is also has been in 2022.
(14:02):
It's a very recent study done about that.
Mindfulness meditation also appears to lead to increased telomere length.
This is going to be extremely useful because increase our ability to impact our DNA,
our RNA, our cell function, physiology is going to be the game changer in our next generations.
(14:28):
So this is quite impressive and interesting.
The last morsel I leave for you is from Dr.
Katta, a practicing dermatologist who was on faculty with Baylor College of Medicine
for 17 years, where she found a passion in mentoring the next generation of physicians.
Dr. Katta believes in the importance of evaluating one's career health and uses
(14:49):
a well-child exam analogy to evaluate physician's task load and measure burnout risk.
If we talk about energized at work, one of the key points that I'm already learning
is that there are physicians in every field and every specialties who who are
still thriving and learning despite the challenges.
(15:11):
But one of the things that I think is really helpful is that all of them have
shared at certain points how they've evaluated the health of their career.
And I like to I really like mental models. It really breaks down for me how
to approach a different topic. I really like things to be very tangible.
And when I think about the health of a career, I really think about doctor thinking.
(15:32):
And if you approach it as a doctor, if you approach the health of your career
as you would with a physician lens, so how do we look at the health of our patient?
Well, it's certainly not just what's your BMI.
We look at a lot of different factors. We look at a lot of different vital signs,
review of systems, and the same thing with our career.
It's not just your paycheck or promotion or your publications.
And certainly we celebrate every victory.
(15:56):
So I'm going to ask you right now and feel free to take a little notation for
yourself, but I am going to ask you to put a number on this.
Are you energized at work on a scale of one to 10?
And I'd like to see where you are today and have you compare yourself to a year
from now to just think about that. Are you energized at work?
And when we think about the strong, healthy career, that's the goal.
(16:19):
You want to be, you don't want failure to thrive. You want your well-child exam.
You want that strong, healthy, energized child.
And I think we can break it down into three main organ systems that I'm going to talk about today.
Like I mentioned, that's my mental model.
And I think before we talk about energized at work, it is important to think
(16:40):
about and talk about burnout. out.
This is the ICD-11 World Health Organization definition, where it's resulting
from chronic workplace stress that hasn't been successfully managed.
And they characterize three dimensions.
And I'm going to start with the first dimension, which is reduced professional efficacy.
(17:01):
So if we think about how to make that tangible, to me, that's the organ system of vision.
And I break it down into short distance and long distance vision.
And if you think about short distance vision, that's your day-to-day.
That's really your task management.
And if you think about that spectrum of tasks are manageable versus overwhelmed.
(17:25):
So I'm going to ask you this question. Can you complete your daily tasks at
work without feeling overwhelmed?
On a scale of 1 to 10, where are you on that manageable to overwhelmed?
When I think about productivity and just getting through the day,
it's energy management first, time management second.
(17:45):
And what I mean by that, when I think about energy, it's brain,
body and emotional energy.
So I'm going to start with the physician task load.
So when we were writing our article about practice efficiency,
this was a tool that I had never heard of before. It's really pretty simple,
but it's been validated in many different studies.
(18:07):
So it's called the NASA Physician Task Load.
And they studied the task load score and the risk of burnout.
And it's four domains. It's mental, physical, time demands, and effort demands.
So let me ask you, and you can write this number down if you want,
because I'm going to have you add up these four numbers.
(18:30):
Reflect on a day that you performed clinical work during the last one to two weeks.
Think about that day, and it should be representative of your typical work day.
Question number one is how mentally demanding was that work day on a score of zero to 100?
So 100 means that it was incredibly mentally demanding. That's question one.
(18:51):
Question two, how physically demanding was that work day? Score zero to 100.
Question three is how hurried or rushed was the pace of your workday?
And then question four was how hard did you have to work to accomplish your
level of performance during the workday?
(19:15):
And so now that you have those four numbers, go ahead and quickly add them up.
Once you add those up, you have a score. And in that study, what they found
was that if you had a score of, let's say, 227, no symptoms of burnout.
But once you started to get in
(19:36):
the 280s, that's when physicians started to have one symptom of burnout.
And as you went higher, your risk of burnout.
I hope this episode showcased a variety of CME programs TMA offers,
all at no cost to TMA members and their staff.
Remember to check the episode description to get the link for the full programs
(19:57):
from today's episode and to register for TexMed.
Like and follow this podcast to receive every episode from TMA Practice Well.
Until next time, stay well.
Music.
Thank you for listening to TMA's Practice Well podcast. TMA,
helping you improve the health of all Texans.
Music.
TMA has a long, proud history of promoting patient rights, advocating for physicians,
(00:24):
and providing real solutions for your practice.
We can accomplish so much when we unite in one voice.
Call the TMA Knowledge Center at 1-800-880-7955 or visit texmed.org to find
out how you can join or renew your membership today day.
Music.
(00:55):
Hi, I'm Cheryl Kroviak. I produce the TMA Practice Well podcast,
and I'm the director of the TMA Education Center, where physicians can find
CME and training for a thriving practice.
In this episode, I will share with you a taste of CME from TMA's largest conference, TexMed.
TexMed is TMA's annual meeting where physicians can attend CME talks across
(01:17):
various specialties, all geared toward educating on new best practices and empowering
the physicians of Texas.
TMA members can attend the conference free by pre-registry.
Click the TexMed link in the episode description to register for our next conference.
We begin with Tony Bertolino and Troy Bower, two healthcare attorneys who have
(01:39):
years of experience helping physicians deal with complaints from the Texas Medical Board.
Tony and Troy discuss what's raising flags at the TMB now that many practices
have kept telemedicine services post-pandemic.
Is really three issues. Compliance, first with the minimum legal requirements
providing telemedicine services to patients, records retention that's required
(02:02):
by law, and compliance with prescription laws.
First, the standard of care. What are the expectations of the standards of care
required when employing a telemedicine or implementing a telemedicine kind of
procedure in your office?
Well, the standard of care is quite frankly the same. It is the standard of
what a reasonable, ordinary physician would do under those similar circumstances.
(02:26):
So that doesn't change whatsoever just by the use of telemedicine.
And of course, the process, procedure, and the practices that physicians have
in order and place to meet the minimum requirements is also what we'll discuss next.
The notice to the patients, you
know, what sort of notice obligation do physicians have to their patients?
And according to the administrative code, section 174.4, it requires the physicians
(02:52):
to comply with the HIPAA requirements, the privacy practices,
and the preservation of privacy.
And this is supposed to take place prior to the treatment, even if you are meeting
with a patient through telemedicine technology.
And there, of course, the complaint procedures must also be provided to the patient as well.
Going to be a need to provide notices of how to file a complaint to the Texas
(03:18):
Medical Board, and that needs to be be provided in the website,
for instance, or other written intake materials that you provide to your patient.
And of course, it's got to also be both in English and Spanish and 10-point type, at least.
And then, of course, the contact information to the Texas Medical Board must
be provided to the patient, or even at that point would be a potentially prospective patient.
(03:40):
Records retention. Again, you know, what we're going into is really discussing
the things that we're finding in this post-COVID world that is significant and
really uses a basis for an increase in medical board complaints.
And of course, record retention is very important, as you can imagine,
as practicing physicians.
The record retention is important to staying out of trouble.
And it's required not just by the board rules, but also by the statute itself.
(04:04):
A well-documented file, of course, minimizes your risk in the first place.
And it makes it easier to act quickly when you know where everything is located,
particularly if you You happen to suffer from receiving a notice,
a complaint from the medical board so that you can go and retrieve that information quick.
And then, of course, what we urge is that you invest in some type of cloud based
digital file management system or tool, particularly if you're going to be using
(04:26):
this kind of telemedicine technology.
And speaking as a as a former regulator, I can't stress enough how this issue of records comes up.
I saw it time and time in the area that I worked in for years.
And so taking the time, you know, sometimes you might get an illegitimate complaint
in terms of the actual substance.
(04:47):
But as the regulator is going through, they notice, oh, there is serious records deficiency.
So what might otherwise have been a dismissal ends up being some type of action,
because in the course of trying to see if there's, for example,
a standard of care violation, you determine, oh, there's a serious records issue here.
So it's really important to take that time, invest in that up front.
(05:08):
And it used to make all the difference in the world to me as a regulator when
I got a well-documented response that showed that license holder had their records,
what was required by law, and it was all there.
And it immediately put the relationship, you know, it's a difficult time for
the license holder, but it puts that relationship on a good footing to start off.
(05:28):
So I would just really stress and encourage taking some time.
I know physicians are extremely busy and overworked, but making that effort,
time up front and investing, whether it's in the staff, an IT provider,
whatever you need to do, that'll pay dividends in the long run.
So when you say well-documented records, what does that look like?
We're, again, guided by law, guided by Chapter 22 of the Texas Administrative Code, Section 165.1.
(05:53):
And it lays out what physicians are required to maintain in their records so
that they are, quote-unquote, adequate. And that's really what the standard is, is adequate.
You don't have to, you know, have extra, you know, extra perfect kind of documentation in your file.
This has to be, you know, adequate kind of information or at least meet the
minimum requirements under the law.
(06:14):
And those minimums include, of course, the documentation of the patient care
itself, the initial assessment of the patient, the past and the present diagnoses,
the rationale for and results of diagnostic and other ancillary services,
the patient's progress, including the response to treatments,
change in diagnosis, and patient's noncompliance, the relevant risk factors,
of course, associated with the treatment of that patient, and the written plan of care.
(06:37):
These are, for the most part, the minimal or what's deemed to be adequate.
Another popular talk at TexMed last year was using vaccine-informed practices
to navigate the new normal.
Dr. Mary Manis, a board-certified family medicine physician,
was part of a research team on vaccine hesitancy, and she shares findings and
techniques to improve vaccine adherence.
(07:00):
So who is the research team that I'm representing?
It's a multidisciplinary team, mostly from the College of Health Sciences at
Sam Houston State University.
We've been working on this grant for approximately a year and a half and have a fairly big team.
It's been very interesting and very enlightening and also very fun.
(07:20):
And I'm happy to share some of our results with you. Learning objectives after participating,
hopefully you will be able to list barriers to vaccine recommendation adherence,
to explain the components of vaccine-informed practice, and address barriers
to adherence in your own practices.
As part of having this presentation accepted, I needed to submit an abstract answering a question.
(07:45):
So that was, what is the practice-based problem TMA wanted to know?
So what I submitted was, in other words, what needs to be addressed?
And I thought that one of the important things to address, aside and even apart
from our research, is the gap in vaccination. And I think we've all been made
more acutely aware of those gaps over the last several years.
(08:06):
The gap between current and best practice in vaccination is fairly significant for our state.
For instance, rates in Texas for key vaccine-preventable diseases are either
below state public health goals or below U.S.
Vaccination rate goals set by public health experts.
(08:28):
So, for instance, pertussis. State vaccination rates in 2021,
and that's the latest data I could find to prepare for this presentation,
for kindergarten students.
So there are two groups that they track, kindergartners and seventh graders.
So for kindergarten students, 93.7% rate of vaccination for protests at seventh grade, 92.1.
(08:50):
Now, state's public health goals are 95%. And, you know, honestly,
when I first looked at those data, it doesn't seem so bad, right?
You know, 93.7 versus 95. But when you consider the numbers of kindergartners
in our state, that refers to a whole lot of children, tens of thousands of children
that are under or unvaccinated for pertussis.
(09:13):
Now, what can we do to overcome barriers? We know a little bit more,
perhaps, about those barriers in the state.
So what can we do to overcome them?
Broad literature searches and focus group interviews and expert consultations,
we came up with vaccine-informed practice.
Let me explain a little bit more about that. Based on our survey results,
(09:34):
it appears that we can address vaccine hesitancy in our patients by discussing
health benefits of vaccination, by discussing risk and safety associated with vaccines.
But I believe equally as important, discussing these in ways that promote their trust.
If we're number one in trusted source, we need to maintain that.
(09:55):
We need to make sure that we stay there and that the information that we present
as their trusted source is accurate, it, but it addresses their concerns and their hesitancies.
So vaccine-informed practice. That is using motivational interviewing to help
patients manage their mixed feelings, perhaps, about getting vaccinated.
(10:16):
I don't know that anyone walks in 100% and says, I am fully and completely confident.
Please give me my vaccination today and tell me when my next one is due.
Maybe your patients say that to you. I don't have any that say that to me.
When patients talk about out their views, though, especially about the benefits of vaccination.
It can help change the way they process their choices and move them forward
(10:37):
to use certain tools and techniques from motivational interviewing.
As a physician-led organization, TMA has many resources to help physicians with
the business side of medicine and with personal well-being.
This next snippet showcased Dr. Mehta, past chair of TMA's Committee on Physician
Health and Wellness, discussing Mindfulness in Practice.
(11:00):
When we decided as a part of Physician Health and Wellness Committee that we
want to talk to our physicians about how to get centered, how to balance life,
how to be more mindful in day-to-day basis,
everyone's question was, yeah, we hear that all the time, but how do we do it?
(11:22):
How do we learn to be actually mindful? mindful and it's a buzzword nowadays, right?
Mindfulness or a lot of different things has been talked about.
So we decided that, okay, let's go and see if I can put some information,
some practical tips to all of you from all the research and studies that has
(11:45):
been done over the the years and see if there is any one of it that work for any of you.
Mindfulness has become buzzword. Everyone talks about physician resilience,
physician mindfulness.
It's a $4 billion industry right now in our country.
There are more than 60,000 books on Amazon on mindfulness.
(12:07):
And there is all sorts of mindfulness, mindfulness for dogs,
mindfulness eating, Eating mindfulness, pets.
And I mean, it's amazing what that word mindfulness has taken to the next level.
You just add mindfulness in front of it and all of a sudden it becomes trendy and cool.
So that's not trendy and cool that we are talking about today.
(12:32):
Mindfulness, it's a type of meditation and it is a meditation where one focuses
on being intensely aware of what's happening,
what we are sensing at this very moment and not being non-judgmental about it.
So accepting whatever is we are sensing, feeling, acknowledging it that,
(12:57):
yes, this is what I'm sensing and this is what I'm feeling.
Feeling, but at the same time, not try to judge ourselves, not try to interpret
in any negative connotation, just feeling it, just acknowledging it.
So in last 10 years, there has been
a plethora of studies in all different universities about what this does.
(13:17):
So evidence suggests engaging in mindful meditation may influence physical health,
psychological habit of repeating dwelling or stressful that appears to intensify
physiological effect of the stressor.
Basically, that midbrain attenuation, decreasing limbic activity,
and increasing prefrontal lobe activities where the executive functioning is
(13:39):
the key, is the goal of this mindfulness practices.
Also, favorably influence immune system as well as inflammation.
And we all know that chronic inflammation or chronic health problems are one
of the the biggest ticket item when it comes to money being spent in our country.
So that is also has been in 2022.
(14:02):
It's a very recent study done about that.
Mindfulness meditation also appears to lead to increased telomere length.
This is going to be extremely useful because increase our ability to impact our DNA,
our RNA, our cell function, physiology is going to be the game changer in our next generations.
(14:28):
So this is quite impressive and interesting.
The last morsel I leave for you is from Dr.
Katta, a practicing dermatologist who was on faculty with Baylor College of Medicine
for 17 years, where she found a passion in mentoring the next generation of physicians.
Dr. Katta believes in the importance of evaluating one's career health and uses
(14:49):
a well-child exam analogy to evaluate physician's task load and measure burnout risk.
If we talk about energized at work, one of the key points that I'm already learning
is that there are physicians in every field and every specialties who who are
still thriving and learning despite the challenges.
(15:11):
But one of the things that I think is really helpful is that all of them have
shared at certain points how they've evaluated the health of their career.
And I like to I really like mental models. It really breaks down for me how
to approach a different topic. I really like things to be very tangible.
And when I think about the health of a career, I really think about doctor thinking.
(15:32):
And if you approach it as a doctor, if you approach the health of your career
as you would with a physician lens, so how do we look at the health of our patient?
Well, it's certainly not just what's your BMI.
We look at a lot of different factors. We look at a lot of different vital signs,
review of systems, and the same thing with our career.
It's not just your paycheck or promotion or your publications.
And certainly we celebrate every victory.
(15:56):
So I'm going to ask you right now and feel free to take a little notation for
yourself, but I am going to ask you to put a number on this.
Are you energized at work on a scale of one to 10?
And I'd like to see where you are today and have you compare yourself to a year
from now to just think about that. Are you energized at work?
And when we think about the strong, healthy career, that's the goal.
(16:19):
You want to be, you don't want failure to thrive. You want your well-child exam.
You want that strong, healthy, energized child.
And I think we can break it down into three main organ systems that I'm going to talk about today.
Like I mentioned, that's my mental model.
And I think before we talk about energized at work, it is important to think
(16:40):
about and talk about burnout. out.
This is the ICD-11 World Health Organization definition, where it's resulting
from chronic workplace stress that hasn't been successfully managed.
And they characterize three dimensions.
And I'm going to start with the first dimension, which is reduced professional efficacy.
(17:01):
So if we think about how to make that tangible, to me, that's the organ system of vision.
And I break it down into short distance and long distance vision.
And if you think about short distance vision, that's your day-to-day.
That's really your task management.
And if you think about that spectrum of tasks are manageable versus overwhelmed.
(17:25):
So I'm going to ask you this question. Can you complete your daily tasks at
work without feeling overwhelmed?
On a scale of 1 to 10, where are you on that manageable to overwhelmed?
When I think about productivity and just getting through the day,
it's energy management first, time management second.
(17:45):
And what I mean by that, when I think about energy, it's brain,
body and emotional energy.
So I'm going to start with the physician task load.
So when we were writing our article about practice efficiency,
this was a tool that I had never heard of before. It's really pretty simple,
but it's been validated in many different studies.
(18:07):
So it's called the NASA Physician Task Load.
And they studied the task load score and the risk of burnout.
And it's four domains. It's mental, physical, time demands, and effort demands.
So let me ask you, and you can write this number down if you want,
because I'm going to have you add up these four numbers.
(18:30):
Reflect on a day that you performed clinical work during the last one to two weeks.
Think about that day, and it should be representative of your typical work day.
Question number one is how mentally demanding was that work day on a score of zero to 100?
So 100 means that it was incredibly mentally demanding. That's question one.
(18:51):
Question two, how physically demanding was that work day? Score zero to 100.
Question three is how hurried or rushed was the pace of your workday?
And then question four was how hard did you have to work to accomplish your
level of performance during the workday?
(19:15):
And so now that you have those four numbers, go ahead and quickly add them up.
Once you add those up, you have a score. And in that study, what they found
was that if you had a score of, let's say, 227, no symptoms of burnout.
But once you started to get in
(19:36):
the 280s, that's when physicians started to have one symptom of burnout.
And as you went higher, your risk of burnout.
I hope this episode showcased a variety of CME programs TMA offers,
all at no cost to TMA members and their staff.
Remember to check the episode description to get the link for the full programs
(19:57):
from today's episode and to register for TexMed.
Like and follow this podcast to receive every episode from TMA Practice Well.
Until next time, stay well.
Music.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.