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a company that specializes in strategic healthcare initiatives such as mergers and acquisitions, management services organizations, private equity, succession planning, physician partnerships, and strategic planning. He can be reached at 

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While analyzing the competition is an essential component of your strategy, most medical practices don't conduct this type of analysis systematically enough.

Are you working on a 2025 strategy?

Ryne Natzke is Chief Revenue Officer at TrustCommerce, a Sphere Company.

Practices have tools at their disposal that can help alleviate some of the problems that women face with health care affordability and access. 

How digital tools can alleviate health care access and affordability issues for women

Your monthly collection of insights from the Physicians Practice Pearls writers is available now!

Physicians Practice digital edition: Best states to practice

Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.

Her evidence-based work enables physicians to sail through the challenges of influencing others to deliver excellent care. Her clients learn simple, quick ways to lead high quality, thriving care groups – one conversation at a time. She’s an Affiliate Faculty at AriadneLabs (Brigham & Womens Hospital and Harvard’s Chan School of Public Health), as well as a scholar at Brandeis University WSRC. 

https://www.linkedin.com/in/nancegoldstein/

, curates recent research and stories of physicians making medical practice better – leadership that honors their purpose 

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Her podcast offers conversations with seasoned women MDs talking about how they navigated the competing demands of practice, family and the rest of life.

She’d like to hear what troubles you in your practice. Email her: 

De-escalating situations and emotions can settle disagreements between staff members.

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Fifteen years after his 300-pound, 6’4” patient offered to toss him through his office window, psychiatrist Dennis Helmuth explains why he now looks forward to their appointments.

When a Patient Makes Threats

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I came across an unusual phrase the other day: “compassion fatigue.

Practicing compassion

Physicians Practice® spoke with Dr. Nada Elbuluk, practicing dermatologist and director of clinical impact at VisualDx, about how cognitive biases present themselves in care strategies and how the industry can begin to work to overcome these biases.

Cognitive Biases in Healthcare

 One of the effects of social isolation resulting from pandemic response protocols that has caused great concern is the potential for exacerbation of mental health issues, particularly the risk of self-harm and suicide in at-risk populations.

Thankfully, two recent papers published in JAMA Open in the last few weeks of January indicate that these fears may have not come to fruition.

Suicide-Related Internet Searches During the Early Stages of the COVID-19 Pandemic in the US

", John W. Ayers et. al. replicated the methods of a previous cross-sectional study to examine Google search rates per 10 million searches for the term 'suicide'. The authors found that these searches deceased during the early stages of the pandemic, between March and July of 2020.

Though counter to their expectations, the authors report that their findings are supported by extant literature. They also suggest that the search rates may change and even increase, warranting continued monitoring.

In a second paper published in January, "

Suicide Deaths During COVID-19 Stay-at-Home Advisory in Massachusetts, March to May 2020

" Jeremy Samuel Faust, MD, MS, et. al., assembled suicide death data for persons aged 10 years and older form the Massachusetts Department of Health Registry of Vital Records and Statistics from January 2015 to May 2020. Here, suicide deaths remained at levels previous recorded in recent years, indicating that the early pandemic did not necessarily have a resultant increase on suicide.

However, the authors note that as the pandemic continues, these rates may change, especially as more cases are completed by a medical examiner.

, though we won't be discussing the pandemic's effects on suicide rates, you will hear from Dr. Anisha Abraham, author of the book "Raising Global Teens: A Practical Handbook for Parenting in the 21st Century," about addressing suicide risks in your patients.

Though her book focuses on parenting in general, her insights into addressing suicide risks in pediatric and adult patients remain crucial for all caregivers treating these populations.

In stark contrast to the studies mentioned earlier, the CDC still holds that death by suicide is the second leading cause of death among adolescents between 10 and 24 years of age. The prevalence of suicidal tendencies among teens presents an interesting conundrum for physicians who want to help prevent the worst possible outcome: how and when can you intervene, and what does care look like when one of your patients presents suicidal warning signs?

 Well, there are a number of warning signs that providers need to be thinking about when they're working with young people that can include: someone talking about death, or writing about death, feeling increasingly depressed or anxious. Other signs might be feeling increasingly irritable, having a change in sleeping or eating patterns, and giving away their belongings. These are all things that providers should be aware of when they're working with young people.

 Beyond these behavioral warning signs, Dr. Abraham says that there are also common physical signs and risk factors for physicians to watch out for.

 Other physical facts that I think are really important to look out for are, if there are signs when or certainly in the interview, that they're not giving you good eye contact, if they clearly seem that they're withdrawn, if there are any recent changes in terms of what's happening in their own home environment or in terms of their own physical health.

There are certainly a number of risk factors that we need to consider as well. Young people that have had a history of suicide in the past are at an increased risk for having a suicidal ideation in the future. And many times, people that have actually attempted suicide have come in to see a health provider in the last six months to a year. So being aware of that I think is really important.

Certainly, other risk factors include having a history of depression or anxiety; having a family History of suicide also increases their likelihood. Use of alcohol or drugs or an increasing use of alcohol or drugs puts younger people at higher risk as well. What we do know is if there's been any history of bullying, or particularly cyber bullying, there's been a higher risk of suicide. If young people identify as being LGBTQ—they could also be at increased risk. There's a host of different issues that we as providers need to be aware of.

 If you suspect that one of your patients might be at risk of suicidal tendencies, Dr. Abraham suggestions asking very direct questions when your patient comes in for an appointment.

 I would certainly say that if you are concerned about a patient that might be suicidal, asking very specifically about how they're feeling, have there been any issues in terms of depression, and have there been times that they felt sad or down or life was not worth living, asking about other self-harm related issues as well. So certainly, has there been any history of them trying to cut before—we certainly know that that might increase your likelihood of suicidal ideations as well.

I just want to reiterate that by specifically asking, you're more likely to get information, not to put them at higher risk for suicide, but getting direct information and providing the opportunity to get them support. The questionnaire that I would recommend using and certainly in our academy of pediatrics also encourages the use of questionnaires, would be one called the patient health questionnaire nine, which is a validated survey, but there are many validated surveys that, again, providers can use in their clinical setting.

But in addition to that, asking very specific questions about depression and suicide are also very helpful. Those questions will include things like have you been feeling down or sad or depressed? Have you felt that life was not worth living? Do you have a specific plan? And is there a way that you would act on this? These are all questions I think are very important to consider. If you are concerned about a patient being depressed or suicidal.

 Once you have identified that r patient may be suicidal, the next step, Dr. Abraham says, is to get psychiatrists or psychologists involved.

: I believe it's very important for physicians to ensure that they get a psychiatrist or a psychologist involved as soon as possible.

If a patient is actively suicidal, then certainly making sure they go into the nearest emergency room or they are screened by a psychiatrist would be very important. If they are not actively suicidal, that certainly have some ideations there are some risks in terms of them being suicidal in the future. Certainly, assessing whether or not there may be any way for them to act on it. Also, ensuring that there are not any firearms or other methods in which they could actually attempt suicide, giving an information about suicide hotlines, and ensuring that they will be able to see a provider counselor as soon as possible are all very important.

It's challenging in a clinical setting, but I think it's again, very important to make sure you have a good connection with mental health providers and providing those referrals as quickly as possible.

Jeremy Samuel Faust, M. (2021, January 21). Suicide Deaths During the COVID-19 Stay-at-Home Advisory in Massachusetts. Retrieved January 21, 2021, from 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775359?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=012121

John W. Ayers, P. (2021, January 21). Suicide-Related Internet Searches During the Early Stages of the COVID-19 Pandemic. Retrieved January 21, 2021, from 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775358?resultClick=3

Physicians Practice® spoke with Dr. Anisha Abraham, author of the book "Raising Global Teens: A Practical Handbook for Parenting in the 21st Century", about signs that a patient may be at risk of suicide and self-harm as well as interventions and communication methods physicians can employ in the clinical setting.

Addressing patient suicide risks in your practice

 One of the most important conversations that a provider can have with a patient regards end-of-life plans. As you'll hear from today's guest, Dr. Caroline DeFilippo, most providers—most people in general—are reasonably not prepared for these conversations.

To begin to have more effective end-of-life conversations, it will help to have a better understanding of how these conversations differ form those you routinely have with patients.

 So I think the big differences with end of life conversations are that they're not necessarily a conversation where the physician is in the driver's seat in terms of prescribing or sharing information about a patient's illness, as much as it's actually the opposite. In that the physician is asking guiding questions, and trying to understand how the patient feels learning about his or her wishes. But really, we're doing more of the listening than the talking. And that's a big shift for us, physicians and providers who are used to a very fast paced and sort of having a certain amount of control and rhythm to how those visits go. And that's one of the many things that makes these conversations hard to do and a natural barrier for us to wanting to start them.

 Though most may be unfamiliar or even uncomfortable with such conversations, Dr. DeFilippo says these conversations are some of her most rewarding.

This week on Perspectives, Dr. Caroline DeFilippo, MD, MPH, FACP of CareMount Medical in New York, explains how physicians can grow more comfortable with these conversations and when they should consider having them with their patients.

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