Foundations In Transition - Institute On Disability: Fill & Download for Free

I live in Seattle and I have struggled with this. First, I think it is important to let go of the sterotype that most homeless people are drug addicts or mentally ill. This is a gross exaggeration.On any given night in King County (that contains Seattle), there are over 1,000 youth and young adults, ages 13 - 25, who are homeless. [1] Over 60 percent of them were physically abused in their homes, which contributed to their homelessness. Help by getting involved with TEEN FEED (see footnote below). 23 percent of all homeless in the U.S. are under 18.During their "one night count," on January 23, 2015, from 2am to 5am, the Seattle/King County Coalition on Homelessness counted 10,047 people homeless: 2993 in transitional housing, 3282 in shelters, and 3772 on the street. The majority WERE NOT drug addicts.More and more "regular people" and familes are finding themselves homeless.Over 3,000 of Seattle homeless are people in families. [2]Over 650 are veterans (we should be VERY ashamed of this).There is no one best way to help and organizations struggle with this question. The core of the problem may be at the foundation of our society - that we are taught that it is "everyone for themselves." In the U.S., we are not brought up to feel a sense of responsibility toward our fellow humans. We are taught to fear the homeless, the elderly, the disabled, and pretty much anyone who has less than we do.Our culture has to change to embrace the idea that it is fundamentally unacceptable for some people to have so much are for others to have nothing. Until that changes, nothing will change. The Seattle billionaires could write a check to eliminate the problem. Oh, they will swear that isn't true, but I don't buy it.But we live in a culture where it is OK to spend millions to build an office building that remains 2/3 empty while humans sleep on the street on the sidewalk in front of it!It is a convenient excuse to declare all homeless drug addicts who will take your dollar and buy drugs and that attitude helps us justify looking away. I think one of the best ways to consider this to imagine how close you may be to homelessness. Most of us are living paycheck to paycheck and it isn't much of a stretch to see any one of us on the street. What would you do if every aspect your support system were stripped from you? You might get a little nutty out in the cold.There is a real part of the homeless population who have mental illness - about 20 to 25 percent. There are lots of reasons for this, but many of them come from the state programs who prematurely released people who never should have been let go from institutions to save money.What I do: I refer people to the many food banks in the Seattle area. Some of these food banks leave excess food out for any to take. I have held one of my speed reading classes in a building that houses a food bank and I encourage my students to take some of the excess food and give it to homeless people they encounter on the way home (it's usually bread products). I have volunteered with my 14-year old son for Teen Feed, donating food and helping run a dinner service for all who show up.I need to do more. I have thought about printing up cards that have the local bus lines that go by shelters and the shelter's address and buying some bus cards (ORCA cards) and loading them with money so they an only be used for bus fare.I have always thought that an organization should buy a fleet of the massive motor homes that celebrities use for dressing rooms and staff each one with a doctor and social workers and drive around town. Refit them with multiple showers and medical examining rooms. Offer showers and medical care and food to the homeless the fleet encounters and bring them to shelters. More shelters would have to be built. Institute job-training programs.Come on Seattle billionaires: step up![1] Facts About Homeless Youth - Teen Feed[2] Seattle/King County: 3rd Largest Homeless Population In 2013 HUD Report

I live in Seattle and I have struggled with this. First, I think it is important to let go of the sterotype that most homeless people are drug addicts or mentally ill. This is a gross exaggeration.On any given night in King County (that contains Seattle), there are over 1,000 youth and young adults, ages 13 - 25, who are homeless. [1] Over 60 percent of them were physically abused in their homes, which contributed to their homelessness. Help by getting involved with TEEN FEED (see footnote below). 23 percent of all homeless in the U.S. are under 18.During their "one night count," on January 23, 2015, from 2am to 5am, the Seattle/King County Coalition on Homelessness counted 10,047 people homeless: 2993 in transitional housing, 3282 in shelters, and 3772 on the street. The majority WERE NOT drug addicts.More and more "regular people" and familes are finding themselves homeless.Over 3,000 of Seattle homeless are people in families. [2]Over 650 are veterans (we should be VERY ashamed of this).There is no one best way to help and organizations struggle with this question. The core of the problem may be at the foundation of our society - that we are taught that it is "everyone for themselves." In the U.S., we are not brought up to feel a sense of responsibility toward our fellow humans. We are taught to fear the homeless, the elderly, the disabled, and pretty much anyone who has less than we do.Our culture has to change to embrace the idea that it is fundamentally unacceptable for some people to have so much are for others to have nothing. Until that changes, nothing will change. The Seattle billionaires could write a check to eliminate the problem. Oh, they will swear that isn't true, but I don't buy it.But we live in a culture where it is OK to spend millions to build an office building that remains 2/3 empty while humans sleep on the street on the sidewalk in front of it!It is a convenient excuse to declare all homeless drug addicts who will take your dollar and buy drugs and that attitude helps us justify looking away. I think one of the best ways to consider this to imagine how close you may be to homelessness. Most of us are living paycheck to paycheck and it isn't much of a stretch to see any one of us on the street. What would you do if every aspect your support system were stripped from you? You might get a little nutty out in the cold.There is a real part of the homeless population who have mental illness - about 20 to 25 percent. There are lots of reasons for this, but many of them come from the state programs who prematurely released people who never should have been let go from institutions to save money.What I do: I refer people to the many food banks in the Seattle area. Some of these food banks leave excess food out for any to take. I have held one of my speed reading classes in a building that houses a food bank and I encourage my students to take some of the excess food and give it to homeless people they encounter on the way home (it's usually bread products). I have volunteered with my 14-year old son for Teen Feed, donating food and helping run a dinner service for all who show up.I need to do more. I have thought about printing up cards that have the local bus lines that go by shelters and the shelter's address and buying some bus cards (ORCA cards) and loading them with money so they an only be used for bus fare.I have always thought that an organization should buy a fleet of the massive motor homes that celebrities use for dressing rooms and staff each one with a doctor and social workers and drive around town. Refit them with multiple showers and medical examining rooms. Offer showers and medical care and food to the homeless the fleet encounters and bring them to shelters. More shelters would have to be built. Institute job-training programs.Come on Seattle billionaires: step up!Footnotes[1] Facts About Homeless Youth - Teen Feed[2] Seattle/King County: 3rd Largest Homeless Population In 2013 HUD Report

This may be one of the biggest social problems that is quietly evolving in an American background of physician secrecy, burnout and stress. Today, I work with young physicians, residents and medical students to teach them basic financial literacy, proper income protection and offer life-coaching for the physicians I have as clients. If they were to become disabled, I offer advocacy through that process, so the doctor does not have to be alone… and trust me, as a disabled physician in America, you feel very alone. I was a trauma and cardiac anesthesiologist until 2010. As a disabled doctor who has also attended law school and business school my life has been very interesting educationally and full of many of the greatest instants a medical career has to offer, as well as some of the career’s worst moments.Physician suicide is at an all-time high currently. More than one doctor per day is choosing suicide and physicians are the #1 professional to both attempt and succeed at suicide. Physician early retirement is a growing phenomenon due to stress, burnout and a horrid sense of hopelessness on the part of our physicians towards their careers.In 2018 the number of medical students choosing “any surgical specialty” has fallen 50% since just 2010. That will create a debacle for our society 10-15 years from now… the coming shortage of talented surgical technicians will make the 2001-2005 shortage of anesthesiologists look like it was a just a cloudy day for hospital staffers to deal with and overcome. Physician Assistants and Nurse Practitioners will not be able to fill the surgical needs of America in that timeframe. Something will give, or something will break.Physicians first feel the stress of near inhuman perfection in medical school where the pressure to perform and outperform colleagues begins with exams, then the first steps of Boards and finally with The Match each and every March. In 2018 over 1,000 medical students went unmatched into the fields of their choice and had to compete for unmatched transitional Intern years (think grunt for a hospital) and the number of individuals on their 3rd year consecutive unmatched year has reached a new record in the USA. Why? Residency program accreditation to increase slots takes longer than expanding the number of medical students in the overall system. There exists the widest gap between the number of graduating medical students and number of available training positions even in the United States.The problem is not just big, it is small and personal. Dr. Robert Chu wrote a letter to both national medical officials and government leaders explaining the flawed system of the Match that undercut his career before it even started. Dr. Robert Chu went unmatched to residency. He committed suicide. That’s a loss for tens of thousands of his would-have-been patients. That was before training even began, some doctor’s suicide notes reveal a fear of harming a patient so much from extreme sleep deprivation or other despondent work-environment issues. Instead, utterly hopeless, they choose to kill themselves.Why do they regret their careers?Because they were lied to, that’s why. The entrepreneurial spirit of the American Doctor has been subverted by the 21st Century efficient ‘business’ of medicine. Factory-work medical assembly kills doctors’ dreams first and then their bodies and finally, their souls. In a last act of self-punishment, they die by their own learned hand. Highly intelligent, compassionate and expertly educated individuals cannot properly care for suffering people in 7.5 minutes in order to stay on-track for the business inventory- flow numbers that day. With milestones competitive in the business-practice of medicine; “inefficiency” or “low productivity” labels sometimes push doctors to continuously ‘feel’ like a failure in their own practices. Government mandates create soul-crushing environments for brilliant talented doctors with increasing pressure from insurance companies beating the doctor’s reimbursement into submission along the way. All they really want to do is take care of people!Many suicide letters and notes form doctors point to working conditions with simply inhuman expectations. One big universal complaint is the paperwork/electronic record time to patient time ratio that has, by some measures, completely ruined the practice of medical care from the physician’s perspective. And ‘physician suicide’ as an issue is not just an American problem or a gender problem. Male doctors shoot themselves, female doctors’ overdose, New York docs jump and docs in India and China hang themselves by ceiling fans. Educated in how the body works for over a decade credentials doctors to have a suicidal proficiency seldom seen in any other group of individuals.I did not escape this phenomenon, myself. After my disability, it took six years for me to hit bottom. I was treated for suicidal ideation after learning I could not, no matter how hard I tried, no matter what legal methods I utilized… I simply could not learn how my group disability policy worked. I had to live knowing any ‘mistakes’ I made in returning to gainful employment would or could devastate my family’s finances. That just ‘killed’ me.Point in fact, male anesthesiologists are the highest number of physician suicides in America… and I was a male anesthesiologist. There was a study of ‘suicide attempts’ looking specifically at male anesthesiologists and the time it took between them deciding to try to kill themselves and their initiation of the suicide attempt… the answer was just minutes. They are found in their call rooms, in the operating rooms or they jump from the hospital parking lots… they have been found dead from overdose in their hospital chapels. They are showing those left behind where they were injured, hurt and let down.The secrecy surrounding physician suicide often leads to more doctors to think about or choose suicide as a method out of the mess of modern medical practice. We, physicians, are taught in medical school and residency to bury our emotional responses in order to be better diagnosticians and more efficient practitioners. We mask our emotions even to ourselves and so you get outwardly happy and content doctors returning from vacations killing themselves their next clinical day.The divorce rate is higher among doctors than the normal population. Child custody and care battles for more than a decade can erupt into nasty financial bouts between two emotional and psychologically injured people both using a physician’s income to sustain old wounds that won’t heal. No one enters medicine or a medical marriage thinking ‘I’m going to have to fight this highly educated, highly intelligent person for years over the kids.’ Infidelity is a known issue among doctors, as is the ‘skipping out’ on family issues including the death of family members or parenting duties to disabled children. You can hide a lot of your own pain and misery from yourself and your family by working 80-100 hours per week. Perversely, that incredible ‘work ethic’ leads to personal relationship dysfunction, infidelity, divorce, self- loathing and even suicide.In 11 years of treating patients in operating rooms… only one time did I lose my composure and let my feelings show in front of a patient’s family. Only once in more than 15,000 anesthetics. Thankfully, I was with an older doctor, the chairman of cardiothoracic surgery when it occurred, and he was kind in that moment, reminding me to never lose that compassion. When we lose patients under our care, we hurt…. and we hide that hurt from the outside world, we hide it from our colleagues, our families and ourselves. We practice this self-emotional-secrecy so many times it becomes habitual. Even in my own one-time case of emotional showing, I had done everything correct that day… I do not know why I lost my self-emotional-control. Yet, I still, to this day, sometimes wonder if I could have done more… like forgiving my-physician-self for doing my best is simply an impossibility.As I attended law school, I have assisted in many medical-legal situations generating a few dozen opinion letters both for plaintiffs and for the defenses of physician’s actions. I did this to be balanced and remove myself from leaning one direction or another on medical-legal issues. Yet, humans are mistake-machines during our lives no matter how much precaution is taken… especially unconscious mistakes. One of the last medical-legal cases I was involved with led to the discovery that the number and type of procedures being performed had shifted dramatically right after the previous employment contract had been completed between hospital and their little ‘factory workers’ called doctors. These physicians had ‘shifted’ their procedure numbers to maintain their incomes… consciously or unconsciously, doesn’t really matter because the expected number of errors rose dramatically… and in the particular case I was involved with, the changes had led to the death of a woman in her 30’s.Anything and everything a doctor screws up ends up a public story. The higher more-perfect standard one is held to in society, i.e. U.S. Doctors, the better the story of their collapse and public shaming is for society’s appetite to be entertained, enthralled and sickened by the actions of others. Sex, insurance fraud, DUIs, Medicare scams, greed, stupidity and loneliness all lead to poor decision making and the inevitable highly visible public shaming… all on a backdrop of the habitual inability to confront one’s own emotional state. Now with the Internet… these ‘human’ mistakes and the accompanying shame are forever for the American doctor.One big ‘advance’ was supposed to be the 80-hour work week! Begun on July 1, 2002, all medical trainees were prevented from working more than 80-hours in a given week or more than 28 hours in a row. I graduated in the late 1990’s. I was present for the 2002 switch-over… what happened in reality since the work still had to be completed is that all the residents went home at 5pm or 7pm depending on assigned hours restrictions and the attending physicians (me) just stayed until whenever to complete the work in the operating rooms. I recall working 100 hours per week as a resident and then, in late 2002, I was working 110 hours, even some 120-hour work weeks as an attending physician! Do I need to go into what sleep deprivation does to the human psyche?No one made me do it. That’s right, I chose to work 110 hours in a week. I could have just thrown my hands up and complained… but that’s just the problem, you can’t do that as a doctor in America.One bright spot pertaining that the work week reduction was the increased scrutiny concerning the maltreatment and hazing of younger residents by older ones in the pecking order of training programs… however this was coupled with necessary increased secrecy about lying about work hours so as to not get the training program in trouble with their accreditation bodies with violations on resident and intern time cards. I guess the bright spot was shoved back into the darkened corners of medical education and training. Worse, some resident and intern violators are then ‘outed’ semi-publicly within their residency program with ‘inefficiency’ or ‘low-productivity’ labels and are given the worst call schedules.Let’s back up for one moment. Doctors chose this career, right? They get paid great, right? They should just suck it up? Right? Unfortunately, that is exactly what they do, blaming and shaming go hand in hand pushing doctors to early career burnout. In the land of physician disability insurance, which I now inhabit, the greatest percent increase in claims illnesses are for mental/nervous conditions among doctors. The hopelessness and desperateness expressed by some doctors sounds almost incredulous unless you have walked in their shoes, which I have.My wife, a thoracic anesthesiologist, is a caring, compassionate and intelligent doctor. Sometimes the mercilessness medical system’s impositions and requirements and its accompanying political infrastructures seem unsympathetic towards the reality of physically practicing medicine properly. She works for what I consider one of the leading large medical institution in America. I know personally this system puts tremendous money and time into physician wellness… but they often miss the mark when it comes to application of those resources for their stated goals. Physicians just need to grin and bear the abuse, right?Normal people would scream by this point, “If you just can’t stand it anymore… get help… see a therapist… right?” Wrong. The confidentiality afforded regular Americans for psychological services does not exist for physicians. Even leaving town, paying cash and using a fake name sometimes cannot hide the treatment from the overall medical system, or your own colleagues. Your hospital, your own insurance carriers and even the medical board finds out you’ve sought therapy and then you are doubly screwed for trying to hide that fact from them. Confiding in colleagues does not work out well either, we are notoriously bad with ourselves as patients and even more so with colleagues because we believe we all have to just, ‘put up with it.’ Things are downplayed, rationalized away and any substantive discussion of true psychiatric issues are disregarded as weakness.Why do they regret their careers?Imagine knowing you have mental health issues and having nowhere to go and no one to talk to without making things worse for yourself, your patients, your family and your colleagues and friends… and left untreated and ignored, mental health deteriorates, and doctors choose suicide to escape the pain and the internal suffering. Do you know how humiliating it is for intelligent, compassionate, forthright and duty-bound individual who has championed for their patients to not use drugs and alcohol for years to be forced into random drug screening because the business of medicine wants cover from liability? For those suffering from emotional and psychological issues, coping with it via substances occurs very late in the disease state. If you think doctors do not know to avoid ‘testing positive’ then you are hopelessly naïve.Now some career specialties have more psychiatric issue than others; Emergency Department physicians and Anesthesiologists have higher rates of PTSD than other physicians. Whether as a soldier on the battle field or a doctor in the trauma bay or operating room… seeing human bodies apart unnaturally is a psychic-trauma for the caregivers. The cleaner the environment, think about a modern trauma bay, the starker the contrast of human misery are the traumatic gruesome moments in one’s medical career.What does society do after a physician suicide? Its hidden from the public and from other community physicians or explained in the newspapers as accidental death. Do you know what it is like to know your colleague hung themselves at home and have the community and newspapers all claim, ‘accidental death of this happy doctor’? Imagine answering questions for months about the loss to the community and having to lie about it. Medical schools cover up the suicide of its students because it hurts admissions. The obituaries claim ‘some accident’ or ‘passed away suddenly while asleep’ or worse, the newspaper mentions absolutely nothing about the cause of death… they just write about the happiness and accomplishments of the doctor, not the person.Are there solutions to the off-course nature of the 21st Century physician-career? Yes. They are complex and will take decades to categorically bring to the training and work environments of American physicians.I can’t fix the system. I start with the very simple idea of taking care of yourself first, before you take care of others. I try to assist each of my clients in the ways they need help. What I’ve noticed among young physicians and residents is that they are not taking care of the very basics of financial planning nor are they laying those foundational protections for their incomes. This is something I did very well myself and learned even more about how well I planned my life advocating on my own after disability. That is how I am doing my part to help others in this world, providing physician-to-physician education one doc at a time.~ChrisDr. Christopher YeringtonColumbus, OhioBio: Retired from clinical anesthesiology by a disability in 2010, Dr. Yerington has turned his love of teaching and service to others to his family, colleagues and community. He speaks and educates medical groups and residency programs about the importance of great disability insurance. Having attended law and business schools, Chris is a perpetual student, currently working on his financial certifications.