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Timothy J. Alford, MD VOL. LI
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2010-2011 MSMA President No. 6
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Lucius M. Lampton, MD Editor D. Stanley Hartness, MD Michael O’Dell, MD AssociAtE Editors Karen A. Evers MAnAging Editor PublicAtions coMMittEE Dwalia S. South, MD Chair Philip T. Merideth, MD, JD Martin M. Pomphrey, MD Leslie E. England, MD, Ex-Officio Myron W. Lockey, MD, Ex-Officio and the Editors thE AssociAtion Randy Easterling, MD President Tim J. Alford, MD President-Elect J. Clay Hays, Jr., MD Secretary-Treasurer Lee Giffin, MD Speaker Geri Lee Weiland, MD Vice Speaker Charmain Kanosky Executive Director JOURNAL OF THE MISSISSIPPI STATE MEDICAL ASSOCIATION (ISSN 0026-6396) is owned and published monthly by the Mississippi State Medical Association, founded 1856, located at 408 West Parkway Place, Ridgeland, Mississippi 39158-2548. (ISSN# 0026-6396 as mandated by section E211.10, Domestic Mail Manual). Periodicals postage paid at Jackson, MS and at additional mailing offices. CORRESPONDENCE: JOURNAL MSMA, Managing Editor, Karen A. Evers, P.O. Box 2548, Ridgeland, MS 39158-2548, Ph.: (601) 853-6733, Fax: (601)853-6746, www.MSMAonline.com. SUBSCRIPTION RATE: $83.00 per annum; $96.00 per annum for foreign subscriptions; $7.00 per copy, $10.00 per foreign copy, as available. ADVERTISING RATES: furnished on request. Cristen Hemmins, Hemmins Hall, Inc. Advertising, P.O. Box 1112, Oxford, Mississippi 38655, Ph: (662) 236-1700, Fax: (662) 236-7011, email: cristenh@watervalley.net POSTMASTER: send address changes to Journal of the Mississippi State Medical Association, P.O. Box 2548, Ridgeland, MS 391582548. The views expressed in this publication reflect the opinions of the authors and do not necessarily state the opinions or policies of the Mississippi State Medical Association. Copyright© 2010, Mississippi State Medical Association.
JUne 2010
VolUMe 51
nUMber 6
Scientific ArticleS Domestic Violence Screening in a Military Setting: Provider Screening and Attitudes
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Monica Lutgendorf, MD, MC, USN; Jeanne Busch, MD, DO; Everett F. Magann, MD, MC, USN and John C. Morrison, MD
SPeciAl Article An interview with timothy J. Alford, MD 2010-2011 MSMA President
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PreSiDent’S PAge i Wish You Hearts that race, Minds that Dream…
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Randy Easterling, MD; MSMA President
eDitoriAl if only We Knew
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D. Stanley Hartness, MD; Associate Editor
relAteD orgAnizAtionS Mississippi State Department of Health
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DePArtMentS new Members images in Mississippi Medicine Poetry in Medicine the Uncommon thread Placement/classified Una Voce
165 171 172 173 174 175
AboUt tHe coVer:
tiMotHY J. AlforD, MD; 2010-11 MSMA PreSiDent - During our MSMA’s 142nd Annual Session, held June 3-6 at the Natchez Convention Center, Dr. Tim Alford of Kosciusko was installed as the 143rd president of the association. Dr. Alford is board-certified by the American Academy of Family Physicians and is a Past President of the Mississippi Academy of Family Physicians. He is in the private practice of family medicine with Kosciusko Medical Clinic, a division of Premier Medical Group of Mississippi. You will also find an interview with Dr. Alford in this issue of the JMSMA. r
VOL. LI
Timothy J. Alford, MD
June
No. 6
2010-2011 MSMA President
2010
June
Timothy J. Alford, MD VOL. LI
2010
2010-2011 MSMA President No. 6
Official Publication of the MSMA Since 1959
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• SCienTiFiC ARTiCLeS • Domestic Violence Screening in a Military Setting: Provider Screening and Attitudes Monica Lutgendorf, MD, MC, USN; Jeanne Busch, MD, DO; Everett F. Magann, MD, MC, USN and John C. Morrison, MD
A
bStrAct
Domestic violence is an important healthcare problem, and it appears more prevalent in military patient populations although no one has demonstrated the cause behind this phenomenon. The purpose of this observational study was to assess data regarding domestic violence screening from practitioners at one military training center. This study used an anonymous questionnaire for physicians, nurses and nurse midwives, which surveyed current methods, attitudes toward screening, and barriers for such assessment. Fifty-seven surveys were distributed, and 26 were returned for a response rate of 45.6%. Only about a third (38.5%) of the practitioners screened all obstetric patients while the remainder screened selected patients for domestic violence. Even less (19%) screened gynecology patients routinely, whereas 69% reported they screened selected women with chronic or somatic complaints. A history of prior abuse in the respondents led practitioners to try to identify such patients within their practice. Lack of education or training was the most common barrier to universal screening followed by time constraints and frustration about not being able to address adequately the problem when noted. These results emphasized the importance of an educational program to increase domestic violence awareness and routine screening.
KeY WorDS:
DOmEsTic viOLEncE, scrEEning, prOviDEr ATTiTuDEs
introDUction Domestic violence has important healthcare implications including injuries, mental illness, and complications during pregnancy.1 The incidence of domestic violence is estimated to be between 2-23% AUtHor inforMAtion: Drs. lutgendorf, busch and Magann are in the Departments of Obstetrics and Gynecology at the naval Medical Center in Portsmouth, VA. Dr. Morrison is in the Department of Obstetrics and Gynecology at the university of Mississippi Medical Center in jackson, MS. correSPonDing AUtHor: john C. Morrison, MD, Department of Obstetrics and Gynecology; university of Mississippi Medical Center; 2500 north State Street; jackson, MS 39216-4505; Telephone: (601) 984-5300; Facsimile: (601) 815-4096; e-Mail: jMorrison@uMC.edu
annually2 with its victims reporting a poorer overall health status and more frequent use of health care services.3 such women seek care for a variety of somatic and psychological complaints including gynecologic, gastrointestinal, chronic pain, and psychiatric complaints.4 The healthcare costs related to domestic violence are significant. in 2003, the centers for Disease control and prevention’s national center for injury prevention and control reported an estimated $5.8 billion spent per year for the direct and indirect costs of domestic violence in the u.s.5 in fact, these costs are likely an underestimate as domestic violence is often unrecognized and underreported. many professional organizations including the American college of Obstetricians and gynecologists (AcOg), the American Academy of Family physicians (AAFp), and the Joint commission on Accreditation of Health care Organizations (JcAHO) recommend routine screening for domestic violence.6 The military healthcare setting presents a unique situation with respect to domestic violence. previous work has shown that stress within the military and lack of control in various military occupations may lead to adverse pregnancy outcome.7 Additonally, dependents of military personnel have increased stress due to long separation and often times to hazadous duty assignments of their spouses.8 it is not surprising then that the incidence of spousal abuse in the military is higher than the civilian sector with estimates of one third of military spouses experiencing abuse during their marriage.9 military personnel and their families also have ready access to healthcare resources and the unique Family Advocacy program (FAp) that provides social support to families struggling with domestic violence. The purpose of this study was to examine clinicians’ screening profile for domestic violence in a military healthcare setting and to identify barriers to such screening.
MAteriAlS AnD MetHoDS With approval from the naval medical center portsmouth institutional review Board, all practitioners (nurses, midwives, and doctors) in the obstetrics and gynecology clinic at naval medical center portsmouth were anonymously surveyed regarding their current methjune
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ods of screening patients for domestic violence as well as their attitudes toward screening. participants were also questioned regarding 19 potential barriers to screening. Written permission was obtained from the author to use the questionnaire previously published by parsons in a nationwide survey of AcOg fellows10 which used a series of closed ended questions. The first part of the survey contained questions regarding current screening practices. practitioners were asked (1) is it part of your routine obstetric history to screen all patients for abuse? (2) Do you screen selected patients for abuse? (3) is it part of your routine to screen patients for abuse at their annual gynecologic visit? (4) is it part of your routine history taken on women with chronic somatic complaints, sexual problems, or chronic pelvic pain to ask about abuse? One question was designed to assess past training on abuse/domestic violence with instructions to include all prior sources of training including no training, formal continuing education course, local hospital, county family services, other local agency, residency program, battered women’s shelter and the AcOg Educational Bulletin.6 The second part of the survey addressed 19 potential barriers to screening using a 5-point Leikert scale. responses were designed to assess time constraints as a barrier, education/training, deficiencies, patient type, fear of offending the patient, frustration at inability to help the patient, a personal history of abuse, inability to verify the abuse, intention to screen but not yet initiated, and the belief that abuse is not a medical problem.
reSUltS A total of 57 surveys were distributed to clinicians in our practice area. surveys were anonymously collected over the following month. Twenty-six surveys were returned with a response rate of 45.6%. respondants were 34.6% male, and 65.4% female with 10 (38.5%) aged 20-40 years, 6 (23%) 41-50 years, and 10 (38.5%) > 50 years old. Fourteen (56%) respondents were physicians (mD/DO) with the remainder being rn’s or nurse midwives. Thirteen (68.4%) completed residency (or are still in training) from 1991-present, and 6 (31.6%) completed residency from 1971-1991. Only 38.5% providers reported that they screened all obstetric patients for domestic violence while 58.3% screened selected obstetric patients for abuse. Only 31% of physicians screened all obstetric patients for abuse, compared to 60% of nurses. Additionally, 62% of physicians screened selected obstetric patients for abuse while a similar percentage (60%) of nurses employed selective screening among obstetric patients. Even less (19%) of respondents screened all gynecology patients at routine annual exams while 69% reported that they assessed only women with chronic pelvic pain, sexual problems or chronic somatic complaints. When stratified by provider, 14% of physicians surveyed and reported that they screened gynecology patients at annual visits compared to 29% of nurses surveyed. Of those who used selective screening, 80% of physicians and 71% of nurses questioned women with chronic pelvic pain, sexual problems or chronic somatic complaints for domestic violence. When questioned about a personal history of abuse, 67% of physicians and 27% of nurses reported no history of abuse. conversely, 27% of physicians and 73% of nurses reported that their own exposure
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to abuse led them to try to identify victims of abuse within this patient population. Lack of education or training was one of the most common barriers (53.8%) to screening with 47% of physicians and 64% of nurses reporting that they felt inadequate in dealing with abuse because of a lack of training. On a personal level 67% of physicians and 50% of nurses felt more qualified to deal with physical problems than psychosocial issues. Time constraints, cited as a barrier by a third (33%) of physicians and nearly two-thirds (64%) of nurses, prevented adequate screening and consultation with such patients. One half (53%) of physicians and 18% of nurses responded that they felt frustrated that they could not do anything about such problems even if they could identify them. no one responded that “such contact is normal in a relationship” or that “women bring this on themselves.” Only 40% of physicians and 27% of nurses followed all four American medical Association (AmA) screening guidelines whereas 13% of physicians and 18% of nurses followed the six AcOg screening guidelines. When questioned regarding what outcome they would take if a patient responded with a history of abuse, 100% of physicians and 91% of nurses said they would obtain a more detailed history while most physicians (93%) and nurses (64%) would record it in the patient’s chart. in addition, 80% of physicians and 73% of nurses would provide patients with emergency numbers whereas 53% of physicians and 64% of nurses would provide information on referral sources. About half of the physicians (47%) and nurses (46%) would inquire about child abuse. Fifty-three percent of physicians and a greater number of nurses (73%) would advise counseling.
DiScUSSion Our departmental policy is to screen all pregnant women for domestic violence at their initial visit by a question on the standard intake form. The American college of Obstetricians and gynecologists recommends screening for domestic violence at routine annual exams, at preconceptual counseling, once each trimester in pregnancy and postpartum.6 if nothing else, we have highlighted how we did so poorly in screening for abuse in this high risk population. Therefore, while a limited response rate at one military base may hamper geralization, the results would seem compatiable with other military installations and in other branches of the service. indeed, the majority of providers do not routinely screen women health patients for domestic violence. providers are more likely to screen selected obstetric and gynecology patients with chronic pain/chronic somatic complaints or at certain times rather than follow the routine screening guidelines for all patients. Lack of education or training was the most commonly cited barrier to screening. The second most common complaint was time constraints since military physicans have to see more and more patients per unit of time because of overseas deployment of other practitioners. This is compounded by the lack of time and reasons to deal effectively with such cases when they are identified. The small numbers in this study preclude drawing general conclusions regarding screening within the military as a whole. However, physicians as well as their patients represented geographic areas from all over the country and patients from all branches of military service. These results underscore the importance of educational programs to increase domestic violence awareness and routine screening. ideally such
programs should focus on the unique situation of the military with its reporting requirements and the Department of Defense’s Family Advocacy program designed to provide support for victims of domestic violence. All physicians and providers should be familiar with the available resources within their community and appropriate channels for referral. Finally, active duty women support routine screening in the military: a recent survey of 474 active duty women deomonstrated that 57% supported routine screening, 87% supported mandatory screening, and 48% felt that abuse should be reported to the commanding officer.11
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AcKnoWleDgeMent: The authors wish to acknowledge the practitioners and patients of the Department of Obstetric and Gynecology Naval Medical Center, Portsmouth VA and Keesler Air Force Base Medical Center, Biloxi, MS. The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. The Chief, Navy Bureau of Medicine and Surgery, Washington, DC, Clinical Investigation Program sponsored this study (CIP #P05091E). This work was prepared as part of the official duties of a military service member. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.
referenceS 1.
ramsay J, richardson J, carter YH, Davidson LL, Feder g. should health professionals screen women for domestic violence? systematic review. Br Med J 2002;325:314-318. 2. Laumbach sg. Detecting Domestic violence: To screen or not to screen? The Female Patient 2004;29:47-57. 3. campbell Jc. Health consequences of intimate partner violence. Lancet 2002;359(9314):1331-1336. 4. Eisenstat sA, Bancroft L, Domestic violence. N Engl J Med 1999;341 (12):886-892. 5. centers for Disease control. Costs of Intimate Partner Violence Against Women in the United States. Atlanta, gA: u.s. Department of Health and Human services, cDc, national center for injury prevention and control, 2003. 6. American college of Obstetricians and gynecologists. The Battered Woman. ACOG Educational Bulletin Number 257. Washington Dc: AcOg; 1999. 7. magann EF, Winchester mi, carter Dp, martin Jn Jr., Bass JD, morrison Jc. Factors adversly affecting pregnancy outcome in the military. Am J Perinatol 1995;12:462-6. 8. Haas Dm, pazdernik LA. partner deployment and stress in pregnant women. J Reprod Med 2007;52:901-6. 9. Brannen sJ, Bradshaw rD, Hamlin Er, Fogarty Jp, colligan TW. spouse Abuse: physician guidelines to identification, Diagnosis and management in the uniformed services, Mil Med 1999;164(1):30-36. 10. parsons LH, Zaccaro D, Wells B, stovall Tg. methods of and attitudes toward screening obstetrics and gynecology patients for domestic violence. Am J Obstet Gynecol 1995;173:381-386. 11. gielen Ac, campbell J, garza mA, O’campo p, Dinemann J, Kub J, Jones As, Lloyd DW. Domestic violence in the military: Women’s policy preferences and Beliefs concerning routine screening and mandatory reporting, Mil Med 2006;171(8):729-735.
There’s a lot going on in organized medicine so it’s easy to miss something if you’re on the go. To help you stay in touch no matter where you are, MSMA is now communicating via “Twitter.” In about three minutes, you can set up a free Twitter account for yourself. Simply visit www.twitter. com and submit your name, email address and mobile phone number (optional, standard text messaging rates apply). Once you’re signed up with Twitter, you can add MSMA by going to the following web page http://twitter.com/ MSMA1 and clicking “Follow” next to the MSMA icon.
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• SPeCiAL ARTiCLe • An Interview with Timothy J. Alford, MD 2010-2011 MSMA President Karen A. Evers, Managing Editor [Each June the JMSMA interviews the incoming president. Here we go behind the scenes. Due to space limitations, the answered questions do the speaking for this interview.] —Ed.
tiMotHY JoHnStone cHilDren…
AlforD, tHe YoUngeSt of foUr
After my mother, virginia small Alford, reared us, she renewed her career as a registered dietitian and went to work for Dr. John Bower’s Kidney care. Like so many registered dietitians, she was a marvelous resource and, by golly, she made sure that we ate our fresh fruits and vegetables! my eldest brother, John, lives in macon, georgia, with his family and is a dentist there. Helen, my sister, met her husband at southwestern (rhodes) college in memphis. she is a teacher of choral music in the Jackson, Tennessee; public schools and her students continue to top the charts in Tennessee. Helen has a knack for getting the best from young people. Brother peter, is an intensivist in statesville, north carolina. peter attended Davidson college, and we could never get the carolina out of him. my dad, John Alford, mD was a tough taskmaster and expected excellence from all of us regardless of what we were doing. He had a strong work ethic and was a very principled physician. Dad never purchased a dime’s worth of medical malpractice insurance and insisted that such contracts violated the sacred patient-physician trust. Fortunately he was never sued. However, this stand abbreviated his tenure on the medical staff at greenwood-Leflore Hospital. mike carter, mD, former msmA president, once told me that Dad was right about many such “cries in the wilderness.” Dad grieved over medicine succumbing to corporate America and the inherent erosive effect that profiteering had on the doctor-patient relationship. He openly admitted that he was not programmed for organized medicine and on one occasion was convinced by Dr. Ed Hill to rejoin the Association after a three to four year hiatus.
DeciSion to becoMe A Doctor… i would say that not only my father’s influence but also the collaborative influences of a congenial group of physicians in a small Delta town along with outstanding high school science teachers were what motivated me toward medicine.
going to MeD ScHool… my class at the university of mississippi school of medicine was one of the last of the mega-classes – 140 plus before it dropped to 100. it is a good thing, too, because i probably would not have gotten into a smaller class and that is the truth! The sTEp exams are much more rigorous i believe than the FLEX. We have a steady stream of m-3’s and m-4’s rotating through our
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(Kosciusko) clinic doing their Family medicine blocks. To me these students are extremely bright and even better rounded than we were.
MArrYing forMer StAte HeAltH officer Dr. Alton cobb’S DAUgHter, MArY Al…
tiM AnD MArY Al AlforD
i met mary Al at millsaps during my freshman year there. she was a year ahead of me and was my orientation advisor. We did not date until her senior year, though. Our wedding was held the saturday after my graduation from millsaps. mary Al was fortunate enough to land a job in governor Winter’s administration and worked at the governor’s mansion during my medical school days. As for my father-in-law Alton and mother-in-law mary cobb, i am not sure there are two better public health servants in mississippi than these two. mary worked as a public health nurse at the high risk clinic at umc. she took on many exceedingly challenging patients, babies, and home environments with intense devotion. As for Alton, i spent many a sunday afternoon at his beloved home place in camden, mississippi. This log home built in 1832 is the oldest residence in madison county. i have been well schooled in the critical matters of public health along with the best way to grow pine trees. in my opinion, Alton is mississippi’s foremost health analyst and genuinely attempts to look at issues on balance.
becoMing inVolVeD in MSMA… my entry into msmA began in the early years of the Young physicians’ section. Dr. stanley Hartness, my partner at Attala medical clinic, offered much encouragement in my involvement with msmA. i owe my service on the Board of Trustees to Dr. Dwalia south who convinced me to run for the Board position.
on SerVing AS MSMA PreSiDent… i cannot say that being msmA president has been a life-long pursuit, but i am humbled by the fact that my colleagues would see fit to elect me to this position and i am committed to doing the best i possibly can to serve organized medicine in mississippi.
orgAnizeD MeDicine iSSUeS iMPortAnt to YoU… • At the practicing level, bringing greater efficiency and “value” to our practice. This translates into better health care for our patients and is a neverending, labor-intensive process. • At the policy level, laying the groundwork for the eventual rolling out of the patient centered medical Home statewide. HB 1192 signed into law and drawn up collaboratively by mAFp and msmA empowers our state Health Department to assist physicians statewide in adopting this new model of care. most of us are on the “lower limb ” of the learning curve with regards to this revolutionary approach of caring for our patients. The good news is that physicians will lead the team in this plan of care.
FiRST ROw: MArY brUce AlforD, MArY Al AlforD, leAH HenDrix, tAl HenDrix, MArY cobb; SeCOnD ROw: tiMotHY AlforD, JoHn PAUl AlforD, tiM AlforD, Alton b. cobb
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“What they say about him...” Tim Alford is just a great guy. As a new physician getting involved in organized Family medicine he allowed me to participate, excel, make mistakes and learn from them, and then challenge me to move on. i am grateful for his guidance, his thoughtfulness, and his leadership. Tim, i wish you the best during your year as president of msmA. Thanks for all of your hard work to make mississippi a better place! —Jason B. Dees, DO, FAAFP, New Albany Tim and i go way back, mostly connected through our years with the mississippi Academy of Family physicians and through some American Academy of Family physician activities. Tim was, at one time, chair of the American Academy of Family physicians council on Legislation. it was in that capacity that he often invited me to attend several other national meetings. remember, i was a guest, there only to learn from Tim and others. Like most medical meetings, they all began early in the morning (around 7:00 a.m. and concluded by noon). Having some measure of OcD, i was dutifully at each meeting by 7:00 a.m. sharp, often times employing toothpicks to hold my eyes open. Each morning, Dr. Alford’s absence was conspicuously obvious. Then around 11:00-11:30 a.m., you could set your watch by it, in would saunter Dr. Alford. After several mornings, i asked him, “Where in the hell have you been?” “Well,” he would say, “i slept until 7:00, took a leisurely jaunt, and then went to the hotel masseuse for a massage.” Beware, if Dr. Alford is late for any meetings this year, he may well be found running around the block or getting a “butt rub” from the local masseuse. This association is in for a treat. Tim will do a great job. — Randy Easterling, MD; MSMA Immediate Past President, Vicksburg
i knew that Tim was destined for great things when he beat me out several years ago as winner of the relay for Life Womanless Beauty pageant. must have been his height advantage…and five o’clock shadow! —Stanley Hartness, MD; MSMA Past-President, JMSMA Associate Editor, Jackson For many years Tim Alford has done a really great job working for our mississippi Academy of Family physicians. i think he will represent us well and do an equally impressive job as president of msmA. no one else can carry a “Torch” like Tim can!! He can carry my “Torch” anywhere-anytime! —Joe Johnston, MD, Mount Olive i see Tim Alford as the moses of mississippi medicine. He is one of the most visionary leaders that i have ever met, and he can see the promised Land for our patients and our profession. He recognized critical medical and public health issues well before the rest of our professional community. He also has extraordinary skills as bridge builder. He doesn’t lead by running over people; he leads by rallying the troops and showing the way to go. Too often, we forget what’s really most important in our leaders. Yes, they need intellect and competence, but at the core of great leadership are kindness, grace, vision, and integrity. Tim’s got all of those traits, and we docs need them in our leadership at this difficult transitional period in medicine. Few know that Tim was one of the state’s best swimmers in his earlier days and coached Hanging moss country club swim Team, one of the perennial champions in the Jackson swim Association. The discipline of an athlete is a basic component of his character. He knows about working hard and training today in preparation for success in the future. Also, being a swim team coach brings you into contact with a bunch of often loony and demanding parents. This, too, has prepared him for what he does today. He’s affable and gracious in all of his interactions, whether you are on his side or against him, and he’ll lead in that same manner. He’s also wildly funny and his self-effacing humor will warm many a msmA member’s heart. One final thing: Don’t ever underestimate Tim Alford. His kindness and good humor may be what you see first, but his intellect is keen and complex, and he’s one of the medical profession’s best warriors in our state. —Lucius M. “Luke” Lampton, MD, Editor, JMSMA; Chairman, Mississippi State Board of Health, Magnolia i can remember Tim saying after attending his first Young physicians’ section meeting of the AmA, “i think this thing is bigger than i am!” As history has unfolded, i think he’s proven he’s quite big enough to be a superb representative and leader in organized medicine for all of us! —George McGee, MD; MSMA Past-President, Hattiesburg
AMericAn cAncer SocietY relAY for life fUnDrAiSer— in The DR. STAnLey hARTneSS AnD DR. TiM ALFORD weRe PARTiCiPAnTS in A "wOMAnLeSS BeAuTy PAGeAnT" BeneFiT heLD SeVeRAL yeARS AGO. The ACS ReLAy FOR LiFe RePReSenTS The hOPe ThAT ThOSe LOST TO CAnCeR wiLL neVeR Be FORGOTTen, ThAT ThOSe whO FACe CAnCeR wiLL Be SuPPORTeD AnD ThAT One DAy CAnCeR wiLL Be eLiMinATeD. See DR. hARTneSS'S COMMenT.
SPiRiT OF SuPPORTinG A wORThy CAuSe,
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Dr. Alford has worked with iQH through his leadership to assist our physicians with quality improvement activities in our state. He has also been a leader and an advocate for health information technology within our state. —James McIlwain, MD; President, Information and Quality Healthcare, Jackson i have heard a lot of great things about Dr. Alford, but i don’t think he ever got to be the official “pageant Doctor” for the miss mississippi contest, did he? —anonymous
controlling HeAltH cAre coSt… We should acknowledge that more tests and procedures do not necessarily equal better care. Although increasing overhead and inflationary costs are real to our practices, again i believe that the pcmH approach puts patients in the appropriate care setting and keeps them out of the emergency rooms and hospitals which will alleviate much of the increasing costs in health care.
AffiliAtion AS A PASt-PreSiDent of tHe MiSSiSSiPPi AcADeMY of fAMilY PHYSiciAnS…
JoHn PAUl AnD tiM
There is a rich heritage of family physician involvement in msmA. This organization has managed to tap talent from most all specialties over the years. not so long ago family physicians were at risk of being another shelf item for the smithsonian. now we are an integral part of the solution to the health care challenge. stay tuned; this may be the cinderella story of medicine over the next decade.
concernS oVer HeAltH SYSteM reforM… Well, we know that healthcare reform evolved quickly into health insurance reform much to the insurance industry’s chagrin. There is concern that the insurance companies will learn new ways to game the system, but i am hopeful that many of our patients who are uninsured or underinsured will get relief. it is worth noting that at least 25% of citizens in mississippi 19-64 years of age fall into this un/underinsured category. This inadequacy has kept a foot firmly planted into the back of further economic development. After the dust settles and this all unfolds over the next decade, i do wonder whether enough substance will be left to heal a broken system. Will physicians have the high fortitude to lay aside their differences and be part of the solution?
PreSiDentiAl PlAtforM… From my vantage point, the patient centered medical Home (pcmH) model of health care delivery springs from the Future of Family medicine project. The concept, first spun by the American Academy of pediatrics and now the American Academy of Family physicians, the American Osteopathic Association, and the American college of physicians, has emerged with joint principles. These principles include: A. personal physician relationship B. comprehensive care c. Enhanced accessibility many would say that they are already accomplishing nePhew, conner AlforD; BROTheR, Dr. JoHn AlforD; tiM AlforD; these goals but i would question any ambulatory clinic in SOn-in-LAw, tAl HenDrix mississippi that thinks they have finally arrived in this regard. The piloted clinics that have really “done the patient medical home deal” report better patient and physician satisfaction, improvement outcomes and considerable cost savings to the system. The specialists like it, too!
ADVocAcY iSSUeS… • We are one supreme court justice away from losing everything we have gained with our very strong tort reform laws. pressure from trial lawyers legislatively may become a challenge again. • scope of practice concerns can best be managed if we position ourselves early on as head of the medical home household, but we have to be vigilant in this regard.
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on being An olYMPic torcHbeArer… it was a humbling and gratifying experience that i considered to be a high honor. it was especially rewarding to meet fellow torchbearers from the united states who, while in their teen years, are doing amazing things for their fellow citizens.
AnYtHing to KnoW?
i HAVen’t ASKeD YoU WoUlD liKe MeMberS
Just that the health care debate and legislation was a huge distraction for our Association and threatened its very existence. i believe we are even stronger now, and it is time to gather our wits and help this state produce a better health report card. r
2010 olYMPic torcH beArer; StrAtHMore, cAlgArY—DR. ALFORD wAS SeLeCTeD FOR The ReLAy when The MAFP SuBMiTTeD An eSSAy On hOw he heLPS OTheRS LiVe POSiTiVeLy By STAyinG ACTiVe AnD PhySiCALLy FiT, wORkinG TO MAke GOOD ThinGS hAPPen in The COMMuniTy, AnD heLPinG The PLAneT By ReCyCLinG OR DOnATinG TiMe TO A ReCyCLinG PROGRAM.
Dr. tiMotHY AlforD; Dr. JAMeS PiVArniK, PReSiDenT OF The AMeRiCAn COLLeGe OF SPORTS MeDiCine; Dr. JUDitH PAlfreY, PReSiDenT OF The AMeRiCAn ACADeMy OF PeDiATRiCS; JeSSie PAVlinAc, PReSiDenT OF The AMeRiCAn DieTeTiC ASSOCiATiOn; Dr. elizAbetH nAbel, DiReCTOR OF The nATiOnAL heART, LunG, AnD BLOOD inSTiTuTe
BlueCross BlueShield of Mississippi Committed to a Healthier Mississippi.
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About Tim... You're most likely to see me around at: the Kosciusko Medical clinic On the weekends I love to: ride the tractor The high school, college or pro sports teams I root for are: Kosciusko Whippets, go Majors! (Millsaps), st. louis cardinals – i love me some tony larussa.
tiM AnD “neW blUe” At bUcKSnort fArMS
If I'm watching a movie or listening to music, it's probably: the Kosciusko Movie theater doubles as a bingo parlor so my movie going is a bit limited. i like all kinds of music. Music has always been a very important part of my life, with the exception of rap. Ipod or Stereo? both My favorite book is: “huck Finn” Latest splurge: the stealth, our electric all-terrain cart for the cabin I am passionate about: My family Something about me not everyone knows: i hate beavers and their offspring.
cHriStMAS 2009 - TAL henDRix, TiMOThy ALFORD, LeAh henDRix, MARy BRuCe ALFORD, MARy AL ALFORD, TiM ALFORD, jOhn PAuL ALFORD
Do you like to go out or stay in? depends on the weather! Perfect meal: Vegetables, fresh out of the garden with crispy cornbread – can’t beat that! Perfect day: cool, crisp, late fall day of quail hunting Favorite color: green Cologne: no Text, email or cell phone: text tiM AnD JerrY
Pets: A moccasin killing boykin spaniel (buddy); English setters - 3 (sugar, Yock and Kate); one digging cairn terrier (bela); one adopted something dog found on the natchez trace (o.d. – other dog) and a huge 15 pound white cat leah brought home from senior play practice (Van) MSMA Member since: 1986 i believe
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• MSDh • Mississippi Reportable Disease Statistics
May 2009
* Totals include reports from Department of Corrections and those not reported from a specific district NA - Not available (temporarily) for the most current MMr figures, visit the Mississippi State Department of Health web site: www.HealthyMS.com 164
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• new MeMBeRS • AMOS, HEATHER, Biloxi; Born 10/4/1978 Hollywood, Florida; graduated DO southeastern college of Osteopathic medicine, miami 2005; specialty: Family medicine; cedar Lake Family practice.
KERBY, SEAN C., gulfport; Born 5/28/1971; graduated mD university of south Alabama college of medicine, mobile 1997; specialty: Family medicine; southern coast Family medical.
NEILL, JAMES S. A., Jackson; Born 8/25/1953 Jackson, ms; graduated m.D. university of mississippi of school of medicine, Jackson 1978; specialty: Anatomic pathology; Ameripath mississippi, inc.
CUMBEST, MIMI C., Hattiesburg; Born 4/28/1958 pascagoula, ms; graduated DO university of Health sciences, Kansas city 1992; specialty: Anesthesiology; southern Bone & Joint specialists, pA.
LEATHERBURY, CLIFTON T., gulfport; Born 3/3/1979 mobile, AL; graduated mD university of south Alabama college of medicine, mobile 2008; specialty: radiology; smB radiology, pA.
PATTERSON, SCOTT B., Jackson; Born 8/2/1971 Jackson, ms; graduated DO pikeville college, Kentucky 2003; specialty: general surgery; Lakeland surgical clinic, pLLc.
HAQUE, NIAZ M., gulfport; Born 11/10/1976; graduated mD st. christopher’s college of medicine, senagal 2006; specialty: internal medicine; memorial Hospital-gulfport.
MCCALOP, LAURA E., Jackson; Born 5/4/1968 Bolivar county; graduated mD university of Health sciences, Kansas city 2002; specialty: Ophthalmology.
RUBELOWSKY, JOSEPH JOHN, Hattiesburg; Born 5/18/1961 Brooklyn, nY; graduated mD university of medicine & Dentistry of new Jersey, new Jersey 1987; specialty: Thoracic surgery; Wesley physician services.
MUSICK, STAN, Jackson; Born 6/27/1955; graduated mD Baylor college of medicine, Houston 1982; specialty: Anesthesiology; university physicians, pA.
SEALS, SCOTT R., gulfport; Born 11/4/1976; graduated mD ross university, school of medicine, Dominica 2005; specialty: internal medicine; Hospitalist services mHg.
NAMAN, MICHELLE K., grand Bay; Born 12/30/1974 mobile, AL; graduated mD university of south Alabama college of medicine, mobile 2001; specialty: pediatrics; grand Bay medical center.
SHEPHERD, JINNA M., Jackson; Born 10/29/1968 Jackson, ms; graduated mD university of mississippi of school of medicine, Jackson 1994; specialty: internal medicine; DcA mississipppi, LLc.
HOPKINS, ERICA, gulfport; Born 1/9/1977 south Korea; graduated mD Temple university school of medicine, philadelphia 2003; specialty: nephrology; south mississippi nephrology.
HUGHES, VERNON THOMAS, clarksdale; Born 7/2/1952; graduated DO West virginia school of Osteopathic medicine, Lewisburg 1992; specialty: Family medicine; v Tommy Hughes, DO.
JOINER, SARAH, grand Bay; Born 8/26/1979 Biloxi, ms; graduated mD university of south Alabama college of medicine, mobile 2005; specialty: internal medicine; grand Bay medical center.
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• PReSiDenT’S PAGe •
I Wish You Hearts that Race, Minds that Dream…
A
s i pen my last presidents page, it is 5:30 a.m. sunday may 9th, mother’s Day. Janie is still asleep (as are most sane folk) and i find myself in a reflective mood.
rAnDY eASterling, MD 2009-10 MSMA PreSiDent
mother’s Day is one of those times that many of us are flooded with mixed emotions. To sum it up, human nature dictates that we rarely appreciate something or someone until a defining event occurs. What i would give to be able to spend today with my mother! (she passed away 11 years ago.) But the natural progression of our lives will allow me the next best thing - a day with the mother of my children. god is good! Along those lines of not appreciating something until it is gone (or almost gone), indulge me a moment as i reflect on this past year.
it seems only yesterday that we donned our blue jeans, cowboy hats and boots, and i took the oath as mississippi state medical Association’s 142nd president in Oxford, mississippi. As i settled into what was to be a quiet and uneventful year, June 16, 2009, descended on us all like a mississippi thunderstorm. it was on this day, 16 days after assuming the mantle of leadership of our association, that president Barack Obama stared down the American medical Association House of Delegates as he presented his plan to reshape, redefine, and reconstruct a health care system that we have all grown to know and love. needless to say, the ensuing 11 months have been all things but uneventful. i will not bore you by recanting the last year in detail. i have made every effort through the president’s page, components society talks, television, newspaper, and radio to enunciate the concerns of our membership over the Democratic plan for health system reform. i say Democratic plan because this was the first time in our nation’s history that a piece of legislation of this magnitude has been signed into law by either of the two bodies in the united states congress without a single yea vote from the minority party. pretty impressive, huh! While i have spent the last decade immersed in the goings on of the mississippi state medical Association, it was not until this past year that i have grown to appreciate fully our association and what it does for the physicians of mississippi (whether they are members or not), but more importantly for our patients. The past 12 months of heated debate and dialogue have brought out the best in most of us and the worst in a few of us. The AmA support for Hr 3200 and subsequent backing of Hr 3590 sent shock waves through our membership. The very existence and livelihood of our association were threatened (remember we were the only unified state left standing one year ago). in October 2009, in a rarely called special session of the mississippi state medical Association House of Delegates, your elected representatives spoke loud and clear. seven months later you no longer have to be a member of the AmA in order to be a member of the mississippi state medical Association. in hindsight, that was a defining moment for our association. Be it good or bad, right or wrong, to date AmA membership in mississippi has plummeted by over 3,000 members. At the same time, msmA membership appears to have increased by anywhere from 200 to 400 members (final tally is pending) for 2009/2010. This speaks volumes. in my opinion, the aforementioned numbers are not only a reflection of mississippi physicians’ disapproval of the AmA but equally as much a barometer of the affection and support that our members hold for msmA. We should all be proud of that!
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As i complete my year as president, i can say without reservation that your mississippi state medical Association is ready, willing, and able to meet whatever challenges come her way. none of the events of the past decade (Tort reform Bill of 2002, revolutionary Tort reform Bill of 2004, reshaping the mississippi state Board of Health (law requires the chairman be a physician), Fully funding medicaid, Limiting the scope of those who want to practice medicine without the benefit of medical school, Electing fair-minded judges to the mississippi state supreme court, Electing a fellow msmA member president of the American medical Association, the rural physicians scholarship program, Effective and respected mississippi political Action committee, Tobacco Tax, etc., etc., etc. . .) happened by accident. it took untold hours of planning, scheming, and down right hard work by a dedicated Board of Trustees, an engaged membership, and a cadre of mississippi state medical Association employees whose devotion and labor are second to none. We have served our patients well. For that you should all be proud! A word about your staff. regardless of how engaged we may be with msmA issues, the association takes a back seat to our patients, practices, communities, and families, as it should. in order to be effective, physicians must be herded in the right direction by knowledgeable, skilled, and caring staff. To chairman, neely, steve, Karen, and the others who make this train run on time: thank you from the bottom of my heart for your support this past year. more importantly, for what you do day in and day out to make the mississippi state medical Association such a bright and shining star, you will forever have my undying appreciation and deepest gratitude. To our members: You have honored me by allowing me to serve as your president. For that alone, but more importantly for your support, friendship, and prayers, i will forever be grateful. You have touched me in a manner way beyond what i deserve. god bless you all! in closing, you have heard me say from the coast to corinth, from vicksburg to meridian, your msmA is about the business everyday of earning your membership dollar. Do what you want with AmA, that is a personal decision. i, along with your entire board of trustees, have decided for now to stay with the AmA. But for the sake of your practices and more importantly your patients, for god’s sake don’t leave the mississippi state medical Association. We need you and your patients! Because you choose to practice medicine in mississippi, each morning you will get up earlier than most, stay up later than most, work harder than most, do more paperwork than most, hold more hands than most, and care more deeply about the well being of your patients than most. Each morning when you go to work your patients will be sicker than most and poorer than most. Your patients will have less education than most, have less access to quality care than most. Your patients will eat less nutritious food than most. They will be fatter than most and exercise less than most. They will have the highest rate of diabetes, hypertension, and coronary artery disease than most. Each day when you enter that exam room, hospital room, and or operating room, you carry with you a more awesome responsibility than anyone other than another physician can begin to comprehend. To that end, i wish all of you “HEArTs THAT rAcE, minDs THAT DrEAm, AnD cLOcKs THAT HAvE nO HOur HAnD.” Your partner in making mississippi healthier,
Randy Easterling, MD President, Mississippi State Medical Association
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• eDiTORiAL •
If Only We Knew
A
s it turned out, it really was a chance of a lifetime.
since retiring and moving to Jackson (i even recently attended my first central medical society meeting!), Beth and i make occasional runs back to Kosciusko in attempts to tie up those proverbial “loose ends.” On our most recent pilgrimage, my partially empty gas tank provided a reasonable excuse to patronize one of my favorite local businesses, Town pump—service station / corner coffee shop combo. After settling up inside and treating myself to a cup of the always fresh brew, i was headed back to my car when an imposing black pickup truck wheeled in and jerked to a stop. To my surprise, out sprang diminutive sue sartain, retired registered nurse with whom i had worked at montfort Jones memorial Hospital. Whatever her age, she looked at least twenty years younger! sue had always been the consummate professional: her appearance neat as a pin, her judgment “spot on,” her knowledge current, and her energy boundless. The fact that she always seemed to “get” my attempts at humor (no matter how corny or obtuse) made the two of us kindred spirits. A warm hug followed by the exchange of pleasantries made time disappear as if we’d never been apart. she was especially excited to tell me that she and her sister had once again attended our church’s passion play the previous week. Then, almost as an afterthought, she asked offhandedly, “You knew that i had a big heart attack last month?” Well, no, i hadn’t known. “But i didn’t have to have any surgery or stents, and the doctor says i’m doing fine.” Hopping back into the truck, she leaned out the open window and, sort of like santa claus, exclaimed as she drove out of sight, “i love you, Dr. Hartness.” “i love you, too, mrs. sartain,” i echoed. And just like that, she was gone. Two mornings later as i was downing my granola with fat free vanilla yogurt and skimming the Clarion-Ledger, there it was…Obituaries…sue sartain…retired registered nurse…age 75…needless to say, i’m glad i was sitting down. A quick call home revealed that on the very evening of our chance encounter, mrs. sartain had suffered a massive heart attack and had been airlifted to Jackson where she underwent emergency bypass surgery but never made it off the ventilator. And just like that, she was gone. Had our earlier meeting been only chance? Who knows? Had our earlier meeting been a chance of a lifetime? You betcha! if only we had the luxury of knowing the finality of such chance contacts…overdue gratitudes that have been taken for granted could be expressed, damaged fences that have eaten at the soul mended, relationships that have been idling thrown into high gear. At the risk of sounding like a sermonizer, i offer that we have the opportunity to make some of those “chances” happen. it has been my personal experience that the power of a handwritten note…of thanks…of congratulations…of condolence…of apology…can never be underestimated…or imagined! Take that chance! —D. Stanley Hartness, MD Associate Editor
The Pen is Mightier than the Sword! Express your opinion in the JMSMA through a letter to the editor or guest editorial. The Journal MSMA welcomes letters to the editor. Letters for publication should be less than 300 words. guest editorials or comments may be longer, with an average of 600 words. All letters are subject to editing for length and clarity. if you are writing in response to a particular article, please mention the headline and issue date in your letter. Also include your contact information. While we do not publish street addresses, e-mail addresses or telephone numbers, we do verify authorship, as well as try to clear up ambiguities, to protect our letter-writers.
You can submit your letter via email to KEvers@msmAonline.com or mail to the Journal office at msmA headquarters: p.O. Box 2548, ridgeland, ms 39158-2548.
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• iMAGeS in MiSSiSSiPPi MeDiCine •
Miles A. Jones B.s., Alcorn college m.D., meharry medical college College Physician Alcorn A & m college
COLLEGE PHYSICIAN, ALCORN A & M, 1925-6— This photo is of Miles A. Jones, MD, College Physician of Alcorn Agricultural and Mechanical College in 1925-6. Jones had graduated with a B.S. from Alcorn and had obtained his M. D. from Meharry Medical College. I have been unable to find little else about him. He operated out of the original hospital for students at Alcorn A. and M. College which was featured in last month’s Images and which was one of the earliest hospitals for African Americans in the state. Located in Claiborne County, four miles south of Port Gibson near the Jefferson County line, Alcorn State University was founded in 1871 as one of the nation’s first state-supported colleges for African American students. In 1974 Alcorn Agricultural and Mechanical College became Alcorn State University. This photograph is from the first volume of “The Alcornite” which was published by the Alcorn senior class of 1926. The Alcorn Ode in that same pioneer annual reads: “Beneath the shade of giant trees, Fanned by a balmy Southern breeze, Thy classic walls have dared to stand, A giant thou in learning’s band.” For those interested in a history of Alcorn, “Against Great Odds” by Josephine McCann Posey, published in 1994 by the University of Mississippi Press, is a quality resource. Anyone with additional information on Dr. Jones is asked to contact Dr. Lampton. If you have an old or even somewhat recent photograph which would be of interest to Mississippi physicians, please contact the JMSMA or me at lukelampton@cableone.net. —Lucius Lampton, MD, Editor
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• POeTRy in MeDiCine • [This month, we print the poetry of Richard D. deShazo, MD, Chairman and Professor, Department of Medicine, Professor of Pediatrics, and Billy S. Guyton Distinguished Professor at the University of Mississippi School of Medicine. He is board certified in the medical specialties of internal medicine, allergy-immunology, rheumatology and geriatrics. He is also known to the listeners of Mississippi Public Radio as the host of “Southern Remedy,” a vibrant weekly program where his passion for serving his patients is clearly evident. While he has no pretentions as a poet, he has found joy in poetic expression and notes he has always been encouraged to “be poetic.” He explains: “For instance, my sixth grade auditorium teacher encouraged me to enter the city poetry reading contest. She was a short, animated, thin lady we called ‘Miss Maude.’ She always smelled like a tobacco factory. She had a private bathroom off the property room in the back of the auditorium. She smoked like a chimney in there. Miss Maude made me read ‘The Village Blacksmith’ by Henry Wadsworth Longfellow in the city-wide contest. Later, some of the other boys in my class questioned my sexual identity because of the poetry thing. To protect myself from further humiliation, I abstained from further poetry reading contests. By the freshman year of high school, I had figured out I was heterosexual and another school teacher, ‘Miss Frances,’ forced our class to submit poems to the National Poetry Anthology. Like Miss Maude, she was short, and had a distinct odor. She weighed about 325 pounds and had one of the worse cases of body odor I have ever experienced. My poem was accepted to the National Anthology, and I had to ride with her to a ceremony to get my certificate. Being with her in a closed space induced my first migraine.” About the poem below, Gratitude, deShazo adds: “Speaking of migraines, the patient I describe in my poem gave me one too. So many of my patients want to lose weight. She had come to clinic on multiple occasions complaining about weight gain and peripheral edema. I had tried to explain basic metabolism to her but she claimed to ‘eat like a bird’ despite having tell-tale evidence of calorie excess on the person more often than not. I wrote ‘Gratitude’ out of exasperation one night after clinic when she opened her very large purse to check the dose of her oral hypoglycemic, only to reveal a treasure trove of junk food.” Any physician with Mississippi ties is invited to submit poems for publication in the JMSMA, attention: Dr. Lampton or email to him at lukelampton@cableone.net.] —ED.
Gratitude she eats like a bird, but still is fat Twinkies are in her purse, And a coke is on her lap. portion control is fully explained she thanks me for my time, But has to rush and will not be detained. Are good deeds remembered or to the contrary, Am i correct to conclude that All gratitude is temporary? — Richard D. deShazo, MD Jackson
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• The unCOMMOn ThReAD •
The Manchurian Candidate r. Scott Anderson, MD
i
t’s June and i will have just run for president of our msmA and will either have won or lost. Well, i guess i could have tied, but they would have probably had a runoff or something, so i guess it would come out one way or the other anyway. now. i could just pretend that wasn’t the case and write about something else entirely, but who could pass up such a delicious opportunity. i get to engage in unbridled speculation, which, i will admit, is my favorite type. First, let me say that it doesn’t matter a bit who won. Tom Joiner is a good man and i’ve worked with him on the board for years and i really respect him. There is no one i know that i’d rather see as president at this point in time, unless it was i. so, whoever it turns out to be, i think everything is going to be just fine. Either one of us who is elected is going to try and do as good a job as possible to deal with whatever it is that shows up down the road and needs to be dealt with. Who can predict what it’s going to be? not i; that’s for sure. god never gave me a crystal ball. One thing i’m sure of, being president isn’t such a big deal as you think it is going to be when you get on this medical politics merry-goround. it’s a chance to keep on working and trying to do a good job for another three years as you work your way through president-elect, president, and then past president. Then you get thrown off the ride and your ticket’s punched. Enjoy the grass out in the pasture. so the only meaningful thing you can do to make a difference is to try and reflect the will of all the folks out there who aren’t president. if i’m president, then i’m asking you to keep your eyes peeled, watch what i’m doing and don’t hold off telling me if you don’t like it. The editor of the Journal should be keeping an eye on me too, and he should write about any bad stuff that i do just so you know what i’m up to. i’ll try not to embezzle all of the association’s money, run off with any of the staff, or embarrass the association in any way i can avoid. if i’m not president, then i’m really happy for Tom. i’ll do whatever i can to help out with either the AmA delegation or anything else he can think of for me to do. some of you may have noticed that Dr. south has returned and is writing away. she will resume her role as the author of the “una voce” section. i’ve been asked to move to a new column, this one, which is called, “The uncommon Thread.” One of the complaints received during my time writing “una voce” was that i tended to run a bit long. so i’ll try to keep this one to a page (a page and a half, tops, unless…) To show how hard i’m trying to fit in, i’m going to wind this up. no matter how this election thing turns out, i’m just happy to be here and writing. i look forward to seeing where we can go with this new column. if you like it, let me know, if you hate it, let me know that too. see ya next time. — R. Scott Anderson, MD Meridian
R. Scott Anderson, MD, a radiation oncologist, is medical director of the Anderson Regional Cancer Center in Meridian and vice chair of the MSMA Board of Trustees. Additionally, he is an accomplished oil-painter and dabbles in the motion-picture industry as a screen-writer, helping form P-32, an entertainment funding entity. june
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• unA VOCe •
Culture and Sensitivity: Part 1 “Adventures with Juan and Bud” Dwalia South-bitter, MD
B
y a recent conservative estimate there are over 12 million illegal aliens (primarily Hispanics) living in America today. There are some days when it almost seems believable that half that number is living in northeast mississippi and a great percentage of them are patients in my office on any given day. When i make the mistake of perusing my daily slate of patients and note that the four final patients scheduled for the day have distinctly Hispanic names, i make unpleasant groaning sounds in the direction of the clinic receptionist. she can’t seem to fathom that i cannot adequately care for the complex problem presented by a non-English speaking patient in the reprehensible 10 minute time slots which comprise my day. it is certainly not because of any racial prejudice or dislike of our Hispanic patients that i have this mournful knee-jerk response. On the contrary, interactions with my mexican patients are almost universally pleasant and mutually beneficial learning experiences. i try not to allow one of them to leave without teaching me a new word or phrase. my dread comes from knowing that it will take at least four times as long to diagnose and treat these patients as it would even the most obtuse geriatric patient with 17 different prescriptions in their meds bag. And, so many times when a visit with one of my Hispanic patients comes to a close, i cannot shake the uncertainty of whether we have truly understood each other or that i have done “the right thing.” i would speculate at least 75% of my Hispanic patients “have no English” and many of them rely on their grade school children to serve as interpreters in the clinic. This proves a sticky wicket when mom complains of something like a bacterial vaginosis, pelvic pain or dysparunia, and her 6-year-old son is there to translate. There are simply no words for the frustration of these experiences. i am fairly certain that i got my message across to two of my pre-med shadowing students recently. i had told this semester’s students that they did not need to leave Blue mountain college without some spanish courses under their belts. They saw this first hand as we mutually struggled with non-English speaking patients simply to understand what the chief complaint was, not to mention outlining a proper diagnosis and treatment plan. The students gave me a very appropriate parting gift at the end of their school year recently…a book and accompanying cDs called “spanish for the Health care professional.” i laugh out loud when i remember my own pre-med days when my advisor recommended with all seriousness that i would be wise to study either german or French before applying to med school. i have yet to run across one Frenchman in Tippah county! One hot summer day, perhaps 15 years ago, i had my first experience with a totally non-English speaking patient in my office. This was about the time that the local furniture and timber mill industries began recruiting large numbers of Hispanics into their workforce. “Juan” was approximately 35-years-old and, though our initial interaction of greeting was pleasant, there was an undercurrent of pain and fear in his dark brown eyes (obviously, the names have been changed to avoid HippA violation). He was accompanied by one of his supervisors, “Bud,” a local good ol’ boy who had absolutely no knowledge of spanish. Luckily, i am, however, fluent in my native redneck tongue so here was our starting point. The two worked at the big sawmill east of town that was at that time producing vast quantities of cross ties for the railroad industry. Even with modern mechanization, many parts of that production process are back-breakingly laborious. Juan’s supervisor said, “The feller that usually does his talkin’ for him had to go to memphis with the boss man today. m’am, i really don’t know why they sent me ‘cause i don’t know a word of that mexican lingo.” Then i asked the inevitable opening question “What problem brings Juan to the office today?” Bud offered, “All’s i know, miss south, is that boss says to bring him here because he was hurtin’ pretty bad and something is wrong with his ass.” i thought about this a moment and began making inquiring gestures toward Juan’s derriere. something about his agonized expression june
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gave me the brilliant insight that because Juan’s job was stacking cross ties we perhaps would be treating hemorrhoids. i gestured for him to remove his jeans and lie on his side on my exam table. This being unclear, i then pantomimed exactly what i intended him to do for my exam. i quickly learned that Juan knew only one English word, “Ho-Kay,” which was his sole response to my every instruction. Juan dutifully assumed a lateral recumbent position. i donned exam gloves and walked around to face him, demonstrated the K-Y jelly and mimed that i was about to examine his behind. Juan said, “Ho-Kay.” Then, after several minutes of positioning and repositioning Juan in preparation for his rectal inspection and exam, i placed my hand on Juan’s hip and tried to calmly reassure him that my exam would not hurt. “no dolor!” i promised, using perhaps the only spanish word i knew besides ‘taco.’ Juan said, “Ho-Kay.” Bud did not help matters. sitting facing Juan and grimacing he murmured, “Oh, hell, doc, do i have to stay in here for this?” i walked back to the business end of the patient, and quietly told him i was about to begin if he was ready. And Juan said timidly, “HoKay….” As gingerly as i could, i inspected Juan’s problem area and touched the hot, floridly engorged hemorrhoidal flesh while calculating what my next move would have to be. And Juan yelled, “HOOO-KAAAAY!!!!” For whatever it was worth, i uttered, “La hemorrhoida thrombosa,” a pronouncement which added nothing to the solution of the problem. collecting my thoughts, i told Bud that Juan’s treatment was going to require a minor surgical procedure which would involve his understanding and consent, the use of a knife, not to mention pain, a good deal of blood, and some time off from work. i explained that i would not, could not do this procedure today in the office, and that he would need to come back in a few days with a real interpreter and hopefully also bring a family member. Bud whined, “The boss man ain’t gonna like this. He is our best hand.” i simply shrugged in reply. Then i sat Juan up on the table and put my hand on his shoulder and he smiled at me slowly for the first time, relieved for the moment that his ordeal was past. i wrote him a prescription for hemorrhoidal cream, wrote out my verbal instructions on a script for his treatment for the next few days (including time off from work) and crossed my fingers that these things would be accomplished. And Juan said to me, “gracias, doctora, gracias!” For this, i had no need St. Dominic’s Cancer program is the FIRST and ONLY of an interpreter. recipient in Mississippi to receive the read more in next month’s “una voce.” 2009 Outstanding Achievement Award
Today I’m a survivor!
for providing ongoing high-quality, multidisciplinary cancer care by the Commission on Cancer.
—Dwalia South-Bitter, MD Ripley
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2010
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