MAG Journal Vol. 109, Issue 2, 2020

Vol. 109, Issue 2, 2020

Exploring the increasing interest in a D.O. degree Sen. Kay Kirkpatrick, M.D.’s COVID-19 experience Physicians’ responsibilities for medical records COVID-19 pandemic liability Why resilience matters more than ever Naloxone and the opioid epidemic

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TABLE OF CONTENTS VOLUME 109, ISSUE 2

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IN EVERY ISSUE 3 President’s Message 4 Editor’s Message 6 CEO’s Message 14 GCMB Update: Your responsibilities for your patients’ medical records 16 Legal: COVID-19 pandemic liability

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FEATURES 8 The D.O. will see you now 12 Georgia Sen. Kay Kirkpatrick, M.D.’s experience as a COVID-19 patient 15 Why resilience matters more than ever 19 Naloxone and the opioid epidemic

20 Patient Safety 22 Medical Ethics 24 County, Member & Specialty News 28 Perspective

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About the cover: Students at PCOM South Georgia in Moultrie, which welcomed its first class in 2019.

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PRESIDENT’S MESSAGE

The COVID-19 president Andrew Reisman, M.D. docreisman@gmail.com

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wo years ago, I was convinced that the biggest hurdle that I had to clear when I decided to run for the office of MAG president-elect was convincing my wife that it was a good idea. “Don’t worry, I got this,” I told her with great confidence, “a few extra meetings, it will be fine.” I figured I would coast for a year while I watched my predecessor, Rutledge Forney, M.D., work her way through her one-year term as MAG’s president.

But my plan started to show signs of unraveling before the end of 2018 – when then-Gov. Nathan Deal appointed me to the Georgia Composite Medical Board. “Okay, so things might be a little busier than I thought,” I said to myself, “but I still got this.”

The 2019 economy was on cruise control. MAG CEO Donald Palmisano and I were working on getting my local hospital‘s employed physicians to join as a group. The AMA state advocacy meeting brought some helpful new contacts and some exciting ideas for legislation for my tenure as president. The legislative session was going smoothly. We were discussing innovative ways to increase non-dues revenue. MAG’s financials were showing revenues above and expenses below the budget and our overall financial and membership positions were strong. What could go wrong?

I continued to coast through my president-elect year, talking to MAG’s past presidents, learning the workings of the Medical Board, and getting tuned up on MAG’s agenda and issues.

Surprise billing appeared to be the major issue. Tort reform, the issue that brought me to the House of Delegates and meaningful medical political advocacy, also brought my appointment to a Senate study committee on tort reform. My priorities included other key issues, including scope of practice, continuity of care, and the state’s new cannabis laws. This is the track we were on when Donald said one day, “You can make plans as president, but you never know what will happen.” This comment stayed in my mind, but I would never have guessed coronavirus would be the thing that happened.

As I watched the news from China, I was sad and concerned for the people who live there. But I never thought that this virus would sprint across the planet and sicken and kill millions of people in a matter of weeks. This invisible enemy has pushed the global community to its breaking point in every conceivable, way including (and especially) when it comes to our health care systems.

The COVID-19 outbreak has changed physicians’ world in dramatic ways. We have had to alter how we interact with and care for our patients – including the use of telemedicine. We have had to deal with shortages of PPE, supplies and tests. And our practices have been pushed to the economic brink.

MAG, too, has had to adapt to meet the needs of its members.

We had to decide to cancel many important events and worked on promoting legislation that would enable practices to survive (e.g., loans and advanced and accelerated payment), clearing regulatory and administrative red tape, and disseminating the information our members needed to make the best decisions.

We held the first Board of Directors meeting in the history of MAG electronically.

It is also worth noting that the MAG Medical Reserve Corps mobilized a multi-disciplinary COVID-19 Response Team that has been deployed by the state in a variety of ways and settings during the pandemic. Every MAG member should be proud of these tireless and selfless volunteer heroes.

As MAG’s president, I have learned that we must always be prepared for the unexpected. I have learned that organizations like MAG have never been more important. And my colleagues and allied staff have confirmed what I have always known – that they would step up and meet the challenge in the most professional and exemplary ways when we needed them the most.

My term as MAG’s president has been drastically different from the one I expected, but it has been far more meaningful than I could have ever imagined.

I would have never predicted that a mysterious virus, half a world away, would affect every civilization on earth. Amazingly, five percent of the delegates at the 2019 HOD listed a pandemic as their biggest concern over the coming years, a worry I did not share. This pandemic brought the legislative session, our health care system, our economy, and our entire society to a sudden standstill.

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EDITOR’S MESSAGE

The Medical Association of Georgia 1849 The Exchange, Suite 200 Atlanta, Georgia 30339 800.282.0224 www.mag.org MAG’s Mission To enhance patient care and the health of the public by advancing the art and science of medicine and by representing physicians and patients in the policy-making process.

Editor Stanley W. Sherman, M.D. Executive Director Donald J. Palmisano Jr. Publisher PubMan, Inc. Richard Goldman, rgoldman@pubman.net 770.855.3608 Editorial Board Sara Acree, M.D. John S. Antalis, M.D. Mark G. Hanly, M.D. John S. Harvey, M.D. William Kanich, M.D. Frank McDonald, M.D. Mark E. Murphy, M.D. Barry D. Silverman, M.D. Michael Zoller, M.D. MAG Executive Committee Andrew B. Reisman, M.D., President Lisa Perry-Gilkes, M.D., President-elect Rutledge Forney, M.D., Immediate Past President Thekkepat G. Sekhar, M.D., First Vice President James L. Smith Jr., M.D., Second Vice President Frederick C. Flandry, M.D., Chair, Board of Directors Steven M. Huffman, M.D., Vice Chair, Board of Directors Edmund R. Donoghue Jr., M.D., Speaker James W. Barber, M.D., Vice Speaker Debi D. Dalton, M.D., Secretary Thomas Emerson, M.D., Treasurer S. William Clark III, M.D., Chair, AMA Delegation W. Scott Bohlke, M.D., Chair, Council on Legislation Advertising PubMan, Inc. Brian Botkin, bbotkin@pubman.net 678.643.7250 Subscriptions Members $40 per year or non-members $60 per year.

Foreign $200 per year (U.S. currency only).

The Journal of the Medical Association of Georgia (ISSN 0025-7028) is the quarterly journal of the Medical Association of Georgia, 1849 The Exchange, Suite 200, Atlanta, Georgia 30339.

Periodicals postage paid at Atlanta, Georgia, and additional mailing offices. The articles published in the Journal of the Medical Association of Georgia represent the opinions of the authors and do not necessarily reflect the official policy of the Medical Association of Georgia. Publication of an advertisement is not to be considered an endorsement or approval by MAG of the product or service involved.

Postmaster Send address changes to the Journal of the Medical Association of Georgia,1849 The Exchange, Suite 200, Atlanta, Georgia 30339.

Established in 1911, the Journal of the Medical Association of Georgia is owned and published by the Medical Association of Georgia. © 2017.

The coronavirus pandemic war

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Stanley W. Sherman, M.D.

iven the fact that, at the time of this writing, there is little else in the news than the current coronavirus pandemic, it is only appropriate for me to write about this unfortunate subject. I also would not want to miss the opportunity to say how grateful and proud I am of all of my colleagues who in any way care for COVID-19 patients. They brave the risks to themselves and their families to treat them. Because of these efforts, the public is appreciating, respecting, and honoring the medical profession.

Perhaps not unlike Pearl Harbor, we had a surprise attack that woke up our country and led us to join in the war against a powerful foe. I recently, however, read the Winter 2019 Emory Health Digest with the cover article entitled ‘CONTAGION – Flu is coming.’ The article asked if we are ready for the next pandemic. The article recounted that when a new strain of the flu appears, it is so different than previous strains that people have no immunity to it. The 1918 H1N1 Spanish flu pandemic infected a third of the world’s population, killing an estimated 50 million to 100 million people. Since then, the 1957 Asian flu pandemic death toll was 1.5 million to 2 million, the Hong Kong flu of 1968 was one million, while the Swine flu in 2009 had an estimated death toll of 284,000 people. A normal flu season claims between 12,000 and 56,000 lives in the United States. The 2018 flu season, however, was the deadliest in 40 years, killing an estimated 80,000 Americans, including 180 children.

The article stated that “the demand for hospital beds and services quickly outstripped supply. Grady Memorial Hospital converted waiting rooms into inpatient units, rented ‘mobile ERs’ for the parking lot, and asked staff to work overtime.” Although this article dealt with potential ways to deal with another influenza virus pandemic, what was written and predicted is exactly what we have had to do to deal with during this similar SARS-CoV-2 (COVID-19) virus infection. As of June 23, this virus has caused more than 120,000 deaths in the U.S. with, unfortunately, many more to come. This is an even higher mortality rate than most influenza strains.

The article goes on to quote infectious disease experts who met for a Rollins School of Public Health/CDC Conference in 2018 – the 100-year anniversary of the 1918 pandemic – to discuss pandemic preparedness. They noted that the majority of our critical medical supplies are not made in the U.S., that federal funding for emergency preparedness was 30 percent lower, and hospital preparedness was 50 percent lower than it was in 2003. This status quo was felt to be unacceptable.

Clearly, these experts thought preparedness requires better support yearly, not just in response to a pandemic crisis.

Since the COVID-19 outbreak began, the stock market has been crashing and unemployment claims are at a historical level. The appropriate legislative action to support our people and businesses through our “shelter in place” and business closings has caused the largest budget deficit since World War II. Do any of us believe that more spending yearly on pandemic preparedness can cost anywhere near what COVID-19 has cost us? I do not want to point any fingers at anyone for not realizing the cost of human life, suffering, and devastation our economy

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is experiencing, since this virus is to blame. My greatest fear, however, is that we learn nothing and go back to not preparing for the next pandemic – which WILL OCCUR. In the midst of so much loss, we also mourn the passing of Roy Vandiver, M.D., who died of cancer on April 15. A born leader, Roy chaired the surgery department and was chief of staff at DeKalb Medical Center, as well as a member of the DeKalb Hospital Authority. He was president of the DeKalb Medical Society (DMS), chairman of the Georgia Neurosurgical Society, and president of MAG (1993-1994).

To my knowledge, he was the only Georgia physician to serve as chairman of the board of the AMA PAC (20002002). Many also knew Roy in his second career as chairman of MagMutual Insurance Company, where he maintained both support and much welcomed involvement in both DMS and MAG. I was proud to call Roy both a friend and a mentor. A gifted neurosurgeon at DeKalb Medical, now Emory Decatur, he made a house call to see me when I ruptured a lumbar disc, and soon after operated to relieve my constant pain and inability to walk. I have been able to dance ever since, thanks to his wonderful care! We all send condolences to Maureen, his loving wife of 58 years and a past MAG Auxiliary president, and the rest of the family.

We thank him for a lifetime of service – he will be missed.

This issue of the Journal features an article on the differences between allopathic and osteopathic medical

training. Representing the GCMB, John Antalis, M.D., reviews a physician’s responsibilities for patient medical records. Our MagMutual article deals with legal and regulatory risks of locum tenens doctors. Our Mercer ethics article that was written by Christopher Issenock discusses the determination of a decision-making capacity in a schizophrenic patient. Susan Blank, M.D., discusses naloxone prescribing for patients who are taking opioids.

MAG President Andrew Reisman, M.D., and MAG CEO Donald Palmisano join us all in thanking the MAG MRC and all others who have volunteered to treat COVID-19 patients, and review MAG’s successful efforts to help us practice through this pandemic. Dan Huff, Esq., discusses one of these efforts – emergency immunity from liability.

Keisha Callins, M.D., discusses another important effort – MAG’s Physician Resilience Task Force, which is developing resources to help us cope with this crisis. Sen. Kay Kirkpatrick, M.D., generously shares her personal experiences as both a physician and a state senator, surviving this infection. Finally, Mark Murphy, M.D., reminds us as we all struggle personally and financially through this pandemic that we must remember we are all in this together and should appreciate our blessings compared to those many less fortunate. Please stay safe and enjoy this unusual summer with your families.

MAG member weighs in on ethics article with letter to the editor Dear editor, The article ‘The need to preserve the crucial link between free speech and patient care’ by Mercer University medical student Leah Gober [that appeared in the 1Q, 2020 Journal] is not an “ethics” subject, but more of a political nature with her opinions attached. As such, this should have more properly been published in the MAG Journal as a “letter to the editor.”

The subject of women’s health care, including birth control and abortions, is a topic rife with controversy, both in whether or not these services should be provided by government with tax moneys, health insurance coverage, or if they should be provided at all. Supporters of “women’s rights” are advocating for a special group that might enjoy rights and privileges under the law which causes them to be treated differently, not the intent of our country’s Founding Fathers in their construction of our Constitution. Women, as do all U.S. citizens, have certain inalienable rights to “control their bodies.” However, once they

have made the decision to have unprotected sexual relations and/or have otherwise become pregnant, those rights might be abrogated by the creation of new life. Government intrusion into the physician-patient relationship has become an important roadblock over the past 50 years to the provision of ethical, let alone beneficial, medical care for our patients. The subject in Ms. Gober’s article is one that should be presented as a matter of opinion, not medical fact, and it should be identified by the Journal as such.

Roger A. Meyer, M.D., FACS Greensboro Editor’s note: Dr. Meyer was responding to the “ethics” column that appeared in the 1Q, 2020 Journal. The Journal’s ethics columns are submitted to J. David Baxter, M.D., FACP, who is an associate dean at the Mercer University School of Medicine. MAG members can contact Dr. Baxter at baxter_jd@mercer.edu.

MAG introduces health insurance plan for member practices The Medical Association of Georgia (MAG) has introduced the ‘MAG Association Healthcare Solutions Plan’ – which is expected to deliver savings of up to 20 percent compared to standard small group plans, although savings will vary for each practice.

The MAG Association Healthcare Solutions Plan features…

• Medical, dental and vision plans from Humana®.

• Customized plans, deductibles, co-pays, and cost-sharing.

• HR technology and support that make benefits administration less time-consuming.

• Humana’s Go365 wellness program, which rewards individuals for making healthy choices and can save practices even more in premium credits.

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Alpharetta-based Decisely Insurance Services administers the MAG Association Healthcare Solutions Plan, which is available to MAG member practices that enroll five or more full-time physicians and practice staff – keeping in mind that every physician at the practice must be a MAG member for the practice to qualify for the plan.

Decisely also offers “competitive prices [for health, dental and vision insurance plans] from Aetna and Cigna for practices with two to four employees.”

Go to magbenefitscenter.decisely.com or contact Ryan Larosa at rlarosa@mag.org for details.

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CEO’S MESSAGE

Reasons for hope and optimism Donald J. Palmisano Jr. dpalmisano@mag.org

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hen I wrote this column in May, Georgia was on the eastern half of the COVID-19 curve and in the process of “re-opening” – albeit with lots of restrictions and under some very specific conditions. Physicians were in the early stages of getting back to delivering routine and elective and non-COVID care, although they were far from full capacity to be sure. Large segments of the population were also beginning to venture out of their homes – some adhering to CDC’s social distancing and mask and other guidelines, others not so much.

And if you happened to catch the nightly news during the first several weeks of the outbreak, you might have seen the MAG MRC recognized for erecting several mobile hospitals.

There was a collective sense that life was returning to some degree of normal. Yet the elephant in the room never flinched: Would we see a second wave, and would we be prepared? Our economy and health care system had just taken a strong punch to the midsection, so the big unknown was whether we could withstand another heavy blow two to three weeks later.

MAG also took steps to ensure that physicians had a direct pipeline to Georgia’s Congressional delegation, Gov. Brian Kemp, and other key stakeholders at the state and federal levels – keeping in mind that MAG President Andrew Reisman, M.D., served on one of Gov. Kemp’s COVID-19 Task Force advisory groups.

Of course, I was concerned. That is a normal reaction during something like a pandemic. But there was also a big part of me that was growing more confident with each passing day because of the way physicians and hospitals and allied health care professionals in our state were responding to the COVID-19 outbreak.

The includes the Medical Association of Georgia’s Medical Reserve Corps (MAG MRC). I received a call from MAG MRC Medical Director John S. Harvey, M.D., on March 21 (I remember the call because I was on a hike with my family at Sweetwater Creek) who informed me that the Georgia Department of Public Health and the Georgia National Guard were activating the MAG MRC to support the state’s efforts to care for COVID-19 patients – and that we needed to recruit more members.

Within two weeks, and with MAG’s help, the MAG MRC’s ranks grew from about 80 volunteers to more than 300. Along with physicians, this includes PAs, nurses, dentists, pharmacists, and every other conceivable kind of health care professional.

Pretty powerful stuff.

The MAG MRC had trained for several years to respond to an array of disasters, including hurricanes and tornadoes and a disease outbreak like COVID-19. It was prepared to deploy its members to every corner of the state to provide care for up to 72 hours, when there would be a handoff to the federal government.

Throughout the pandemic, MAG MRC volunteers were sent to health care sites across the state, including the Atlanta metro area, Thomasville, Valdosta, Bibb County, Clark County, Mitchell County, Randolph County, and Tift County.

In addition to the extra peace of mind, it makes me proud knowing that MAG is the only state medical association that is capable of taking this kind of direct role during this kind of statewide emergency.

One of MAG’s really noteworthy accomplishments was ensuring that the executive order that Gov. Kemp issued to deal with COVID-19 was modified to include language to protect physicians from lawsuits that are related to providing care during the pandemic.

MAG also worked with AMA to enhance the federal stimulus packages, and we worked hand-in-hand with the Georgia Composite Medical Board and the Georgia Insurance Commissioner to ease restrictions on the use of telemedicine and ensure that coverage was the same as in-person visits.

MAG developed a ‘COVID-19 Resources Center’ on its website (and pushed out alerts on a nearly daily basis) and increased the number of ‘Top Docs’ videocasts it produced to ensure that physicians had the latest and most pertinent information they needed to make the best possible decisions, whether the topic was PPE, testing, or federal loans.

And MAG held weekly conference calls with physician leaders from health systems and rural hospitals from across the state to determine what they need if and when a second wave occurs.

It feels good to know that MAG was prepared for this challenge and didn’t hesitate for one moment – and I tip my hat to the MAG MRC (and Dr. Harvey and MAG’s Fred Jones, in particular), our physician leaders, our members, and every MAG staff member for their heroic and tireless efforts.

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The D.O. will see you now

By Tanya Albert Henry

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hile doctors of allopathic medicine (M.D.’s) still account for the vast majority of practicing physicians in Georgia and the rest of the nation, 2019 marked the highest number of doctors of osteopathic medicine (D.O.’s) ever – with more than 120,000 in the U.S., according to the American Osteopathic Association (AOA).

AOA reports that nearly 7,000 new physicians graduated from osteopathic medical schools last year. And today, one of every four medical students attend a college of osteopathic medicine. Overall, the profession has grown by more than 60 percent in the past decade – a nearly 300 percent increase over the past 30 years per AOA’s ‘2019 Osteopathic Medical Profession Report.’

Georgia now boasts two osteopathic medical schools, the newest campus opening in South Georgia last fall. There were nearly 1,700 practicing D.O.’s in Georgia in 2019 – up from about 1,600 in 2018 – representing 1.6 percent of the state’s practicing physicians, keeping in mind that there were less than 1,000 D.O.’s in Georgia in 2006.

So, what is the driving force behind this increase and what makes D.O.’s unique?

In part, there are simply more osteopathic schools of medicine in the U.S. Georgia’s new campus was one of three that opened last year, with others opening in Tennessee and Florida. There are now 38 osteopathic schools that offer instruction at 59 locations, a 150 percent-plus increase from the 23 colleges and branch campuses in 2005.

But that growth would not be possible without demand. In addition to a shortage of physicians, many believe that there has also been a change in mindset in what some patients expect from their physician. They want physicians who will spend more time listening, focusing on wellness, and “treating the whole person” – which are the cornerstones of osteopathic philosophy and training.

“Today’s patients are more informed as a practical matter, and many are looking for specific qualities in a physician,” says H. William Craver III, D.O., a general surgeon who became the dean of the Philadelphia College of Osteopathic Medicine (PCOM) South Georgia in Moultrie after serving in that role at the PCOM Georgia campus in Suwanee since 2010. “We want every osteopathic medical student to graduate with an understanding of how to treat the patient as a whole and focus on wellness.”

The D.O. philosophy Andrew Taylor Still, M.D., D.O., designed the osteopathic medicine model in Kirksville, Missouri in the 1870s and 1880s. He then opened the first school of osteopathy in 1892 to “promote the body’s innate ability to heal itself,” a philosophy that continues to be instilled in today’s D.O. students.

Osteopathic medicine, which is known for producing a lot of primary care physicians, emphasizes the need for physicians to create partnerships with their patients to assess how one’s lifestyle and community affect their health. D.O.’s help patients manage acute and chronic illnesses, while preventing disease and promoting wellness.

A D.O. is educated and trained to view their patients’ body parts and functions as interconnected, with one part impacting the others. For example, Dr. Craver says that if a patient comes in with knee pain, a D.O. is trained to check their ligaments and cartilage, but they are also trained to look at the bigger picture.

He explains that, “Sometimes there may be knee pain that is coming from a problem with the hip or the ankle, or it could be a problem with your back that is changing your gait, and perhaps that is causing the pain to show up in your knee.”

Dr. Craver says it comes down to making sure that the physician is coming back and evaluating the whole person and then asking what they as a physician can do to help the

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patient, noting that, “It may be that there is some action that we should be taking, in addition to what would be considered the standard practice of care.”

How is osteopathic training unique?

D.O.’s are synonymous with osteopathic manipulative medicine (OMM).

Osteopathic students complete four years of academic study and learn the same core subjects as their allopathic counterparts.

But they spend an extra 200 hours or so training above and beyond those topics to learn about OMM. This hands-on diagnosis and treatment technique involves manipulating the musculoskeletal system. It can help alleviate pain, restore motion, support the body’s natural functions, and influence the body’s structure to help it function more efficiently.

There are about 15 major types of osteopathic manipulative treatment and more than 1,000 individual techniques.

According to the American Association of Colleges of Osteopathic Medicine (AACOM), the “therapeutic application of manual pressure or force” can…

• Treat common ailments such as headaches, arthritis, stress injuries, sports injuries, and pain in areas such as the lower back, neck, shoulders, and knees • Provide a non-invasive and medication-free treatment option • Be performed in many different health care settings • Enhance a physician’s overall diagnostic skills • Be administered safely in combination with other medical treatments to improve outcomes One of the key concepts that osteopathic medical students learn is that structure influences function. If a patient is experiencing a problem in one part of the body’s structure, function in that area and potentially other areas of the body may also be impacted.

If someone has a heart attack, M.D.’s and D.O.’s are going to follow the same standard of care throughout the treatment, explains Savannah emergency physician John Sy, D.O., the former chair of the MAG Foundation’s Georgia Physicians Leadership Academy Steering Committee and an associate professor at the Mercer University School of Medicine.

John Sy, D.O.

H. William Craver III, D.O.

complete an Accreditation Council for Graduate Medical Education residency program (and some complete fellowship training), which prepares them to become board certified.

You will find D.O.’s in the military and specialties ranging from surgery to aerospace medicine, but most end up in primary care. According to AOA’s ‘2019 Osteopathic Medical Profession Report,’ nearly 57 percent of the nation’s D.O.’s go into primary care, including about 34 percent in family medicine, 18 percent in internal medicine, and seven percent in pediatrics.

That is by design, says AACOM, as the mission of most osteopathic medical schools is to produce primary care physicians.

At PCOM and other colleges of osteopathic medicine, there is an emphasis on preventive medicine and holistic patient care during the medical school years.

Of course, every D.O. does not end up in primary care (e.g., Dr. Sy). Nearly 44 percent go into another specialty.

According to AOA’s ‘2019 Osteopathic Medical Profession Report,’ some of the common D.O. specialties include…

• Emergency medicine (9.7 percent) • Anesthesiology (4.2 percent) • OB-GYN (4.1 percent) • General surgery (3.6 percent) • Psychiatry (3.4 percent)

D.O.’s are fully licensed physicians who use the latest technology, surgical procedures, and prescription drugs. But if a patient comes in with pain, aches or musculoskeletal complaints, osteopathic manipulation provides an additional tool for D.O.’s to use to treat that patient.

“If a patient has chronic back pain, I can refer them to a physical therapist or specialist and/or I can prescribe the appropriate medication,” Dr. Sy says. “But I also try to alleviate their pain with osteopathic manipulation. I might not be able to eliminate the patient’s pain altogether, but this approach can reduce the amount of medication that I am prescribing – which is a big win.”

A focus on primary care D.O.’s can be licensed to practice the full scope of medicine in all 50 states. After graduating from an osteopathic medical school, D.O.’s, like M.D.’s, who plan to go into practice must

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First-year PCOM South Georgia medical students learn to identify cardiac sounds in the school’s Simulation Center.

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Dr. Craver is among those who went into one of those “other” specialties, and he values the osteopathic education he received – and has frequently drawn on the lessons he learned during his training – during his career as a surgeon.

“I believe that my background as a D.O. has enabled me to make better diagnosis,” he explains. “I have been trained to listen to the patient and look at them in the context of a whole patient rather than focus on one specific organ or complaint.”

Focus on underserved areas As the nation faces a physician shortage, osteopathic medical schools also have a special focus on caring for patients who live in underserved areas.

Over the past three years, more than a third of osteopathic medical school graduates indicated that they planned to practice in a rural or underserved area, according to a survey that was conducted by AACOM. Georgia’s first osteopathic school, PCOM Georgia in Suwanee, opened about 30 miles north of Atlanta in 2005.

Meanwhile, the goal of PCOM’s new campus in Moultrie – which is between Albany and Valdosta – is to become a “regional health professions education center in the medically underserved area of the state.” PCOM South Georgia welcomed its inaugural class of 59 doctor of osteopathic medicine students in August of last year.

While studies show that physicians often end up practicing close to where they complete their residencies, Dr. Craver believes that by opening a campus in South Georgia, PCOM will highlight the need and value for having physicians in underserved areas – with the hope that many will ultimately settle in these areas.

“We believe that this approach will help these students understand and appreciate the great potential and emotional rewards of serving in an underserved community and showing them that they really can make a difference,” says Dr. Craver, who served as the only surgeon in a rural county for a period of time. “By opening a campus in an underserved part of the state, we have created the opportunity for students to go out and spend time with physicians and gain that experience.”

He is convinced that, “The students that we are attracting at PCOM are looking for an education that is going to allow them to have a significant impact on underserved communities in the primary care setting.”



“I believe that my background as a D.O. has enabled me to make better diagnosis,” [Dr. Craver] explains. “I have been trained to listen to the patient and look at them in the context of a whole patient rather than focus on one specific organ or complaint.”  like Georgia confused about the differences between an M.D. and a D.O. “I can’t tell you how many times in my career, both with training residents and working on a national and local level, that I heard comments like ‘I had no idea your students were so knowledgeable and well-versed’,” Dr. Craver says. “I think it’s human nature to question what we don’t understand.”

But Dr. Craver believes that attitudes are changing as the numbers of osteopathic medical physicians increase and people become more familiar with the D.O. skill set and philosophy. “At the end of the day,” he believes, “it really comes down to personal preference – as there are far more similarities than differences between M.D.’s and D.O.’s.”

Over the years, Dr. Sy has had countless conversations with his M.D. colleagues, and people in general, to clear up misconceptions about his training in holistic medicine.

“When I ask them to define holistic medicine, most can’t,” he says. “I explain that it’s treating the whole body. I ask my fellow physicians, ‘When someone comes in with a cellulitis of their leg and their other organs display signs in other organs, are you only treating the leg?’ They say, ‘No. We treat all the organs because it’s multiorgan sepsis.’ And I say, ‘Well, yes.’ The point is that we all treat patients holistically on some level.”

Dr. Sy adds that, “In the years since I graduated from medical school, there has been a greater awareness among patients…a lot of them want to try something other than just hearing let’s throw some drugs at it.”

Gaining popularity

And he concludes that, “Once patients experience the benefits of osteopathic manipulation, it’s an approach many of them will embrace for the rest of their lives. And since many physicians have less time to spend with their patients given the practical realities of today’s health care system, a lot of patients welcome and enjoy the osteopathic manipulation process and holistic approach and getting a chance to spend 45 minutes to an hour with their physician.”

For years, osteopathic schools were more common in the Midwest and Northeast. The small numbers of osteopathic physicians often left patients, and even some M.D.’s, in states

Of MAG’s 8,400 members, about 400 are D.O.’s. Go to www. pcom.edu/campuses/georgia-campus for additional inform on PCOM Georgia.

And Dr. Craver notes that, “It seems like PCOM appeals to individuals who want to give back and serve the community and make a difference. By choosing to open a school in an underserved area, we are creating those pathways and opportunities.”

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COVID -19

My experience as a COVID-19 patient

By Georgia Senator Kay Kirkpatrick, M.D. Senator Kay Kirkpatrick, M.D.

A

s a state senator, I am around hundreds of people every day during our legislative session.

The year’s ‘Crossover Day’ (i.e., the last day a bill must pass at least one of the two chambers to have a chance of passing) was March 12, and on March 14, I developed a fever and dry cough.

Because the combination of my age (65) and respiratory symptoms and a fever met the criteria, my primary care physician had me take a COVID-19 test. She also recommended that I remain in complete isolation – in a separate room from my husband, Dr. Tom Haltom.

As a fellow physician, Tom was very strict when it came to me remaining isolated and making sure that we both followed CDC’s recommendations to a tee. I ended up staying in my bedroom for two weeks.

As for my symptoms, the fever was present for a couple of days.

My doctor told me that I could come out of isolation seven days after the onset of the first symptom and three days with no fever without taking acetaminophen. Unfortunately, my fever returned before I hit that milestone. This seems to be a common occurrence with this virus, as there is a cytokine response that can worsen the pulmonary symptoms that results in a “second wave” of symptoms.

It took me a full two weeks to fully recover. The nonproductive cough lingered well past the fever. Although my appetite was poor, I’m not sure if I ever lost my sense of smell, which is another common symptom. My energy level was low, but not as much of a complete wipe-out as the normal flu.

Had I experienced any shortness of breath or decreased O2 saturation, I would have gotten a chest X-ray. But the last place I wanted to be was the hospital.

get the test results. In a precautionary move that I supported in full, the entire legislature was eventually quarantined for 14 days. Based on the feedback that I received from fellow lawmakers, we were all lucky enough to have friends who were kind enough to drop off some food, run some simple errands for us, and be good neighbors in general. I also received a lot of much-appreciated well wishes from my family and friends, constituents, and fellow physicians.

I continued to work from home and participated in conference calls that were related to Senate business, the Primary Care Subcommittee of the Governor’s COVID-19 Task Force, and the MAG Medical Reserve Corps. I also continued corresponding with and helping my constituents.

I hope that the large percentage of COVID-19 cases are similar to mine. I hope that most people can recover at home with symptomatic treatment. I also hope that my beloved colleagues and their families are safe.

Finally, I appreciate and admire every physician and allied health care provider and support staff who showed up and did their job despite the personal risk. I will continue to do my best to be an effective advocate for doctors and other health care professionals in my role as an elected official.

Editors note: Thank you to Dr. Kirkpatrick for taking the time to write this article and sharing her experience.

Senator Kirkpatrick represents the 32nd District, which includes East Cobb and Sandy Springs. An orthopaedic hand surgeon in Atlanta for over 30 years, she served as the president of Resurgens Orthopaedics. Senator Kirkpatrick is a member of the MAG Medical Reserve Corps. MAG members can contact Senator Kirkpatrick at kay. kirkpatrick@senate.ga.gov or 404.656.3932.

For the most part, I relied on Tylenol and cough drops – although I did get an albuterol inhaler that seemed to help with the cough. Some have suggested taking hydroxychloroquine and azithromycin, but I didn’t see any medical reason to do so.

Without clinical trials, I would be reluctant to take something off-label that people need for other conditions. That said, I also understand that doctors who are treating patients who have severe cases of COVID-19 are in a completely different situation.

As it turned out, five of the members of the Georgia Senate tested positive for COVID-19 – although it took a full week to 12 MAG Journal

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GCMB UPDATE

Your responsibilities for your patients’ medical records

By John S. Antalis, M.D., past chair and member, Georgia Composite Medical Board John S. Antalis, M.D.

O

ne of the problems we face in health care is a patient’s ability to obtain their medical records once a clinician retires or their license is suspended or revoked. The usual procedure for these patients is to ask for their medical record to be sent to another/new clinician, and they normally pay a transmission fee. But if a clinician leaves their practice abruptly, the process for patients can be complicated and ambiguous.

The Medical Association of Georgia (MAG) has posted some suggestions to help patients retrieve their medical records at www.mag.org/medicalrecords. Patients are encouraged to keep a record of their health history, medications, and insurance claims.

Patients can email MAG General Counsel Bethany Sherrer at bsherrer@mag.org if they need help contacting a physician. As a last resort, a patient can submit a complaint to the Georgia Composite Medical Board (GCMB).

Medical records, including electronic ones, are owned by the treating clinician or pharmacist. Georgia law states that clinicians own their patients’ medical records, and they have decisionmaking authority to share those records with other clinicians – keeping in mind that this requires the patient to sign a consent and confidentiality waiver, except in cases that involve a subpoena or court order or suspected child abuse or venereal disease.

The policy that the American Medical Association adopted in 2017 (3.3.1) only addresses physicians who are leaving practice, selling their practice, retiring, or have died. It is silent on a physician’s suspension or revocation.

It is also worth noting that a patient’s HIV medical information can only be shared with 1) the patient or 2) the patient’s parents or guardians if they are a minor or 3) someone that the physician “reasonably” believes is the patient’s spouse or partner.

HIPAA generally requires a medical record to remain confidential.

The three exceptions include 1) emergency treatment and 2) the introduction of health complications or injuries in a court case arising from an auto accident and 3) reporting to the federal government of births, deaths, and communicable diseases.

Although a clinician owns their patients’ medical records, Georgia law requires them to provide a copy of the medical record to the patient upon the patient’s request. The first step for a patient or authorized representative (e.g., guardians) to acquire their medical record is to call the doctor’s office or hospital that has requested the record to determine if they want it in email, fax, letter, or some other form. Of course, the patient must always sign a written authorization. The clinician must retain their patients’ medical records for 10 years. If a clinician is going to retire, they should 1) notify their patients and 2) offer their patients a way to obtain their records in a reasonable amount of time. I would suggest four to six weeks. The same notification applies when a clinician sells their practice. If the new clinician is in the same office, the 10-year retention rule still applies. To transfer records to another/new clinician’s office, a patient needs to submit a written authorization requesting the records be sent.

Patients who request that their medical records be transferred should expect to pay a record copying fee. The Georgia Department of Community Health sets this rate on July 1 of each year and posts it at https://dch.georgia.gov/medical-records-retrieval-rates.

What should a patient do if their doctor’s practice closes or their clinician is suspended or has their license revoked?

If a clinician closes their office without advance warning, a patient can…

If a physician is suspended by GCMB, it is in their best interest to comply with GCMB’s rules and release all requested medical records. On MAG’s website, there are guidelines that can inform both physicians and patients. Georgia statutes don’t address the need for physicians who have had their license revoked to maintain their patients’ medical records in any specific way.

As an alternative, contact the U.S. Department of Health and Human Services’ Office of Civil Rights at https://www.hhs.gov (especially when it involves Medicare or Medicaid services). And I always emphasize that Georgians should request their medical records as soon as they find out that their physician has had their license suspended or revoked.

Neither AMA policy nor Georgia statutes are specific concerning the acquisition of medical records for a revoked physician. This is a major issue for the next physician who will care for the patient. Unfortunately, the only option is to acquire the records before the office is closed in Georgia.

The Texas Medical Board has developed a solution that I believe warrants Georgia’s strong consideration. It has ruled that any physician who has their license relinquished, surrendered, or revoked must notify their patients within 30 days. And within the same timeframe, these physicians must designate a Boardapproved custodian to manage their patients’ medical records.

I encourage physicians to contact me at jsantalis@gmail.com with any questions.

Dr. Antalis is a member of the Whitfield-Murray County Medical Society, and he was MAG’s president in 2004-2005.

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PHYSICIAN RESILIENCE

Why resilience matters more than ever

By Keisha Callins, M.D., M.P.H., chair, MAG Physician Resilience Task Force Keisha Callins, M.D., M.P.H.

E

ven before the COVID-19 pandemic, a physician’s life was challenging. Fortunately, conversations around physician wellbeing and burnout had become mainstream. Many organizations, including the Medical Association of Georgia (MAG), have prioritized the need to address these issues in order to preserve the physician workforce and enhance patient safety.

An important and timely precedent MAG’s Board of Directors passed its first physician wellness resolution in 2018. This strategic move was validated by a MAG House of Delegates’ survey that found that nearly 90 percent of delegates believed that “physician burnout is undermining patient care.” The resolution led to the formation of MAG’s Physician Wellness Initiative Committee (PWIC), a diverse mix of specialists, residents, and medical students that are charged with developing evidenced-based recommendations to promote physician wellbeing and mitigate the effects and consequences of burnout.

An important assignment The MAG PWIC created a long-term plan using a multidimensional approach due to the inherent complexity of these issues...

• Research the root causes of burnout, recommend appropriate education for physicians and health systems, and recommend appropriate resources • Educate legislators and propose regulatory and legislative solutions to fund the Georgia Professionals Health Program (Georgia PHP) • Collaborate with the Georgia Composite Medical Board • Promote relevant resources on MAG’s website and social media platforms An important transition The Academy of Medicine (Epstein RM, 2013) says that, “Resilience is a key to enhancing quality of care, quality of caring, and sustainability of the health care workforce… [and a key to] reduce errors, burnout, and attrition.” Based on the research that we evaluated and the physician feedback we received, the committee had experienced a paradigm shift by the time the HOD met in 2019. We consequently shifted gears and focused our efforts on developing physician resilience resources to meet the needs of MAG’s members and the state’s

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overall health care system. We have intentionally focused on 1) individual responsibility (i.e., promoting constructive engagement, limit-setting, self-monitoring, and mindfulness) and 2) institutional responsibility (i.e., creating a culture of trust, transparency, revolving door communications, competence, shared decision-making, transdisciplinary engagement, and continuous process and quality improvement that is based on metrics). Hence, we renamed our committee the Physician Resilience Task Force (PRTF).

An important diversion Much of 2020 has been dominated by the COVID-19 pandemic. It has wreaked havoc in a manner that we have not seen since the 1918 influenza pandemic. In addition to the human toll, there has been an immeasurable impact on the nation’s socio-economic and collective psychological stability.

Physicians now face a more challenging terrain that has been complicated by an increased workload, equipment shortages, safety concerns, threats to practice sustainability, evolving science regarding COVID-19, and rapidly changing health care delivery models (e.g., telemedicine). This pandemic has undoubtably put our resilience to the ultimate test. So in conjunction with the outstanding MAG leadership and physician support efforts, the PRTF quickly shifted gears to develop pandemic recommendations and post pertinent resources on its web page. The PRTF’s ‘Health Care Workforce Resilience in a Pandemic Fact Sheet’ provides a proactive framework for physicians, health care workers, and health systems – addressing the pandemic stages (i.e., what to expect based on where you are in the pandemic’s timeline), system and practice resilience leadership roles (i.e., who needs to do what during a pandemic), and a R.E.S.C.U.E. checklist (i.e., how to work through a pandemic).

An important prediction I believe that resilience is a superpower that is inherent to physicians. The MAG PRTF has strived to build on that quality and empower MAG members to maintain their wellbeing while they lead the health care workforce and care for patients during the pandemic. We have also encouraged the leaders of our health care systems to cultivate a supportive and responsive environment.

Go to www.mag.org/resilience for MAG’s ‘Physician Resilience’ web page. Dr. Callins is an OB-GYN with Community Health Care Systems in central Georgia. She graduated from the MAG Foundation’s Georgia Physicians Leadership Academy in 2017. www.mag.org 15

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LEGAL

COVID-19 pandemic liability

By Daniel J. Huff, Huff, Powell & Bailey, LLC

L

et me begin by saying thank you for your service. I wrote this at the end of April, and you are likely reading it in June. The work you do is vital to keeping our communities safe and healthy. Words cannot express our gratitude to each of you, our physician protectors.

In recognition of the unprecedented circumstances posed by COVID-19, Georgia Gov. Brian Kemp issued an executive order extending legal protections to the employees of certain medical providers. This executive order provides, at a minimum, significant tort immunity to all employees of hospitals, nursing homes, and long-term care facilities for all services related to COVID-19 after April 14 and ending with the expiration of the Public Health State of Emergency. We believe, however, that the order may relate back to services provided beginning on March 14 and may potentially apply to all services, not just COVID-19 services.

Overview of April 14 executive order On March 14, Gov. Kemp declared a Public Health State of Emergency, and on April 8 he extended that until May 13. Then on April 14, Gov. Kemp issued Executive Order 04.14.20.01 (“Designation of Auxiliary Emergency Management Workers and Emergency Management Activities”). The governor issued this order under a provision of Georgia law that grants him broad authority to suspend state statutes and regulations and issue other orders he deems necessary to protect the public during a state of emergency. O.C.G.A. § 38-3-51. As part of his April 14 executive order, Gov. Kemp recognized that “health care institutions and facilities require additional flexibility to provide the critical assistance and care needed by this state during this unprecedented emergency.”

In recognition of that need for flexibility, Gov. Kemp ordered that all employees, staff, and contractors of qualifying health care institutions and medical facilities be classified as auxiliary emergency management workers – as defined by Georgia law. The order then goes on to define which employees, staff, and contractors qualify for this classification, and it states that “services provided or performed” by qualifying health care institutions and medical facilities are considered emergency management activities as defined by Georgia law.

Protections provided by this order Qualifying entities and their individual providers receive substantial legal protection under this order. Georgia law provides that auxiliary emergency management workers engaged in emergency management activity are not subject to the usual standards of tort liability. O.C.G.A. § 38-3-35 (b). Although there is some ambiguity in the statute and no authority interpreting its application to auxiliary emergency management workers, we believe that the statute provides absolute immunity for any death or injury to a person or property arising from a qualifying worker’s emergency management activity. Id. As its

name implies, this immunity provides an absolute defense to all tort actions arising from an auxiliary emergency management worker’s qualifying activities.

It is possible that plaintiffs may argue for a less natural reading of the statue. Even the reading of the statute most generous to plaintiffs, however, grants immunity from tort liability to auxiliary emergency management workers for all incidents except those arising from “willful misconduct, gross negligence, or bad faith.” Even this lesser immunity is an incredibly high standard. Georgia law defines gross negligence as the failure to exercise the “the degree of care which every man of common sense, however inattentive he may be, exercises under the same or similar circumstances.”

At a minimum, the order and the statute it references will provide protection from all but the most egregious conduct.

To whom does the order apply?

The order extends heightened protections to employees, staff, and contractors of hospitals, nursing homes, assisted living communities, personal care homes, ambulatory surgical treatment centers, and several other facilities. The order specifically does not extend heightened protections to employees of physicians’ and dentists’ private offices and treatment rooms used primarily for patient care. O.C.G.A. § 31-7-1(4). The specific health care institutions and medical facilities which qualify are as follows…

1) Any building, facility, or place that provide two or more beds and other facilities and services that are used for persons received for examination, diagnosis, treatment, surgery, maternity care, nursing care, assisted living care for periods continuing for 24 hours or longer and which is classified by [the Department of Community Health or DCH, as provided by law], as either a hospital, nursing home, assisted living community, or personal care home.

O.C.G.A. § 31-7-1(4)(A) 2) Any building or facility, not under the operation or control of a hospital, which is primarily devoted to the provision of surgical treatment to patients not requiring hospitalization and which is classified by the department as an ambulatory surgical treatment center. O.C.G.A. § 31-7-1(4)(C) 3) Any fixed or mobile specimen collection center or health testing facility where specimens are taken from the human body for delivery to and examination in a licensed clinical laboratory or where certain measurements such as height and weight determination, limited audio and visual tests, and electrocardiograms are made, excluding public health services operated by the state, its counties, or municipalities. O.C.G.A. § 31-7-1(4)(D)

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4) Any building or facility where human births occur on a regular and ongoing basis and which is classified by [DCH] as a birthing center. O.C.G.A. § 31-7-1(4)(E) 5) Any building or facility which is devoted to the provision of treatment and rehabilitative care for periods continuing for 24 hours or longer for persons who have traumatic brain injury, as defined [by law]. O.C.G.A. § 31-7-1(4)(F)

(i.e., initiated on March 14 and extended until May 13).

There is an argument the order is not retroactive. The final portion of the order provides that it became effective upon Gov. Kemp’s signature on April 14 and expires at the conclusion of the Public Health State of Emergency. Other portions of the order, noted above, suggest that it is meant to apply to the Public Health State of Emergency from its inception until its expiration.

6) Any freestanding imaging center where magnetic resonance imaging, computed tomography (CT) scanning, positron emission tomography (PET) scanning, positron emission tomography/computed tomography, and other advanced imaging services as defined by [DCH] by rule, but not including X-rays, fluoroscopy, or ultrasound services, are conducted in a location or setting not affiliated or attached to a hospital or in the offices of an individual private physician or single group practice of physicians and conducted exclusively for patients of that physician or group practice. O.C.G.A. § 31-7-1(4)(G)

Summary of scope

7) Any licensed general hospital, destination cancer hospital, or specialty hospital, institutional infirmary, public health center, or diagnostic and treatment center. O.C.G.A. § 31-7-1(5)

Several legal challenges will be made regarding the application and scope of this order. At the forefront will be constitutional challenges that the order violates the separation of powers, equal protection, and the right to a jury trial.

As noted above, the order specifically does not apply to employees of physician’s and dentist’s private offices. Employees of nearly all other medical or health care institutions, however, qualify for the increased protections provided by this order.

What care and services does the order cover?

Although Gov. Kemp may have intended to extend enhanced statutory immunity only for COVID-19 related services, the language of his order does not limit this enhanced immunity only to individuals treating COVID-19 patients. Instead, his order provides plainly that “services provided or performed by healthcare institutions and medical facilities…shall be considered emergency management activities[.]” This interpretation is reasonable since the pandemic affected and strained even non-COVID-19 aspects of health care.

Additionally, the statute providing immunity to auxiliary emergency management workers does not appear to limit immunity to COVID-19 related services. The statute provides that immunity is extended to any qualifying worker “engaged in any emergency management activity complying with or reasonably attempting to comply with…any order promulgated [by applicable law.]” O.C.G.A. 38-3-35(b). Gov. Kemp’s order was promulgated under legal provisions cited by this statute. All qualifying entities can credibly argue that the terms of that order extend to all of the services they “provide or perform.”

Is the order retroactive?

A review of the executive order suggests that its provisions are retroactive to March 14 and extend until the expiration of the Public Health State of Emergency (which was May 13 when this article was written). Although the executive order does not explicitly provide that it is retroactive, it is effective for the duration of the Public Health State of Emergency. Moreover, the order explicitly references only one Public Health State of Emergency

Based on the foregoing, that this executive order extends, at a minimum, significant immunity to the employees of most medical institutions for any tort occurring on or after April 14 related to COVID-19 related services. We are confident, however, that this order extends absolute immunity to the employees of most medical institutions for any tort arising out of services provided between March 14 and the expiration of the Public Health State of Emergency.

Legal challenges

Editor’s note: On May 12, Gov. Kemp expanded his executive order by “designating all individuals who are licensed, certified, or otherwise authorized under Title 43, Chapter 26 and Chapter 34 to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program, whose practices are affected by the Public Health Emergency caused by the spread of [COVID-19], and all workers at health care facilities (except those wherein abortion procedures are performed) as auxiliary emergency management workers.”

Huff is a founding partner in the Atlanta law firm Huff, Powell & Bailey, LLC. He and his firm defend physicians, institutions and other health care providers in lawsuits alleging malpractice. Contact Huff at dhuff@huffpowellbailey.com or 404.892.4022.

Paid editorial content.

MAG ‘Top Docs’ videocast passes one million views milestone The Medical Association of Georgia’s (MAG) Facebook ‘Top Docs’ videocast show recently passed the one million views milestone – reaching an average of 18,000 per episode.

“The Top Docs show has evolved into one of MAG’s most accessible and important communications platforms,” says MAG Communications Director Tom Kornegay. “It features leading subject matter experts addressing today’s most pressing health care issues, including COVID-19, which provides our members and their patients and other key stakeholders with information that enables them to make better decisions.”

The program is supported with a grant from Alliant Health Solutions.

Every ‘Top Docs’ episode is available at www.mag.org/topdocs.

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MAG FOUNDATION ‘THINK ABOUT IT’ INITIATIVE

‘Hey, Doc, did you forget something?’ Naloxone and the opioid epidemic

By Susan K. Blank, M.D., FAPA, DFASAM, FABPM-ADM, MRO Dr. Smith, a pain management physician, is seeing Ms. Jones for chronic pain management. Dr. Smith had reviewed her medical records and imaging studies and checked for her name in the Georgia Prescription Drug Monitoring Program data base. He checked her history of pain, her prior treatments and interventions, her current pain level, and any limitations that she has as a result of her pain.

Dr. Smith also explored lifestyle issues like sleep, diet, exercise, depression, and addiction for both Ms. Jones and her immediate family. He wanted to know what her expectations were (i.e., her reasonableness) when it came to the relief that he could provide.

Dr. Smith performed a physical exam and had her urine tested for medications and illicit substances. After discussing the risks and benefits associated with the medication, Dr. Smith agreed to prescribe an opioid for Ms. Jones. They reviewed his opioid contract and the need for drug testing, pill counts, and clearing any new medications or supplements with him. Ms. Jones signed the contract and Dr. Smith wrote the prescription. Before he left, Dr. Smith reviewed safe medication storage and disposal procedures, he asked her to check in with him in two to three days to review the drug’s effectiveness and side effects, and he had her schedule a follow-up appointment in a week.

This sounds like an appropriate visit, right? Well, not so fast. Dr. Smith should be aware that Georgia pharmacists are allowed to dispense naloxone (aka Narcan) without a prescription based on a standing order of Georgia Department of Public Health Commissioner Kathleen Toomey, M.D.1 Of course, this would apply to Ms. Jones. Dr. Smith should have also discussed the risk of overdose with Ms. Jones, who was getting an opioid prescription for the first time. The odds that she knew that she could ask her pharmacist for a naloxone prescription was low. According to a study that was conducted by the University of Michigan and the VA Ann Arbor Healthcare System that was published in the Journal of General Internal Medicine in January, 2020,2 less than two percent of the patients who are at risk for an opioid overdose actually get a naloxone prescription from their doctor, Dr. Smith should have written Ms. Jones a prescription for naloxone along with instructions on when and how to use it when he gave her an opioid prescription.

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Susan K. Blank, M.D.

According to the Centers for Disease Control and Prevention, patients who take opioid dosages at or above 50 MME (morphine milligram equivalents) per day are twice as likely to overdose as those taking dosages of 20 MME/day. Furthermore, the risk increases as the MME/day increases. Prescribing naloxone for at-risk patients and co-prescribing naloxone for patients who are taking opioids for pain that meet or exceed this threshold has the potential to save lives.3 While opioids can provide useful pain relief to many patients, they still pose a very real risk for addiction, overdose, and death – as well as the potential to be misused by family members.

We must maintain an “all hands-on deck” approach to reduce overdose deaths by providing prescriptions for naloxone.3 In 2018, the U.S. Surgeon General called for greater awareness and the increased availability of naloxone. The data clearly indicates that there is a significant, persistent gap in our response due to the infrequent co-prescribing of naloxone when a patient is given a prescription for opioids, even for shortterm use. When they take their pain medications as prescribed, these patients are at increased risk of accidental overdose as well as drug-alcohol or drug-drug interactions with sedating medications, such as benzodiazepines.4 The evidence is clear: doctors are writing fewer prescriptions and taking extra precautions to stem the tide of opioid misuse. Please continue to do your part and write naloxone prescriptions to help prevent opioid overdoses and save lives.

Dr. Blank is the immediate past president of the Georgia Society of Addiction Medicine, the chair of the MAG Foundation’s ‘Think About It’ initiative to reduce opioid misuse, and a member of the Technical Expert Panel for the U.S. Preventive Services Task Force Guidelines for Alcohol, Tobacco, and Influenza.

References Georgia Pharmacy Association- Naloxone without a prescription. https://wwwgpha.org/ Naloxone “Association of Opioid Overdose Risk Factors and Naloxone Prescribing in U.S. Adults” Journal of General Internal Medicine, DOI: 10.1007/s11606-019-05423-7 3.

Centers for Disease Control and Prevention. Preventing an Opioid Overdose Tip Card, Available at https://www.cdc.gov/drugoverdose/pdf/patients/Preventing-an-OpioidOverdose-Tip-Carda.pdf 4.

Surgeon General’s Advisory on Naloxone and Opioid Overdose. 2018 https://www.hhs.gov/ surgeongeneral/priorities/opioids-and-addiction/Naloxone-advisory/index.html 1.

2.

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PATIENT SAFETY

Managing the legal and regulatory risks of locum tenens physicians

By Raj Shah, senior regulatory attorney, and Baylee Culverhouse, risk intern, MagMutual

T

he use of locum tenens continues to rise as many organizations take advantage of these physician services. Hiring locum tenens (“locum”) physicians gives providers a flexible option to fill absences for a variety of reasons, including illnesses, vacations, paternity or maternity leave, and continuing medical education opportunities. Bringing on a new physician for a short period of time can expose a medical practice to certain legal and regulatory risk management issues. MagMutual recommends the following legal and risk management best practices when using a locum physician at your organization.

Notifying your malpractice carrier The medical practice should notify their malpractice carrier of the locum arrangement to ensure malpractice coverage applies for physician services provided by the locum provider.

Most malpractice carriers will provide malpractice coverage for a locum arrangement for 60 days per malpractice policy period. Conveniently, MagMutual provides policyholders with malpractice coverage for locum physicians for up to 60 days per policy period.

Selecting a locum tenens physician within the same specialty Based on MagMutual’s experience advising medical practices on issues involving locum providers, we have found that choosing a locum tenens physician within the same specialty as the absentee physician can reduce exposure to liability. Especially in rural areas where locum tenens providers may be difficult to recruit, a medical practice can be tempted to fill a position with a similar specialty in hopes that the skills are generally transferable or that other physicians in the medical practice can step in if needed.

For example, if the medical practice generally treats large numbers of pediatric patients and genuinely needs a family practice physician to fill the vacancy, advise the medical practice against accepting an internist physician in hopes that other physicians can cover the pediatric patients. Circumstances will inevitably arise that will put the internist in charge of treating a pediatric patient, so medical practices should avoid settling for any specialty other than the one they are specifically seeking.

Specifying the requisite skill and expected case load before hiring It is important for medical practices to be realistic about the skills and the time commitment required for the position they are temporarily trying to fill. Ensure that this information is conveyed to the potential locum tenens physician. For example,

if the medical practice sees an unusually high number of patients with autoimmune diseases, it might be wise for the medical practice to disclose this information to a potential locum candidate to ensure the locum physician is equipped with the experience and expertise to provide care to these patients.

Medical practices might also find it beneficial to inquire about the locum physician’s past case load management to make sure they are comfortable with the time commitment required to fill the position. While working a 24-hour call shift may not seem unusual for many physicians, others may not feel comfortable working those hours. By discussing these issues during the hiring process and understanding any limitations of a locum physician before they begin seeing patients, medical practices can reduce exposure to liability.

Verifying all physician documentation and licensing Medical practices should ensure that all documentation and licensing requirements of the locum physician are up-todate and authentic. This may require verification of criminal background checks, education, training, past and future privileges, Medicare certification, and board certification.

Additionally, physician practices that are affiliated with larger organizations should determine whether there are any requirements for locum physicians.

Providing a thorough orientation for locum tenens physicians The medical practice should schedule time before the locum tenens physician is scheduled to see patients to provide a proper orientation for them to become acquainted with their facility, staff, and equipment. At a minimum, this orientation should cover…

• A facility tour (including the locations of equipment, supplies, and medications) • A point of contact (for the duration of the locum physician’s services) • The code of conduct or specific rules at the facility, if applicable • The medical records system at the facility • The process for ordering and follow-up on diagnostic tests • The availability of specialists, equipment, and support staff • The process for referrals • The medical practice’s philosophy on prescription drugs Conveying the availability of specialists and support staff to the locum provider is especially important in rural areas. Locum

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physicians need to know whether the nearest cardiologist is in their building or 30 miles away. And if a locum physician is used to a lot of staff support, they may feel uncomfortable in a setting where they have to handle procedures without that level of support. Therefore, a thorough discussion between the medical practice and the locum physician about the practice environment reduces the chances of surprising the locum physician with unexpected circumstances that can affect the quality of care.

Becoming familiar with locum tenens billing requirements Billing requirements for locum physicians vary by payer. Even though both public and private payers tend to follow Centers for Medicare and Medicaid Services (CMS) guidelines for locum reimbursement, medical practices should confirm that on the front end and, if not, determine which rules will govern the reimbursement procedures for locum providers.1 CMS allows payment for services provided by locum physicians, subject to the following conditions…

• If a medical practice needs locum physician services for less than 60 days, the medical practice should bill under the name and billing number of the absent physician while the medical practice pays them “on a per diem or similar feefor-time basis.”2 The locum physician must have a National Provider Identifier (NPI), and the medical practice must document each service provided by the locum with the locum physician’s NPI.3 Claims for services provided by locums should be submitted with a Q6 modifier appended to each procedure code.4 • If a medical practice needs locum physician services for more than 60 days, the medical practice should enroll the locum physician in the medical practice’s contracted payer mix prior to their start date.5 The 60-day period begins on the first day that the locum physician sees a patient.6 Note that it is impermissible to bill for any locum physician services for more than 60 days – even if the medical practice rotates among different locum physicians. For example, a medical practice cannot avoid enrolling the locum in their contracted payer mix by switching locum providers on day 50 of the services.

Ensuring compliance with DEA requirements As locum physicians sometimes practice in different states, medical practices should ensure that the locum physician has a separate U.S. Drug Enforcement Administration (DEA) registration in the state in which the medical practice is located.7 In certain situations, the DEA allows locums who will be working solely in a hospital or clinic setting to use the hospital’s DEA registration instead of registering independently with the DEA.8

of the medical practice, your locum tenens physician should mirror the practice’s attitude towards prescribing and dispensing medication. Dispensing drugs and controlled substances in a manner inconsistent with other physicians in the organization could open an organization up to liability.9

Understanding physician supervision requirements If a locum tenens arrangement involves supervisory duties of advanced practice clinicians, the medical practice should be clear with the locum physician regarding what these responsibilities entail. When applicable, the organization should make sure the locum tenens realizes they will still be considered a supervising physician in the new setting.

Maintaining timely documentation and ensuring coordination of care While maintaining timely documentation and ensuring coordination of care is important in any medical practice, it is especially important when employing a locum physician due to the short-term nature of the arrangement. If a new patient sees the locum physician and needs to be monitored closely to avoid progression of a condition, this should be thoroughly documented and carefully coordinated with other physicians and support staff to avoid any gaps in coverage for the patient once the locum leaves. Failing to document care or coordinating follow up with a patient can expose a practice to significant liability.10 Following these legal and regulatory risk management best practices will ensure that a medical practice is able to enjoy the benefits of filling short-term physician vacancies with locum physicians while still managing the risks and exposure to liability that these arrangements can bring.

References CompHealth, How to Bill for Locum Tenens Services, COMPHEALTH BLOG (Jan. 7, 2015), https://comphealth.com/resources/bill-locum-tenens-services/.

CTRS. FOR MEDICARE & MEDICAID SERVS., MEDICARE CLAIMS PROCESSING MANUAL (2008), https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/ downloads/clm104c01.pdf.

3.

Id. 4.

Id. 5.

A narrow exception to the sixty day limit on locum tenens physician services exists for absent physicians who have been called to active duty in the Armed Forces. See id.

6.

CTRS. FOR MEDICARE & MEDICAID SERVS., supra note 3.

7.

21 C.F.R. § 1301 (2016).

8.

Id. 9.

Kelly K. Dineen & James M. DuBois, Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanctions, 42(1) AM. J. LAW MED. 7–52 (2016).

10.

Am. Med. Ass’n, Medical liability: Missed follow-ups a potent trigger of lawsuits, AMEDNEWS. COM (July 15, 2013), https://amednews.com/article/20130715/profession/130719980/2/.

1.

2.

In addition, medical practices should be clear with the locum about their prescribing pattern and comfort level with dispensing drugs and controlled substances. As a representative

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MEDICAL ETHICS

The decision-making capacity of a patient with schizophrenia seeking an abortion

By Christopher Isennock, MS-3, Mercer University School of Medicine

E

ach year in the U.S., inexperienced and impressionable first-year medical students are outfitted in white coats and gather to recount the Hippocratic Oath, officially joining the ranks of the medical community. Within this oath is found the following words: “If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.”1

These are powerful words for a group of mostly 20-somethings who have not yet learned to wield a stethoscope, let alone honed the skills needed to administer life-saving care. The Hippocratic Oath is one of the oldest documents outlining the principles of medical ethics, and it is a wonderful tradition with which to focus the first moments of one’s medical career.

However, during the first two years of education, medical students’ time becomes all but fully saturated in learning the intricate details of human anatomy, pharmacology, microbiology, pathology and histology, and the foundations of medical ethics tend to become overlooked among the great volume of other material.

The true importance of these ethical foundations is not fully realized until students transition out of the classroom and into clinical medicine during the third year of medical training ‒ when they are exposed to the many diagnostic uncertainties, conflicts of interest, and competing principles of medical ethics that abound in the real practice of medicine. During this transition, students quickly realize that their decisionmaking capacity and the ethical principles of medicine can no longer take a backseat to other studies but are a crucial factor to consider in every patient’s care.

No one ethical dilemma was more pronounced and eyeopening for me than a patient at a federally qualified health center. The resident physician and I were tasked with interviewing a young woman in her 20s who was there to discuss the results of her pregnancy test. The resident explained that she was approximately six weeks pregnant. As I entered her room, expecting to meet eyes with the patient, I was surprised

Christopher Isennock

to see strips of paper scattered about the floor and a somewhat disheveled woman standing with her eyes fixed on the floor.

After speaking with the patient for a few moments, it was clear that while she was able to answer my questions, something unseen was drawing her attention away from our conversation.

The resident motioned towards the computer screen and my eyes were drawn towards the patient’s medical chart, which indicated that she had been diagnosed with schizophrenia. I can remember the patient’s words clearly: “I already have two kids at home and struggle to pay my bills as is. I don’t think I want to go through with this pregnancy.”

In many parts of the country, abortion is still considered a highly controversial ethical dilemma and health care providers must consider the many medico-ethical principles involved in caring for this patient population. My experience with this patient left a lasting impression on me concerning not only the arguments surrounding abortion, but also the ethical principles that give patients the ability to make their own medical decisions at all.

Being involved in this young woman’s care would provide me my first opportunity to participate in the determination of a patient’s decision-making capacity in the real world. As defined

by Western University Department of Philosophy member Louis Charland, PhD, decision-making capacity incorporates four important components: communication of a choice, understanding, rationale for a given decision, and appreciation of consequences of the choice.2 The first, and easiest, component in this situation to determine was communication of a choice. As described before, the patient had vocally indicated her preference in this situation saying, “I don’t think I want to go through with this pregnancy.” This proves her ability to communicate her choice and satisfied the first element in decision-making capacity.

Second, the patient’s understanding had to be assessed. In speaking with the patient during the interview, it was apparent that despite her diagnosis of schizophrenia, disheveled appearance, and somewhat eccentric behaviors, she understood her condition. She expressed an understanding that she was pregnant and understood that in her words, not going through with the pregnancy meant to terminate the pregnancy.

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Although she did not have detailed knowledge of each procedure available to her, in my opinion it was not necessary for her to do so to satisfy the understanding provision, as she understood the basics of the situation she was in and that there were termination options available.

Thirdly, we must deal with the question of her ability to rationalize her choices. The concept of reasoning is often left vague in discussions of decisional capacity, yet consistency and the ability to derive conclusions from premises are often used as criterion for rationalization of a decision.2 The patient demonstrated her ability to derive conclusions from premises as she indicated that in order to relieve the financial burden of having another child, she wanted to terminate the pregnancy.

Whether or not her diagnosis of schizophrenia would affect her consistency in making that choice over time is more difficult to determine, as we only saw the patient on that one day.



“My experience with this patient left a lasting impression on me concerning not only the arguments surrounding abortion, but also the ethical principles that give patients the ability to make their own medical decisions at all. ”  The remaining component of decision-making capacity, appreciation of consequences, is more abstract to determine and physicians are often left with some ambiguity in doing so. According to Dr. Charland, appreciation of consequences means that “subjects must be able to appreciate the nature and meaning of potential alternatives – what it would be like and ‘feel’ like to be in possible future states and to undergo various experiences – and to integrate this appreciation into one’s decision making.”2 Clearly, this is the deepest level of understanding of the four criterion and means that patients must be able to imagine themselves in different outcomes based on their choices.

One common way to assess a patient’s ability to appreciate the consequences of their decisions is to get them to describe what it would be like to live with the various outcomes of their decisions. But in this instance, the patient was not walked through the potential options and outcomes of her decisions. Therefore, I speculate that it did seem that she was able to appreciate the consequences of her choices, although

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I wish that we had done a more thorough job assessing this.

I believe that this conclusion is supported by the reasons behind her choice.

Her primary concern was that the pregnancy would result in financial hardships. In order to provide this reasoning, she must have been able to place herself into the frame of mind of what it would be like to have another child and could therefore appreciate the consequences both having and not having a baby. Although we did not explicitly walk through potential scenarios to assess her ability to appreciate the consequences of her decision, I believe that she did successfully meet the final component in decision-making capacity, rendering her capable of making her own medical decisions.

There is also support for the patient’s decision in the literature. In a meta-analysis of decision-making capacity in schizophrenia, researchers found that “impairment in capacity is not a distinguishing feature of schizophrenia.”3 This means that a diagnosis of schizophrenia alone cannot be used to remove someone’s decision-making capacity. Furthermore, the researchers found that the “majority of people with schizophrenia were deemed to have adequate decision-making capacity” and that only around 18 percent of patients with schizophrenia were found to lack decision-making capacity.3 Therefore, determining a schizophrenic patient’s decisionmaking capacity must be done on a case-by-case basis.

The transition from textbook to clinical medicine challenges third-year medical students to realize the importance of the ethical foundations of medicine and marks a monumental step in their journey to becoming health care providers. During this time, students begin to appreciate that real-life medicine is much less black and white than the medicine practiced in textbooks, and it often involves competing ethical principles of medicine. My experience with the young woman with a history of schizophrenia seeking an abortion strongly exemplified this fact to me.

This experience taught me that decision-making capacity is nuanced and can be difficult to establish, especially in a patient who is at risk of having impaired decisional capacity. Despite this potential challenge, determining a patient’s decisionmaking capacity is a foundational part of a physician’s duties and is not one that can be overlooked.

References Miles, S. H. (2004). The Hippocratic Oath and the Ethics of Medicine. New York: Oxford University Press, 2004.

Charland, L. C. (2015). Decision-Making Capacity. The Stanford Encyclopedia of Philosophy (Fall 2015 Edition). Retrieved from: https://plato.stanford.edu/archives/fall2015/entries/ decision-capacity.

3.

Jeste, D. V., Depp, C. A., & Palmer, B. W. (2006). Magnitude of impairment in decisional capacity in people with schizophrenia compared to normal subjects: an overview.

Schizophrenia bulletin, 32(1), 121–128. https://doi.org/10.1093/schbul/sbj001.

1.

2.

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CMS & SPECIALTY NEWS

COUNTY MEDICAL SOCIETY NEWS DeKalb Medical Society

by Melissa Connor, Executive Director The DeKalb Medical Society (DMS) will host a free ‘Medical Cannabis in Georgia’ dinner meeting at the Druid Hills Golf Club in Atlanta from 6:30 p.m. to 9 p.m. on Thursday, August 6 – an event that was originally scheduled to take place on April 16. The event is being sponsored by Curaleaf (curaleaf. com), which is a medical cannabis company. The event will address Georgia’s medical cannabis laws, the medical conditions that are covered

by Georgia’s medical cannabis laws, the steps a physician needs to take to “certify” that a patient has one of the conditions that are covered by Georgia’s law, and the steps that low-THC/CBD oil producers are taking to ensure patient safety. Contact Melissa Connor at mconnor@pami.org to make a reservation, which is required.

Bibb County Medical Society

by Dale Mathews, Executive Director The Bibb County Medical Society’s (BCMS) meeting in February featured an outstanding risk coding

BCMS President-elect Dr. Cameka Scarborough with Dr. Ronnie Smith following his presentation in February.

presentation by Ronnie R. Smith, M.D., MBA. He discussed how practices should code for patient risk to be reimbursed accordingly.

Dr. Smith is a primary care physician in Vidalia, and he is a well-known coding expert. The BCMS members and their office staff that attended the meeting said that the presentation was “really interesting,” and they asked numerous questions.

Go to www.bibbphysicians.org or contact Dale Mathews at bibbphysicians@gmail.com for information on BCMS.

SPECIALTY SOCIETY NEWS Atlanta Association for Dermatology and Dermatologic Surgery

by Maryann B. McGrail, CAE, CMP, Executive Director The Atlanta Association for Dermatology and Dermatologic Surgery (AADDS) will hold CME activities on July 14, September 12, and October 27. Contact Maryann McGrail at maryann@ theassociationcompany. com for details. Go to www. atlantaderm.org for additional information on AADDS. Georgia Chapter of the American College of Cardiology

The Georgia Chapter of the American College of Cardiology (GA-ACC) will reschedule its ‘Southeast WIC Conference’ as a result of the COVID-19 pandemic, according to event co-chairs Gina Lundberg, M.D., FACC, and Alison Bailey, M.D., FACC. GA-ACC has also cancelled the ‘Cardiovascular Update’ meeting that was scheduled to take place in

Athens in May. This event will now take place at Callaway Gardens on April 21-25, 2021.

Contact Melissa Connor at mconnor@pami.org with questions or to join GA-ACC.

MAG mourns loss of former President Roy W. Vandiver, M.D.

Georgia Gastroenterologic and Endoscopic Society

The annual Georgia Gastroenterologic and Endoscopic Society (GGES) meeting for 2020 is scheduled for September 12 at the W Midtown Atlanta. For more information or to join GGES, visit www.ggesonline.org.

Georgia Society of Dermatology and Dermatologic Surgery

by Maryann B. McGrail, CAE, CMP, Executive Director The Georgia Society Dermatology and Dermatologic Surgery (GSDDS) has rescheduled its annual ‘Congress of Clinical Dermatology’ at the Hilton Sandestin for August 28-30, 2020. Contact Maryann McGrail at maryann@ theassociationcompany.com for details. Go to www.gaderm. org for additional information on GSDDS. Submit your county medical society, member or specialty society news to Tom Kornegay at tkornegay@mag.org. Also contact Kornegay with any corrections, which will run in the next edition of the Journal.

The Journal reserves the right to edit submissions for length and clarity. Bolding recognizes the physicians who are active MAG members at the time the Journal was prepared. Go to www.mag.org/membership to renew your MAG membership.

The Medical Association of Georgia (MAG) is mourning the loss of Roy W. Vandiver, M.D., who served as MAG’s president in 1993-1994.

Having joined Atlanta Neurosurgical Associates, Dr. Vandiver practiced neurosurgery for more than 30 years at Emory Decatur Hospital (then DeKalb General and later DeKalb Medical) and Eastside Medical Center.

In addition to his MAG leadership roles, Dr. Vandiver was MagMutual’s chairman from 1999 to 2011, and he was the president of the DeKalb Medical Society, the chairman of the Georgia Neurosurgical Society, a member of the DeKalb Hospital Authority, and the chairman of the board of the American Medical Association’s Political Action Committee.

Dr. Vandiver graduated from the Medical College of Georgia in Augusta.

He is survived by his wife, Maureen, three sons, and six grandchildren.

Memorial contributions can be made to the DeKalb Medical Oncology Fund at www. supportmedicine.emory.edu/ Vandiver and/or the Global Village Project at www. globalvillageproject.org.

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PERSPECTIVE

On slowing down Mark Murphy, M.D.

M

y wife and I were riding bikes when we first saw the owls, high up in the crook of a massive live oak tree heavily draped with Spanish moss.

The owlets were fuzzy things, wide-eyed and staring, their heads swiveling about nearly 360 degrees in a manner that seemed to defy biology as they took in the new world around them. Their parents were a broad-winged pair of Great Horned Owls, with fishhook talons and saffron beaks, soaring silently from limb to limb and tree to tree in unaccustomed daylight. One of the parents fluttered overhead and landed by the nest, bringing food to the owlets. Seeing that was spectacular.

I was off early that day because a couple of my telemedicine visits had cancelled. During a “normal” week, I would never have been home early enough to see the owls. I’m usually up at 4 a.m. and doing procedures by 6:30 a.m., working through lunch and often into darkness, without respite, adapting to the unrelenting needs of a patient population who demand my ready availability.

But not now.

An unseen enemy has humbled me. The novel coronavirus SARS CoV-2 has reordered my life, restructured my days, and reminded me of that fundamental truth which I should have already known all too well: That we, and the entire society we live in, are made of very fragile stuff. Life is precious and miraculous, and yet we take it for granted, every aspect of it, assuming the false pretense of our own immortality while simultaneously failing to recognize how intrinsically connected we all are, both to one another and to the amazing planet we live on.

In 1972, MIT meteorology professor Edward Lorenz presented a paper which posed the question, “Does the flap of a butterfly’s wings in Brazil set off a tornado in Texas?” The idea Lorenz was positing became widely known as an explanation of chaos theory called “The Butterfly Effect.” The modern epidemiologic version of The Butterfly Effect is this: A single strand of RNA, encapsulated in an envelope of protein, made the jump in December 2019 from a creature of another species to one of our own in Wuhan, China.

The rest is history.

That first COVID-19 patient never knew what it was that he had.

We don’t know his name, what he looked like, or even whether he lived or died. But his illness has changed the entire world. It is unprecedented and cataclysmic, a once-in-a-lifetime event.

My grandmother used to say that, “Every cloud has a silver lining, if you look hard enough.” It’s certainly hard to find a silver lining in all of this, with millions of people sick, thousands dying, and many, many people out of work. But sure enough, as we were biking back home after seeing the owls on a warm, sun-dappled Spring day, I found it.

Seeing the owls made me realize that having an opportunity to slow down and absorb some of the world’s beauty is not such a bad thing. Tiny miracles like that one surround us every day, but we are often too busy or too distracted to appreciate them.

To be certain, these are trying times. The threat of contracting COVID-19 is always there, lurking about in the shadows. My medical practice is going to be financially stressed for months, and perhaps longer. But I am blessed with a loving spouse, healthy children and grandchildren, and the opportunity to help others at work every day. All of this has given me a renewed perspective about what is truly important in life – and about what is not.

In recent years, encouraged by the influence of social media, people have tended to be tribalistic, emphasizing their differences instead of focusing on the shared aspects of the human condition.

The practice of medicine has taught me that human beings are actually far more alike than they are different – a viewpoint the pandemic has only reinforced. Perhaps, as we make this collective journey through the dark realm of pestilence, we will begin to understand that our species’ shared destiny links us all inextricably to one another. And perhaps amongst all of the virally-induced heartache, we will more readily comprehend that the fate of Homo sapiens sapiens as a species is largely dependent upon how much we care for each other – and upon our avid stewardship of that singular blue orb, careening through the vast emptiness of space, that we all call home.

Dr. Murphy is a Savannah gastroenterologist, a longtime MAG member, and a former president of the Georgia Medical Society.

S

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