By Emily Liu, Melissa M. Donate, Zeba Bemat, Anuradha S. Helekar, MD and Blake A. Harrell, DO

from San Antonio Medicine October 2021

By Tue “Felix” Nguyen, Marie Vu and Caroline Zhu

The San Antonio Refugee Health Clinic:

Addressing Barriers to Refugee Mental Health

By Emily Liu, Melissa M. Donate, Zeba Bemat, Anuradha S. Helekar, MD and Blake A. Harrell, DO

he United Nations Refugee Agency defines a refugee as someone who has been forced to flee their country because of persecution, war or violence.1 In 2020 alone, 82.4 million people were forcibly displaced.2 This is an increase from past years, even with the COVID-19 pandemic slowing the rate of new displacement. Furthermore, the U.S. has historically resettled more refugees than any other country, with Texas often resettling the highest number of refugees compared to other states.3,4 Since 2010, more than 10,000 refugees have resettled in San Antonio as permanent residents.5

Though the specifics of refugee experiences vary widely, many of these individuals have had an arduous path, including forced displacement, a difficult journey away from their home country and the struggles associated with resettling in a new, unfamiliar country. Thus, an important consideration to make when characterizing the health needs of refugees is to examine the trauma they experience preflight, during flight and in resettlement.6 These stressors put refugees at an increased risk for mental health disorders.7,8 On average, one in every three refugees experience depression, anxiety or PTSD, with prevalence rates ranging between 20-80%, depending on the population.9 Despite the high prevalence of mental health concerns, many refugees do not seek out mental health

Tcare. Common structural barriers include lack of access to health insurance, logistical barriers (transportation, child care needs, access to care, etc.) and language or other communication barriers.10,11 Of note, refugees admitted to the United States are provided short-term health insurance called Refugee Medical Assistance for eight months.12,13 However, after that expires, up to 50% of refugees may be uninsured, even with policies which allow for immediate access to Medicaid, CHIP and the health care marketplace. Language and communication barriers complicate all stages of health care, through filling out health insurance forms, scheduling appointments and filling prescriptions.11

Differences in cultural beliefs surrounding health care is another social barrier that must be addressed.11 Due to previous health care experiences, refugees often have different expectations of health care compared to native U.S. citizens. For instance, some refugees are not accustomed to preventative care or having providers who are a different gender from themselves.11 This can contribute to negative perceptions of medical care. Finally, stigma around mental health disorders may deter seeking care due to fears of hospitalization, alienation from their community, being seen as “crazy” or loss of confidentiality.14

Finally, the detection of mental health problems in refugees can be challenging due to differences in mental health conceptualization.10,15 For example, mental health presentations in refugees may not adhere to the norms of what is considered a “symptom” of a mental health disorder. For example, previous trauma experienced by refugees can present through somatic symptoms which cause distress, a phenomenon known as somatization.16 Furthermore, some refugees may believe their symptoms and/or mental health concerns have no treatment.14 Others may also think that talking about mental health problems can worsen their condition, and thus, it is best not to discuss it.14

There is still much to do regarding the appropriate treatment for refugees and asylum seekers. Providers can open meaningful discussions and provide education to destigmatize symptoms and mental health services, as well as make refugees more comfortable during visits with the use of direct questions and trained interpreters.17 Another potential solution is through a holistic approach focusing on collaboration with local community partners to decrease risk factors for adverse mental health outcomes.

An evidence-based intervention to detect ongoing mental health concerns for the purpose of connecting with care is through the use of culturally competent screenings for refugee mental health, such as the Refugee Health Screener 15-item questionnaire (RHS-15). The RHS-15 is a sensitive, validated instrument for screening various refugee populations for emotional distress and mental health considerations.18 The RHS-15 has been translated and validated for use in several languages. The translated screeners have language-specific semantics to ensure the meanings are accurate in their own language. The screener is only recommended for use if there are adequate resources available for the conducting and scoring of screenings, as well as the method of referral for further evaluation and treatment.18

Program Overview:

The San Antonio Refugee Health Clinic (SARHC) is a collaborative effort of students and faculty from medical, nursing and dental schools at the University of Texas Health Science Center San Antonio. The clinic is held weekly at a local church, within walking distance of an area where a significant portion of the city’s refugee community has settled. The SARHC provides free preventive and acute medical, psychiatric and dental care to uninsured and underinsured members of the refugee community. On-site interpreters help facilitate communication between providers and patients. In addition to health concerns, patients can consult the Center for Refugee Services (CRS). The center often has representatives on-site for social needs, including employment opportunities, ESL classes and citizenship applications. The SARHC has made additional efforts to be community- and patient-centered by allowing walk-in services and providing prayer mats as needed for religious practices.

In 2018, SARHC began working with UT Health Psychiatry residents and faculty to provide mental health care in response to community-expressed need, titled “Wellness Nights.” At weekly SARHC clinics, patients can request to be seen or referred by their medical provider to psychiatry staff, who see patients monthly. Additionally, medical student coordinators have implemented screening with the RHS-15. Once someone is identified as potentially benefitting from referral to wellness resources, medical student coordinators are the first point of engagement, normalizing the need to request help for their mood and/or physical symptoms, while also providing context around psychiatric services. Patients who consent to being seen will then be scheduled for a future Wellness Night appointment by a psychiatrist. Since April 2019, 35 patients have received both acute and long-term, follow-up care through Wellness Night. Common diagnoses seen include depression (57%), PTSD (34%) and anxiety (26%), with many patients having comorbid disorders. Medications are provided on-site via a pharmacy stocked through the Center for Medical Humanities and Ethics at UTHSCSA. Labs can also be performed through University Health.

continued from page 29

Future opportunities for growth include expansion of mental health services outside of psychiatric care. Some patients express reluctance to see a psychiatrist, but would potentially be open to approaches such as talk therapy or support groups. In addition, as student coordinators, we hope to engage student volunteers more meaningfully through Wellness Nights. Recently, Wellness Night staff held a training session for RHS-15 survey administration, trauma-informed care and handling challenging patient encounters. This also allows student volunteers from multiple disciplines to participate in screening. Our work would not be successful without the years of trust that the SARHC and CRS have built within this community. It has been inspiring to see the relationships built through the dedication of faculty, residents and students. Furthermore, the experience of engaging our patients in these vulnerable conversations has been a privilege, and this opportunity has been invaluable to practice trauma-informed care and psychological first aid. We look forward to drawing on these experiences in our future practice as students and physicians.

References: 1. What is a REFUGEE? Definition and

Meaning: USA for UNHCR. Definition and Meaning | USA for UNHCR. https://www.unrefugees.org/refugeefacts/what-is-a-refugee/. Accessed September 6, 2021. 2. Refugee statistics. USA for UNHCR. https://www.unrefugees.org/ refugee-

facts/statistics/. Accessed September 6, 2021. 3. Fact sheet: U.S. refugee resettlement. National Immigration Forum. https://immigrationforum.org/article/fact-sheet-u-s-re fugee-resettlement/. Published November 5, 2020. Accessed September 6, 2021. 4. Krogstad JM. Key facts about refugees to the U.S. Pew Research Center. https://www.pewresearch.org/fact-tank /2019/10/07/key-facts-about-refugeesto-the-u-s/. Published August 20, 2020.

Accessed September 6, 2021. 5. Center for Refugee services located in

San Antonio, Texas. Center For Refugee

Services. https://sarefugees.org/. Published August 20, 2021. Accessed September 6, 2021. 6. Mental Health. Refugee Health Technical

Assistance Center. https://refugee-

healthta.org/physical-mental-health/mental-health/. Accessed September 6, 2021. 7. Schlaudt VA, Miller AB. Refugee communities. APA PsycNet. https://psycnet.apa .org/record/2019-70450-017. Published 2019. Accessed September 6, 2021. 8. Peterson C, Poudel-Tandukar K, Sanger

K, Jacelon CS. Improving mental health in Refugee Populations: A Review of intervention studies conducted in the

United States. Issues in Mental Health

Nursing. 2020;41(4):271-282. doi:10.1080/0161 2840.2019.1669748 9. Turrini G, Purgato M, Ballette F, Nosè M,

Ostuzzi G, Barbui C. Common mental disorders in asylum seekers and refugees:

Umbrella review of prevalence and intervention studies. International Journal of

Mental Health Systems. 2017;11(1).

doi:10.1186/s13033-017-0156-0 10. American Psychological Association,

Presidential Task Force on Immigration. (2012). Crossroads: The psychology of immigration in the new century. Retrieved from http://www.apa.org/topics/immigration/report.aspx 11. Morris MD, Popper ST, Rodwell TC,

Brodine SK, Brouwer KC. Healthcare barriers of refugees post-resettlement. J

Community Health. 2009;34(6):529538. doi:10.1007/s10900-009-9175-3 12. Health insurance. The Administration for Children and Families. https://www.acf.hhs.gov/orr/programs/refugees/health. Accessed September 6, 2021. 13. Refugee populations. Centers for Disease

Control and Prevention. https://www.cdc .gov/coronavirus/2019-ncov/need-extraprecautions/refugee-populations.html# :~:text=Underlying%20medical%20conditions%20and%20lower%20access%20t o%20care&text=However%2C%20after %20their%20short-term,of%20 refugees%20may%20be% 20uninsured.

Accessed September 6, 2021. 14. Shannon PJ, Wieling E, Simmelink-Mc-

Cleary J, Becher E. Beyond stigma: Barriers to discussing mental health in refugee populations. Journal of Loss and

Trauma. 2014;20(3):281-296. doi:10.1080/ 15325024.2014.934629 15. Song S. Mental Health Facts on Refugees,

Asylum-seekers, & Survivors of Forced

Displacement. https://www.psychiatry. org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-Refuge es.pdf. Accessed September 6, 2021. 16. Rohlof HG, Knipscheer JW, Kleber RJ.

Somatization in refugees: A review. Social Psychiatry and Psychiatric Epidemiology. 2014;49(11):1793-1804. doi:10.1007 /s00127-014-0877-1 17. Shannon PJ. Refugees' advice to physicians: How to ask about mental health.

Family Practice. 2014;31(4):462-466.

doi:10.1093/fampra/cmu017 18. Hollifield M, Verbillis-Kolp S, Farmer B, et al. The refugee Health SCREENER15 (RHS-15): Development and validation of an instrument for anxiety, depression, and PTSD in refugees. General Hospital Psychiatry. 2013;35(2):202-209. doi:10.1016/j.genhosppsych.2012.12.002

Emily Liu and Melissa M. Donate are medical students at the UT Health Long School of Medicine and serve as Wellness Coordinators at the San Antonio Refugee Health Clinic (SARHC). Zeba Bemat is a medical student at the UT Health Long School of Medicine and served as a previous Wellness Night Coordinator. Anuradha S. Helekar, MD and Blake A. Harrell, DO are Wellness Night Resident Coordinators and resident members of the Bexar County Medical Society.

Post-COVID Complications and Neurological Sequelae: PM&R Perspective

By Monica Verduzco-Gutierrez, MD and Carol Li, MD

To date, millions of Americans who have been affected by COVID19 have residual symptoms that result in a heterogenous post-infectious condition referred to as “long COVID syndrome,” or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). The CDC has now defined this as persistent symptoms after initial infection with a lack of return to usual state of health that lasts more than four weeks.

Severity of acute illness correlates with post-COVID complications, as 36.4% of patients with severe COVID had a higher probability of neurological symptoms, such as acute disseminated encephalomyelitis, ischemic stroke and Guillain-Barre syndrome,1,6 compared to those with mild to moderate disease.2 However, persistent symptoms can also occur after noncritical COVID-19 infection. A recent prospective study reported 66% of patients with mild-moderate course had at least one symptom that persisted beyond 60 days.3

Management of this patient population has yet to be standardized, but a comprehensive and multidisciplinary approach is necessary. Since physiatry has a strong focus on medical complications impacting function, and many of PASC symptoms can have significant implications on quality of life and functional status, a multi-disciplinary PM&R led outpatient clinic for post-COVID recovery has been suggested.5

A Physiatric Approach to Care for Post-COVID Conditions: A Brief Overview

The most common PASC symptoms include fatigue, post-exertional malaise and decreased endurance. There are different therapeutic approaches when addressing these symptoms. Some patients may respond very well to a structured, progressive return-to-activity program with physical therapy. A proposed protocol for this progressive reconditioning is described in the Salman study,7 as well as by other resources such as ‘Couch to 5K’ put forth by National Health Service – England. For others who present more like myalgic encephalomyelitis/chronic fatigue syndrome, slower paced physiotherapy to address breathing pattern disorders and education on pacing and energy conservation are more helpful. For patients with persistent dyspnea with minor activities, pulmonary rehabilitation can be considered, especially for patients with respiratory failure requiring ICU admission.8 More research is needed for pharmacologic interventions, but amantadine and duloxetine have shown some benefits for improving central fatigue in the right patient population.

There may also be exacerbations of chronic pain symptoms. Multi-joint arthralgias or generalized myalgias can be responsive to NSAIDs, given the inflammatory pathophysiology of PASC. New onset paresthesias involving upper extremities or unmasking of premorbid asymptomatic neuropathies may also occur. In cases where paresthesia symptoms fall within a certain nerve distribution or associated with focal weakness, electrodiagnostic and nerve conduction studies may be indicated to localize the lesion or look for myopathy. Further physiatric evaluation on how these symptoms can be managed to maximize patient’s functional ability with orthotics, PT/OT, steroid injections or nerve blocks can be done.

“Brain fog” can manifest as cognitive impairment, behavioral changes, poor concentration and attention, short term memory deficits and psychological symptoms. A brief neurocognitive screen can be helpful. The mini mental status exam can be completed for inperson encounters. For patients with physical limitations where telemedicine platforms may be more effective, the Modified Telephone Interview for Cognitive Status can be useful in screening for mild cognitive impairment. Speech therapy can provide compensatory strategies and structured cognitive retraining, especially for patients who are experiencing cognitive symptoms that are functionally disruptive. The long-term effects on the central nervous system are poorly understood at this time, but because the inflammatory changes parallel that of accelerated intracellular aging exposed to multiple stressors over time,4 it has been suggested that the very persistence of this inflammation in the brain can potentially be associated with neurodegeneration. This may bring into light the potential role of incorporating a wellbalanced, anti-inflammatory diet and certain nootropic supplements in neuro-recovery.

Other common PASC symptoms seen in PM&R clinic include headaches, autonomic dysfunction and anosmia. Episodic migraine management can mostly follow the AAN guidelines,9 depending on phenotype. For migraines occurring more than 15 times a month, a

combination of magnesium oxide, riboflavin and coenzyme Q10 can be a good prophylactic before considering other sedative pharmacologic alternatives. Advanced imaging should be considered in patients with new onset headaches with auras or focal neurologic deficits. Anosmia may persist for as long as six months post infection, and a trial of intranasal steroids in conjunction with olfactory training can be considered before consulting ENT, while simultaneously monitoring for malnutrition as the impact of anosmia can affect oral intake. In addition to evaluating cardiopulmonary status, assessing autonomic dysfunction with regards to volume status, orthostatic intolerance with sit to stand changes and need for compression garments may also be necessary.

Adjustment post-COVID recovery can present as increased anxiety or depression. Patients with pre-morbid psychiatric conditions may be more at risk. This makes the collaboration with psychology and neuropsychology specialists invaluable. It is in this author’s opinion that managing neuropsychiatric symptoms can synergistically improve management of other symptoms of cognition, sleep disorders, headaches and fatigue, as they often coexist with each other. Most importantly, empowering patients with self-management strategies, appropriate coping strategies, educational resources about vaccination and data regarding the risk of re-infection is also important.

The frequency of outpatient follow-up care is variable and individualized depending on when the decision about clinical resolution of PASC symptoms is made and the return to baseline function has occurred. Given the complexity and variety of presentations of PASC, a collaboration between PM&R, primary care, therapy teams and various subspecialties is essential to further deepen our understanding of how to best manage the unique needs of this patient population. The increasing prevalence of PASC suggests that even as the pandemic evolves and restrictions begin to decrease, the demand for longterm follow up and rehabilitation management for COVID-19 survivors will continue to increase. The end goal is learning how to balance the use of available public health resources to match this demand while optimizing a patient’s daily routine, lifestyle or work/school performance.

References 1. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M, Meziani F. Neurologic Features in Severe SARS-CoV-2

Infection. N Engl J Med. 2020 Jun 4;382(23):2268-2270. doi: 10.1056/NEJMc2008597. Epub 2020 Apr 15. PMID: 32294339;

PMCID: PMC7179967. 2. Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan,

China. JAMA Neurol. 2020;77(6):683-690. doi:10.1001/jamaneurol.2020.1127 3. Carvalho-Schneider C, Laurent E, Lemaignen A, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021;27(2):258-263. doi:10.1016 /j.cmi.2020.09.052 4. Lippi A, Domingues R, Setz C, Outeiro TF, Krisko A. SARS-CoV2: At the Crossroad Between Aging and Neurodegeneration. Mov

Disord. 2020;35(5):716-720. doi:10.1002/mds.28084 5. Barratta JM et al. Post Acute Sequelae of COVID-19 Infection and

Development of a Physiatry-Led Recovery Clinic. American Journal of Physical Medicine & Rehabilitation. 2021 6. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A,

Kneen R, Defres S, Sejvar J, Solomon T. Neurological associations of COVID-19. Lancet Neurol. 2020 Sep;19(9):767-783. doi: 10.1016/S1474-4422(20)30221-0. Epub 2020 Jul 2. PMID: 32622375; PMCID: PMC7332267. 7. Salman D, Vishnubala D, Le Feuvre P, Beaney T, Korgaonkar J, Majeed A, McGregorA. Returning to Physical Activity after COVID 19. BMJ 2021;372:m4721. http://dx.doi.org/10.1136/bmj. m4721. Published: 08 January 2021 8. Al Chikhanie Y, Veale D, Schoeffler M, Pépin JL, Verges S, Hérengt

F. Effectiveness of pulmonary rehabilitation in COVID-19 respiratory failure patients post-ICU. Respir Physiol Neurobiol. 2021

May;287:103639. doi: 10.1016/j.resp.2021.103639. Epub 2021

Feb 12. PMID: 33588090; PMCID: PMC7879818. 9. Update: Pharmacologic treatment for episodic migraine prevention in adults. American Academy of Neurology Summary of Evidencebased Guideline for Clinicians. American Headache Society. 2012.

Monica Verduzco-Gutierrez, MD runs the Post-COVID Recovery Clinic at UT Health San Antonio. Carol Li, MD is the medical director of outpatient neurorehabilitation services at the Polytrauma Rehabilitation Center of the Audie L. Murphy VA Hospital. Dr. Verduzco-Gutierrez and Dr. Li are members of the Bexar County Medical Society.

How Social Determinants of Health Impact Wellness Programs

By Roxanne Leal

There are many factors that affect our health. We know that eating well, exercising and seeing a doctor when we are sick are simple steps that we can take to keep ourselves healthy, but our health is also affected by access to social and economic opportunities. Social determinants of health include the following factors:

• Socioeconomic status • Education • Neighborhood (zip code) • Physical environment • Employment • Social networks • Access to care

According to the Centers for Disease Control, “Poverty limits access to healthy foods and safe neighborhoods and more education is a predictor of better health. We also know that differences in health are striking in communities with poor social determinants of health, such as unstable housing, low income, unsafe neighborhoods, or substandard education.”

Addressing social determinants of health is important for improving health and reducing health disparities. Studies propose that health behaviors such as smoking, poor diet, lack of exercise and social and economic factors are the main drivers of health outcomes, and that social and economic factors can shape individuals’ health behaviors. Not only are social determinants of health important factors that affect overall health, but addressing them can also help reduce health disparities that are often rooted in social and economic disadvantages.

Education is Key

I grew up with my grandparents in a low-income community where nutrition wasn’t a high priority. As in the case with many low-income families, my grandparents did not really know enough about proper nutrition or how to create a healthy living environment to equip me with the proper resources for leading a healthy lifestyle.

How do we change this? I believe the key is education. When I was 18 years old, a friend took the time to show me how to eat healthy and the importance of exercise. I was able to change my nutrition and start engaging in regular physical exercise, which improved my overall well-being and enhanced my enthusiasm for living a healthy lifestyle. This friend is the reason I got into the corporate health world. Every time I make a nutrient-packed smoothie or go for a jog, I thank that friend. Thanks to that introduction to healthy living, I devoted my career to creating those opportunities for others.

Reaching out to those individuals who need educational resources can create positive change in the health of any employee population. The most effective and successful benefits programs are only further enhanced by education—both for leadership and employees. Through regular communication, you can give your employees tips on leading a healthy lifestyle such as balanced nutrition, regular exercise and regular health screenings. Provide information on the effects of smoking, obesity, alcohol use and unhealthy practices that can lead to high blood pressure, high cholesterol, stress and depression.

Understanding Your Employee Population

The success of a targeted wellness program is defined by each organization’s unique employee population. Building a successful wellness program that positively impacts the health of your employees begins with understanding their demographic makeup, baseline health status, and overall health and wellness education.

When creating wellness programs for your employees, it’s crucial to understand their living conditions, income and education levels and access to care. Un-

derstanding the population is the first step to creating a successful targeted program. According to the Office of Disease Prevention and Health Promotion, “By working to establish workplace policies that positively influence social and economic conditions and those that support changes in individual behavior, we can improve health for large numbers of people in ways that can be sustained over time.” Understanding the demographics of your workforce can help you determine what types of benefits will be most effective for your business and employees.

Building the Best Wellness Program for Your Employees

It’s important that you understand how your employees feel about the benefits you’re offering them so that you can continue to optimize your program over time. You can find out how your employees feel about your program by conducting surveys, analyzing provider reports, or studying provider and actuarial research. If you’re aware of what your employees like or don’t like about their benefits, you can make an effort to highlight those things in your regular communication. For example, if your plan includes a free annual biometric screening but your employees do not take advantage of it, you can include reminders in your communication program. Learning how your employees feel about their benefits will arm you with the information you need to revise your communications to meet realistic goals and expectations, your employees’ needs, your communication plan objectives and your business’s requirements.

Developing Healthy Partnerships

By taking the time to develop partnerships with local health vendors such as dietitians, fitness trainers and mental health professionals, and making access to these services easy to access and understand, organizations can provide their employees with resources and services that will help them stay healthy.

Whether your organization would like to add a corporate wellness program to your employee benefits plan, or would like to enhance an existing program, SWBC’s Employee Benefits Consulting Group can provide consulting services to help you design and maintain a plan that meets the requirements of your organization. SWBC can provide the analytical support, develop custom communication materials and assess the benefit to your company. Visit swb.us/custom-benefits to learn more.

Roxanne Leal has been with SWBC since December 2019. As a Wellness Program Manager, Roxanne specializes in developing strategic wellness programs based on high-cost claims, survey data and aggregate reports. She has worked in the health & wellness industry for over 7 years. SWBC is a Gold Circle of Friends Sponsor of the BCMS.

Chicken Soup for the ICU: A Review of “Kitchen Table Wisdom – Stories That Heal”

By David Alex Schulz, CHP

When Dr. Rachel Remen’s work was first published in 1996, it seemed a radical approach to healing. By its 10th anniversary reprint, it was seen as pioneering “new age” medical care and respected, if not fully adopted. Today, a quarter-century after its appearance, “Kitchen Table Wisdom” is doctrine. Call it “integrated,” call it “alternative,” call it “holistic,” Dr. Remen, as both a health care leader and long-time chronically-ill patient, invites us to consider wellness from a perspective that looks beyond diagnosis, increasing the scope to the widest angle possible.

First as a pediatrician, later as a counselor, Dr. Remen began exploring the spiritual dimension of the healing arts. Her experiences have taught her that life is "coherent, elegant, mysterious, aesthetic,” she writes. “When I first earned my degree in medicine, I would not have described life in this way. But I was not on intimate terms with life then."

Now, Clinical Professor of Family and Community Medicine at UCSF School of Medicine; Founder and Director of the Institute for the Study of Health and Illness at Wright State University Boonshoft School of Medicine in Dayton, Ohio; and author of The Healer’s Art, a groundbreaking curriculum for medical students, she is considered a leader of Relationship-Centered Care and Integrative Medicine.

More than seventy vignettes comprise “Kitchen Table Wisdom,” stories related by patients, colleagues, seers, clergy, and her own professional and personal testimony. Not all are concise parables with beginnings, middles and ends; some are homilies, others fables, salted with a scattering of straightforward philosophical discussions of essence and being; of experience and its meaning.

She tells of three stonecutters: the first, who saw his effort as boring piece-work; the second, who delighted in the same piecework, as it enabled his family a secure life; and the third, who saw the integral role his stones would have in the great cathedral for which they were cut. He saw their meaning. “Meaning may become a very practical matter for those of us who do difficult work or lead difficult lives. Meaning is strength. Physicians often seek their strength in competence. Indeed, competence and expertise are two of the most respected qualities in the medical subculture, as well as in our society. But important as they are, they are not sufficient to fully sustain us,” reflects Dr. Remen.

From the birth, through the span of life’s challenges (many selfimposed, such as an ‘urge to judgment’) to palliative care and beyond, Dr. Remen’s stories cross all borders and religions.

“As St. Luke wrote in Acts of Apostles 4:11, the stone rejected by the builders may prove in time to be the cornerstone of the building. What we believe about ourselves can hold us hostage. Over the years I have come to respect the power of people’s beliefs. The thing that has amazed me is that a belief is more than just an idea—it seems to shift the way in which we actually experience ourselves and our lives. According to Talmudic teaching, ‘We do not see things as they are. We see them as we are.’ A belief is like a pair of sunglasses. When we wear a belief and look at life through it, it is difficult to convince ourselves that what we see is not what is real,” writes Remen, who is equally conversant in Buddhist, Islamic and Hindu beliefs. “Kitchen Table Wisdom” finds its connective tissue in both how we affect one another, and the therapeutic effect of relating stories about healing. These narratives are about more than helping people embrace healthier lives: they lead to accepting the role that each person plays in others’ health, and understanding our own place in the cycle of life with serenity. I emphasize ‘our’ in the belief

that no health care professional can finish this book it without having found strong identification with at least one if not many of the situations, circumstances, conundrums, koans, or life-passages portrayed.

For example, her recounting of visiting a parent in palliative care, when the author’s mother imagined her own mother, the author’s namesake and long-passed, was also visiting: “My mother began to tell her mother Rachel about my childhood and her pride in the person I had become. Her experience of Rachel’s presence was so convincing that I found myself wondering why I could not see her. It was more than a little unnerving. And very moving. Periodically she would appear to listen and then she would tell me of my grandmother’s reactions to what she had told her.” No one attending a parent in the end-transition would find this story in the least remarkable or unusual except in its lucidity.

Dr. Remen is at heart an anti-reductionist, advocating that health simply cannot be explained in terms of its constituent parts and their interactions. She comments, “My tendency to tell stories had always been frowned upon by my medical colleagues and rejected as ‘anecdotal evidence.’ They preferred to measure truth in terms of hard data. So I had learned to keep my stories to myself.”

Dr. Dean Ornish agrees in the book’s forward, “Anecdotal evidence — in other words, stories — is viewed with suspicion by scientists. There are too many confounding variables, so the facts are harder to prove, to replicate.” Now, a quarter-century later, “Kitchen Table Wisdom” continues to defy reductionist thinking, using deeply moving and life-changing anecdotes, convincingly illustrating the remedial power of stories, from easing suffering and dispelling fear, to healing shame and restoring the sense of worth.

The reason it has been continually in print is the author’s sincerity: “In the end, I write about something I know intimately: that every one of us matters. And that we have the power to befriend and strengthen the life in one another and to change the world, one heart at a time.”

David Alex Schulz, CHP is a community member of the BCMS Publications Committee.

LETTER TO THE EDITOR

It is with pleasure that I write to commend you for the exceptional quality of San Antonio Medicine magazine. I appreciate reading about the most recent COVID developments, the workings of the Bexar County Medical Society, and the goings-on of our two sterling medical schools: the UT Health San Antonio Long School of Medicine and the University of the Incarnate Word School of Osteopathic Medicine. The ‘Art in Medicine’ feature reminds me of those JAMA covers and essays that I enjoyed for so many years. Book discussions by David Schulz are very entertaining as well. Keep up the good work!

Sincerely, Neal S. Meritz, MD

Neal S. Meritz, MD is a retired Family Practice physician and a member of the BCMS Publications Committee.

If you would like to send a letter to the editor of San Antonio Medicine magazine, please email editor@bcms.org. The Bexar County Medical Society is proud to welcome a New Platinum Sponsor

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Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”

ATTORNEYS

Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice. Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions” Norton Rose Fulbright (HHH Gold Sponsor) Norton Rose Fulbright is a global law firm. We provide the world’s preeminent corporations and financial institutions with a full business law service. We deliver over 150 lawyers in the US focused on the life sciences and healthcare sector. Mario Barrera Employment & Labor 210 270 7125 mario.barrera@nortonrosefulbright.com Charles Deacon Life Sciences and Healthcare 210 270 7133 charlie.deacon@nortonrosefulbright.com Katherine Tapley Real Estate 210 270 7191 katherine.tapley@nortonrosefulbright.com www.nortonrosefulbright.com “In 2016, we received a Tier 1 national ranking for healthcare law according to US News & World Report and Best Lawyers”

ASSETT WEALTH MANAGEMENT

Bertuzzi-Torres Wealth Management Group (HHH Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

BANKING

BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President 512.547.6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210.253.0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Shawn P. Hughes, JD Senior Vice President, Private Banking (210) 283-5759 shughes@broadway.bank www.broadwaybank.com “We’re here for good.”

The Bank of San Antonio (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. Brandi Vitier, 210-807-5581 brandi.vitier@thebankofsa.com www.thebankofsa.com

BB&T (HH Silver Sponsor) Banking Services, Strategic Credit, Financial Planning Services, Risk Management Services, Investment Services, Trust & Estate Services — BB&T offers solutions to help you reach your financial goals and plan for a sound financial future Claudia E. Hinojosa Wealth Advisor 210-248-1583 CHinojosa@BBandT.com www.bbt.com/wealth/start.page "All we see is you"

Synergy Federal Credit Union (HH Silver Sponsor) Looking for low loan rates for mortgages and vehicles? We've got them for you. We provide a full suite of digital and traditional financial products, designed to help Physicians get the banking services they need. Synergy FCU Member Services (210) 750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

BUSINESS CONSULTING

Medical Financial Group (★★★ Gold Sponsor) Healthcare & Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller & past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210.846.9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210.557.9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”

FINANCIAL ADVISOR

Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”

Elizabeth Olney with Edward Jones (HH Silver Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals. Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you. Elizabeth Olney, Financial Advisor 210-858-5880 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"

Bertuzzi-Torres Wealth Management Group ( Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending & estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Jeffrey Allison 210-268-1530 jallison@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Michael Leos Community Relations Manager Cell: 201-279-2442 Office: 210-376-3318 mleos@swbc.com swbc.com

HEALTHCARE BANKING

First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512.797.5129 Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”

Amegy Bank of Texas (HH Silver Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett EVP | Private Banking Manager 210 343 4556

Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President | Private Banking 210.343.4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President | Private Banking 210.343.4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210.343.4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”

HEALTHCARE TECHNOLOGY SOLUTIONS SUPPLIER

Nitric Oxide innovations LLC, (★★★ Gold Sponsor) (NOi) develops nitric oxide-based therapeutics that prevent & treat human disease. Our patented nitric oxide delivery platform includes drug therapies for COVID 19, heart disease, Pulmonary hypertension & topical wound care. info@NitricOxideInnovations.com (512) 773-9097 www.NitricOxideInnovations.com

HOSPITALS/ HEALTHCARE FACILITIES

UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Anderson Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options. Laura Kouba Manager, Physician Relations 210-265-7662 NorrisKouba@uthscsa.edu Lauren Smith, Manager, Marketing & Communications 210-450-0026 SmithL9@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229

INFORMATION AND TECHNOLOGIES

INSURANCE

TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need. Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

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

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”

INVESTMENT ADVISORY REAL ESTATE

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com

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 PAYMENT SYSTEMS/CARD PROCESSING

First Citizens Bank (★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512.797.5129 Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”

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”

MORTGAGES

SWBC MORTGAGE - THE TOBER TEAM (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Jon Tober Sr. Loan Officer Office: 210-317-7431 NMLS# 212945 Jon.tober@swbc.com https://www.swbcmortgage.com /jon-tober

PRACTICE SUPPORT SERVICES

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”

Foresite Real Estate, Inc. (HH Silver Sponsor) Foresite is a full-service commercial real estate firm that assists with site selection, acquisitions, lease negotiations, landlord representation, and property management. Bill Coats 210-816-2734 bcoats@foresitecre.com https://foresitecre.com “Contact us today for a free evaluation of your current lease”

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/

RETIREMENT PLANNING

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

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

2021 FORD BRONCO SPORT

By Stephen Schutz, MD

This is not a review of the new and long-awaited Ford Bronco. New Broncos are finally arriving at dealerships around the country to rapturous applause from anxious customers, many of whom put down hefty deposits over a year ago. But the Bronco Sport is not a Bronco.

In fact, it’s so different that I wondered why it’s named, “Bronco” at all. The real Bronco is a direct competitor to the Jeep Wrangler, and for that reason is a legit off-road intending big tough truck. The Bronco Sport, on the other hand, is a much smaller crossover SUV with styling elements that connect it to its big brother, but has nothing else in common with it. It’s not wrong to think of the Bronco Sport as a rebodied Escape.

A Ford Escape is a nice vehicle owned by many fine, hardworking Americans, but exciting it is not. Ford probably thought, “wouldn’t making a more ‘off-roady’ version generate some enthusiasm that the Escape can’t?”

Yes, it would, and after driving the Bronco Sport for a week, I understand why it’s here—for that enthusiasm.

Importantly, it looks way more like a Bronco than it does an Escape. Three people asked me what I thought of “the new Bronco” and were disappointed that it wasn’t that (all three said something like, “Oh that makes sense, it seems too small”).

Bronco-esque styling cues on the Bronco Sport include a boxy profile, an upright grille with the name “Bronco” across it in big letters, a hefty clamshell hood, short front and rear overhangs, and big chunky door handles.

I haven’t driven the Bronco yet—I very much hope to soon, by the way—but I’m certain that it will drive nothing like the Bronco Sport. The latter drives, no surprise, a lot like the Escape (and Toyota Rav4, Honda CRV and GMC Terrain), which is to say pleasant. Handling is reassuringly neutral, the ride is comfortable without being too cushy and acceleration is acceptable.

A 181HP 1.5-liter 3-cylinder turbo are the guts of the Bronco Sport, but a 245HP 2.0-liter four-cylinder turbo is also available as an option. Both come with an eight-speed automatic transmission, and all versions come with AWD. The 3-cylinder gets you a 0-60 MPH time of 8.7 seconds, while the 4- does it in just 5.9. Fuel economy is 25 MPG City and 28 Highway for the 3-cylinder, and 21/26 for the 4-cylinder.

The interior of the Bronco Sport is surprisingly good. The materials are nice to look at and touch, and the boxy shape of the vehicle provides a lot of space. In fact, there’s enough space in the configurable cargo area for two mountain bikes (if you lay the rear seats flat).

The screens, tech and what have you are as contemporary as anything from the competition. And like most new vehicles in 2021, the user interface is a central touch screen, which enables you to control the audio, phone and climate functions effortlessly without much distraction from the road. The overall impression from behind the wheel is that this is a tougher and (slightly) bigger Escape.

The many Bronco-esque styling cues in and outside of this mainstream small SUV may make it seem a bit more adventurous than it really is. For instance, when you start the Bronco Sport, a little “movie” plays on the central screen, showing rolling boulders in a desert scene that suddenly come together to become a young horse (a Bronco!). I suspect the “real” Bronco will do the same thing.

I get it, Ford wants to imbue Bronco Sport buyers with as much Bronco as they can, but it seems a bit like fans getting backstage passes to a rock concert—they feel almost like they're rock stars, but they’re not.

For the record, the Bronco Sport does have some off-roading chops. While the upmarket Badlands edition sports an enhanced AWD system, stouter suspension components, and more ground clearance, even the base model Bronco Sport has been engineered for more off-road capability than the Escape. So, if off-roading is your thing, I’d go with the Badlands version.

Pricing of the Bronco Sport is aggressive, with a base MSRP of just under $29,000. Badlands models, which I suspect BCMS members will be most interested in, start at around $35,000. This is 2021, the year of “no discounts,” so expect to pay right around MSRP (or more) for your Bronco Sport.

The Bronco Sport is not a real Bronco, but it kind of looks like one, and it costs a lot less. While it can’t do what a Bronco can off road, onroad it’s a pleasant small SUV, and for many buyers these days, that’ll be just fine.

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.

ABCD Pediatrics, PA Dermatology Associates of San Antonio, PA Diabetes & Glandular Disease Clinic, PA ENT Clinics of San Antonio, PA Gastroenterology Consultants of San Antonio General Surgical Associates Greater San Antonio Emergency Physicians, PA Health Texas Medical Group Institute for Women’s Health Little Spurs Pediatric Urgent Care, PLLC Lone Star OB-GYN Associates, PA M & S Radiology Associates, PA

MacGregor Medical Center San Antonio MEDNAX Peripheral Vascular Associates, PA San Antonio Eye Center, PA San Antonio Gastroenterology Associates, PA San Antonio Infectious Diseases Consultants San Antonio Pediatric Surgery Associates, PA South Texas Radiology Group, PA South Texas Renal Care Group Star Anesthesia (USAP Texas-South) The San Antonio Orthopaedic Group Urology San Antonio, PA

Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of September 22, 2021.

By Emily Liu, Melissa M. Donate, Zeba Bemat, Anuradha S. Helekar, MD and Blake A. Harrell, DO

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LETTER TO THE EDITOR

Join our Circle of Friends Program

2021 FORD BRONCO SPORT

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This article is from:

San Antonio Medicine October 2021