Week 13: Quality of Care and Quality of Life

The tireless work of nearly 1000 physicians in the department of medicine (DoM) has underpinned the tremendous clinical growth of UCLA Health in recent years. However, it has not been without challenges. Since I arrived I have come to understand some of the difficulties that many of you face. For this and other reasons, we deployed a survey, under the leadership of Dr. Sun Yoo, at the recent DMPG retreat, to evaluate physician wellness and engagement. The response was overwhelming with 620 out of 785 UCLA faculty in primary care and subspecialties completing the survey, with a response rate of 79%! You had a lot to say. There were more than 50 pages of comments and I read through them all.

I am pleased by your willingness to provide detailed and candid feedback.  It is clear that you, our clinicians, are deeply passionate about providing the best possible care for our patients and for the most part, derive great satisfaction from supporting your patients’ health and well-being. You commented favorably on the supportive interactions with colleagues and other members of your respective teams. There were pain points though. The most striking being the in-basket burden and for many a sense of reduced autonomy. There was specific feedback about areas where ancillary support for your practices could be augmented or better managed. These concerns were the major drivers of feelings of burnout that were endorsed by 3 out of 5 of our physicians who completed the survey. This is too high. Based on my earlier impressions including a smaller survey of primary care physicians, and reinforced by the survey results, I created a work group to develop recommendations to address these drivers. I specifically asked to identify potential solutions that could be implemented in a relatively short time frame and others that might require longer term adjustments. We are discussing and evaluating these recommendations now. The department will be presenting some recommendations in the next month or so when we host regional town halls to discuss the survey findings in depth and share our recommendations to address these concerns.

In reflecting on the importance of the clinical mission to our department, I was reminded that March 30 was National Doctors Day. This might have been missed by many of you, but it got me thinking from whence this arose. 

Evidently, it was started by the spouse of a physician in Barrow County Georgia; was first observed in 1933 and was officially made a National Day of Celebration by President George H.W. Bush in 1991.

Another online entry stated:

“This special day was established to recognize the incredible work of physicians and the contributions to the communities they live in." The first Doctors' Day was celebrated on March 30, 1933, and the initial celebration involved mailing greeting cards to doctors and placing flowers on deceased doctors' graves.

Our DoM is not going to mail greeting cards or wait until you die, to leave flowers on your grave to show you our appreciation. We will be taking steps to tangibly demonstrate how much we value and appreciate you now.  

Consistent with the exceptional care that you provide to our patients, I receive many letters of praise from patients, and want to share some excerpts here.

I would like to share my experiences with one of the UCLA physicians at the Toluca Lake UCLA medical offices. His name is Dr. Jason Lee. He has been my primary doctor for several years now and I can honestly say he is just OUTSTANDING. He always goes above and beyond in his care, answering my questions in layman’s terms and always making sure I understand any treatments or diagnosis. His professionalism, kindness and overall patient experience is not something you find every day. I am so thankful that you have him as part of your UCLA family and I wanted to express my gratitude and appreciation. Often doctors may only hear the “bad” experiences and I wanted to make sure his management heard what makes you different than other providers, and that is having doctors like Dr. JASON LEE!

“I recently saw Dr. Evangelia Kirimis here, a hematologist, on referral from my OBGYN.  I'm pregnant and my OBGYN was very concerned with my unusually low WBC pre-pregnancy, so she wanted me to see a hematologist just in case. Dr. Kirimis is very personable and sweet.  She made a very scary appt. much less scary by cracking jokes and asking me non-medical questions to keep my mind from racing.”

Dr. Callahan is amazing. From the first day we met, she explained things in detail and in a way I could understand. She is warm, friendly, and intelligent. Having been diagnosed with cancer during COVID was scary and she put me at ease during chemo. I am doing great now.  I couldn't want for a better breast cancer doctor.”

“Dr. Mihaela Taylor is a superb doctor. She has changed my life. I've been in her care since 2008, and I'm lucky to be in her care. She listens and has a comprehensive approach. She always responds quickly to messages. Definitely recommend!”

“I am 62 years old, and Dr. Agrawal is without a doubt the best GP I have ever had. She is meticulous, methodical, kind, knowledgeable and provides copious notes from each visit. I cannot say enough good things about her. I have never had a doctor of any kind with a better bedside manner and a compassionate, kindhearted smile. She is absolutely fantastic!!”

I didn't know the challenges that I would face by moving to Arroyo Grande when it came to finding good doctors. Many doctors here do not accept new patients and/or pay in cash – no insurance accepted. [REDACTED] now manages the health care system up here. I tried a [REDACTED] doctor for my yearly wellness check-up. The doctor didn't have an interest in me and appeared to be very rushed. After the exam, I found myself locked in the office with no one around. I fired her! I was so happy to hear that UCLA Health is located in San Luis Obispo which is about 10 minutes from where I live. I made an appointed to see Dr. Jacqueline Gallardo so I can meet my new primary doctor. I was so relieved to find such a caring person who spent the time getting to know me and what questions I might have. Please do more advertising on KSBY our local TV station. I'm also on Nextdoor.com and I have mentioned that UCLA is now in the area. Please, I'm begging UCLA to bring in more doctors.”

Our commitment to clinical excellence, particularly for groups of patients who are underserved by established medicine or require unique expertise, is also reflected in initiatives to ensure that our patients have access to unique and specific care that they need. As such we have several non-ACCGME accredited fellowships that in some cases might be the only one, or one of a small number of such training programs in the USA.

  1. Clinical Nutrition (PD: Zhaoping Li, MD; 1-2 trainees)
  2. Interventional Endoscopy (PD: Stephen Kim; 1 trainee)
  3. GI Quality Improvement (PD: Fola May, MD; 1 trainee)
  4. East-West Medicine (PD: Katie Hu, MD; 4 trainees)
  5. Extensivist (PDs: Sun Yoo, MD; Neil Wenger, MD; 1 trainee)
  6. LGBTQ (PD: George Yen, MD; 1 trainee)
  7. National Clinician Scholars (PD: Joanne Elmore, MD; 19 trainees)
  8. NRSA T32 Primary Care Research (PDs: Mitch Wong, MD, PhD; Neil Wenger, MD: 6 trainees)
  9. Global HIV Research: (PD: Jesse Clark, MD; 1 trainee)
  10. Advanced Clinical Transplant Infectious Disease (PD: Joanna Schaenman, MD; 1 trainee)
  11. DOM Global Health (PD: Chris Tymchuk, MD, 1 trainee)
  12. Kidney and Pancreas Transplant (PD: Julie Yabu, MD, 1 trainee)
  13. Interventional Pulmonary (PD: Scott Oh, MD; 1 trainee)                  
  14. Lung Transplant (PD: Allison Ramsey, MD; 1 trainee)

We are a clinical engine but also clinical innovators. This is core to our identity as a department.

Finally, I want to give a shout out to Dr. Arleen Brown in the Division of General Internal Medicine (SGIM), who was recently appointed to a major leadership role on the Council of the Society for General Internal Medicine, with her appointment as Secretary. Below is the citation from the SGIM.

Dr. Brown is Professor of General Internal Medicine and Health Services Research at the Geffen School of Medicine at the University of California, Los Angeles (UCLA), where she serves as Co-Director of the UCLA Clinical and Translational Science Institute. She is a graduate of the UCLA Robert Wood Johnson Clinical Scholars Program and a recipient of the Harold Amos Faculty Development Award. Her research has focused on understanding chronic disease disparities and using community engaged strategies and multilevel interventions to promote health equity. She has served in several roles at SGIM, including membership on the Research Committee and Chair of the Health Equity Commission (previously Disparities Task Force). Dr. Brown currently leads the California Community Engagement Alliance (CEAL) against COVID-19 and the UCLA/UC Irvine END DISPARITIES Center to address cardiometabolic disease disparities in Los Angeles and Orange Counties.

Congratulations Arlene! Keep the UCLA flag flying high.



DMV part 3.

On Tuesday March 29, we returned to the DMV to register my car (my car needed to be in person of course), and my wife was armed with all the necessary documentation to get a real ID, including a document with her name and address from (guess where), the DMV.

In any event, I was full of confidence, saying to myself that “I can do this….” as I strutted confidently to the door.

I was greeted by a burly guard at the door seeking verification of my appointment, which I confidently showed him.  See screen shot.

He took one look at the date (March 29) and declared that was yesterday. You can’t make this stuff up. I gently reminded him that today was March 29 and went to my appointment, where the attendant told me to hold a moment, until she was ready. The good news though, is that we now have California plates, and my wife has her real ID.

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