By Joshua Carrasco, Louisa Xie and Brent Arcayan

Perspective on Care for the Transgender Patient Experiences from the PRIDE Clinic

By Joshua Carrasco, Louisa Xie and Brent Arcayan

Over one million transgender individuals, including transfeminine, transmasculine, non-binary, gender-nonconforming and gender-diverse (trans) individuals live in the United States (Meerwijk & Sevelius, 2017). “Trans” serves as an umbrella term that includes all people who do not identify with their sex assigned at birth, whether that is female or male. This assignment is most often given at birth based on phenotype and genotype; however, we know that having only two options “biological male” or “biological female” does not fully capture the complex variations that can occur in disorders of sexual differentiation (García-Acero et al., 2020). Thus, gender is more nuanced than sex assigned at birth. Gender identity is how one feels inside and how those feelings are expressed through clothing, appearance and other behaviors. Martin and Ruble (2010) found that this inner sense of gender identity develops between the ages of three and five while most people feel they are either male or female, some people may feel both, neither or somewhere else along the spectrum of gender.

Gender transition is a multifaceted process. People can change their name and gender marker on identification documents. Not all trans people transition, nor do they transition in the same way. Some may choose to transition only socially and forego any medical transition which would entail hormone therapy and gender-affirming surgeries.

Barriers

Transgender individuals may face discrimination in a multitude of environments. Investigative studies have captured anti-trans discrimination and bias and its negative effects on the trans community (Grant et al., 2011). Individuals within the trans community disproportionally report worse health outcomes. When compared to their cisgender counterparts, trans adults are more likely to report poor mental health, higher rates of substance abuse and greater reports of being physically or sexually assaulted. A staggering 81% of trans respondents have contemplated suicide, compared to just 30% of cisgender adults (Grant et al., 2011).

The number one barrier faced by the community is a lack of access to providers that are knowledgeable about the special care they may require (Safer et al., 2016). The inclusion of transgender-informed healthcare in medical school or residency curricula is not widely standard. Other barriers to care include stigma, self-perceived or experienced and cost. While research identifying barriers to care for transgender individuals has solidified, solutions for addressing these barriers remain.

Trans Care is Health Care

According to Paine (2021), “trans broken arm syndrome” is understood, colloquially, as the phenomenon that occurs when physicians attribute a trans person’s health concerns and conditions solely to their hormone replacement therapy (HRT) without engaging in further diagnostic workup, for example, a trans-masculine patient’s hyperlipidemia may be chalked up to their testosterone use and brushed aside. Medical residents have reported a lack of formal education in trans care, specifically HRT and screening guidelines. Survey of internal medicine residents at a large urban academic center (Johnston & Shearer, 2017) revealed that the majority did not have knowledge of how to provide HRT, cervical cancer and STI screening or explanations

of gender-affirming surgery. These results have been replicated in other surveys of physicians (Potter et al., 2015) and create barriers to care for transgender patients seeking routine and gender-affirming care because of physician uncertainty, hesitancy, and discomfort. According to the American College of Obstetricians and Gynecologists (2021), professional guidelines for routine cervical cancer and STI screening in trans patients are identical to those recommended for cisgender patients. Ultimately, trans health should be included throughout medical training. Trans patients should feel confident that their primary care physicians have adequate training to care for and help people make informed decisions about their care. The Clinical Practice Guidelines from the Endocrine Society is a good resource for physicians when prescribing HRT and caring for trans patients. These guidelines provide diagnostic criteria for gender dysphoria in adults and children. They also provide valuable information on monitoring for adverse effects and long-term outcomes. Clinical Practice Guidelines are used at UT Health San Antonio’s Pride Community Clinic, a Student-Faculty Collaborative Practice at the Long School of Medicine that serves LGBTQ+ patients in Bexar County.

To learn more about physician advocacy for transgender individuals and improving the wellbeing of the trans community in medical spaces, please visit the following informational websites.

The Pride Center San Antonio: https://pridecentersa.org/

American Medical Association, Creating an LGBTQ Friendly Practice: https://www.ama-assn.org/delivering-care/population-care/creating-lgbtq-friendly-practice

Texas Medical Association:

LGBTQ Health: New TMA Section Helps Physicians Treat a Misunderstood Population (texmed.org)

References 1. Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender Population

Size in the United States: a Meta-Regression of Population-Based

Probability Samples. American journal of public health, 107(2), e1–e8. https://doi.org/10.2105/AJPH.2016.303578 2. García-Acero, M., Moreno, O., Suárez, F., & Rojas, A. (2020). Disorders of Sexual Development: Current Status and Progress in the

Diagnostic Approach. Current urology, 13(4), 169–178. https://doi.org/10.1159/000499274 3. Martin, C. L., & Ruble, D. N. (2010). Patterns of gender development. Annual review of psychology, 61, 353–381. https://doi.org/10.1146/annurev.psych.093008.100511 4. Grant, J. M., Mottet, L. A., Tanis, J. J., & Min, D. (2011). Transgender Discrimination Survey. National Center for Transgender Equality and National Gay and Lesbian Task Force: Washington,

DC, USA 5. Safer JD, Coleman E, Feldman J, Garofalo R, Hembree W, Radix

A, Sevelius J. Barriers to healthcare for transgender individuals.

Curr Opin Endocrinol Diabetes Obes. 2016 Apr;23(2):168-71. doi: 10.1097/MED.0000000000000227. PMID: 26910276;

PMCID: PMC4802845. 6. Paine E. A. (2021). "Fat broken arm syndrome": Negotiating risk, stigma, and weight bias in LGBTQ healthcare. Social science & medicine (1982), 270, 113609. https://doi.org/10.1016/j.socscimed.2020.113609 7. Johnston, C. D., & Shearer, L. S. (2017). Internal Medicine Resident Attitudes, Prior Education, Comfort, and Knowledge Regarding Delivering Comprehensive Primary Care to Transgender

Patients. Transgender health, 2(1), 91–95. https://doiorg.libproxy.uthscsa.edu/10.1089/trgh.2017.0007 8. Potter, J., Peitzmeier, S. M., Bernstein, I., Reisner, S. L., Alizaga, N.

M., Agénor, M., & Pardee, D. J. (2015). Cervical Cancer Screening for Patients on the Female-to-Male Spectrum: a Narrative Review and Guide for Clinicians. Journal of general internal medicine, 30(12), 1857–1864. https://doi.org/10.1007/s11606-015-3462-8 9. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, & American College of Obstetricians and

Gynecologists’ Committee on Health Care for Underserved

Women (2021). Health Care for Transgender and Gender Diverse

Individuals: ACOG Committee Opinion, Number 823. Obstetrics and gynecology, 137(3), e75–e88. https://doi.org/10.1097/

AOG.0000000000004294

Joshua Carrasco is a medical student interested in Pediatrics at the UT Health San Antonio Long School of Medicine, Class of 2023. He serves and works in front of the transgender flag at the Pride Community Clinic.

Louisa "Lou" Xie is a medical student interested in Internal Medicine at the UT Health San Antonio Long School of Medicine, Class of 2023. Lou Xie serves and works in front of the transgender flag at the Pride Community Clinic.

Brent Arcayan is a medical student interested in Internal Medicine at the UT Health San Antonio Long School of Medicine, Class of 2023. Brent Arcayan serves and works in front of the transgender flag at the Pride Community Clinic.

Wound Healing

By Winona Gbedey

My history is carved deep into my skin, A rich tapestry of what was, What will be, And what could have been. These stories, They’re mine to keep And mine to tell.

So, dissect through my walls Like a specimen on your table. Let my body be your guide. Peel away parts of me Until you find What stitched me back to life.

One day we’ll reach The very core of my being, And you’ll see what gave me these scars.

Author’s Note: The inspiration for this piece struck me late at night while reviewing for the first musculoskeletal weekly quiz. Scar formation. I thought it fascinating how several layers of skin must be breeched before our bodies decide to memorialize our injuries. This got me thinking about my own scars, and how they merely serve as reminders of funny stories to tell my friends. Emotional scars, though, they’re different. They inflict so much pain without even piercing the skin. Somehow, they cut deeper than physical wounds. This poem explores that dichotomy.

Winona Gbedey is a medical student at the UT Health San Antonio Long School of Medicine, Class of 2023. She is a co-founder of the student organization, Auscultations. She is a member of the BCMS Publication Committee.

More Than a Diagnosis

By Lauren C. Jameson

Missed appointments, lack of response Life has not been easy for you How can I learn more about your needs and wants? I am here to listen to what you’ve been through

Why are you afraid of him? The man to whom you were once wed Did he hurt you, make you a victim? When he calls and threatens you, what words are said?

HIV positive and blood sugar rising Food insecurity and no car of your own Feelings of depression you’ve been disguising You are so much more than what your labs have shown

You are more than a diagnosis, a problem to treat You are a human being with value – intrinsic and complete

Author’s Note: I wrote this poem as a letter to one of my patients who was lost to follow-up. I wish I had the opportunity to tell her, that she is not alone and that there are many resources we can connect her with.

Lauren C. Jameson is a student at the UT Health San Antonio Long School of Medicine, Class of 2023.

The Gifts of Orion

By Dawson Tan

This is a composite image of 60 pictures of the Orion Nebula taken with a mirrorless camera. The Orion Nebula can be seen in the center while the Flame and Horsehead Nebulae are in the top left of the image. To the right is the bright star, Tau Orionis. All of these are located within the constellation of Orion. This was my first attempt at capturing a deep sky object. I started astrophotography during my first year of medical school and it has been a great way to take a break from studying.

Dawson Tan is a student at the UT Health San Antonio Long School of Medicine, Class of 2025.

How I Got Here

By Yousef Salem

According to the Association of American Medical Colleges (AAMC), 80% of admitted students come from the top 40% of income nationwide. This is my story from the bottom 20%.

When I was eight, my family did not have a stable income, so I helped my mom apply for food stamps. We received the bare minimum amount for food, $300/month for our entire family and we played a game of stretching that as long as possible. But we never made it to the last week. It just had to suffice.

Over nine years, we rode a rollercoaster of ups and downs, where our situation improved briefly, and then an unexpected car repair or a high utility bill would add pressure again. We knew exactly how long it took before getting cut off from electricity and water. Sometimes we made it without. We dreaded going home after school where there was no A/C or lights.

After graduating high school, I applied to university even though I couldn’t actually afford it, but everyone around me was doing it. I applied for a scholarship and was rejected, so I reached out to Financial Aid to explain my situation. I got lucky in finding someone who empathetically walked me through the appeals process. Thankfully, I won the scholarship, which meant I could work less while helping keep a roof over our heads. Between this increased stability, further hard work, and many other lucky breaks, I was able to focus on studying medicine, and now here I am.

At some point, we will treat “non-compliant” patients who need to feed their kids. Or they delay treatment until the point of no return because they had to pay rent. I am thankful for my experiences as they allow me to better understand the difficulties these patients face and I hope to see more students in medical school who have overcome similar challenges.

Yousef Salem is a student at the UT Health San Antonio Long School of Medicine, Class of 2024.

55 Word Stories – On Kindness

By Medical Students

These stories are written by medical students in the Long School of Medicine at UT Health San Antonio and reflect the diversity of their patients’ lives and their own experiences in caring for them. They emphasize the importance of looking closer at each patient as an individual with their own unique identity, language, values, culture and hope. And by honoring the humanity of their patient, each student seeks to pay attention to their own.

Alone I took a moment to collect my thoughts and walked into her room. She was intubated and clearly dejected. This was her second time presenting in myasthenic crisis and she hated that she was in the hospital again. I tried to console her but my words bounced off. She wanted to be alone in her suffering.

By Ritwick Mynam, Class of 2023

Why didn’t you ask her pronouns? I’m sure you meant no harm. You took an oath to do no harm. I’m sure you felt uncomfortable. I’m sure you were rushed. But you hurt her. She came to us asking for help, just wanting to breathe. You made an assumption. You called her, “him,” a pronoun she has despised her whole life.

This is a story about a transgender patient who was mis-gendered by someone else. This happened before I walked in the room to introduce myself. It took me less than five seconds to ask her, “what are your pronouns?” She responded, “she/her/hers,” with a smile on her face. I immediately felt that I had gained her trust. I will take this experience forward with me in my future practice of medicine. We are busy. We work long nights sometimes. It might be uncomfortable to ask patients what their pronouns are, but it makes a difference. Our patients have likely experienced discrimination in the past, and we need to remember that. We need to create a safe space within our hospital. It only takes a few seconds to ask, “what are your pronouns?”

By Jacob Houser, Class of 2023

Polka dots on his chest CT He came in with shortness of breath. CXR, CT, and bronchoscopy showed why. He said, “I used to have cancer. They removed it in that surgery last November.” He thought he was cured. I’m now saying he wasn’t. He said, “I’m sorry, translator, could you repeat that?” I said, “Tiene cancer en sus pulmones, señor.”

This patient had a right radical orchiectomy last year. He believed he was cured since they removed the source of his cancer. What I wonder though is if the patient truly understood the extent of his disease or his postoperative management, and the reason I ask this is because the patient is Spanish-speaking and I think about the possible breaks in communication with the language barrier. Was the care team able to properly convey the information about the patient’s cancer, his treatment plan and his prognosis? I’m not sure because the patient truly believed he was completely cured after surgery. I believe we have to make each and every effort to confirm understanding in our patients. When that involves an initiation or change in the treatment plan, teach-back is commonly used. When a highly sensitive matter such as the diagnosis of cancer is involved, I think the discussion needs to be more inclusive of everyone on the treatment team so that the patient may fully and wholly understand the plan moving forward.

By Megana Challa, Class of 2023

His family kept offering us food Coughing and gasping, satting 75%, he said in his own language, “I was born with a funny heart.” No doctors here would touch him, too afraid of causing harm, so he sat throwing septic emboli into his lungs. Still, his brother offered us sweets, “You’re the doctors, you know what’s best, Thank you so much.”

This experience was really poignant for me because this patient was a refugee from Afghanistan, and a lot of the cultural view of medicine is very similar to what my own family members in India express. Even though the patient was really afraid, he blindly trusted us to do the right thing and his family also didn’t question us. As a provider, it was frightening for me to have that much absolute faith placed upon the words I said. I feel that in the Western world, we are very used to patients and families asking questions, wanting more clarification and even disagreeing with us. In that way, it’s

much more of a two-way street rather than a paternalistic approach, as is still common in many parts of the world. I think it is very important for us as providers to recognize the cultural differences of patients who might be approaching us from backgrounds where doctors aren’t questioned. It is important to not just expect them to ask us questions for clarification, but speak up when they feel that we are not doing right by them. Similar to my own culture, food is a very important way of bonding. Sweets in particular are hand selected for moments of joy and celebration. To accept sweets from this family, who literally have nothing as they flee from their home country, especially when I feel as if I am doing nothing to help their suffering family member, felt wrong. I know that I will carry this experience with me throughout my career. The days and days we spent waiting will drive me to be a stronger and louder advocate for my patients. Perhaps as a medical student, I was too timid and I did not have any real authority, but I refuse to let my patients be sidelined again.

By Anjali Prasad, Class of 2023

Chasing a future on false hope I’m in so much pain that I have to drink. I’ve run out of pain meds. I’ll be better when I have my surgery. I promise I won’t drink. I’m going to be a preacher when I’m off the streets and better. Sorry, doc, I promise I won’t drink again. The pain…it’s just so bad.

By Evan Caston, Class of 2023

Promising future. Stranger now. The pride of a loving mother and father Role model Left to serve Came back lost He was alone filled with anger, confusion and fear Worried parents call every day in hope The remnants of who he is surface occasionally, but are overshadowed by a new identity He is still the son of loving parents.

This experience impacted me deeply. I was randomly placed to speak with this patient on psychiatry and was told a brief history. Upon more chart checking and history taking, it seems this patient went to serve in the military but he never returned the same. He was diagnosed with schizophrenia. I spent many days speaking with him and his family, only to learn more and more about this person who was in military training before. I could hear the pain in his parent’s voices. I learned what it meant to help a patient holistically. I learned that this patient although on a cursory look seemed like an agitated individual, who was intimidating to speak with was truly the pride and joy of two loving parents, who wished nothing more than to have the son they once knew. I realized that oftentimes it is easy to get lost in the mundane life of a physician and only when you take a step back and truly introspect on what it means to be a physician and how you impact others will you truly remember why it is rewarding.

By Subhash Venigalla, Class of 2023

Nothing feels worse than false promises

A sigh of relief, exhausted eyes look hopefully at the clock. Days and nights blending together under the fluorescent sun, nothing seems more relevant than going back home. Door opens up, expression hidden by mask. Every word, a hammer heavily brought down on hopes of escape. Door clicks shut, nothing feels worse than false promises. I chose this story due to the frequency these thoughts occur in both physician and patient and to emphasize that everyone in the hospital is a person with their own agendas and feelings. Recognizing your own as well as others can put things into perspective.

By Aaron Fanous, Class of 2023

All she asked for was chapstick It all happened so fast. She was vomiting so much blood. She agreed to intubation, just asking that we use chapstick for her dried lips. She coded after intubation. Still bleeding. The line for compressions grew and I waited for something to feel during each pulse check. Nothing. She died the day before her birthday.

This was my second code in the Emergency Department and particularly striking, because of how quickly she decompensated. She had ruptured esophageal varices and as anyone who has ever seen these patients knows, it is a true emergency. During the code, I was checking for a femoral pulse. Because I was there for so long, I found myself looking at her face frequently and it is one that I don’t think I will forget. This patient made a huge impact on me and the other two medical students I was with that night, and that impact is ever-changing. I think we must never forget that our patients are all people with their own worries, joys, dreams, and loved ones and that all of these things can be taken away in an instant. We must also never forget that these same things apply to us as well – and we should remember to live our lives in the way that brings us the most happiness and joy.

By Amber Warren, Class of 2023

Two Generations Serving BCMS – A Look Back

By John M. Smith III, MD

John M. Smith, Jr. was born in 1914 in Caldwell, the country seat of Burleson County. His mother was part of the Burleson family, a distinguished group of patriots and leaders beginning with the creation of Texas as a republic.

His early childhood was spent in San Antonio, where he attended Main Avenue High School. He received further education at St. Mary’s University and in Denton the institution there to become University of North Texas. He felt privileged to attend the Tulane University School of Medicine, the first medical school west of the Mississippi. Following medical school, he interned at the Robert B. Green hospital where he was a roommate with Dr. John Hinchey. Both of these gentlemen were to become giants in leadership of their city, state and national organizations both within the medical profession and in civic affairs.

Dr. Smith graduated from Tulane Medical School in 1940 and joined the Army the following year. He served in his general hospital that established a tent hospital in the sand dunes of Normandy following D-day. They ultimately moved their base operations to Metz, where they occupied a 3,000-bed hospital that had been evacuated by the Germans following their eviction by General Patton. In Metz, they received the majority of casualties of the Battle of the Bulge from both sides of the conflict.

Following V-E Day, Dr. Smith was transferred back to the United States where he immediately asked Jane Jordan from Victoria, Texas; a student at Newcomb when he was attending medical school to marry him. The two began their married life at Fort Bliss, El Paso, Texas where Dr. Smith was involved in the orthopedic rehabilitation surgery of the soldiers hospitalized there.

After discharge from the Army, considering San Antonio his home, Dr. Smith wanted to practice in San Antonio. Dr. Witten B. Russ offered him, one of his extra rooms at the M&S Hospital in which he was permitted to establish his own practice. His practice was begun with one employee and a shingle hanging in the lobby. Dr. Russ was a great inspiration for him, having been the youngest president ever of the Texas Medical Association. Under Dr. Russ’ leadership the initial Texas Medical Practice Act and the State System for Treatment of Tuberculosis were established. Dr. Russ was no doubt an inspiration for him to become involved in the medical affairs of San Antonio and the State of Texas.

Upon establishing practice and joining the Bexar County Medical Society (BCMS), Dr. Smith was appointed to head a committee to study the health care needs of the city of San Antonio going forward. His findings were that San Antonio was the largest city in the United States without a medical school, and was the most deficit hospital bed per capita city of half a million in country. A coalition that included the Chamber of Commerce, the Bexar County Medical Society and other city leaders joined together to form the Bexar County Medical Foundation. The foundation was established in 1947, and the initial object of the foundation was not only to see that a medical school was built in San Antonio, but also to establish a medical center and to improve quality of medicine overall. At the time, Texas had one medical school located in Galveston. There was a medical school in Dal-

las which was encouraged to move to Houston by the efforts of the leaders in Houston, then establishing a medical center and school there. It goes without saying that there was significant political pressure for the State of Texas to create another medical school. Dr. Smith and the medical foundation were involved in this achievement from day one. The effort to create a medical center in San Antonio involved a great deal of effort on the part of city leaders and citizens who understood the necessity and challenge. The political effort to establish a medical school in San Antonio, took a lot of convincing of the various politicians involved. The year that the Texas Legislature passed a bill establishing a new medical school for San Antonio, Dr. John M. Smith, Jr. was voted the most outstanding citizen in San Antonio for his efforts and success in that regard.

One of the pieces of this effort required some group to build a teaching hospital within the medical center. Dr. Smith lobbied the Methodist bishop for them to establish a hospital within the medical center, along the lines of the Methodist in Houston and Dallas. Regrettably, he was rebuffed by the Methodist bishop at that time. Leadership changed, he encountered another bishop who was more attuned to supporting the effort of having a Methodist Hospital to anchor the new medical center in San Antonio. Fortunately, this was accomplished and was part of the success in garnering a medical school for the new medical center.

Further the other piece that was necessary was for a bond issue to pass Bexar County in which a new teaching hospital would be constructed within the medical center. A lot of political effort was expended in this endeavor which is a separate story by itself. Ultimately with the leadership of the county judge, Blair Reeves, this succeeded.

Dr. John M. Smith, Jr. received numerous awards for his efforts in organized medicine. These included the distinguished service awards from the Texas Medical Association, the American Medical Association, and others. He served in the leadership position of the Bexar County Medical Society as its President and the Texas Medical Association as its President and Chairman of the Board of Trustees. His leadership position of the San Antonio Medical Foundation guided it as well. His leadership and judgement both within the city, the region, the state and nationally was respected and sought.

During this time, Dr. Smith carried on an active medical practice which was for the most part a solo practice with others substituting when he was out of town. His family practice waiting room included city employees waiting to be seen with various injuries, pregnant women who were anticipating delivering children and families of those who established the banks and major industrial endeavors about the town and region. All were considered as VIPs.

I was a first-hand observer of how hard my father worked and what few leisure hours he actually enjoyed. I was somewhat skeptical of the medical profession pressures. However, after making house calls with him all over Bexar County and observing deliveries and surgical procedures, I became much more interested in it as a personal career. In that respect, I was never pushed to pursue medicine, but I was provided the opportunity to see the rewards to the practitioner were from people grateful for the care that they received.

I graduated from Tulane Medical School in 1972. I was enormously proud of the education and opportunity that I had received there which was broad and diverse to say the least. Charity Hospital in New Orleans provided a glimpse of almost every condition that a human being could experience.

While in my first year at Tulane, Christian Barnard came to speak. He had not long before implanted the first human heart and the thought that this could be done encouraged me to pursue the thoughts of becoming a thoracic and cardiovascular surgeon.

My internship was spent in Dallas with Dr. Tom Shires as the Chief of the Department of Surgery. As part of this internship year, I spent three or four months on medical services with the idea of becoming an “adept medical practitioner” in addition to whatever surgical ability I might ultimately acquire. The surgery program in Dallas was indeed an academic one and I was offered a year in the laboratory prior to a beginning a more traditional surgical residency, thinking that I ultimately wanted to pursue another four years of thoracic surgery hesitant to lengthen it further. After general surgery I transferred to the medical school in San Antonio where Dr. Aust offered me a traditional four-year surgical residency. It should be noted that Dr. Aust held the Witten B. Russ Chair of Surgery, one endowed by Dr. Russ’ brother. During those four years of surgery residency, I was privileged to spend 18 months in total with Dr. Kent Trinkle, a gifted

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and inspiring thoracic surgeon. Dr. Trinkle had established a rotation with Dr. Denton Cooley to expose the San Antonio residents to the truly world-wide practice that Dr. Cooley enjoyed. While working under Dr. Cooley’s tutelage, I was offered a residency in the fall of the coming year at the Texas Heart Institute, which I gladly accepted. This was an exceptional opportunity for me as it exposed me to a world of cardiovascular surgery in both adults and children as perhaps no other program would have under the mentorship of one of the world’s truly great heart surgeons.

When I reflect on the medical profession beginning with my father’s graduation from medical school in 1940 up to the present, it is indeed an interesting history. Despite the number of distinguished medical families in Bexar County and the number of people who are truly visionaries in their fields, it is the case that my father and I are the only father-son who have served as presidents of the Bexar County Medical Society. As a leader for the profession and for public health, the Bexar County Medical Society has accomplished many achievements both locally and on a statewide basis. This type of participation is essential to preserve the future of medicine.

Following my rotation with Dr. Cooley, I entered the United States Air Force to serve at the Wilford Hall US Air Force Medical Center. This was the one location that the Air Force did heart surgery at the time I entered active duty. We received patients from literally all over the world and my experience in serving my country was a definite bright spot in my career. At the end of my service at Wilford Hall, I was the Acting Chief of the Department of Thoracic and Cardiovascular Surgery and received the Air Force commendation medal for my service in that capacity.

Medicine is a profession. The meaning of the word is that the practitioner places the interest of the patient above his own. I fear that medicine as it has moved away from individual practices and to employed practitioners of the present day, some of that sense of responsibility and service may have been lost. I fear that too many present-day graduates are seeking employment first and foremost which may result in the bending of their view concerning the profession and service to their communities. As the institutions have become increasingly taken over by commercial entities as opposed to educational and benevolent organizations, I see that the pressure placed on the practitioner is heavily weighted towards economic or production goals versus that which the practitioners think is best for their patients. The individuals in these various organizations must be vigilant in protecting the best interest of those whom they serve and the communities in which they live.

Great privileges are afforded to doctors and the medical profession which are based on the belief from the public that their interests are being placed first and foremost. Should it ever be the case that the public sees that their interests are being subjugated to commercial benefit, that respected appreciation for medical practitioners will evaporate.

I observed first hand many of the civic pursuits my father pursued. At a young age I was impressed that it was incumbent upon the doctor to be part of the development of his community, his professional organizations, and the profession. I personally witnessed the groundbreaking for the Methodist Hospital in the San Antonio medical center and as a citizen of San Antonio have taken great pride in seeing the progress of our medical school and medical center. My public service included the first resident delegate to the American Medical Association, eight years on the Board of Managers of the Bexar County Medical Society, eight years on the Standards and Ethics Committee of the STS and serving on the Board of the Methodist Hospital Foundation.

The governance of Methodist Hospital which initially was directed first and foremost by its medical staff. As the staff has increasingly been employed by the hospital corporation, the governance of the hospital has been increasingly influenced by economic motivations rather than quality issues. This is manifested in the evidence of the hospital placing less interest in rewarding the nursing staff to maintain its satisfaction. This is evidenced by less tenure and experience in the medical staff.

Some 60 doctors became involved in the creation of Texsan Heart Hospital for the purpose of providing excellence in cardiovascular care. The hospital did indeed achieve its purposes. The Affordable Care Act made doctor ownership in hospitals untenable going forward and Texsan was subsequently purchased by Methodist. In my opinion, this resulted in diminished tenure and ability of those working within the hospital.

The challenges for the profession going forward are many. I learned a number of lessons from the examples set for me by my father and his service to the community and the profession. I am hopeful that through some set of circumstances this can be conveyed to the next generation of professionals who will assume the mantle of leadership in medicine.

Texas State Historical Association, Smith, John Marvin, Jr. (1914-2003) by William V. Scott Marquis Who’s Who Top Doctors, 2022

J. Marvin Smith III, MD has been a cardiothoracic surgeon in San Antonio since his honorable discharge from the Air Force in 1982. He has received numerous awards and appointments within and outside the medical community. He holds certifications by the American Board of Surgery and the American Board of Thoracic Surgery, is a fellow of the American College of Surgeons and a fellow of the American College Cardiology. Dr. Smith is an Adjunct Professor of Surgery in the Department of Cardiothoracic Surgery at University of Texas Health Science Center at San Antonio and a member of the Bexar County Medical Society.

“To See Ourselves”

The Works of Dr. Oliver Sacks

By David Schulz

Oeuvre is a word not used casually outside the works of a Dickens or a Doyle, and rarely does the effort of a brilliant scientist find expression in sufficient numbers of volumes, but for Oliver Sacks, MD, his manifold writings on neurological issues in lay terminology earned him the title “The Poet Laureate of Medicine” by The New York Times. From Awakenings (1973) to Gratitude (2015), Dr. Sacks’ legacy explores the vagaries of the human mind, documenting and spurring advances in the study of brain and thought over a half-century in practice.

Awakenings describes his work in the 1960s at Beth Abraham Hospital in the Bronx, where he found a population of immobile adult patients, speechless and apparently depressed. Working back, he found their commonality was contracting a sleeping sickness, encephalitis lethargica, during an epidemic forty years prior. His novel approach to treating them with levodopa (L-dopa), then only recently applied to Parkinsonism, unlocked his patients, and for a brief period, returned them to a state of full self-consciousness. Unfortunately, side effects became as debilitating as the disease. Their story was so compelling that the film version, which starred Robert De Niro and Robin Williams, was nominated for three Academy Awards in 1991, including best picture.

Dr. Sacks’ curiosity about perception, selfperception, and experiential perception were explored in more than a dozen works. He investigated the world of deaf people and sign language in Seeing Voices, a rare community of colorblind people in The Island of the Colorblind, and examined the visual brain in his books The Mind’s Eye and Hallucinations. He explored the many manifestations of migraines in Migraine, wrote about an unfortunate accident involving a bull in A Leg to Stand On, and published a spellbinding account of his trip to Mexico with a group of fern enthusiasts in Oaxaca Journal. The Man Who Mistook His Wife for a Hat is a compendium of people afflicted with fantastic perceptual and intellectual aberrations, studies of life struggling against incredible adversity.

In Musicophilia, he examines the powers of music through the individual experiences of patients, musicians, and everyday people–from a man who is struck by lightning and suddenly inspired to become a pianist at the age of forty-two, to an entire group of children with Williams syndrome who are hypermusical from birth; from people with “amusia,” to whom a symphony sounds like the clattering of pots and pans, to a man whose memory spans only seven seconds–for everything but music.

From beginning of his career to its end, the compassionate tales of people struggling to adapt to different neurological conditions have fundamentally changed the way we think of our own brains, and of the human experience. Just as his first book describes the return to functioning life, albeit briefly, of his earliest patients, the last work, Gratitude, deals with aging, illness and death, with he himself as the subject: “I am now face to face with dying, but I am not finished with living,” he prefaces.

Knowing the terminal nature of his cancer, first occurring in the eye (leaving him blind in one), then metastasizing in the liver, he wrote, “Over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.… I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work, and my friends. I shall no longer look at the NewsHour every night. I shall no longer pay any attention to politics or arguments about global warming.”

In essays published following his passing in 2015 (The River of Consciousness), Dr. Sacks is revealed to be as perceptive a student of science history as he is a scientist. His writing on Darwin and the meaning of flowers puts his theories of evolution and origin of species into clear, concise prose: “Here, in no uncertain terms, Darwin is throwing down the gauntlet, saying, “Explain that better—if you can.”

Tribute to Dr. Sacks was suggested by a reader, and all of Dr. Sacks’ books are available in print, e-edition and audio from San Antonio Public Library. Please don’t hesitate to let us know if there’s an author of which you believe our readership ought to be aware.

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

Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed.

ACCOUNTING FIRMS

Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Sol Schwartz & Associates is the premier accounting firm for San Antonio-area medical practices and specializes in helping physicians and their management teams maximize their financial effectiveness. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

ACCOUNTING SOFTWARE

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” 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

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Thomas M. Duran SVP, Private Banking Team Lead 210-283-6640 TDuran@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

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!”

CLINICAL DIAGNOSTICS

Livingston Med Lab (HHHH 10K Platinum Sponsor) High Complexity Clia/Cola accredited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infectious Disease, & Genetics. Robert Castaneda (CEO) 210-316-1792 Email: Robert@livingstonmedlab.com Sean Villasana (Chief Scientific Officer, CSO) 210-237-8557 Sean@livingstonmedlab.com Joey Martinez (Director of Operations) 210-204-7072 Joey@livingstonmedlab.com Dwight Chapman (Account Manager) 210-591-2649 Dwight@livingstonmedlab.com www.livingstonmedlab.com/home “Trusted Innovative, Accurate, and STAT Medical Diagnostics”

Genics Laboratories (HHH Gold Sponsor) Genics Laboratories offers accurate, comprehensive and reliable results to our partners and patients. Genics Laboratories is committed to continuous research, ensuring our protocols are always at the peak of current technology. Yulia Leontieva Managing Partner, Physician Liaison (210) 503-0003 (Phone) yulia@genicslabs.com (Email) Kevin Setanyan Managing Partner (210) 503-0003 kevin@genicslabs.com Artyom Vardapetyan Managing Partner (210) 503-0003 www.genicslabs.com “Accurate results in record time.”

CREDENTIALS VERIFICATION ORGANIZATION

Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities. Betty Fernandez Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998”

FINANCIAL ADVISORS

Oakwell Private Wealth Management (HHHH 10K Platinum 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. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

HEALTHCARE BANKING

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” Nexus Neurorecovery Center (HHH Gold Sponsor) A post-acute rehabilitation facility focusing on brain injuries. Programming provides individual and group physical, occupational, cognitive, and speech therapy. We help residents return to lives of productivity and meaning. Sydney Kerr Liaison 346-339-2654 skerr@nhsltd.com Caitlyn Tewksbury ctewksbury@nhsltd.com Justin Sanderson CEO 210-854-4732 jsanderson@nhsltd.com Nexus Neurorecovery Center 227 Lewis St, San Antonio, TX 78212 https://nexushealthsystems.com “To return patients to lives of productivity and meaning”

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

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”

INSURANCE

TMA Insurance Trust (HHHH 10K Platinum Sponsor) TMA Insurance Trust is a full-service insurance agency offering a full line of products – some with exclusive member discounts and staffed by professional advisors with years of experience. Call today for a complimentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits 512-370-1776 wendell.england@tmait.org 800-880-8181 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Guardian (★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge 210-332-3757 ned@nedhodge.com www.nedhodge.com | www.Opesone.com “Take care of today then plan for tomorrow”

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 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’s rating is AM Best A (Excellent). Mike Rosenthal Senior Vice President, Business Development 800-282-6242 MikeRosenthal@ProAssurance.com www.ProAssurance.com

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

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 SUPPLIES AND EQUIPMENT

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.”

MILITARY

San Antonio Army Medical Recruiting office (★★Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families. 1LT Thomas Alexandria 210-328-9022 Alexandria.n.thomas12.mil@army. mil https://recruiting.army.mil/mrb/ “Service to Country, Army Medicine, Experientia et Progressus”

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”

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! Kevin Barber, President 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 Medical Group Management Association (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. Alan Winkler, President info4@samgma.org www.samgma.org REAL ESTATE SERVICES COMMERCIAL

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

CARR Realty (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 210-573-6146 Brad.Wilson@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”

RETIREMENT PLANNING

Oakwell Private Wealth Management (HHHH 10K Platinum 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”

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.”

San Antonio Army Medical Recruiting office (HH Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families. 1LT Thomas Alexandria 210-328-9022 Alexandria.n.thomas12.mil@army.mil https://recruiting.army.mil/mrb/ “Service to Country, Army Medicine, Experientia et Progressus”

2022 Ford Maverick

By Stephen Schutz, MD

In January of this year, Ford stopped taking orders for its new compact Maverick pickup truck because it had become too popular. Amazing but true.

They’re taking orders now, but expect to wait up to six months if you order one today unless you get lucky and find an unsold one on a dealer’s lot (expect to pay over MSRP by the way).

The Maverick’s popularity shouldn’t surprise anyone. In these pickup-crazy times the compact Maverick pickup provides seating for five, a small but decent size bed and good fuel efficiency. That last part is extra welcome as we all struggle with inflation and high gasoline prices.

And having the same name as a certain Navy aviator played by Tom Cruise in the box office smash Top Gun can’t hurt.

Design-wise the four-door Maverick doesn’t break any new ground, but most pickups don’t. The styling is boxy with hints of its showroom siblings the Ford Bronco Sport and F-150, and maybe, a touch of Honda Ridgeline (interestingly but not surprisingly the Maverick looks almost nothing like its slower selling mid-size brother the Ranger). Anyway, it looks good.

The Maverick is more capable than you might think with plenty of space for stuff and a 4,000 lbs. towing capacity. The bed is small, as noted above, but most DIY-ers will find it big enough for whatever they need from Lowes or Home Depot, and Costco runs will be no sweat.

There are many people driving (thirsty) full-size pickup trucks today who would do just fine with a Maverick. If you regularly haul drywall or tow a big boat then you’re better off with an F-150 or Chevy Silverado, but otherwise Ford’s smallest pickup is a good choice.

Typically, pickup powertrains are easy to describe—a couple of engine choices with RWD vs 4WD is generally it—but that’s not the case with the Maverick. The standard setup is a hybrid 2.5L four-cylinder with e-assist good for 191HP, although FWD and the dreaded continuously variable transmission (CVT) are the only way to get the base powertrain. Optional is a non-hybrid 250HP turbocharged 2.0L four-cylinder engine mated to a (much better) 8-speed automatic transmission. The turbo can be configured with either FWD or AWD, and that along with AWD would be my choice (the turbo FWD truck is a reasonable alternative because it avoids the CVT).

All Mavericks get excellent fuel economy. Hybrid models get 42MPG City and 33MPG Highway, non-hybrids with FWD get 23MPG and 30MPG respectively, and AWD non-hybrids are 22MPG/29MPG. Those are all impressive numbers, and they easily best those of any mid- or full-size pickup on the market.

Driving the Maverick is very pleasant, especially around town and on B-roads. It’s not sporty by any means, but it at least handles, unlike full-size pickups, and, of course, it’s much easier to park than any big truck.

Naturally, interstate driving is significantly more enjoyable in a fullsize pickup than a Maverick. I’ve gone on record before stating that the Ford F-150 is just about the best interstate vehicle you can buy, and I think that’s still true.

Mavericks are available in three trims, XL, XLT and Lariat. XL Mavericks lack many creature comforts that most buyers today expect, but it could make for a good commuter vehicle/occasional hauler. Springing for the XLT adds 17-inch aluminum wheels, cruise control, a power lock for the tailgate, power exterior mirrors and more, which predictably results in it being the most popular model. As noted above, I'd select the optional turbocharged 2.0-liter four-cylinder for its superior acceleration and drivability. To get the Maverick's maximum towing capacity of 4,000 pounds, I'd also order the Tow package.

A new Tremor Off-Road package will be available for 2023 models. The Tremor option includes more rugged exterior styling elements as well as off-roading enhancements, and it can be added to either XLT or Lariat Mavericks. Only non-hybrid AWD models can be had with the Tremor package.

In an era when the average MSRP of new cars approaches $50,000, the Maverick’s pricing is a bright spot: a stripped version stickers for around $23,000, and a loaded Lariat Tremor lists for under $35,000.

Spoiler alert: it’s doubtful that anyone can pay sticker for a Maverick right now, so it’s extra important that you buy through Phil Hornbeak at BCMS to get your best deal.

The Ford Maverick compact pickup truck is very popular, and after driving one for a week I can see why. It provides a lot of the utility of a full-size pickup, easier parking and much better fuel economy. I expect it to sell for over sticker and be hard to get for quite some time.

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.

11911 IH 10 West San Antonio, TX 78230 Coby Allen 210-696-2232

Kahlig Auto Group

Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130 Matthew C. Fraser 830-606-3463

Land Rover San Antonio 13660 IH 10 West San Antonio, TX Cameron Tang 210-561-4900

Kahlig Auto Group

North Park Mazda 9333 San Pedro San Antonio, TX 78216 John Kahlig 210-253-3300

Kahlig Auto Group

North Park Subaru 9807 San Pedro San Antonio, TX 78216 Raymond Rangel 210-308-0200

Audi Dominion 21105 West IH 10 San Antonio, TX 78257 Rick Cavender 210-681-3399

Northside Ford 12300 San Pedro San Antonio, TX Marty Martinez 210-477-3472

Kahlig Auto Group

North Park Lexus 611 Lockhill Selma San Antonio, TX Tripp Bridges 210-308-8900

Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX James Godkin 830-981-6000

Kahlig Auto Group

North Park Subaru at Dominion 21415 IH 10 West San Antonio, TX 78257 Phil Larson 877-356-0476

Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216 Charles Williams 210-912-5087 Chuck Nash Chevrolet Buick GMC 3209 North Interstate 35 San Marcos, TX William Boyd 210-859-2719

Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216 Paul Hopkins 210-988-9644

Kahlig Auto Group

North Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX James Cole 210-816-6000

14610 IH 10 West San Marcos, TX 78249 Mark Hennigan 832-428-9507

Kahlig Auto Group

North Park Lincoln 9207 San Pedro San Antonio, TX Sandy Small 210-341-8841

Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX Al Cavazos Jr. 210-366-9600

Cavender Toyota 5730 NW Loop 410 San Antonio, TX Gary Holdgraf 210-862-9769

9455 IH 10 West San Antonio, TX 78230 Douglas Cox 210-764-6945

Kahlig Auto Group

North Park Toyota 10703 Southwest Loop 410 San Antonio, TX 78211 Justin Boone 210-635-5000