Getting a Pulse

Writer: Christine Riccelli

With the convulsive changes COVID has unleashed on the health care industry, both providers and patients have been navigating a terrain as unknowable as Mars. Thus, we decided it was a good time to check in with local physicians to find out how they’re maintaining their own mental and physical health as well as what they wish we, as patients, would do to take better care of ourselves. We also asked the doctors to share the most pressing challenges they’re facing as they seek to provide their patients with the best care possible. Seventeen physicians, representing a range of specialties, offered their thoughts and ideas. What they told us was interesting, insightful and inspiring.


What is one preventive or wellness practice you wish all your patients would follow?

Exercise.

Most of the physicians who responded to our query wish their patients would exercise more. As Dr. Thomas Benzoni, an emergency medicine physician and an assistant professor at Des Moines University, put it: “Get outside. Get moving.” Instead of viewing it as a chore, “find exercises you actually enjoy,” advises Dr. Tyler Olson, a family physician with the Iowa Clinic, “and then go do them.”

Several physicians also suggested being more mindful of ways you can incorporate exercise into your daily routines, such as taking the stairs instead of the elevator or riding your bicycle to work instead of driving.

Exercise is so important, in fact, that the majority of physicians said that’s the top way they maintain their own physical health. They reported they take walks, run, practice yoga and Pilates, bicycle, hike, climb steps, and more. As Dr. Matt Nicholson, a family physician with the Iowa Clinic, said: “I exercise for not only my own physical health but also as a way to relieve stress and maintain my mental health. I encourage my patients to do the same as this benefits the whole body.”

Pay closer attention to nutrition.

You’ve heard it before: More fresh veggies and fruits. Fewer refined carbs and saturated fats. But many people don’t realize how eating better can dramatically change their life, physicians said. “I wish patients would realize that food … can be medicinal,” says Dr. Jessica Kennedy, a family medicine physician with the Iowa Clinic. “For both mind and body, changing your diet can have profound effects on how you feel, sleep and deal with stress.”

Get enough sleep.

“Make good-quality sleep a priority,” advises Dr. Yogesh Shah, chief medical officer at Broadlawns Medical Center. Dr. John Tentinger, radiology section chief at Broadlawns, adds that it’s important to get “adequate deep REM sleep, which is the sleep that provides the most health benefits.”

He follows this advice himself by sticking to a routine sleep schedule that includes “avoiding caffeine after 1 p.m., [getting] regular exercise but not within three hours before bed, not eating meals two hours before bed, sleeping in a dark/cold room, and [having] no screen time an hour before bed.”

Keep up with preventive screenings and get annual checkups.

“Be aware that colon cancer screening now starts at age 45 and lung cancer screening starts at age 50,” notes Dr. Timothy McCoy, a family medicine specialist at MercyOne’s clinic on the south side.

In addition to focusing on physical wellness, patients should strive to incorporate mental and emotional health in their preventive practices, some physicians emphasized. They suggested the following:

Make wellness a family affair.

“Remember the importance of considering the entire family when setting wellness goals,” says Dr. Wendy Woods-Swafford, medical director of Blank Children’s Hospital. “More than ever, helping our children build resilience to manage life stressors is critical; this begins by building open communication with our kids.”

Embrace gratitude.

Dr. Noreen O’Shea, an assistant professor at Des Moines University and a family medicine physician, recommends “a daily gratitude practice, such as thinking about three good things that happened to you today.”

Focus on relationships.

Both Olson with the Iowa Clinic and Shah of Broadlawns stress the importance of strong relationships to overall health. “Have three to five deep social connections,” Shah says. Adds Olson: “Be kind to yourself and engage in meaningful relationships.”

Practice mindfulness.

Dr. Maria Guevara Hernandez, an internist with MercyOne Des Moines Medical Center, advises patients to live “in the present moment, in the now. As Eckart Tolle said, ‘Realize deeply that the present moment is all you ever have.’ I think that will bring more consciousness to our decisions, the food we eat, the exercise we do, and how we deal with stress. When we stop doing things in an automated fashion and start being more mindful of our decisions, we are more likely to make the right decisions and the ones that will provide better long-term benefits for our health.”


What is one piece of advice you have for navigating the continuing challenges of COVID-19?

Not surprisingly, the physicians urged everyone to get vaccinated, receive booster shots, and keep up with—and trust—the latest CDC findings and recommendations. Beyond that, they offered additional ideas:

“Trust science. There are people with an immense amount of knowledge dedicating their lives to improving the public health of our communities and doing extensive research to find the best evidence-based answer.”
Dr. Maria Guevara Hernandez, internist, MercyOne Des Moines Medical Center

“Use this as an opportunity to decide what is really important to you, and how you can be creative in doing it. For example, if you want to be with people but are worried about COVID exposure, try yoga in the park.”
Dr. Noreen O’Shea, assistant professor, Des Moines University, and a family medicine physician

“Approach the unknown with curiosity instead of fear.”
Dr. Wendy Woods-Swafford, medical director, Blank Children’s Hospital

“Use common sense. If you are sick, stay home, consult your doctor about your symptoms, and protect yourself and others while in public.”
Dr. Jessica Kennedy, family medicine physician, the Iowa Clinic

“Keep calm and carry on. This means you can go about living your life but be cautious of your surroundings and the people around you.”
Dr. Aneesa Afroze, infectious disease specialist, MercyOne Central Iowa

“Be kind to others.”
Dr. Timothy Van Dyke, trauma surgery specialist, the Iowa Clinic

“Follow the basic precept: Think of others first.”
Dr. Thomas Benzoni, assistant professor, Des Moines University, and an emergency medicine specialist


What is one thing you do to maintain your mental health and handle the stress of your job?

“Talk regularly with family and friends.”
Dr. Tyler Olson, family medicine physician, the Iowa Clinic

“Garden.”
Dr. Arshin Sheybani, radiation oncologist, the John Stoddard Cancer Center

“As an avid fly fisherman, my joy, sense of peace and calm, and the best way to feel centered and refreshed is to connect with nature. Appreciating and embracing the grandeur, beauty and purity of Mother Earth nourishes me spiritually, emotionally and psychologically. Filling my lungs with fresh air, flexing my muscles with each cast, and being surrounded by animals in their organic habitat bring me closer to God, knowing how truly blessed I am to be alive and able to serve others in the work that I do.”
Dr. Lisa Laurent, chief medical officer, MercyOne Central Iowa

“Remember why I went into medicine and search for activities that bring me back to that state of mind.”
Dr. Timothy McCoy, family medicine physician, MercyOne South Des Moines Family Medicine

“Finding joy in small moments, being grateful for the opportunities I have, staying centered in my faith.”
Dr. Jessica Kennedy, family medicine physician, the Iowa Clinic

“I enjoy traveling to explore new places and new cultures. The world is so big, and it’s amazing to enjoy a new place while taking a step away from work and getting a recharge.”
Dr. Kevin Cwach, urologist, the Iowa Clinic

“Practice mindfulness.”
Dr. Yogesh Shah, medical director, Broadlawns Medical Center

“Go out on a walk to get fresh air or read a book.”
Dr. Aneesa Afroze, infection prevention specialist, MercyOne Central Iowa

“Yoga.”
Dr. Wanakee Carr, obstetrician and gynecologist, the Iowa Clinic

“Enjoy quality time with my family and friends. Meditate. Listen to podcasts that help me grow as a person.”
Dr. Maria Guevara Hernandez, internist, MercyOne Des Moines Medical Center

“I go on a retreat one day a month.”
Dr. Larry Severidt, director of medical education, Broadlawns Medical Center


What is the biggest challenge health care providers face today as they seek to provide the best services possible to their patients?

“The system is stressed beyond all ability to understand.” That’s how Dr. Thomas Benzoni, an emergency medicine physician and assistant professor at Des Moines University, summed up the formidable and systemic challenges currently facing health providers, a sentiment echoed by many of the physicians we queried. They explained some of the urgent issues they’re dealing with, which have only intensified since the pandemic.

Burnout and staff shortages. In May, U.S. Surgeon General Vivek Murthy issued an advisory on the burnout crisis among health care workers. Physicians, nurses and public health workers, among others, were facing high levels of burnout even before the pandemic, the report said, with COVID-19 only exacerbating the problem as providers risked their own lives to serve others. “As we transition towards recovery, we have a moral obligation to address the long-standing crisis of burnout, exhaustion and moral distress across the health community,” Murthy wrote in the advisory, noting we owe health workers “an urgent debt of action.”

Indeed, nearly 1 in 5 health care workers have quit the profession since COVID-19, according to a survey of 1,000 health care workers by the data research firm Morning Consult. The Association of American Medical Colleges has projected that physician demand will continue to outstrip supply, with the U.S. facing a shortage of between 54,100 and 139,000 physicians by 2033. What’s more, with some 500,000 registered nurses anticipated to retire by the end of this year, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs.

In Greater Des Moines, staffing shortages have resulted in postponed procedures and hospitals sometimes running at limited capacity. “Health care providers have become tired throughout the last two years, and there is now a shortage of providers, particularly nurses and hospital staff,” says Dr. Kevin Cwach, a urologist with the Iowa Clinic. “Unfortunately, this has had a trickle-down effect, and I have to often delay operative cases for patients as [there’s not enough staff] to care for the patients [who] require admission after their surgery.”

“Staffing challenges affect health care in so many ways; we need to get to the root of why we cannot attract and retain staff,” says Dr. Noreen O’Shea, an assistant professor at Des Moines University and a family medicine physician.

Time pressures. Dr. Wanakee Carr, an obstetrician and gynecologist at the Iowa Clinic, says a major challenge is “making sure patients have access and quality time with us as providers so they feel heard and understood.”

The Iowa Clinic’s Cwach explains that some patients “do great with a chosen treatment and are an easy and quick visit, and some patients need more time and attention to figure out a correct treatment for them. I respect all of my patients’ time and commitment to come see me for their health issues while I also try to balance and maintain a time schedule. Ultimately, it can be a challenge, but I do my best to devote all the time I need to work toward making a patient better.”

“All health care providers are very compassionate and caring,” adds Dr. Aneesa Afroze, an infection prevention specialist with MercyOne Central Iowa. “We like to spend more time with patients and know them better so we can provide the best care; however, time constraints prevent us from doing so.”

Misinformation. “Faceless online sources” are especially troubling, notes Dr. Arshin Sheybani, a radiation oncologist at the John Stoddard Cancer Center. Dr. Maria Guevara Hernandez, an internist with MercyOne, adds that “finding wrong information is easier and more accessible than getting a hold of [information that’s] trustworthy [and] based on evidence and research.”

Insurance constraints. Hernandez also says that “pressures from insurance companies obstruct and delay the diagnostics tests and medications that our patients need, sometimes leading to patients abandoning treatment and causing an unfavorable clinical outcome.”

Socioeconomic factors. Dr. Tyler Olson, a family medicine physician with the Iowa Clinic, notes that “the complex socioeconomic determinants of health—the ‘non-medicine’ part of our lives” create additional care challenges. Dr. Larry Severidt, director of medical education at Broadlawns Medical Center, points out that “everyone should have access to high-quality health care, and many don’t.”

Social determinants of health typically refer to the overlapping social, political and economic systems that influence health outcomes. In addition to a lack of access to health care, these determinants can include education disparities, income inequality, housing and food insecurity, lack of transportation, and more.

Patient disrespect. The overall decline of civility in society is reflected in how some patients treat medical professionals, several physicians noted. The stress of the pandemic has only amplified the problem. “Patients have less patience and lower tolerance for others,” says Dr. Yogesh Shah, medical director at Broadlawns. “From being a hero, health care providers have become ‘villains.’ ”

Overall, physicians emphasized their No. 1 goal remains meeting their patients’ needs. “Providers are doing our best to continue to provide high-quality health care with the many challenges faced during the last few years,” says Dr. Timothy McCoy, a family medicine physician at MercyOne’s clinic on the south side. “Even though we are short-staffed, overworked and many are burned out, we still want what’s best for our patients. As long as we continue to do what is right for the patient, we will be fine.”

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