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Professional Resolutions with a New Perspective

Let me add myself to the collective millions (billions?) of folks who are glad to have passed the year-end milestone and are hoping, beyond a shadow of a doubt, that this coming calendar year is very different! We can finally say now “2020 is behind us!”. Many have faced personal and professional challenges that could not be foreseen. Some have had success as well, despite the difficulties on the road to personal and professional progress. Some have had success because 2020 provided them ingredients for it, and I hope that these individuals utilized this success to benefit others, and provide support to those in need.

Like many others, I use the page-flip into a new calendar year as a marker and opportunity to reflect and reset my mind. By no means is this necessary, I have had years where I was firmly anti “year-end mindset”, because a calendar switch is an arbitrary marker of time passing, and I think a lot of folks have had, or still have, this outlook, which is fine! Still, I think this year I wanted to write this blogpost about professional resolutions just as a fun exercise, and maybe (hopefully) put something out there that would benefit (inspire?!?) someone towards a path for professional advancement. This resolutions list will not contain personal goals like achieving the desired weight or reading more books. Let’s get started.

(Submitted by author, modified from CC-0 images at pixabay.com)

1) Explore and find the potential to grow your professional community.

Trainees and early career folks tend to be very focused on their individual or small team “projects”. While this is important, it could obscure the wider “community” aspect of advancement that’s needed to build and expand one’s career. In 2021, I want to continue exploring new ways to participate in professional community building (like joining committees, participating in campaigns, being active in welcoming new members at work, to give a few examples). However possible, find the potential to grow and connect with other professionals within the field.

2) Make ambitious and novel plans for professional advancement projects (with a catch).

One of the things that are very commonly mentioned about 2020 is the reduction/delay/loss of some desired professional accomplishments, which were planned or anticipated before the global health crisis materialized and became unavoidable. A lot of trainees and early career professionals spent much of 2020 trying to salvage whatever they could to complete tasks. This is understandable. Having said that, the “salvaging work” mentality is at best a temporary approach to professional advancement, and at worst, an active hindrance to progress. Making a concerted effort to plan and perform novel and ambitious projects in the new year is a way to get one’s career trajectory back on a climbing slope. The catch I alluded to earlier is vital to note here: in addition to being ambitious in planning, be forgiving of yourself as you track the progress of these new projects. The global health crisis is still ongoing, and everyone is navigating new territory with this whole career advancement reality.

3) Highlight and celebrate all successes on your career path (small or big).

There is a prevalent stream of thinking within academic, scientific, and medical spaces that orient members of these communities to only focus on the biggest accomplishments achieved. Celebrating a publication years in the making, a graduation (also years in the making), a promotion to more senior status (years in the making… do you see the trend?!), and so on. The past year has certainly reduced the number of success stories for many, especially for the early career folks. In 2021, I think it would greatly benefit us to celebrate more professional milestones, even the small ones, and to highlight and be proud of any professional success achieved. The longer we delay enjoying the journey we are on, the longer and drearier the journey will feel like, and maybe even become. The old saying “success begets more success” can be made more accurate by saying “celebrating success paves the way for more success”.

So, as we all metaphorically and collectively turn the page and start a new chapter, leaving 2020 behind us, I aim and resolve myself to advancing my professional life by connecting more, thinking of novel, fun, and ambitious new projects, and to celebrate each small or big step forward on my early career path towards a fulfilling professional journey. Have a happy and healthy new year!

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Exercise: New Year Resolutions in the Midst of the COVID Pandemic

New Year. New Resolutions. With the start of the New Year, many of us make commitments to improve our health. Some of us take on a new routine or hobby, give up or change old habits.  As the holidays go, many of us take on the resolution to engage in more exercise and lose the extra pounds gained through the indulgence during the holidays.  As we embark on the new journey to better health at the start of a new year, it is important to know that we are not alone. There are many around us that are also trying to engage in a healthy resolution to be fit. And there are many resources available to increase our physical activity and remain fit throughout the year.

It has been well established that physical activity contributes to many health benefits. Those who engage in regular exercise benefit from better sleep, growth, development, mood, and overall health.1 On the contrary, the lack of exercise and an increase in sedentary behaviors may contribute to overweight and obesity. Overweight and obesity have deleterious effects in adults, including increased risk of cardiovascular disease, cancer, metabolic syndrome, depression, poor quality of life, and decreased life span.

As the global COVID‐19 pandemic unfolded in year 2020, over 90% of U.S. adult residents found themselves confined to their homes, with restaurants, shops, schools, and workplaces shut down to prevent the disease from spread.2 For some, it meant additional changes, including working remotely, homeschooling children, and personal changes in lifestyle behaviors. Some of these, unfortunately, have led to increased sedentary activity and decreased physical activity, known risk factors associated with overweight and obesity.

For some groups, the transition to lockdown and social distancing has resulted in increased physical activity, especially for bodyweight training, and higher adherence to a healthier diet. Some individuals have engaged in higher consumption of farmers’ produce or purchasing of organic fruits and vegetables, resulting in lower body mass index.3   However, this has not been the norm. More studies report adults experiencing five-to-ten pound increases in weight as a result of increased eating in the home environment. The increased levels of stress, combined with the lack of dietary restraint, snacking after meals, reduced physical activity, and inadequate sleep has further aggravated the risk of overweight and obesity in our population.4   Some groups report less frequent consumption of vegetables, fruit, and legumes during the quarantine, and higher adherence to meat, dairy, and fast-foods.5   Anxiety, depression, self-reported boredom, and solitude have worsened the consumption of snacks, unhealthy foods, cereals, and sweets. These have correlated with higher weight gain for many.6

Being overweight not only increases the risk of infection and complications for those categorized as obese. Recent studies also suggest that the large prevalence of obese individuals within the population might increase the chance of appearance of the more virulent viral strain, and prolong the virus shedding throughout the total population. This may further increase the overall mortality rate as a result of COVID-19. A study on previous influenza pandemics suggests losing weight with a mild caloric restriction, including AMPK activators and PPAR gamma activators in the drug treatment for obesity-associated diabetes. Practicing mild-to-moderate physical exercise may further improve our immune response. Regular physical exercise enhances levels of cytokine production mediated via TLR (toll-like receptor) signaling pathways during microbial infection, improving host resistance to pathogen invasion.7 Regular physical activity may then serve as a cornerstone measure to improve our defenses against influenza viral infection, cardiometabolic diseases, and COVID-19.

Physical activity remains one of the seven modifiable health behaviors and an important metric of The American Heart Association (AHA) Life’s Simple 7 (LS7), associated with improved cardiovascular disease survival and reduced healthcare costs.8   As we battle the restrictions imposed by the pandemic, we have to also think that these circumstances present opportunities to engage our communities in healthy lifestyle practices. Practice aimed to increase our physical activity, may contribute to improving overall health status in the midst of the COVID pandemic.

Here are some ideas on how to meet the New Year resolution to exercise and increase our levels of physical activity:

  • Move More
    • Set up a timer or alarm to move at least once every hour.
    • A good starting goal is to engage in physical activity at least 150 minutes a week. This represents three 50-minute sessions or five 30-minute sessions a week.
    • Start slowly. Gradually build up to at least 30 minutes of activity on most or all days of the week.
    • Check with your healthcare provider before beginning a physical activity program and follow their recommendations.
  • Establish a routine
    • Start with small changes.
    • Make the time.
    • Try to engage in exercising consistently at the same time every day and every week.
    • Stick to the new routine for at least a month.
    • Find a convenient time and place to do activities.
    • Be flexible. If you miss an exercise opportunity, get back on track.
    • Work physical activity or exercise session into your day in another way.
    • Keep reasonable expectations of yourself and your physical activity or exercise routines.
    • Reward or praise yourself for sticking to the changes.
    • Use non-food items to reward yourself.
  • Get support
    • Find buddies or friends who are also making the same commitment to be fit and engage in physical activity.
    • Invite others to join you on your journey.
    • It becomes more fun when you exercise or move in a company.

Start the New Year with a commitment to better health by increasing activity and engaging in regular exercise. Engage others in exercise while keeping social distancing guidelines. Celebrate the small changes. Make a commitment to a Better You!

References:

  1. Centers for Disease Control (CDC). Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Physical Activity Basics. Reviewed 2020 Nov 18. Accessed 2021 Jan 13. https://www.cdc.gov/physicalactivity/basics/index.htm
  2. Bhutani S, Cooper JA. COVID-19-Related Home Confinement in Adults: Weight Gain Risks and Opportunities. Obesity (Silver Spring). 2020;28(9):1576-1577. doi:10.1002/oby.22904
  3. Di Renzo L, Gualtieri P, Pivari F, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229. Published 2020 Jun 8. doi:10.1186/s12967-020-02399-5
  4. Zachary Z, Brianna F, Brianna L, et al. Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obes Res Clin Pract. 2020;14(3):210-216. doi:10.1016/j.orcp.2020.05.004
  5. Sidor A, Rzymski P. Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients. 2020;12(6):1657. Published 2020 Jun 3. doi:10.3390/nu12061657
  6. Pellegrini M, Ponzo V, Rosato R, et al. Changes in Weight and Nutritional Habits in Adults with Obesity during the “Lockdown” Period Caused by the COVID-19 Virus Emergency. Nutrients. 2020;12(7):2016. Published 2020 Jul 7. doi:10.3390/nu12072016
  7. Luzi L, Radaelli MG. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol. 2020;57(6):759-764. doi:10.1007/s00592-020-01522-8
  8. Garg PK, O’Neal WT, Mok Y, Heiss G, Coresh J, Matsushita K. Life’s Simple 7 and Peripheral Artery Disease Risk: The Atherosclerosis Risk in Communities Study. Am J Prev Med. 2018;55(5):642-649. doi:10.1016/j.amepre.2018.06.021

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Equity & Inclusion in Medicine – Part 1: my experience as a BIPOC in medical training

As someone who integrated her elementary school in Ohio (a Yeshiva), enrolled in an exclusive prep school in New England and became the first AA female in her cardiology program, I’ve spent my life analyzing how to adapt to environments in which I was different. When I enter an environment, I learn the lay of the land, identify key players, and observe interactions. I am a fourth-generation African American physician and was raised learning about my relatives’ experiences as minorities in medicine. If I, as early as age 9, could learn how to thrive in diverse environments others can too. I would like to share these experiences and make a case for diversity in cardiology. With this blog, I will help kick off the New Year with part 1 of a multiple part series that aims to define bias in medical training; openly make a case for and provide solutions towards inclusion in cardiology.

In this blog, I will review specific features that demonstrate bias, which can lead to less diversity in training programs. These are topics related to experiences in medicine that are shared by myself as well as my BIPOC and women colleagues.

Affirmative Action, The myth

There’s this assumption that BIPOC has a leg up unfairly given by Affirmative Action, and therefore are enrolled in academic programs without earning it and being unqualified. Truthfully,  nepotism and ease of identifying mentors provide more opportunities than any small % quota which does not seem to translate to faculty positions. In research, at times I have had to become my own mentor to continue to propel myself forward. Without visible faculty mentors, it is difficult to envision a role in academic medicine which makes this career aspiration less likely for many BIPOC. The educational system’s balance as a whole has been skewed related to the American Caste system (consider reading Caste by Isabel Wilkerson). This affects testing metrics and exposure to certain educational experiences. However, with the right inclusion, training, and belief in someone; talented students will become great physicians and cardiologists. In fact, this idea that BIPOC is all unqualified is ironic; many of us feel we have to work twice as hard with a cool and steady temperament all the way through (think of President Obama) to get half as far. Despite strong backgrounds; I often hear colleagues make comments like: “ They are not as clinical.” I already know the race before hearing the full story. We can’t all be inept; not possible.

Double Standards/ Lack of Benefit of the Doubt

Double standards, a topic at this nation’s center as we watched different responses to the siege on Capitol Hill. In cardiology and medicine, it is not uncommon that the same errors in one person may receive a different response from leadership compared to another. One cardiologist stated that he, like many of his colleagues, inadvertently caused a coronary dissection. The response, however, was harsher than what his colleagues experienced for the same incident.  One simple misunderstanding with a BIPOC resident or medical student led to unnecessary poor feedback to this resident that could have been remedied with a conversation. She was not given the benefit of the doubt like her peers would have; in fact, I don’t think the incident would have been reported at all considering how trivial it was. At times, we feel closely observed and overly scrutinized. At times by other women and BIPOC as well. Perhaps there is a “crabs in a barrel” mentality when there are so few represented in one place, this can actually create tension. What’s most difficult is, there’s less ability to be human; which is amplified when it seems as if there is not always a trustworthy authority to turn to. It may not be that one BIPOC placed in a leadership position; they may not want to rock the boat.

So we feel that we must work twice as hard; smile (wear the mask long before COVID19), with only marginal to no room for error (there is a great scene in the movie about the Tuskegee Airmen on HBO that highlights this point).

Abstract Feedback

Often we receive feedback that is very vague and abstract and seemingly more personal than constructive. It’s generally a vague comment that has one racking their brain over and over with no real tangible solution provided by the person giving the feedback; this was described in “Research: Vague Feedback Is Holding Women Back.” For example, I was once told, “You’re too confident.” How do I change my confidence? How can I be less confident, but at least somewhat self-assured? Do you see how this happens? Not too uncommonly we receive nonactionable feedback that has one racking their brain and can have an emotional impact. It’s distracting. Actionable feedback is more helpful especially if it is not something very personal and aimed more at patient care. One mentee of mine received an overall vague evaluation and marked her with critical deficiencies without good evidence. I did not want this practice to continue, and I wrote to the associate program director to describe the scenario and shared my concerns. It was determined that this evaluation was a mistake after a larger review. Imagine a situation had it stayed on her record; it could have had negative implications to her career, especially, when she is planning to pursue a selective fellowship.

Assumptions

During a medical school interview, I was asked if they should accept fewer women due to pregnancy. I was never comfortable sharing my pregnancy considering this was my first introduction. He assumed women couldn’t make these decisions, and that, affirmative action should be taken away (this was 2008; not long ago). I have also found that, before really knowing one’s interest, it is assumed a female cardiologist will pursue a career in imaging. I am often asked “ You’re doing imaging, right?” Or I’ve heard, “ she is an imager, typical.” This can impact cath scheduling if there are no fixed schedules for all fellows. In fact, scheduling is where bias can creep in ( I have heard of giving longer hours to BIPOC forcing one group of residents to threaten federal intervention.) This can be avoided with as much equal scheduling as possible (not always perfectly feasible) without assuming anything. Assumptions are not meant to be hurtful; it’s human nature. However, at times it may pigeonhole folks to roles that must end with women’s health, equity, or inclusion (exceptionally relevant roles). These folks can also have leadership roles related to other clinical interests as well.

Certainly, these may not all be unique to BIPOC and women; however, I hear similar stories over and over again, as if they are told by the same person. As we enter into a new era, I hope cardiology joins the future of progress. In parts II and III, I will answer why inclusion is important and some solutions on how to cultivate an inclusive specialty.


For this series, we will be discussing –

Part 1. My experience
Being hypnotized that I am lower in the caste system and limited. The emotion clouded my abilities and held me back from further progress. I have to prove my resume more than my colleagues every time and it’s exhausting. In research, I’ve felt like an outsider constantly having to build my own way and have been directly judged for lack of prolific publications.

Part 2. Why?
Embracing difference can help a program evolve (% diversity at Harvard ) it’s a win-win; a synergistic relationship in which we grow together. Representation matters, and to diversify the workforce will help the patients’ comfort and compliance.

Part 3. How?
Aim for a standard similar to Goldman Sachs’s 25%1.  Provide resources and assistance to BIPOC. Show up for each other. Engage ABC and uplift ; normalize discussing differences and being different. Check in with your BIPOC trainees’ wellbeings, if there are issues driven by bias speak up with your peers in a collegial way.

 

Reference

  1. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774738?utm_source=twitter&utm_medium=social_jamajno&utm_term=4395647160&utm_campaign=article_alert&linkId=108893385

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Hopes for 2021

As 2020 concluded with all of the unprecedented events, with the tragedies people had to suffer and are still suffering from, with all the good and bad, we enter the New Year of 2021 with some hope; hoping for better health, better strategies to combat what we are dealing with in this pandemic, and being more responsible for each other.

COVID-19 Pandemic

COVID-19 pandemic has changed how we live our lives, and the impact of this pandemic will likely last at least a few years, if not more after the pandemic is over. There are a lot of “unknowns” about COVID-19 infection, including the long-term effects of this infection and the effectiveness of some medications, that we will get to encounter and manage in the next several years.

COVID-19 Vaccine

With multiple effective vaccines discovered recently, healthcare workers were given priority to get the vaccine, followed by more vulnerable patients, including the elderly and those with significant comorbidities. The Centers of Disease Control and Prevention (CDC) website provides helpful information on the currently available vaccines in the United States (US), Pfizer, and Moderna, including their storage, preparation, and expected side effects (Link is provided below) [1].  The hope is that by the Spring of 2021, 75% of the population in the United States will be vaccinated.  Moreover, efforts by international organizations, including the World Health Organization (WHO), to distribute the vaccine to all countries are ongoing [2].

COVID-19 New Strains

We have seen the discovery of new strains of COVID-19 infection in the United Kingdom and, most recently, the US. These new mutant strains of COVID-19 may not be covered by the available vaccines, as such, the vaccine is an additional layer of protection, with the other protection measures, including social distancing, masks, and hygiene, which may be the most important way to prevent the spread of these new strains at this point of time.

With all that being said, our hopes for a “normal 2021” depend on how we handle the COVID-19 pandemic, we may not see everything going back to normal in 2021, but we can work on making the initial right steps now so that we have less grief, less “loss,” fewer travel restrictions, with healthier and happier upcoming years!!

Special thank you to my sister, Rawan Ya’acoub, an assistant professor of Doctor of Pharmacy/Clinical Pharmacology at the University of Jordan in Amman, Jordan, who helped me write this blog, and for all of her support.

 

References

  • S. COVID-19 Vaccine Product Information: https://www.cdc.gov/vaccines/covid-19/info-by-product/index.html
  • COVID-19 vaccines: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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In Sharing Your Pain, Your Help Others Heal – A tribute to, Dr. Basem Oraby, a resident physician we lost in 2020

I did not know Dr. Basem Oraby but when I wrote a blog in memory of my aunt, Dr, Somaya Saad Zaghloul, who died of COVID-19 in Egypt on December 1, 2020, his sister, a clinical pharmacist, Bassant Orabi, reached out to me on Twitter and said sharing my aunt’s story gave her the courage to share her little brother’s. A beautiful soul, taken from us far too soon. My conversation with Bassant was heart-wrenching but reminded me that in sharing my pain, others heal too. Her tribute is movingly painful. Our paths crossed because of tragic circumstances, but somewhere in there is a glimmer of light. Read on for Bassant’s tribute.

I never thought I would experience something as painful as holding my dad in my arms at 2:00 am with my eyes fixated on the monitor watching his EKG flatten, but I was wrong. Four years later, I saw my little brother Basem in a coffin. But in that coffin was not just my brother’s body, with his passing went his dreams of becoming an attending physician, the goals he planned on crushing, his jokes and unmatched sense of humor, and his outpouring of love and support to anyone in need. I could not believe my brother was gone.

It took me a long time to write a tribute worthy of the legacy Basem left behind.  Although Bassem died at the young age of 25, he lived his life to the fullest. I look back to January 15, 1995, and I see this tiny baby whose little cries captured my heart immediately. Basem was the kindest among our family, never hesitating to offer a helping hand or a shoulder to lean on. He was a true family young man who loved and protected his family. I remember the countless times he comforted me during my most difficult times and I now wonder if I will ever feel that much unconditional love again? Although I am 10 years older than him, he was and will always be my hero.

Basem was a loyal friend to many. It became even more evident by the outpouring of love from his friends all over the world after his death. His compassion and love for everyone were unsurpassed. He always went the extra mile for those he loved and cared about and always believed in saying only what was good. His beautiful heart and tender soul drew many to him. As I read countless messages from his professors, I got to know Basem as the brilliant physician he was. Losing our father was not easy on him, yet he found the will in himself to graduate from Weill Cornell Medical School in Qatar. Everything he did, he did with perseverance. He moved thousands of miles to pursue his dreams to train in internal medicine at Virginia Commonwealth University Health in Richmond, Virginia. He took pride in serving veterans and disadvantaged patients. I remember him being so proud to have diagnosed a case of cardiac amyloidosis, it was clear that medicine was his passion. Basem felt medicine was a career of helping people out of their dark roads. He was the compassionate doctor I wanted to see in an emergency department. 

Basem was a generous soul who never hesitated to help others in need. Basem was the 9-year-old kid who gave all his money to a taxi driver who could not afford the cost of his daughter’s chemotherapy, he was the teenager who supported refugees from his undergraduate scholarship stipend, and he was the young doctor who brought food to many who could not afford it.  I still cry that he died alone in America with no one around him, but soon I remember that such a beautiful soul is never alone. Every time I remember how much he wished he would come to visit us and how proud he was to be working and helping during a pandemic, I realize that he lived the life of giving he wanted.

I used to stand by his grave and weep, there was a hole in my heart that grew every day since we were informed of his death until the day then I realized that his true journey had just begun.  Though he is no longer with us, his love and support shower us. I think of all the charity work he contributed to including water wells, tents, education packages, medical glasses, and food among many other projects done in his name in Africa, Asia, and Europe. Even after his death, his legacy remains. I am inspired to be the best version of myself to make him proud.  

I wish his friends, colleagues, all those who knew him, and us, his family, continue his legacy of love, compassion, generosity, and kindness. I also ask you all to keep him in your prayers. Basem will always be a beautiful part of our journey. I will always carry you in my heart Basem.

In sharing my pain, I was able to help Bassant start her journey to healing. There is a power in vulnerability. You touch lives. As the late, great Dr. Maya Angelou told us, a legacy is every life you touch. Touch as many as you can.

[This is the last photo Dr. Basem Oraby took with his family at the airport before heading to the US for residency]

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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COVID Fatigue

Anesthesia alert! This overhead call alerting pending intubation can be heard bellowing throughout the hallways of my medical center several times throughout the day and is seemingly the soundtrack of COVID-19. My typical routine is to pause, make sure it’s not sounding the alarm to my patient’s room, and then continue with my workday.

It has been 304 days since the WHO has declared COVID-19 a pandemic. COVID numbers at my medical center continue to rise, and although the vaccine is widely available to hospital staff, we are continuing to see some of our highest numbers since the beginning of the pandemic.

As a general cardiology fellow on the advanced heart failure service at a high volume mechanical circulatory support and transplant center, we really get to know our patients while taking care of them during their index hospitalizations. For the past two weeks, I’ve gotten to know one patient in particular. She presented in cardiogenic shock, was stabilized on inotropes and a balloon pump, with plans for upcoming destination therapy LVAD implantation.

Every day when we come to her bedside, she is on FaceTime with her partner. Today, the day before her LVAD implantation, we walked to her bedside, and once again she was on FaceTime with her devoted partner. She is obviously loved. Considering that she was going for LVAD the following day, we spent a bit more time explaining the procedure in-depth to the patient and her partner. After discussing all of the technical details, she timidly asked “Do you think my partner could come to spend the night with me tonight? I just need to see my love and it’s been so long.” You could see the tears begin to drop from her face and her partners.

Donning and doffing, wearing the N95, not knowing what anyone looks like without their mask; things have become routine. Health-care workers have adapted so well to the ever-demanding challenges of practicing medicine in the era of COVID-19. We’ve made guidelines, adjusted our practice, established routines, and found ways to provide quality medical care in the darkest of times. We’ve become oddly accustomed to these necessary rituals in order to protect ourselves, our loved ones, and the patients that we care for.

But none of this is normal.

At that moment, when we told our patient that the person who loved her the most in this world could not sit with her the night before a life-altering surgery, it became dramatically apparent to me that all of this is abnormal. The weight of 304 days of pandemic sat heavy in my heart and the sounds of endless anesthesia alerts echoed in my head.

Depression and burnout were prevalent in the healthcare field even before the pandemic. COVID-19 has undoubtedly placed an added burden on all healthcare providers. I implore people to take time off if you can, spend time with family if able, and be thoughtful of your mental well being because this past year has been anything but normal.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 

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Smallpox to COVID-19: We’ve come a long way!

The history of humankind has never witnessed an infectious agent deadlier than Smallpox. It is thought to have first appeared in Asia or Africa thousands of years ago, before spreading to the rest of the world. This virulent disease was causing hundreds of thousands of deaths each year during the 16th, 17th, and 18th centuries in Europe alone; and when Europeans brought it to Mexico in the 16th century, it killed nearly half of the previously unexposed Aztec and Inca population in less than 6 months.1,2 In the early 1700s, Lady Mary Montague, the wife of the British Ambassador to Turkey, and a disfigured Smallpox survivor, was fascinated by the smooth skin of the ladies at the famous Turkish Baths. A face with no scars was a rare sight in Smallpox-devastated England at the time. “The small-pox, so fatal, and so general amongst us, is here entirely harmless, by the invention of engrafting”, she wrote home in her notable letter.3 She had witnessed the primitive form of vaccination, which was then called inoculation. Turkish mothers would gather their children at Smallpox parties, where an old lady would tear the skin of healthy kids and smear a small sample of the virus (typically from a recently infected child). The kids would then develop a mild form of illness that recovers with no scarring and gives them long term immunity. Lady Montague used this technique to protect her son and has been credited for bringing this historical discovery back to England and advocating for its widespread use despite major opposition from the British medical community at the time (Figure 1). Subsequently, in 1796, Edward Jenner developed the much safer technique of vaccination using Cowpox instead of the Smallpox virus.4 Two centuries later, Smallpox was completely eradicated!

Figure 1: The painting Lady Mary Wortley Montagu with her son, Edward Wortley Montagu, and attendants attributed to Jean Baptiste Vanmour (oil on canvas, circa 1717). © National Portrait Gallery, London: NPG 3924.

What is most remarkable about this story is that the practice of Smallpox inoculation was introduced in Europe only in 1721 by the relentless efforts of a concerned and enlightened mother, despite being successfully used in Oriental countries such as China, India, and Turkey for centuries. In other words, one half of the globe was deeply suffering from an illness that killed millions of people over the years, while the other half held the secret to its prevention. And it was only when knowledge was exchanged between the two halves that humanity finally defeated one of its deadliest historical enemies! There has never been a better moment to relive and celebrate the magnificent product of worldly human collaboration than these days, as people around the globe started receiving their first doses of COVID-19 vaccines. A deadly virus that took the world by surprise and killed more than 1.5 million people, now, only a year later, has more than one vaccine with proven efficacy. It is amazing how far we have come along since the times of Smallpox! The obvious difference is the power of science and research, yet, another big and equally important difference, is how well connected our world is right now. This unprecedented connection is what allowed us to have a global response to this pandemic and unite our efforts to create a solution (Figure 2). Two Turkish immigrants develop a technology in the labs of a Germany-based biotech company to be quickly adopted by an American Pharmaceutical giant, which tests it and subsequently mounts a large-scale distribution process around the world —among other fascinating stories. As much as we seem deeply divided nowadays, due to political and ideological differences, in fact, over the history of humankind, there has never been a time where the world population was more united! Maybe we clearly see our major differences simply because we have never been this close! And our closeness and continued collaboration are what will get us through this! It is too early to declare victory, and things are far from perfect, but it’s a good time to pause and appreciate our progress!

Figure 2: The global effort for COVID-19 vaccine development.
Image credit: Judith Kulich, Cody Powers, Amit Pangasa, Kristyn Feldman, Parul Rewari and Samaya Krishnan. COVID-19 vaccines: Who might win the race to the global market? Published May 13, 2020. Available online on: https://www.zs.com/insights/covid-19-vaccines-who-might-win-the-race-to-the-global-market

References:

  1. Hopkins DR. The greatest killer: smallpox in history. vol. 793. University of Chicago Press; 2002.
  2. Razzell P. The conquest of smallpox: the impact of inoculation on smallpox mortality in eighteenth century Britain. Caliban Books, 13 The Dock, Firle, Sussex BN8 6NY; 1977.
  3. Lady Mary Wortley Montagu, “Lady Mary Wortley Montagu on Small Pox in Turkey [Letter],” in Children and Youth in History, Item #157. Available online: https://chnm.gmu.edu/cyh/items/show/157 (accessed December 27, 2020). Annotated by Lynda Payne
  4. Lindemann, Mary. Medicine and Society in Early Modern Europe. Cambridge University Press. p. 77. ISBN 978-0521732567; 2013.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Start 2021 in a Good Night Sleep

Picture source: (Kuehn 2019)

Should you make new year’s resolutions? Many may think the new year’s resolutions are meaningless. Especially after a year of frustration and uncertainty, New year’s resolutions seem less encouraging. A few small and attainable goals could help to provide a sense of purpose and improve our well-being. The most popular goals for new year’s resolutions include exercise more, eat healthier, and get rid of bad habits.

[1]Sleep deprivation is one of the common bad habits in modern society. According to a study in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Report, 1 in 3 Americans don’t get enough sleep on a regular basis. To promote optimal health and well-being, the American Academy of Sleep Medicine and the Sleep Research Society recommend at least 7 hours of sleep each night for adults aged 18-60 years old. The adverse effects of sleep deprivation (less than seven hours per day) include obesity(Beccuti and Pannain 2011), diabetes(Shan et al. 2015), high blood pressure(Gangwisch et al. 2006), cardiovascular disease(Nagai, Hoshide, and Kario 2010; Kuehn 2019), stroke, and mental distress(Baglioni et al. 2016). It’s undeniable that having sufficient sleep is essential to our optimal health and well-being. Here are some helpful tips to start your 2021 with a good night’s sleep.

Bedroom: light, noise, and temperature

Research shows artificial light at night can disrupt circadian rhythms and cause adverse effects on sleep(Aulsebrook et al. 2018). A dim bedroom environment can help the body to recognize the time to rest. Electronic devices emit blue lights, many studies show that blocking blue light is beneficial for patients to suffer from insomnia(Janků et al. 2020). Restricting electronic devices before sleep or using blue-light blocking approaches are helpful to maintain a good quality sleep.

Noise can also affect sleep(Basner and McGuire 2018). Try to reduce noise in the bedroom environment could fall asleep faster and minimize disruption during sleep. Both environmental and body temperature impact sleep duration and sleep quality(Troynikov, Watson, and Nawaz 2018). Increased bedroom and body temperature decrease sleep quality. Finding a comfortable temperature for yourself will improve sleep quality. For most people, the desirable bedroom temperature is around 70 ˚F (20 ˚C). Taking a good bath or shower before bed will prepare the body to adjust to a favorable temperature for sleep.

De-stress: mentally and physically

Most of us have experienced some form of insomnia when we have something in our minds. Integrative approaches to insomnia such as mind-body therapies (mindfulness mediation, yoga, tai chi) have been shown beneficial to de-stress the body as well the mind(Zhou, Gardiner, and Bertisch 2017). Exercise is beneficial for the overall well-being, can improve the quality of sleep(Kelley and Kelley 2017). Various approaches can help relax the body and mind, finding your favorite ones requires a little bit of exploration.

Routine: timing and time

We are creatures of habits. Especially when it comes to sleep. Disruption of the circadian clock adversely affects sleep, which causes cardiovascular diseases(Chellappa et al. 2019). Cultivating a wake-up and night-time routine will have profound impacts on the overall performance. When to go to bed is different for everyone. Anecdotally, it’s best to go to bed earlier and wake up early each day. This may not work for everyone’s schedule. Keeping the recommended amount of sleep is more important than strictly enforcing yourself against your circadian clock.

Food and drink

Investigation of the impact of food choice and consumption on sleep is an emerging field. Early clinical studies investigated the effects of certain macronutrients such as carbohydrate, protein or fat on daytime alertness and nighttime sleep. Some popular sleep–promoting foods, such as milk, fatty fish, cherries, and kiwifruit have been reported(St-Onge, Mikic, and Pietrolungo 2016). Avoid late caffeine consumption(Clark and Landolt 2017) and alcohol(Thakkar, Sharma, and Sahota 2015) are common practices to improve sleep quality.

All of the above are potential strategies for sleep improvement. Making small adjustments in your sleep hygiene routine could have a promising outcome. The key is to start small and stick to it until it incorporates into your day-to-day life.

Reference:

Aulsebrook, Anne E., Therésa M. Jones, Raoul A. Mulder, and John A. Lesku. 2018. “Impacts of Artificial Light at Night on Sleep: A Review and Prospectus.” Journal of Experimental Zoology Part A: Ecological and Integrative Physiology. https://doi.org/10.1002/jez.2189.

Baglioni, Chiara, Svetoslava Nanovska, Wolfram Regen, Kai Spiegelhalder, Bernd Feige, Christoph Nissen, Charles F. Reynolds, and Dieter Riemann. 2016. “Sleep and Mental Disorders: A Meta-Analysis of Polysomnographic Research.” Psychological Bulletin. https://doi.org/10.1037/bul0000053.

Basner, Mathias, and Sarah McGuire. 2018. “WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep.” International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph15030519.

Beccuti, Guglielmo, and Silvana Pannain. 2011. “Sleep and Obesity.” Current Opinion in Clinical Nutrition and Metabolic Care. https://doi.org/10.1097/MCO.0b013e3283479109.

Chellappa, Sarah L., Nina Vujovic, Jonathan S. Williams, and Frank A.J.L. Scheer. 2019. “Impact of Circadian Disruption on Cardiovascular Function and Disease.” Trends in Endocrinology and Metabolism. https://doi.org/10.1016/j.tem.2019.07.008.

Clark, Ian, and Hans Peter Landolt. 2017. “Coffee, Caffeine, and Sleep: A Systematic Review of Epidemiological Studies and Randomized Controlled Trials.” Sleep Medicine Reviews. https://doi.org/10.1016/j.smrv.2016.01.006.

Gangwisch, James E., Steven B. Heymsfield, Bernadette Boden-Albala, Ruud M. Buijs, Felix Kreier, Thomas G. Pickering, Andrew G. Rundle, Gary K. Zammit, and Dolores Malaspina. 2006. “Short Sleep Duration as a Risk Factor for Hypertension: Analyses of the First National Health and Nutrition Examination Survey.” Hypertension. https://doi.org/10.1161/01.HYP.0000217362.34748.e0.

Janků, Karolina, Michal Šmotek, Eva Fárková, and Jana Kopřivová. 2020. “Block the Light and Sleep Well: Evening Blue Light Filtration as a Part of Cognitive Behavioral Therapy for Insomnia.” Chronobiology International. https://doi.org/10.1080/07420528.2019.1692859.

Kelley, George A., and Kristi Sharpe Kelley. 2017. “Exercise and Sleep: A Systematic Review of Previous Meta-Analyses.” Journal of Evidence-Based Medicine. https://doi.org/10.1111/jebm.12236.

Kuehn, Bridget M. 2019. “Sleep Duration Linked to Cardiovascular Disease.” Circulation 139 (21): 2483–84. https://doi.org/10.1161/CIRCULATIONAHA.119.041278.

Nagai, Michiaki, Satoshi Hoshide, and Kazuomi Kario. 2010. “Sleep Duration as a Risk Factor for Cardiovascular Disease- a Review of the Recent Literature.” Current Cardiology Reviews. https://doi.org/10.2174/157340310790231635.

Shan, Zhilei, Hongfei Ma, Manling Xie, Peipei Yan, Yanjun Guo, Wei Bao, Ying Rong, Chandra L. Jackson, Frank B. Hu, and Liegang Liu. 2015. “Sleep Duration and Risk of Type 2 Diabetes: A Meta-Analysis of Prospective Studies.” Diabetes Care. https://doi.org/10.2337/dc14-2073.

St-Onge, Marie Pierre, Anja Mikic, and Cara E. Pietrolungo. 2016. “Effects of Diet on Sleep Quality.” Advances in Nutrition. https://doi.org/10.3945/an.116.012336.

Thakkar, Mahesh M., Rishi Sharma, and Pradeep Sahota. 2015. “Alcohol Disrupts Sleep Homeostasis.” Alcohol. https://doi.org/10.1016/j.alcohol.2014.07.019.

Troynikov, Olga, Christopher G. Watson, and Nazia Nawaz. 2018. “Sleep Environments and Sleep Physiology: A Review.” Journal of Thermal Biology. https://doi.org/10.1016/j.jtherbio.2018.09.012.

Zhou, Eric S., Paula Gardiner, and Suzanne M. Bertisch. 2017. “Integrative Medicine for Insomnia.” Medical Clinics of North America. https://doi.org/10.1016/j.mcna.2017.04.005.

[1] Picture source: (Kuehn 2019)

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Is Routine Transesophageal Echocardiogram (TEE) Needed Before Atrial Fibrillation Ablation in Patients Treated with Uninterrupted Direct Oral Anticoagulation for At Least 3 Weeks?

What do the guidelines say?

The 2017 AF guidelines give a Class IIa recommendation for performing a transesophageal echocardiogram (TEE) for patients with AF undergoing ablation who are in AF on presentation, even if they have been receiving therapeutic anticoagulation for 3 weeks or longer1. However, the more recent 2020 European College of Cardiology AF guidelines recommend therapeutic oral anticoagulation for at least 3 weeks before ablation (Class 1), or, use of TEE to exclude left atrial appendage thrombus before ablation2.

What is routine clinical practice?

In accordance with the guidelines, many centers, including our own, perform routine TEE before AF ablation, however, my recent Twitter poll suggests that there is wide variation in clinical practice3 (Figure 1). The benefit of performing this TEE is the ability to rule out left atrial and left atrial appendage (LAA) thrombus. However, the routine use of TEE not only adds to the overall risk of the ablation but also increases the cost of care.

Why this practice should be questioned?

There have been multiple changes in recent years that have questioned the role of routine TEE before AF ablation. These include:

1) The advent of direct oral anticoagulants (DOACs) that have better efficacy and safety than warfarin.

2) Increasing preference and guideline recommendations endorsing the practice of uninterrupted DOACs before ablation that has shown to be associated with very low rates of peri-procedural thromboembolic complications.

3) Availability and use of intracardiac echocardiography (ICE) that can be used to rule out LAA thrombus.

What does recent data suggest? (Figure 2)

The September 2020 issue of Circulation Arrhythmia and Electrophysiology had a very interesting study by Diab et al asking this important clinical question4.  In their analysis of 900 patients presenting with AF or atrial flutter for ablation who did not undergo any pre-procedural or intraprocedural imaging for the purpose of ruling out LAA thrombus and were taking uninterrupted DOACs for > 3 weeks, they found that only 4 (0.3%) patients developed thromboembolic complications with 2 ischemic strokes, 1 transient ischemic attack (TIA) and 1 splenic infarct. The authors concluded that in patients taking uninterrupted DOACS and undergoing AF/atrial flutter ablation, omitting the pre-procedural TEE and ICE from the right ventricular outflow tract was feasible and associated with a low risk of thromboembolic complications.

Similar results were observed in the much large multicenter prospective registry data of over 6000 patients by Patel et al5 where only 1 TIA was observed in the setting of a missed dose of Rivaroxaban before ablation. However, in this study ICE ruled out LAA thrombi in all patients in contrast to the study by Diab et al where ICE was not used.

Take Home Message

Recent data from two large observational studies suggest that in patients with AF who are undergoing ablation and taking uninterrupted DOAC for at least > 3 weeks before ablation, performing a pre-procedural TEE is not necessary. Given the very low event rates of thromboembolic complications during ablation, the feasibility of a large randomized trial addressing this specific question seems uncertain as it will require a very large sample size.

Figure 1: Twitter poll showing the equipoise on performing routine transesophageal echocardiogram (TEE) in patients undergoing catheter ablation of atrial fibrillation.

Figure 2: Summary of data from 2 recent large observational studies suggesting that omitting routine transesophageal echocardiogram (TEE) is safe

 

REFERENCES

  1. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20(1):e1-e160. doi:10.1093/europace/eux274
  2. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. Published online August 29, 2020. doi:10.1093/eurheartj/ehaa612
  3. Asad Z. Does your center perform “routine” TEE before AF ablation for patients taking uninterrupted oral anticoagulation for >3 weeks? https://twitter.com/ZainAsadEP/status/1347349701067206656?s=20
  4. Diab Mohamed, Wazni Oussama M., Saliba Walid I., et al. Ablation of Atrial Fibrillation Without Left Atrial Appendage Imaging in Patients Treated With Direct Oral Anticoagulants. Circulation: Arrhythmia and Electrophysiology. 2020;13(9):e008301. doi:10.1161/CIRCEP.119.008301
  5. Patel K, Natale A, Yang R, et al. Is transesophageal echocardiography necessary in patients undergoing ablation of atrial fibrillation on an uninterrupted direct oral anticoagulant regimen? Results from a prospective multicenter registry. Heart Rhythm. 2020;17(12):2093-2099. doi:10.1016/j.hrthm.2020.07.017

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

 

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COVID-19: Healthcare Workers vs The Vaccine

The mid-December rollout of two FDA-approved COVID-19 vaccines coincided with a surge in US infections, as we surpassed 21 million cases and 300k deaths. Amidst the hope for a recovery from the virus, that has captivated the world for the past 10 months, the vaccine rollout was met with stiff resistance from many Americans. Of these, healthcare workers comprise the largest group of those refusing vaccination (albeit, healthcare workers also comprised the majority of people offered the early doses). This theme has persisted over the past few weeks. I will review some of the ideas behind the refusal of vaccine acceptance.

First, the headlines (taken from Forbes):

  • Last week, Ohio Gov. Mike DeWine said he was “troubled” by the relatively low numbers of nursing home workers who have elected to take the vaccine, with DeWine stating that approximately 60% of nursing home staff declined the shot.
  • Joseph Varon, chief of critical care at Houston’s United Memorial Medical Center, told NPR in December more than half of the nurses in his unit informed him they would not get the vaccine.
  • Roughly 55 percent of surveyed New York Fire Department firefighters said they would not get the coronavirus vaccine, the Firefighters Association president said last month.
  • The Los Angeles Times reported that hospital and public officials in Riverside, Calif., have been forced to figure out how best to allocate unused doses after an estimated 50% of frontline workers in the county refused the vaccine.
  • Fewer than half of the hospital workers at St. Elizabeth Community Hospital in Tehama County, Calif., were willing to be vaccinated, and around 20% to 40% of L.A. County’s frontline workers have reportedly declined an opportunity to take the vaccine.
  • Nikhila Juvvadi, the chief clinical officer at Chicago’s Loretto Hospital, said that a survey was administered in December, and 40% of the hospital staff said they would not get vaccinated.

Distrust For The Government Among Black/LatinX

Frontline workers in the United States are disproportionately Black and Hispanic. It is no surprise to my readers, as mentioned briefly in my AHA recap article(s), that structural racism is (and has been) a pervasive force within healthcare. “I’ve heard Tuskegee more times than I can count in the past month — and, you know, it’s a valid, valid concern,” said Dr. Juvvadi. This forms the crux of the argument made by minority frontline workers against receiving the vaccine. A recent survey by the Kaiser Family Foundation found that 29% of healthcare workers were hesitant to receive the vaccine, citing concerns related to potential side effects and a lack of faith in the government to ensure the vaccines were safe. Furthermore, dissenters question the involvement of Black/LatinX participants in the clinical trials that led to the development and deployment of at least two FDA-approved vaccines at the time of this article. Dr. Juvvadi told NPR that “there’s no transparency between pharmaceutical companies or research companies — or the government sometimes — on how many people from.” In an op-ed published in the New York Times last week, emergency physicians Benjamin Thomas and Monique Smith wrote that “vaccine reluctance is a direct consequence of the medical system’s mistreatment of Black people,” exemplified by the unethical surgeries performed by J. Marion Sims and the Tuskegee Syphilis Study, that highlight “the culture of medical exploitation, abuse, and neglect of Black Americans.”

Altruism and Others More Deserving

Medicine is an inherently altruistic field, one that requires a dedication to the service and betterment of others. This theme has largely affected the sentiment concerning the acceptance of the COVID-19 vaccines. In an op-ed published earlier this week by Marty Makary MD MPH, a professor of surgery and health policy at the Johns Hopkins University School of Medicine, the case for delaying vaccination is made. Dr. Makary states:

“After a summer of corporate statements pledging that Black Lives Matter, America’s vaccine rollout is creating inequities stemming from a ruling class making rules to favor themselves. In the first two weeks after the FDA authorized the life-saving vaccine, hospital board members, spouses of physicians, cosmetic surgery receptionists, and young firefighters have been getting the vaccine ahead of our society’s most vulnerable. Low-risk Americans with access and power are cutting in the vaccine line and, by doing so, are essentially telling our society’s most vulnerable members ‘your life matters less.’”

Dr. Makary shares his experience as a physician who performs surgeries on COVID-negative patients in a sterile environment with the highest infection control precautions accounted for. Furthermore, he weighs his personal risk of having a complicated course of COVID-19 infection versus that of his elderly patients, many of whom have multiple comorbid medical conditions. He argues that low-risk healthcare workers, including those who have already been infected, defer their vaccination in order to allow for higher-risk individuals to receive a potentially life-saving intervention. This highlights the chasm in Medicine between altruism and self-preservation. Is it possible to do both?

I end with a quote from Dr. Makary, expressing his views on the matter:

“I’m not criticizing clinicians who get the vaccine — my personal decision might be different if I spent more time in the ICU, took more ER calls, or was at high risk of being a silent carrier of the virus, putting my patients at risk. But that’s not me. Given my very low personal risk of mortality and my very low risk of getting the virus in my clinical work, I have joined a growing chorus of healthcare workers who have taken a pledge to not get the vaccine until every high-risk American has been offered it first.”

Thank you for reading, and please feel free to reach out to me with comments or questions on Twitter @DrDapo.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”