The following is a letter from a member of ABIM Board of Directors, Dr. Robert O. Roswell, addressed to the full Board. It is being shared with his permission as we felt that it carries a striking and poignant message for our community of board certified physicians at this time.
I wanted to share some reflections of my COVID-19 week in NYC. Please do excuse my grammar as I’ve just finished overseeing coverage of 24 COVID ICU patients and 35 COVID telemetry patients (a mere fraction of our COVID patients). As colleagues and I see patients all over the hospital, the value of board certification is so readily apparent. I think now more than ever – it truly is a matter of life and death.
Respiratory failure in our COVID patients is not like respiratory failure from bacterial pneumonia. The acute respiratory distress syndrome (ARDS) characteristics are quite different as it relates to the lung compliance. If you’ve just memorized medical facts all of your medical career, it would have zero benefit right now. Everything is new and different. The ONLY approach to these patients is to take the best guideline-based principles and match them to the new pathophysiology that is evolving in front of your eyes. It’s a sight to see when an entire team descends on a deteriorating patient and tries to match principles of sepsis, inflammation, respiratory failure, and cardiac failure to achieve a desired outcome. ABIM assesses this very critical skill, the application of learned knowledge! I couldn’t be more convinced of the life-saving impact of ABIM’s certification and assessment strategies.
As the pandemic runs its course throughout our nation, it is clear that our dedication to health equity is of utmost importance. The signal of increased mortality from COVID in minority and socioeconomically disadvantaged communities is alarming and underscores the life-saving impact of healthy equity and cultural humility. A non-English speaking patient coded and died from removing their NRB facemask in the ER. Language differences played a role and definitely impacted mortality. A socioeconomically disadvantaged patient collapsed and died on the street at E 77th St and Park Ave (very affluent part of NYC near Central Park). All of the social influences of health are coming to bear in this health crisis.
Finally, I’d like to share that we’ve built eight new ICUs, and it’s still not enough. Details that weren’t ever a thought are now a concern, for example: hemodialysis equipment and tubing, BiPAP equipment, adequate oxygen delivery systems. Each night on is like a chapter in a book with its own vicissitudes. If this was way less than projected, we are dodging a colossal bullet. NYC feels like a war zone, and I can’t even imagine what would have happened if the more serious projections had held. I couldn’t be more proud of the work we’re doing and seeing its impact play out during these times. It’s truly an honor to be a part of such an exceptional Board and team that is dedicated to such a laudable mission.
Stay safe all!
Robert O. Roswell, MD, FACC, FACP
Associate Dean for Diversity, Equity & Inclusion
Associate Professor of Cardiology and Science Education
Zucker School of Medicine at Hofstra/Northwell
Dr. Robert Roswell is Associate Dean for Diversity and Inclusion at the Zucker School of Medicine at Hofstra/Northwell where he also serves as Associate Professor of Science Education & Cardiology. Board certified in internal medicine and cardiovascular diseases, he is Co-Director of the Cardiac ICU and the Associate Cardiology Fellowship Director at Northwell Health’s Lenox Hill Hospital. Dr. Roswell serves as a member of the American Board of Internal Medicine Board of Directors.
A champion of promoting equity in medicine, Dr. Roswell is a graduate of the American Association of Medical College’s Healthcare Executive Diversity and Inclusion Certificate program and has worked to integrate the social determinants of health, implicit bias, and cultural humility into the medical education curriculum. He has been awarded the Certificate of Appreciation from the Student National Medical Association and an Outstanding Mentorship Award from Internal Medicine Residents for his role in medical education.
Dr. Roswell’s academic focus is at the nexus of acute cardiac care and health care disparities. Earlier in his career, he was honored by the American Heart Association and was a recipient of the Young Heart Award for outstanding care to patients. He is on the Steering Committee for the Critical Care Cardiology Trials Network and is active in the leadership of the American College of Cardiology as a NY Councilor and chair of the NY Diversity & Inclusion Taskforce. He is also a member of the Association of Black Cardiologists and is a strong advocate for health equity by providing high-quality, evidence-based care delivered with cultural humility to all patients.
His medical degree was conferred with honors from New York University School of Medicine where he completed residency and chief residency. He went on to fellowship at Georgetown University School of Medicine/Washington Hospital Center. Throughout his career, Dr. Roswell has given numerous talks and authored several publications on acute cardiac care, cardiogenic shock, and health care disparities.