Opportunities in Ophthalmology: Connecting Medical Students and Residents during a COVID-19 Crisis By Christopher Zhu and Brandon Lam

Opportunities in Ophthalmology:

Connecting Medical Students and Residents during a COVID-19 Crisis

By Christopher Zhu and Brandon Lam

As the coronavirus 2019 (COVID-19) pandemic surged in April 2020, unforeseen challenges emerged against the old medical education paradigm, requiring adaptations to address the abruptly altered landscape of student training. Under the guidance of Dr. Lilian Nguyen, Director of Medical Student Education at the Department of Ophthalmology at UT Health San Antonio, our team developed a virtual program to match medical students and ophthalmology residents to address diminished educational opportunities caused by COVID19 in a field with already limited curricular exposure. We then measured the effectiveness of a program matching medical student mentees with ophthalmology resident mentors in the hopes of promoting direct mentorship between mentees and mentors and creating lifelong career impacts.

All 22 of our medical students completed program surveys four months apart, assessing attitudes and available opportunities on a scale from 0 (none) to 10 (significant) regarding mentorship, pursuing ophthalmology, research and how COVID-19 impacted these. All 9 of our participating residents likewise completed surveys measuring attitudes towards mentorship in the specialty and expectations regarding time commitment.

We found from these surveys that while medical students felt COVID-19 tangibly affected available opportunities in ophthalmology at the outset of the outbreak, their participation in the mentorship program significantly increased their overall access to shadowing and research experiences in the specialty. Confidence among students regarding their knowledge of ophthalmology also rose following participation and overall, the program was deemed valuable. In addition to benefitting medical students, residents maintained their high level of comfort in mentoring students and speaking about ophthalmology as a career before and after the program. Our residents also continued reporting high value regarding mentorship in ophthalmology and medicine at-large.

Under novel circumstances plaguing the globe, we were able to create a microcosm allowing for some continuity regarding medical education and mentorship in the relatively small field of ophthalmology. Our team observed student interest in ophthalmology increase as they garnered the opportunity to develop career-long mentors, providing exposure to the field of ophthalmology which otherwise would not have existed during the COVID-19 pandemic.

Christopher Zhu is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2023.

Brandon Lam is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2021 and is an incoming UTHSA Ophthalmology Resident.

Student Research conducted by Omar A. Caballero, MS, OMS-II and Travis B. Fenlon, OMS-II, Mentored by Rebecca L. Sanchez, PhD

Several years into the Peloponnesian War, one quarter of the Athenian population expired independent of a single Spartan blade.1 The beginning of the conflict that would render the once omnipotent city-state of Athens indistinguishable from that of Sparta was characterized by a rapidly spreading and deadly pustular rash. Athenian historian, Thucydides, writing of this plague made note that those who had been afflicted and survived “had now no fear for themselves; for the same man was never attacked twice—never at least fatally.”2 Thus, a fertile soil for the field of immunology was laid down: a facet of human disease was the potential for immunity.

Further investigations into this phenomenon of immunity were limited by etiological theories of disease. Was disease theurgic and immunity merely a reward for righteous behavior? Was disease humoral and immunity only afforded to those with the correct composition of the four bodily humors? Was disease iatrophysical and immunity possible only through proper bodily mechanics? Was disease iatrochemical and immunity only possessed by those with “balsamic blood”?3

Before those questions were either answered or even fully understood, the advent of variolation was upon us. Long since removed from the intuition of immunity, now came the shared eureka moment of cross-immunity in the late 18th century: English farmer Benjamin Jetsy and physician Edward Jenner independently noted that milkmaids seemed to be unaffected by the smallpox running rampant around them à la 5th century BC Athens.4 Jenner’s work in conferring immunity to the Variola virus from cowpox pustules proved sufficient to kickstart a movement that swept the Western world—the first vaccine was born. Enter the 19th century work of Louis Pasteur, and the composition of a vaccine could not only be more than mere “cow substance,” but also now did not necessitate even a mild illness upon administration. Through Pasteur, the vaccination possibilities for which infectious agents to provide immunity to, and how to go about creating such vaccines, seemed limitless.5, 6

Now that so much of the groundwork of vaccinology had been laid down, the 20th century finally provided an opportunity to retroactively answer the questions of the origin of immunity. Emil von Behring won the first Nobel Prize in Physiology or Medicine in 1901 for his work on serum therapy, whereby he demonstrated that endogenous antibodies could neutralize infectious agents,4 drawing a stark contrast between Jenner and Pasteur in that immunity was not directly transferred from infectious particles themselves. Von Behring’s work on antibodies would be furthered by the discovery of specific receptorligand binding by Paul Ehrlich,7 and the structure of the antibody itself by Gerald Edelman and Rodney Porter, garnering them the Nobel Prize in 1972.

Coinciding with a greater understanding of the mechanism through which vaccines work, as well as their efficacy, came sweeping measures to ensure the population at large were protected against now-preventable diseases. General Washington saw to it that his Continental Army was vaccinated against smallpox,6 while President Thomas Jefferson sought public health vaccination initiatives.5 The Supreme Court of the United States put forth landmark decisions in Jacobson v. Massachu-

setts (1905), which upheld the authority of states to enforce compulsory vaccination laws, and in Zucht v. King (1922), which upheld school districts’ ability to exclude unvaccinated students from matriculation. By the 1980s, all states had compulsory vaccine laws regarding schooling. However, during this time, antivaccination movements widened their scope to include not only an objection to government overreach, but also the government’s proclivity to knowingly administer insidious vaccines.8

And while the antivaccination movement increased momentum in recent years, we also witnessed outbreaks of vaccine-preventable diseases among unvaccinated populations. The pivotal example of adverse effects of decreased vaccination has been several outbreaks of measles in populations with low immunization rates. In 2008, an intentionally unvaccinated child knowingly infected with measles returned to San Diego from a trip to Europe. Subsequently, 850 cases of measles were reported that traced back to exposure to the individual. Of the 850 cases, 75% (637) were intentionally unvaccinated as well, with an additional 48 children who were too young to be vaccinated becoming hospitalized.9

And so, while the scientific field of vaccinology is one that is still fairly new, the fundamental experience of human immunity to disease has been expressed in simple terms throughout recorded history. Over the past two centuries since its inception, our understanding of vaccines has widened such that the mechanisms by which they work are better understood, ultimately improving their efficacy and safety. But despite the remarkable inroads that have been made in the field of vaccinology, there is a growing degree of hesitance to their administration, resulting in a growing number of new outbreaks to many vaccine-preventable diseases. Therefore, as part of a growing public health initiative, our research team sought out to identify and eventually combat the etiology of information that yields hesitance to vaccines. To do this, we designed a study for the purposes of establishing correlation with the suspected etiology of vaccine hesitance and its prevalence is a case-control, retrospective study.

The groups involved fall under one of two categories: 1. those parents/guardians who choose to vaccinate their children indicating no hesitation and 2. those parents/guardians who choose not to vaccinate their children indicating hesitation. The survey we developed then explores the patients’ history for exposure to the risk factors (anti-vaccination information). This provides four distinct numbers labeled A, B, C and D. A indicates the total sample with vaccine hesitation who have also been exposed to the risk factor. B indicates the total sample without vaccine hesitation who were exposed to the risk factor. C indicates the total sample with vaccine hesitation who were not exposed to the risk factor. D indicates the total sample without vaccine hesitation who were not exposed to the risk factor. The odds ration formula is then applied to determine correlation of risk exposure to prevalence. At this point in time, our research findings are still in their infancy, but our research team hopes to yield its findings within the near future.

Rebecca L Sanchez, PhD is an Assistant Professor of Microbiology at the UIWSOM. Omar A. Caballero, MS, OMS-II and Travis B. Fenlon, OMS-II are second year Osteopathic Medical Students at the UIWSOM. References 1. Littman RJ. The Plague of Athens: Epidemiology and Paleopathology. Mount

Sinai Journal of Medicine: A Journal of

Translational and Personalized Medicine. 2009;76(5):456-467. doi:10.1002/msj. 20137 2. Thucydides. Book II, Chapter VII, The

Plague of Athens. In: History of the Peloponnesian War. 2nd ed. London: J.M.

Dent; 1914:132-132. 3. Silverstein AM. Chapter 1, Theories of acquired immunity. In: A History of Immunology. 2nd ed. New York, New York:

Academic Press; 2009:5-11. 4. Plotkin SA, Plotkin SL. The development of vaccines: how the past led to the future.

Nature Reviews Microbiology. 2011;9(12):889-893. doi:10.1038/nrmicro2668 5. Stern AM, Markel H. The History Of Vaccines And Immunization: Familiar Patterns, New Challenges. Health Affairs. 2005;24(3):611-621. doi:10.1377/hlthaff.24.3.611 6. Plotkin SA. Vaccines: past, present and future. Nature Medicine. 2005;11(S4):S5-

S11. doi:10.1038/nm1209 7. Hilleman MR. Vaccines in historic evolution and perspective: a narrative of vaccine discoveries. Vaccine. 2000;18(15):1436-1447. doi:10.1016/s0264-410x(99)00434-x 8. Toward a Twenty-First-Century Jacobson v. Massachusetts. Harvard Law Review. 2008;121(7):1820-1841. www.jstor.org/ stable/40042718. Accessed November 9, 2020. 9. Sugerman DE, Barskey AE, Delea

MG, et al. Measles Outbreak in a Highly

Vaccinated Population, San Diego, 2008:

Role of the Intentionally Undervaccinated.

PEDIATRICS. 2010;125(4):747-755. doi:10.1542/peds.2009-1653

Bearing Witness Through Stories By Kristy Y. Kosub, MD

Medical students at the Long School of Medicine, UT Health San Antonio, continue to engage in Project 6 -55, a guided reflective writing workshop where they write and share 6-word and 55-word stories about patient care experiences during their clinical clerkships. Writing stories gives our students the opportunity to connect more deeply with the illness experience of their patients. Their narratives share themes of vulnerability, responsibility and empathy, as they bear witness to patients’ sickness and trauma and attempt to understand their role… to listen and to be present with the patient in their suffering. ~ Kristy Y. Kosub MD, Professor, Department of Medicine, UT Health San Antonio

I only drink 3 or 4 I only drink 3 or 4 a week, I’ve cut down. Yellow, distended belly, puffed up legs. I don’t crave alcohol anymore, I haven’t stopped because my doctor told me it’s dangerous to stop completely. Tremulous, sweat, weakness. Feel free to call my wife and ask her. Hello?..... It’s been this way for 40 years. ~ Gabriela Guerrero

Sister Beginning of a trauma shift. In yellow gowns, goggles, N95s. What happened? Multiple people MVC. Who’s got the pedi? I volunteer. She rolls in, clutching a Frozen blanket. Assess her head-to-toe. Where’s my sister? I don’t know. Her question echoes in the CT. The resident types into her chart. Today, she is an only child. ~Chelsea Wu

Find the needle in the haystack The patient arrived after his fall. He gazed upon me, frustrated. Before speaking, his eyes communicated the countless workups, years of uncertainty, and moment after moment of disappointment. As I stepped closer, he extended his hand and reached to me. I followed and extended mine, our hands meeting. “Find the needle in the haystack, please.” ~ Frank Jing He’s ready to go home now “The bluebonnets at our house are lovely –like heaven.” She wants to move him there, surrounded by everything they grew together. “I love him so much, I’m not ready.” For a second, I see my husband lying there instead of hers. “He said he’s ready to go home, but I don’t think he means Kerrville.” ~ Madison Feng

Hello! My name is student doctor… And I’ll be taking a history and… oh, really? Sorry to hear. Sounds like you’ve been through a lot. When did your symptoms… oh ha ha! That’s really funny. I like your outlook. Do you mind if I check your blood… oh, I’m a third year. Your son too? That’s awesome! Okay, see you tomorrow. ~ Rahul Patel

I have my God, he says A terrible fever, a necrotic ulcer, a veteran staunchly refusing surgery. But you may die, we say. I believe in my God, he says. We want to save your life, we say. I have my God, he says. We’re out of options, we say. Then I suppose we’re done, he says. And he was gone. ~ Anonymous

A life saved, but skin flawed I could feel the eyes of the patient even though they slept. It stings to know that out of all the work, all the expertise in that room, all the patient would see when they wake would be the work of a student. The marks left behind, an everlasting scar for them and for me. ~Ryan Molina

I just want to feel normal Narcan brought him back. ESRD and tied to a hemodialysis machine. Necrotic foot with unfathomable pain. He told his story while holding his foot in pain, picking off a chunk of desiccated skin. Abandoned by his loved ones. I just want my mother. I just cannot take it anymore. I just want to feel normal. ~ Jeffrey Xia

Young mom with pain, life changed She is just 35 with a 7-year-old at home. Now she’s in a hospital bed, scared, alone. She came in for aches and pain. Doctor said it’s cancer, stage 4. Started in her breast, now in her bones. Too young for screenings, no family history. Who could have guessed this was coming next. ~Kalli Henning

He kept reaching for his words Unknown male patient, brought in by EMS. I first met him in the ED, nervous he would tell me to leave him alone or go away. Nervous he would ask me for something I could not give. Most days his prognosis stayed the same; ischemic stroke, damage done. But he kept reaching for his words. ~Brittany Hansen

Pen & Paper By Chase Ballard

When we have the opportunity to provide health care abroad, it is a transition for us — and also for those who invite us in. We may spend months preparing for the trip by attending classes, communicating with community partners and talking with people who have gone before us to help ease the transition. It is always easier said than done. During my time with the Kisoboka Uganda team, I realized that in knowing everything about a community or culture, it’s the simple things that allow us to break the international ice. Something as simple as a pen and paper can give patients knowledge of their medical histories or serve as a sketchpad for children so they can feel more comfortable with a stranger asking them random questions. I feel as though the simple things allow us to bridge the gap between cultures and help us to provide better care.

I took this photo during my pre-clinical years, and now that I am at the end of my clinical year, it’s even more apparent how valuable the connection between physician and patient is. Arguably this could be one of the most critical aspects of patient care, especially for a medical student who still struggles to pronounce Levetiracetam (or remember the brand name!).

Throughout my time as a third-year medical student, I have witnessed another gap between ourselves and our patients. We learn about all these different scans and labs that promise more accurate diagnoses to provide treatment for specific diseases. We learn how to navigate through different electronic medical systems, which are supposed to provide effortless communication between providers. Rotation after rotation, we learn the labs, studies, imaging, exam findings, medications and treatment plans in that respected specialty. All of these have allowed us to become more efficient at treating a disease, but it appears to have disrupted the ability to develop and maintain that connection.

Maybe there is a reason a patient can’t recall the names of their medication, which labs or scans were done, or the name on the white coat they saw last week. It does make our jobs more manageable when we can look this all up ourselves, so it may not seem like a big deal. However, seeing all those notes can trap us into thinking about a patient, in the same way, blinding us to something else that may be going on. New information and clues turn up in face-toface conversations, in the initial visit or a followup, not with a quick glimpse at the computer screen. In the few months of my medical “career,” I have had some of the most moving and meaningful experiences with patients when I let them tell their story initially, with only having my pen and paper in hand.

Chase Ballard is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2022.

Photograph features Dana Glaser, Class of 2022, talking with a young boy on a global health trip to Uganda.

Artistic Expression in Medicine

By Kristy Y. Kosub, MD, Professor, Department of Medicine, UT Health San Antonio

Medical training and the practice of medicine are immensely rewarding, but also rigorous and at times exhausting. Public health crises such as the pandemic, clinician burnout, persistent social and racial injustices and health inequities also challenge efforts to provide whole person care and create a healthier community. Many medical students and physicians are inspired by art as a companion to the study of medicine and a resource for self-expression and finding meaning in their work. The American Association of Medical Colleges (AAMC) has a comprehensive monograph on The Fundamental Role of Arts and Humanities in Medical Education (https://www.aamc.org/what-wedo/mission-areas/medical-education/frah me) that provides an in-depth overview of the importance of the health humanities and art in clinician well-being and understanding of the human condition. In particular, art has been found to improve visual observation skills, communication skills, empathy, reflective skills and tolerance for ambiguity. A core mission of the Center for Medical Humanities & Ethics (CMHE) at UT Health San Antonio is to “nuture empathy and humanitarian values to prepare tomorrow’s healers to act with compassion and justice.” Art and literature have this power. The annual CMHE publication of a literary and visual arts journal, Connective Tissue, allows contributing artists and readers of the journal a shared human experience through art and creative writing. Here are the artistic works of a few of our students.

Rivers and Roots, pen and watercolor by Maggie Carroll, Class of 2021, Long School of Medicine, UT Health San Antonio

Creating art is the way I integrate myself into medicine. By engaging with anatomy on an artistic level, I find myself better able to appreciate the idiosyncrasies of the human body as well as deepen my understanding of its complexities. Art feeds the humanistic, creative aspect of my personality and thereby allows me to connect more deeply with my patients and coworkers. In a way, it’s the foundation of the work I do on a daily basis.

Layers

by Amanda Means, Class of 2022, Long School of Medicine, UT Health San Antonio

While drawing "Layers" I was inspired by the beauty and complexity found in the study of medicine. The overlap between natural sciences and the humanities is something that I enjoy in this field and have been able to use as a source of creativity.

Still Life: Fresh Summer Figs

by Sammar Ghannam, Class of 2021, Long School of Medicine, UT Health San Antonio

This is an oil painting inspired by the beauty in nature that surrounds us in our daily lives. I constantly find myself in awe of the beauty and meticulous organization of colors, textures and patterns in nature. My love for creating and appreciating art led me to choose diagnostic radiology as my medical specialty. I am so fortunate to be able to put my skills and passion for the visual arts to work when I use various imaging modalities to help my patients lead healthier lives. I know that the very visual and artistic field of diagnostic radiology will give me so much meaning, value and purpose in my personal practice of medicine.

Spring Flowers

by Jonathan Espenan, Class of 2021, Long School of Medicine, UT Health San Antonio and incoming resident in UTHSA Psychiatry Residency Program; Gabree Torres, Licensed Clinical Social Worker and Therapist at UT Mental Health Transitional Care Clinic

Inspiration: We both really enjoy the beauty of flowers and had an idea that doing smaller-sized paintings would be fun. We each did three 4" by 4" acrylic paintings to make a series together. We paint because it is fun, it helps us to relax and when we paint, we connect with beautiful things. We use our experience with art to help our patients find meaningful things in their lives.

Lilac-Breasted Roller, oil paint on 4”X4” wood panel by Paula Lorena Pérez, Class of 2022, Long School of Medicine, UT Health San Antonio

I am interested in pediatric hematology-oncology and palliative care. Born in Laredo and raised in the Rio Grande Valley, I became interested in art through the native ecosystems of South Texas at a very young age. Throughout schooling, I held a strong passion for medicine and further continued studies in biology, chemistry and art at St. Mary's University. I now find art through my anatomy studies, particularly in the cadaver lab, and continue to paint in my spare time as an expressive outlet.

Lessons

By Aarushi Aggarwal

I will readily admit I was ecstatic with the idea of a quarantine: a surmise so perfect for a homebody like myself. It was an opportune reason to shy away from certain encounters and to spend hours wrapped in the embrace of a cozy blanket. It’s as if the world slowed down, so that I could see the value of every minute. Perhaps this was the reason that cabin fever struck at a much later time than those around me. I relished being home, surrounded by loved ones, strengthening existing relationships that had been subdued by both time and distance. I was given the headspace, to finally pursue interests I had only longed to try. Yet even then, there were wisps of time, where I would sit on the porch, whipped coffee in hand and just feel sorry for everyone crushed by the toils of the year, myself included. I thought of those, with no choice but to work in unsafe conditions: those who suddenly had their meals vanish from the table, those who had fallen fifteen steps after climbing ten towards their dreams. People say just surviving is a feat itself, I agree; humbling moments that anchored people to the ground and thousands of lessons learned along the way. So, I’d like to share just one of mine. I have chosen a career in which a patient’s social situation is of equal importance to their health. I thought my eyes were already wide open, yet there was still room to open them further, after witnessing how a crippling blow in the right place, at the right moment, could bring a man on his knees and how a stranger passing by, who carries the remnants of a similar blow could help the fallen man back on his feet, so that he then could do the same for others, down the road.

Aarushi Aggarwal is a medical student at the Long School of Medicine, UTHSA, Class of 2022.

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INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze 512-658-0262 Kirsten.Baze@medpro.com www.medpro.com

ProAssurance (HH Silver Sponsor) ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group is A.M. Best A+ (Superior). Delano McGregor Senior Market Manager 800.282.6242 ext 367343 DelanoMcGregor@ProAssurance.com www.ProAssurance.com/Texas

continued from page 41 INTERNET TELECOMMUNICATIONS

Unite Private Networks (HHH Gold Sponsor) Unite Private Networks (UPN) has offered fiber optic networks since 1998. Lit services or dark fiber – our expertise allows us to deliver customized solutions and a rewarding customer experience. Clayton Brown - Regional Sales Director 210-693-8025 clayton.brown@upnfiber.com David Bones – Account Director 210 788-9515 david.bones@upnfiber.com Jim Dorman – Account Director 210 428-1206 jim.dorman@upnfiber.com www.uniteprivatenetworks.com “UPN is very proud of our 98% customer retention rate”

MEDICAL BILLING AND COLLECTIONS SERVICES

PCS Revenue Cycle Management (HHH Gold Sponsor) We are a HIPAA compliant fullservice medical billing company specializing in medical billing, credentialing, and consulting to physicians and mid-level providers in private practice. Deion Whorton Sr. CEO/Founder 210-937-4089 inquiries@pcsrcm.com www.pcsrcm.com “We help physician streamline and maximize their reimbursement by 30%.”

Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”

MEDICAL PHYSICS

Medical & Radiation Physics, Inc. (HHH Gold Sponsor) Medical physics and radiation safety support covering all of South Texas for over 40 years. Diagnostic imaging, radiation therapy, nuclear medicine and shielding design. Licensed, Board Certified, Experienced and Friendly! Alicia Smith, Administrator 210-227-1460 asmith@marpinc.com David Lloyd Goff, President 210-227-1460 dgoff@marpinc.com www.marpinc.com Keeping our clients safe and informed since 1979.

MEDICAL SUPPLIES AND EQUIPMENT

CSI Health (HHH Gold Sponsor) CSI Health is a telehealth technology company providing customized solutions to healthcare professionals, assisted-living facilities, and more. CSI was founded in 1978, it was one of the first companies to move medical testing information from self-service kiosks into the cloud. Brad Bowen President, CEO 210-434-2713 brad@computerizedscreening.com Katherine Biggs McDonald Brand Development Manager 210-434-2713 katherine@computerizedscreening.com Bobby Langenbahn National Sales Manager 210-363-1513 bobby@computerizedscreening.com www.csihealth.net Extend the Reach of Healthcare. Elevate the Level of Remote Care. Enhance the Patient Experience.

Henry Schein Medical (HH Silver Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 to 50 percent.” MOLECULAR DIAGNOSTICS LABORATORY

iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”

PRACTICE SUPPORT SERVICES

Medical & Radiation Physics, Inc. (HHH Gold Sponsor) Medical physics and radiation safety support covering all of South Texas for over 40 years. Diagnostic imaging, radiation therapy, nuclear medicine and shielding design. Licensed, Board Certified, Experienced and Friendly! Alicia Smith, Administrator 210-227-1460 asmith@marpinc.com David Lloyd Goff, President 210-227-1460 dgoff@marpinc.com www.marpinc.com Keeping our clients safe and informed since 1979.

PROFESSIONAL ORGANIZATIONS

The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more! President, Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Valerie Rogler, Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet” San Antonio Group Managers (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising. Tom Tidwell, President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

CARR Healthcare (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of healthcare real estate experts assist with start-ups, renewals, , relocations, additional offices, purchases and practice transitions. Brad Wilson Agent 201-573-6146 Brad.Wilson@carr.us Jeremy Burroughs Agent 405.410.8923 Jeremy.Burroughs@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”

The Oaks Center (HH Silver Sponsor) Now available High visibility medical office space ample free parking. BCMS physician 2 months base rent-free corner of Fredericksburg Road and Wurzbach Road adjacent to the Medical Center. Gay Ryan Property Manager 210-559-3013 glarproperties@gmail.com www.loopnet.com/Listing/84348498-Fredericksburg-Rd-SanAntonio-TX/18152745/

STAFFING SERVICES

Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

TELEHEALTH TECHNOLOGY

CSI Health (HHH Gold Sponsor) CSI Health is a telehealth technology company providing customized solutions to healthcare professionals, assisted-living facilities, and more. CSI was founded in 1978, it was one of the first companies to move medical testing information from self-service kiosks into the cloud. Brad Bowen President, CEO 210-434-2713 brad@computerizedscreening.com Katherine Biggs McDonald Brand Development Manager 210-434-2713 katherine@computerizedscreening.com Bobby Langenbahn National Sales Manager 210-363-1513 bobby@computerizedscreening.com www.csihealth.net Extend the Reach of Healthcare. Elevate the Level of Remote Care. Enhance the Patient Experience.

Join our Circle of Friends Program

The sooner you start, the sooner you can engage with our 5700 plus membership in Bexar and all contiguous counties. For questions regarding Circle of Friends Sponsorship please contact: Development Director, August Trevino august.trevino@bcms.org or 210-301-4366

The Bexar County Medical Society is proud to welcome a Renewing Platinum Sponsor to our Circle of Friends program.

Full Size GM SUVs

By Stephen Schutz, MD

GM is hitting their stride with SUVs these days, particularly since they launched their all-new full-size models, the 2021 Chevrolet Tahoe/Suburban, GMC Yukon/Yukon XL and Cadillac Escalade/Escalade ESV last year. All of those vehicles have been selling strongly since they were introduced—in fact, many have found happy homes with BCMS members and their families.

Besides the usual evolutionary changes—updated styling, nicer interiors and more efficient powertrains—the big news with this generation of GM’s full-size SUVs is that the “smaller” versions are now bigger. One complaint about the Tahoe, Yukon and Escalade was that, for big vehicles, they didn’t provide all that much second or third row seating space. That’s been fixed with the addition of 5 inches to the wheelbase, which has resulted in much more rear passenger space. In fact, things are so much better back there that I would imagine many buyers who would have ordinarily purchased longer wheelbase SUVs like the Suburban will get the shorter models and be pleased.

Another major enhancement for the big GM SUVs is a new independent rear suspension. Not only does that improve ride quality, but it also allows for a lower floor, which further expands storage space.

GM has done an excellent job positioning their full-size SUVs to where they’re almost irresistible to a wide swath of upscale parents and grandparents.

And now GM’s going to kill them. Ok not right now, but GM has vowed to stop making any internal combustion engine (ICE) vehicles after 2035, so these terrific family haulers are on the clock. What will current (satisfied) owners do then?

I think we’ve been given a hint of what’s coming from the Hummer pickup truck due later this year. It’s big and long, like a Tahoe, and it’s electric. Not hybrid mind you, fully electric.

My sense is that the electric Hummer pickup’s main objective is to work the kinks out of a platform that is ultimately meant to underpin an upcoming generation of full-size electric SUVs from GM. Vehicles that will do what today’s big SUVs do, but without gasoline powered engines. Current generation batteries aren’t good enough to allow electric SUVs to do what ICE SUVs can do yet, but I would imagine technological improvements will, at some point, give us electric family haulers that we’ll need and want. And since GM currently makes almost all of their profits from ICE-powered full-size SUVs and pickup trucks, the company needs those upcoming electric SUVs to be money makers.

Anyway, back to today. Since I wasn’t able to drive one of the 2021 full-size GM SUVs—I wanted an Escalade but one wasn’t available—I drove a much smaller Trailblazer, which actually serves as a reminder that Chevrolet, like most divisions of GM, has an SUV or crossover for almost everyone. What does that mean? In order of descending size, you can buy these SUVs from Chevy: Suburban, Tahoe, Traverse, Equinox, Blazer, Trailblazer and Trax.

The Trailblazer is small and modestly priced—the base MSRP is just under $20,000—and looks like something your medical assistant might drive. But it’s easy to live with and in some ways quite luxurious.

How small is it? It’s even smaller than the Honda CRV, and yet I never felt cramped in it despite my 6’ 2” frame. But that’s because I didn’t spend much time in the back seat, where things are less comfortable for adults than they are up front.

Driving the Trailblazer was pleasant thanks to a low curb weight and short wheelbase, which generally optimize handling. The 155 HP turbocharged 3-cylinder engine provided sufficient oomph for my regular driving duties, but I could imagine it struggling with a family of four and their gear on board, even if two of them were small children (the 137 HP base engine is not recommended).

Of course, if you frequently need to carry four people and lots of stuff, the friendly folks at Chevrolet would no doubt suggest that you consider one of their aforementioned larger family haulers.

It’s interesting that many features that were previously available only in luxury vehicles have now trickled down to lower end models. Keyless entry and engine start, Apple CarPlay/Android Auto, adaptive cruise control and more are either standard in the Trailblazer or available as options.

And despite its diminutive size, the Trailblazer has earned a 4-star safety rating from NHTSA. Not only are front and rear passengers surrounded by airbags, but important lessons learned over the years, such as positioning the seats farther inboard (and away from the doors) have also been applied in the Trailblazer.

Most BCMS members are interested in reading about GM’s new full-size SUVs, and I promise to review one as soon as possible. But spending time in one of Chevy’s much smaller crossovers was an eyeopening experience. The Trailblazer gives you just about everything you want in a family vehicle, except lots of space.

As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367), for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates.

Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995.