Grand Rounds Recap 2.5.20
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Leadership: trial and error WITH Dr. Andra Blomkalns, MD, MBA (Dr. Gibler visiting professor, Chair at Stanford university and UCEM Class of 2001)
Everyone has blind spots in leadership.
“An area in which people continually do not see themselves or their situations realistically.” - John Maxwell
These can be lack of awareness, unconscious, automatic, unrealistic
How do these develop?
Personal experience —> Shapes Perception —> Informs Reality
Why are blind spots important?
Initially these can be productive strengths
Problematic if unidentified or mismanaged
Effective leaders work to expose and overcome blind spots
What are common blind spots?
Going it alone
Knowing it all
Avoiding tough conversations
Hiring in your image
Dwelling in the past
“Growth and comfort do not coexist.” - Ginny Rommety
How can we identity blind spots?
Self-Reflection
Self-Identification
Resources: Leadership Blindspots by Robert Bruce Shaw; Blind Spots by Claudia Shelton; Fearless Leadership by Loretta Malandro; What Got You Here, Won’t Get You There by Marshall Goldsmith
Emergency medicine: To the rescue of healthcare? with Dr. Andra Blomkalns
Definition of Innovation: the introduction of something new such as a new idea, method or device
But can this be more?
The ability to continually see things with fresh eyes however familiar they become
To apply a different perspective to something you have done a hundred times
To challenge your hard-won assumption and to believe you may be wrong however right you feel
As emergency medicine physicians, we have to innovate all the time because we have limited information, but need to move forward with our patient care. We get the minimal amount of information needed to make a decision and a plan.
We often focus on clinical care provided to the patient (and we do it well), but we should also focus our attention on population health, QI and patient safety among other larger categories of healthcare.
Healthcare expenditures are $3.4 trillion growing 6%/year and going to the emergency department is expensive. Consider where we are now and where medicine will be in 20 years …
Digital health funding, technology with artificial intelligence, electronic medical records updates, harvest genome, app based care, etc.
We can work on becoming familiar with innovation to relate to our patients and help them with their own healthcare
Knowledge is doubling every 12 hours. We need to be able to keep up and be aware of the changes.
“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again … who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory or defeat.” - Teddy Roosevelt
R4 capstone: Diabetes technology WITH Dr. Golden
For non-diabetics, there is a steady state of insulin throughout the day with spikes during meals. Type 1 diabetics try to mimic this pattern with basal and bolus insulin. In an ideal world this would be approximately 50% basal insulin and 50% bolus insulin. Patients can program insulin pumps to try to maximize this pattern.
Allows patients to have better control of their blood sugar throughout the day
Can titrate to activity level
Can switch to different patterns; for example when a patient works night shift or goes on vacation
Parts of the insulin pump include battery, insulin reservoir, operating button, infusion set, cannula and tubing.
Patients must change the cannula every 2-3 days.
Possible problems include if the cannula is kinked or not attached to the skin or tubing can get disconnected.
If you have a patient with an insulin pump, it is worth it to take a look at the pump to make sure everything is connected properly
You can suspend the pump on the main screen if patient is profoundly hypoglycemic, or you can disconnect the pump altogether
There are also pumps where the entire pump is connected to the patient and these can often be suspended by using a phone or disconnecting completely from the patient.
Continuous glucose monitoring (CGM) systems is a method of tracking glucose levels throughout the day and night.
Reduces hypoglycemia by 72% in those with hypoglycemia unawareness
Average A1c decreased from 7.5 to 6.8 with use, and time spent in normal range glucose (70 to 180) increased from 50% to 70%
Often checks blood sugar every 5 min; these numbers are usually delayed 10-15 min from capillary blood sugar
Patients have to calibrate the device every 2-3 days
Certain brands of CGM including Dexcom which allows bluetooth monitoring so data can be seen by everyone. Often used in pediatric patients so that parents, coaches, teachers, school nurses, etc can access information as well.
Of note, patients with CGM should not be taking acetaminophen as its metabolism interferes with glucose reading and can create a false hyperglycemia causing the pump to administer extra insulin.
Next technology includes dual pump that can include glucagon titration to be administered when patient is hypoglycemic.
