GUSI E-newsletters

August 2023: A Point-of-Care Ultrasound (POCUS) Lightbulb for Physician Burnout

Physician burnout is real, and is costing the US Healthcare system billions of dollars yearly (NPR, 5/31/2019).  In the Medscape Physician Burnout and Depression Report 2023, physician burnout rates have increased from 26% in 2018 to 47 % in 2021 to an alarming 54% in 2022.  This poses a serious challenge to the delivery of healthcare when a critical piece in the healthcare delivery workforce is undergoing its own crisis amidst a physician shortage.  But Why?  The answer is multifactorial.  The concept of moral injury was first coined by VA psychiatrist Dr. Jonathan Shay when recognizing the moral damage and distress experienced by Veterans when an inner conflict arose between their moral beliefs and their actions. The New York Times featured an article on the impact of this moral crisis on doctors resulting from an inability to provide good quality care in line with their moral beliefs.

As Point-of-Care Ultrasound (POCUS) educators, our team at the Global Ultrasound Institute (GUSI) has time and time again witnessed the potential of POCUS to bridge the gap between medical providers and their patients.  

In this 2021 study from the BMC Family Practice, POCUS has been demonstrated to:

• improve patient satisfaction scores 

• increase trust in a physician’s assessment

• increase patients’ understanding of their health problem

• improve patients’ impression of the overall level of service 

• improve patients’ quality of care experience 

The Agency for Healthcare Research and Quality describes physician burnout as a “long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of sense of personal accomplishment.” This month’s GUSI Newsletter posits that POCUS can alleviate some of the “moral injury” experienced by healthcare workers by allowing medical providers to offer better, more personalized care, improve physicians’ sense of accomplishment, and improve the quality of care experienced by patients. 

Case Study #1

A 34-year-old male with a history of methamphetamine use presents with shortness of breath and bilateral lower extremity swelling.  He has been seen in the emergency department several times for acute CHF exacerbation.  Vitals:  BP 160/100, RR 20, HR 90, O2 sat 98% on Room Air.  A bedside ultrasound performed by this provider shows the following:

The patient was diagnosed with another acute CHF exacerbation and discharged with diuretics, medications to control BP, and counseled on the toxic impact of methamphetamine use on the heart and the importance of methamphetamine cessation.

“While the patient clinically appeared to be presenting with a CHF exacerbation corroborated by ultrasound, what I was most struck by was how the ultrasound played a role in my ability to develop rapport with the patient.  He turned to the ultrasound while I was performing it and asked me what his ejection fraction was that day.  We looked at his heart together and I showed him how the walls of his ventricles weren’t squeezing properly and this was leading to a backup of fluid in his lungs and throughout his entire body.  It was a moment of connection for us both.”

Case Study #2

A 40-year-old woman with a history of fibromyalgia was playing softball with her friends over the weekend and over the next few days started to develop some right shoulder pain and soreness.  She saw her primary care doctor a week later to be examined, and was most concerned because her dad had torn his rotator cuff years ago.  She was experiencing no numbness or tingling, or pain while performing daily activities, including reaching overhead.  Her physical exam was largely unremarkable with bilateral shoulder normal active and passive range of motion and negative provocative maneuvers including negative empty can test, negative Neer’s test, and negative scarf and painful arc tests.  

As an extension of the physical exam, a shoulder ultrasound was performed and showed the following:

No signs of acute inflammation around the biceps tendon and an intact rotator cuff.

“Despite a reassuring physical exam, my patient requested an MRI noting her father’s experience with his shoulder.  I counseled the patient given her reassuring physical exam however she was still concerned that something might be torn.  I offered to perform an ultrasound of her shoulder which satisfied her concern to see the tendon.  I was amazed at the impact that seeing has on believing.  She trusted me more after the ultrasound was performed, and we both agreed to hold off on the MRI for now and to try more conservative measures first.  I think she was satisfied with the care she received, I felt more confident in my clinical decision making and appropriate use of resources.” 

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To contribute valuable learning cases and propose future POCUS topics for our newsletters, please email [email protected] with the subject line “Newsletter.”

Dr. Moses Syldort was born and raised in New York City. He completed his undergraduate training at The City University of New York and at The City College of New York. He completed a B.S/M.D program at CCNY and completed his medical degree at Albany Medical College. He completed a Fellowship in Leadership and Public Service at the Colin Powell School of Civic and Global Leadership. Dr. Syldort completed his residency training at the Hofstra/Northwell Glen Cove Family Medicine Residency Program where he completed tracks in POCUS, Women’s Health and pursued passions in Lifestyle Medicine, Clinical Informatics, Global Health, and learned medical Spanish for his patient population. He also was elected to be the national resident delegate representative to the Congress of Delegates to the AAFP.

Dr. Syldort has written policy on increased Point-of-Care Ultrasound training for Family Medicine physicians. Along with his AAFP responsibilities he advocated at Congress on the national and state level regarding issues impacting people who reproduce and family physicians at large. He is currently pursuing a fellowship in advanced obstetrics at Swedish Medical Center with the Swedish Family Medicine First Hill Residency.

Outside of his training, Moses loves to write songs, practice mindfulness, watch anime/movies, peloton, powerlift, and learn languages. After fellowship he hopes to work with the underserved in rural areas and start an academic career teaching future Family Medicine physicians in obstetrics and POCUS.

GUSI in the Community

Members of the GUSI Teaching Team presented a hands-on Introduction to POCUS and Ultrasound-Guided Procedures workshop at the annual Women in Medicine Conference which was held August 23-26 in Suquamish, Washington.

“My favorite part of being a clinical educator is that “lightbulb” moment.  You can visibly see it when things all come together for the learner and feel their excitement at learning a new skill.  That’s the joy of teaching POCUS.”  — Dr. Kara Toles (EM Faculty, UC Davis, Director DEI)

GUSI Scholarship and Leadership

GUSI is thrilled to present 2 oral abstracts at this year’s World Congress on Ultrasound in Medical Education Conference!

Dr. Mena Ramos will present both oral presentations on Friday, September 8, 2023 at WCUME in Detroit, MI. Come join us and learn about GUSI’s work with our international partners to move the global needle towards Point-of-Care Ultrasound implementation.

GUSI’s Health Equity Research Exchange (HERE) Program

At Global Ultrasound Institute, we’re dedicated to sharing POCUS globally and promoting health equity. Through the Health Equity Research Exchange (HERE) program, when residents learn with GUSI, we offer a full scholarship to a resident in a low- or moderate-income country. Join us to advance your skills and be part of a global community of POCUS practitioners shaping the future of healthcare. Learn more and sign up to participate

“The silent threat to our healthcare system is not disease but the burnout of those who heal”