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Message from the chair 

Dr. Laurie C. GreggLaurie C. Gregg, MD

Gratitude can be defined in a number of ways. It is the readiness to acknowledge and return kindness. It is the appreciation of what is valuable and meaningful to you. Numerous research studies demonstrate that gratitude has been associated with an enhanced sense of wellbeing.

My initial exposure to organized medicine began with the American Medical Student Association’s Humanistic Task Force and the ACOG Resident Reporter program. Years later, I became chair of the District IX Wellness Committee, and now I am chair of District IX. Although chair duties have filled my time with much more than volunteer hours dedicated to humanism and wellness, I am grateful to ACOG for nurturing me throughout my leadership journey. The organization has made a commitment to leadership development for any member who expresses an interest.

The Task Force on Leadership in the 21st Century implemented by past ACOG President James T. Breeden (with continued guidance from ACOG Immediate Past President Jeanne A. Conry, MD, PhD, who is also immediate past District IX chair) remains committed to increasing the involvement of ACOG members and making leadership opportunities more transparent. The Robert C. Cefalo National Leadership Institute is a wonderful example of the leadership education that ACOG provides.

I am grateful that ACOG works day in and day out to improve women’s health and to support the physicians who provide women’s health care. At the Annual Clinical Meeting, ideas for improving outreach and assistance to Fellows in the trenches were discussed. Candidates for office will be asked how the value of an ACOG membership can be made more evident or increased. ACOG members can view their benefits on the ACOG website.

I am grateful for all the individuals who dedicate time to ACOG’s work. From Junior Fellows volunteering their time in communities to Fellows serving on the ACOG Executive Board, everyone is focused on advancing the mission and vision of the organization.

I am grateful for friendship and mentors. Work can be demanding, but it is offset by being in the presence of friends. The relationships I’ve developed in my time serving ACOG are invaluable. My ACOG colleagues are members of my team, but more importantly they are my friends. Although there are many people to whom I send my gratitude, Dr. Conry deserves special recognition. I can only hope to learn from the example she has set and mentor others as well as she has mentored me.

My advice is to take time to be grateful, keep a journal about experiences for which you are grateful, and be mindful about your gratitude. Know that you can be grateful for the role ACOG plays in our specialty and that the organization will continue to strive to improve. And, if you would like to feel the gratitude of serving ACOG, contact one of your district or section officers. We will be happy to assist you in getting involved.

 

Legislative priorities: Caring for our patients

Dr. Laura L. SirottLaura L. Sirott, MD, District IX secretary

The 2014 legislative year brings a number of contentious issues to the forefront for ob-gyns. The District IX Legislative Committee focuses on legislation affecting women and those who provide them care. In 2013, a legislative survey was sent to District IX members to help us focus our work on the issues that are important to you.

On March 24, Consumer Watchdog, a front group for the Consumer Attorneys of California, submitted roughly 830,000 signatures to qualify an initiative for the November ballot that would eliminate key provisions in the Medical Injury Compensation Reform Act (MICRA). The initiative would quadruple the non-economic damages cap, which would significantly increase health care costs for patients and operating costs for providers, hospitals, and community clinics that are already struggling to keep their doors open.

You may hear rhetoric from proponents of the measure about how it will increase patient safety through physician drug testing. However, the president of Consumer Watchdog recently admitted in an interview with the Los Angeles Times that the drug-testing provisions were added simply because they polled well.

The ballot initiative is opposed by a broad coalition of nearly 1,000 groups. District IX joins with the California Medical Association and Californians Allied for Patient Protection to strongly oppose this initiative. PLEASE do not respond directly to media inquiries, but refer them to Michelle Clark, District IX manager, at mclark@acog.org.

Other legislative priorities include bills:

  • Prohibiting sterilization of female inmates without state approval
  • Limiting environmental toxin exposure
  • Reversing the 10% Medi-Cal rate cuts
  • Ensuring ob-gyns share in the 10% Medi-Cal primary care rate bump
  • Establishing new primary care residency programs, including ob-gyn

We’re also dealing with ongoing state budget battles for funding for programs essential to patient care, such as the Black Infant Health Program, which has been shown to reduce infant mortality of African-American infants. 

For more information on our positions or concerns or questions regarding our legislative agenda, please contact Shannon Smith-Crowley, JD, MHA, District IX director of government relations, at shannon@partnersadvocacy.com or me at llsirott@gmail.com.

  

Wellness corner: The menace of multitasking

Dr. Joanne L. PerronJoanne L. Perron, MD, District IX Committee on Physician Work-Life Balance co-chair

Robert J. Wallace, MD, MBA, District IX Committee on Physician Work-Life Balance co-chair, and I recently presented on “The Menace of Multitasking” at the Annual Clinical Meeting in Chicago. We chose the topic of multitasking because it is the opposite of mindfulness and decided to use the alliterative word “menace” because of mounting evidence that multitasking has an adverse impact on our daily lives and, more importantly, on the lives of the patients for whom we are responsible.

I was once a proud multitasker and boasted of my amazing ability to talk on the phone, breastfeed my son, and stir marinara sauce while balancing on one leg and rubbing my dog’s belly with my other foot. In retrospect, rather than saving time, it made me feel more rushed, and I wasn't fully present for my baby. How was that satisfying?

Multitasking

Robert J. Wallace, MD, MBA, District IX Committee on Physician Work-Life Balance co-chair, demonstrates multitasking.

Multitasking is defined as doing two or more tasks simultaneously or performing two or more tasks in rapid succession. It becomes more difficult with complexity and in unfamiliar situations. Research across various disciplines has shown that multitasking decreases productivity, information retrieval, creativity, and performance and increases stress, anxiety, workload, and error.

Research done in a busy emergency room found that interruptions occur 6.6 times per hour on average. Beepers, phones, texts, or requests for help, along with our own restless minds, contribute to distracting us from the tasks at hand. Another study showed that, after being interrupted, study participants failed to return to their original tasks 18.5% of the time or spent less time on their original tasks compared to those who weren’t interrupted.

Interruptions and multitasking are a dangerous combination for task accuracy or completion. Interestingly, one of the participants in the study mentioned above, a resident physician, was told by his supervising physician to attend our ACM lecture and bring back pearls of wisdom on how to multitask more efficiently. I hope he can share the ominous truth about multitasking and interruptions, as well as their adverse impacts on our wellbeing and the safety of our patients.

A few people in the audience were not convinced that multitasking is harmful. Perhaps they belong to the 2% of the population that are super-multitaskers, blessed with extraordinary abilities. For the rest of us, however, it is time to knock multitasking off its undeserved pedestal and erase its glorification. An organizational paradigm shift will likely be required, changing our culture to support provider mindfulness and presence—the opposites of multitasking.

If you’d like to hear more about the menace of multitasking, I recently did a podcast interview with ReachMD’s Partners in Practice program.

  

Ob-gyns have legal authority to order shackles removed

Georgia ValentineGeorgia Valentine, Legal Services for Prisoners with Children

The use of shackles, particularly leg irons, waist chains, and handcuffs behind the back, can cause irreversible harm to imprisoned pregnant women. Since 2006, Legal Services for Prisoners with Children (LSPC) has worked to stop the use of dangerous forms of restraint, culminating in the passage of anti-shackling legislation in 2012.

Ob-gyns in California need to know that the new law also grants medical professionals the authority to direct the removal of restraints from pregnant prisoners at any time. 

Pressing for implementation of this legislation, LSPC completed No More Shackles, a report outlining its findings after months of research on written policies for shackling of pregnant prisoners in California counties. On February 18, LSPC held a press conference to release the report with Assembly Majority Leader Toni Atkins (D-San Diego); Yen Truong, MD; and Jesse Stout, LSPC policy director.

The report verifies that a little over a third of counties (21 out of 58) are currently in compliance with the law. However, 15 counties do not have written policies explicitly granting medical professionals the authority to have restraints removed.

LSPC strongly encourages the California Department of Corrections and Rehabilitation, the Board of State and Community Corrections, and all California counties to:

  • Hold counties accountable for up-to-date policies with current legislation
  • Provide translated versions of all materials distributed to female prisoners, especially materials that outline pregnancy rights
  • Educate medical professionals on their critical role in ensuring that restraints are removed from pregnant prisoners
  • Ensure that pregnant juvenile prisoners are afforded the same rights and shackling restrictions as adult prisoners

Mr. Stout stated, “Female prisoners have gender-specific needs that custodial institutions do not always acknowledge. Maintaining the health and wellbeing of incarcerated pregnant women requires unique considerations. The LSPC study has demonstrated that people in many counties support the humane treatment of pregnant women. However, it also shows that our work to protect these women remains unfinished.”

Remember, if you see a pregnant woman restrained with leg irons, waist chains, or handcuffs behind the back, you have the legal authority to order these shackles removed. Questions can be forwarded to Mr. Stout at jesse@prisonerswithchildren.org.

  

Support for breastfeeding mothers

Dr. Susan D. CroweSusan D. Crowe, MD, Lucille Packard Children’s Hospital at Stanford University

The Fourth Annual California Breastfeeding Summit convened in January in Sacramento with the theme “Circles of Support to Remove Breastfeeding Barriers: A Collective Responsibility.” The summit brought together medical professionals and public health leaders to participate in workshops and plenary sessions that discussed methods of removing barriers that still exist for breastfeeding women in California.

The Affordable Care Act (ACA) has increased breastfeeding support for women who plan to return to paid employment by covering breast pumps for most women. With a prescription from their obstetrician during the last month of pregnancy, all women are entitled to a double electric breast pump purchased by insurance carriers (excluding TRICARE) with few exceptions. This service is provided to both Medi-Cal and privately-insured patients.

California leads the country in legislation that provides additional support to breastfeeding women who return to employment with the Paid Family Leave insurance program. However, 4 out of 10 eligible California workers are unaware of this benefit that allows them to take up to six weeks per year of leave and receive 55% of their wages (similar to disability leave). As obstetricians, we can remove this barrier by informing patients of this benefit, which has been shown to increase exclusive breastfeeding rates, particularly for low-wage earners. 

As maternity care practices (such as skin-to-skin contact at delivery) improve and legislative support continues to grow at the state and national levels, the California Breastfeeding Summit celebrated the many successes we have already seen here in California. Ob-gyns should use the tools provided by the ACA, Paid Family Leave, and other policies to support our patients in reaching their desired breastfeeding goals.