From the Director
Good to hear that TB practice went well! We are getting closer to recruitment as well … start to look for all the dinner, tour and recruitment buddy signups. We also have been hearing from applicants that we have the BEST website with all of your profiles, so many thanks for taking time to fill them out. This week we had some special guests at noon conference, including the DIO Dr. Cathy Kuhn discussing security and the CMO Dr. Lisa Pickett joining our outstanding M&M put together by Lindsay Boole and presented by Greg Brown.
Belated congratulations to our Class of 2015 on becoming BOARD CERTIFIED internists! You guys rocked it!
Kudos this week go to Brian Sullivan and Ashley Bock for excellent SAR talks, to Dinushika Mohottige, Dana Clifton, Doran Bostwick and Brian Sullivan for their global health gallops, and to Anubha Agarwal for an outstanding chair’s conference. Dinushika also gets a shout out from Kara Wegermann for her dayfloating skillz. (yes, skillz.). Thank you to the future oncologists who took time to attend the career advice/mentoring session by visiting professor Dr. Barry Coller. Much thanks to Dr. Gow Arepally for including us.
The Social Action Council had a fantastic meeting this week with the leadership of the Lincoln Community Health Center and we are so much closer to getting our evening Lincoln volunteer opportunity off the ground. Many of you have already expressed interest … please contact Lauren Collins or Madi Smith if you are interested and haven’t contacted us already.
Doctoberfest continues .. don’t forget to bring some lunch on Wednesday for our WE CARE Wednesday, and keep answering the questions. Prizes for the winners will be in the office on Tuesday. And...get ready for the second annual Duke IM Paintball Extravaganza! Clearly led by VA Chief Chris Hostler, here is your chance to work through some of that pager-induced rage. Sign up is in your email or contact Chris or Marc Samsky for details!
This week’s pubmed from the program goes to Rajiv Agarwal for his upcoming abstract presentation at the 2016 Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association! His mentor is Dr. Jason Webb, through the GME Resident as Teachers Concentration!
"Palliative Care Core Competencies in Undergraduate Medical Education: Medical Student End of Life Care Training and Experience with Patient Death at Duke University.”
Have a great week (especially you, Alan Erdmann)
Aimee
What did I read this week?
Submitted by: Dr. Lindsay Boole, VA QI Chief Resident 2015-16
The headlines were shocking...
Most Americans Will Get a Wrong or Late Diagnosis At Least Once in Their Lives
-The Washington Post
'Countless' Patients Harmed By Wrong or Delayed Diagnosis
-U.S. News & World Report
Diagnostic Errors Put Millions of Patients At Risk, Report Says
-CBS News
This was Big News in the quality and health care delivery worlds and in the popular media. On September 22nd, the Institute of Medicine released a huge report called Improving Diagnosis in Healthcare. No, I did not read the 450-page report in paperback form… but I did read the summary (linked below) and a multitude of articles reporting on it.
This report is billed as a continuation of the very famous landmark reports To Err is Human (2000) and Crossing the Quality Chasm (2001) that birthed the patient safety and quality improvement movement.
Improving Diagnosis in Healthcare introduces the idea that the prevalence and role of diagnostic errors have been under-appreciated in the quality and safety movement. It argues that “most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequence,” and that “urgent change is warranted to address this challenge.”
The report defines diagnostic error as the failure to (a) establish an accurate and timely explanation of the patient’s health problem; or (b) communicate that explanation to the patient.
It says that each year, 5% of adult outpatients experience a diagnostic error and that diagnostic errors contribute to 10% of patient deaths, per postmortem studies. Diagnostic errors are the leading type of paid malpractice claim.
The news stories went to town with this data, telling personal stories of missed diagnoses and bad outcomes. Remember the missed case of ebola in Dallas, when the patient was sent home from the ED without so much as a travel history? Missed diagnosis. It could happen to you, the media suggested to the American public...and well, it probably will.
One thing's for certain: we have all already made diagnostic errors in our young medical careers. And we will do it again. But how often do we ever know it? Do we learn from it? Are we taught to think about it, to recognize the pitfalls that make it happen?
As we learned in our fantastic Grand Rounds on diagnostic errors by Dr. Fox and Dr. Gordon last month, you just don’t know when you’re making a diagnostic error. (Remember, “What does being wrong feel like before you know you’re wrong?...It feels like being right.”) So rather than setting a goal of reducing diagnostic errors, the IOM report frames the goal as improving the diagnostic process.
It names specific goals, a few of which I’ll highlight here:
· Develop approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice.
· Let work systems and cultures support non-punitive feedback in the diagnostic process.
· Ensure that health IT systems support the diagnostic process.
· Train health care professionals in the diagnostic process—this is “meta-cognition,” when you think about how you think.
· Provide dedicated funding for research on the diagnostic process and diagnostic errors.
Given the IOM's influence on our medical culture, you can expect to hear a lot more about this landmark report. One day we may all be talking about how it changed the way we think, the way we order tests, and the way we communicate with patients. That would be a good thing.
Here is the 4-page report summary: http://iom.nationalacademies.org/~/media/Files/Report%20Files/2015/Improving-Diagnosis/DiagnosticError_ReportBrief.pdf
And here is the IOM release on it, including a video of the press briefing by Victor Dzau, Duke’s recent Chancellor and CEO Emeritus and now President of the IOM.
http://iom.nationalacademies.org/Reports/2015/Improving-Diagnosis-in-Healthcare.aspx
As an epilogue: If you’re like me, you may have at some point wondered what the heck is the IOM? First of all, as of July it is now known as the National Academy of Medicine (NAM). It was founded under the charter of the National Academy of Sciences in 1970, but it is an independent organization working outside the framework of the U.S. government. It is an honorific membership organization with new members elected annually based on their distinguished achievements in medicine and science. Its charge is to obtain authoritative, objective, and scientifically balanced answers to difficult questions of national importance. All of its reports are extensively peer reviewed externally and are made freely available online. IOM reports have historically made huge impacts and, on occasion, have changed the culture of medicine.
QI CORNER
Thank you to those of you who have submitted your Making Wise Choices Easier proposals. We know that there are a number of proposals still out there in the works, and we want to make sure that you have enough time to get them done and get them in. So we are extending the deadline by a week to NEXT Monday, October 26th. Keep discussing your plans or questions with me and Lish, and good luck!
CLINIC CORNER
This feature will return next week.
From the Chief Residents
Grand Rounds
Friday, October 23 - Gastroenterology, Dr. Dan Wild
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 10/19/15 |
Advanced Heart Failure Management/G-Briefing |
Chet Patel/Galanos |
MedRes/9242 | Dominos |
| 10/20/15 | Ambulatory Town Hall |
Clinic Leads |
2001/2002/MedRes | Mediterra |
| 10/21/15 | Common Curbsides in ID |
Chris Hostler |
12:00 | We Care Wed - No lunch |
| 10/22/15 | Fun Lunch! |
Doctoberfest |
12:00/DN Courtyard | Nana's Tacos |
| 10/23/15 | Chair's Conference | Chiefs | 12:00 | Hungry Leaf |
From the Residency Office
DOCTOBERFEST IS HERE!
“Taking Care of Our Community and Each Other”
October 1-31, 2015
Join us this Thursday for a special "Fun Lunch" in the Duke Hospital Courtyard across from Starbucks, catered by Nana's Tacos!
We had some wonderful nominees for our 1st Annual Doctoberfest Compassion in Medicine Awards! Please see the complete list below.
Aly Shogan - Covering multiple co-residents for interviews/conferences
Ryan Jessee - Covering co-residents throughout all 3 years of residency without any clear "pay back"
Jessica Morris - I would like to nominate a resident who I feel has deserved praise over the three years of residency for multiple occasions. I cannot pinpoint one specific occasion because she ALWAYS spends the extra time with patients and residents to ensure that plans are followed through and residents are comfortable with those plans. On multiple occasions she has stayed late to help her fellow residents or ensure that patients obtain the care they need.
Lauren Collins -Lauren demonstrates compassionate care for all of the listed--patients, coworkers, and friends. Her selflessness and loving attitude is exemplar for all of us. From watching her talk to families and patients on the floor to listening to her teaching her team to being on the receiving end of her gestures to take care of her friends, she is always there for the community.
Jason Zhu -Will be covering me on 5 Days of Duke Gen Med so I can go to a conference. Jason immediately offered to cover me without wanting any coverage in return (I had to convince him to let me cover him).
Taylor Bazemore and Winn Seay -Selfless team mates on the MICU who provided excellent and compassionate care for many ill patients
Div Patel - Div is the quintessential leader who does so by example. Understated, humble, and kind, he always goes above and beyond to help a teammate and do more than his share of the work. Great sense of humor and pretty darn good at being 1010. Glad to have had the chance to work with him!
Amanda Verma -Bought and delivered dinner for a co resident who was overwhelmed (and hungry).
Pascale Khairallah -Pascale went above and beyond to cover for a colleague who needs to go out of town in January without expectation of getting anything in return. She is truly an amazing colleague and puts others before herself
David Sterken -David is currently an intern at the VA. When a patient complained that his room was too hot, David called Engineering to arrange to have the temperature lowered, and also went out of his way to find a fan for the patient. The patient was incredibly grateful and the cooler room made him feel much better!
Div Patel -The definition of a team player, incredible patience and quiet compassion for patients.
Jim Lefler -Jim cares a tremendous amount in providing outstanding care for his patients. He embodies altruism, giving his pager number directly to patients he thinks will need direct access to him. He also cares deeply about his co-workers, asking them often how they're doing, and remembering details of their personal lives that are important and meaningful.
Anubha Agarwal -I cannot say enough about the way Anubha displays compassion. She is an extra-ordinary listener, can identify situations where help or compassion is needed and moves swiftly to meet that need without having to be asked. With Anubha around, you never need to ask for help because it is already there. She inspires her co-residents to more kindness and consideration.
Dr. Alyssa Stephany-We had a new admission to 9100 who was sick and urgently needed a procedure and Dr. Stephany stayed well past her shift and in to the early morning hours teaching and performing a procedure. She was more than happy to go out of her way to help both the patient and us as residents.
Duke Medicine Jackets -Order Today!
This year the Duke Internal Medicine Residency Program will be ordering Patagonia ¼ Zip Better Sweater Pullovers in Grey!! They will be $90.00 each. This price will include the Duke Medicine logo. Samples will be available to try on in the Med Res Office during regular business hours: 8am-4:30pm!
To order your 2015 Duke Medicine Pullover, Please complete this survey by Monday, October 26th!! Orders will be placed the following morning (10/27AM) and if you have not ordered and/or paid by the deadline, we will not be able to include you in the order.
Any questions/comments/concerns please contact Lynsey Michnowicz
Get Your Flu Shot!!
A schedule of vaccination clinics will be posted on the employee intranet in early September. This list will be updated throughout the vaccination season. Vaccination is also available at Employee Occupational Health and Wellness (EOHW) during business hours.
If you have questions about the flu vaccine or its availability, please visit the DUHS Influenza Resource Guide or duke.edu/flu, ask your manager or contact EOHW.
Together, we can stop the flu. Thank you for your commitment to keeping our patients, and our community, safe and healthy.
Get this done ASAP.
If you have medical exemption, be sure it shows up on your personal OESO Page—contact EOHW for any questions.
If the flu vaccine is received at any site (including the VA) besides DUH, DRH, or DUKE RALEIGH, you should take a picture of your documentation form (legible name, date, location and lot #) and email it to eohwflu@dm.duke.edu.
Please direct any questions to kathryn.andolsek@duke.edu
BLS Blitz - November 2015
Just a reminder that the bi-annual BLS Blitz is coming up in November. The flier posted at the end of this blog has the dates. REMEMBER - Duke only holds BLS classes during the November and March blitz each yer, so if your BLS is expiring before March, PLEASE sign up for one of the dates in November!!
2015 Carolinas COPD Symposium
When: November 20th, 2015
Location: Cone Center, UNC Charlotte; Charlotte, NC
Registration Link: https://continuingeducation.dcri.duke.edu/2015-carolinas-chronic-obstructive-pulmonary-disease-copd-symposium
Cost: $50 for Healthcare Providers; $25 for Public Health Practitioners
Event Contacts: For registration questions, please contact dcri.cme@dm.duke.edu or 919‐401‐1200. For program questions,
please contact Roy Pleasants at roy.pleasants@duke.edu
Opportunities for Wellness
This fall, Duke Hospital, Duke Regional Hospital, Duke Raleigh Hospital, Duke PRMO, and Clinical Labs leaders invite you to kick off the season with friends, light fare, shopping, and music in appreciation for all you have done in support of creating the best possible Duke Experience for our patients, their loved ones and each other.
New Date Set for Belk Exclusive Shopping Event: Oct. 25
Open to employees of Duke Hospital, Duke Regional Hospital, Duke Raleigh Hospital, Duke School of Nursing, DPC, Clinical Labs, PRMO, School of Medicine, DCRI, Duke HomeCare and Hospice, DHTS and the PDC. Employees must show valid Duke id badge for entry. Guests MUST accompany employees.
Registration Open for the Next Exclusive Shopping Event at Belk, October 25 from 6:00-9:00 p.m.
Belk at Streets of Southpoint
6910 Fayetteville Road
Durham, NC
Belk is closing their store and hosting our event.
Registration is required.
Please Note: Even if you registered to attend before the postponement, you must register again in order to reserve your space for Oct. 25. You will also have to re-register if you want to get a cosmetic mini makeover. New registrations will also be accepted.
Each registered attendee can also register to bring one guest.
REGISTER ONLINE via the following link:
Feeling down? Need to talk to someone?
All trainees at Duke have FREE access to Personal Assistance Services (PAS), which is the faculty/employee assistance program of Duke University. The staff of licensed professionals offer confidential assessment, short-term counseling, and referrals to help resolve a range of personal, work, and family problems. PAS services are available free of charge to Duke faculty and staff, and their immediate family members. An appointment to meet with a PAS counselor may be arranged by calling the PAS office at 919-416-1PAS (919-416-1727), Monday through Friday between 8:00 A.M. and 5:00 P.M. For assistance after hours, residents and fellows can call the Blood and Body Fluid Hotline (115 inside DUH, 919-684-1115 outside) for referral to behavioral health resources. Another resource is Duke Outpatient Psychiatry Referrals at (919) 684-0100 or 1-888-ASK-DUKE.
https://www.hr.duke.edu/pas/
Upcoming Dates and Events
October 30 - Recruitment Kick-off!
November 26 - Turkey Bowl
December 12 - DOM Holiday Party
Useful links
https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
http://duke.exitcareoncall.com/
Main Internal Medicine Residency website
Main Curriculum website
Department of Medicine
Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response
Opportunities
www.bidmc.org/CentersandDepartments/Departments/BIDHC
http://www.careermd.com/employers/latestbulletins.aspx