MD-UPDATE Issue #105

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #105 WWW.MD-UPDATE.COM

VOLUME 8 • #1 • January 2017

Expansion of Service The Kentucky Center for Cosmetic and Reconstructive Surgery expands to meet the growing demands of pediatric plastic surgery patients, locally and globally SPECIAL SECTION PEDIATRICS & PRIMARY CARE ALSO IN THIS ISSUE • CARE FROM CRADLE TO GRAVE • PEDIATRIC ORTHOPEDIC SURGERY • PRACTICING PEDIATRIC UROLOGY

Seeing a provider in

30 minutes

is not just a goal, it’s a pledge.

With our new approach to ER care, your treatment can begin the moment you walk through the door.

An experienced nurse determines the level of care you need and begins the treatment process.

With this model we’ve cut the time it takes to see a provider by 50%. The result is compassionate care, geared towards getting you better, and on your way. Visit ChooseYourDoor.org to find an ER location near you.

Louisville Area: Flaget Memorial Hospital · Jewish Hospital · Jewish Hospital Shelbyville · Medical Center Jewish East · Medical Center Jewish South Medical Center Jewish Southwest · Sts. Mary & Elizabeth Hospital · University of Louisville Hospital Central and Eastern Kentucky: Saint Joseph Berea · Saint Joseph East · Saint Joseph Hospital · Saint Joseph Jessamine Saint Joseph London · Saint Joseph Martin · Saint Joseph Mount Sterling

Mark Chariker, MD FACS

Scott Rapp MD

BOARD CERTIFIED PLASTIC SURGEONS OFFERING EXPERTISE IN: • Pediatric surgery and facial trauma • Oncologic reconstruction • Facial and general cosmetic surgery • Hand surgery • Microsurgery • Cleft and craniofacial surgery • Orthognathic surgery (distraction osteogenesis) • Facial rejuvenation (facelift, eyelid surgery, rhinoplasty) • Breast and body contouring procedures • Skin care • Laser surgery OUR BROAD MEDICAL BACKGROUNDS ALLOW US TO OFFER GREATER DEPTH TO THE QUALITY OF CARE • Craniofacial surgery (Louisville, KY), Director and Co-Director • Operation Hope, Surgical Director • Craniofacial surgeon to Cuba

Please call (502)-568-4800 for your initial consultation

There is another side to aesthetic surgery.

While we offer a wide variety of cosmetic procedures, our expertise is helping people overcome debilitating injuries brought on by illness or disease. Returning to a sense of normalcy and physical outward acceptance is our primary focus to help accelerate the healing process.

At the Kentucky Center for Cosmetic and Reconstructive Surgery, we have helped thousands of patients restore their lives through reconstructive and cosmetic surgery. We understand the importance of offering cosmetic surgery as a compassionate response to a difficult challenge. We are both board-certified in plastic surgery, and Dr. Chariker is certified in hand surgery.

All of us at the Kentucky Center for Cosmetic and Reconstructive Surgery hope to show you a healing and empathetic side to the field of plastic, reconstructive and cosmetic surgery.

222 SOUTH FIRST STREET, SUITE 100 | LOUISVILLE, KY 40202

www.kyplastics.com

LETTER FROM THE PUBLISHER MD-UPDATE MD-Update.com

Legislation in Kentucky that Affects Healthcare and Physicians Welcome to MD-UPDATE for January 2017.

There are several high profile pieces of legislation in this year’s session of Kentucky’s General Assembly that are targeted directly at healthcare initiatives and involve Kentucky physicians. I’m referring to Senate Bill 5, the ban on abortions after 20 weeks; House Bill 2, the ultrasound bill requiring women to view an ultrasound before having an abortion; and Senate Bill 4, sponsored by Dr. Ralph Alvarado, R-Winchester, which would set up medical panels that will issue non-binding opinions about lawsuits against doctors and healthcare institutions before those suits can be filed in a Kentucky court.

In general, at MD-UPDATE, we believe our job is not necessarily to take a position on any particular issue but to raise the question and foster conversations among you and your colleagues.

As our country’s new president takes office this month and the power shifting commences, women’s issues will certainly remain on the forefront. When it comes to women’s healthcare, especially on a state level, consider whether you have a unique perspective as a physician that you can share with legislators.

Tort reform is long overdue in Kentucky. We recognize Dr. Alvarado’s leadership in this important issue and believe it will produce better healthcare for Kentuckians because physicians will be empowered to practice proactively and not defensively.

Additionally, bills to legalize medical cannabis for certain medical conditions have been introduced, including SB 57 by Perry Clark, D-Louisville. Dr. Don Stacy, a Louisville radiation oncologist, has joined this cause. I invite you to read Dr. Stacy’s essay on page 8 of this issue, as well as his research, which was published in last month’s issue, #104.

Physicians are community leaders. Your voices carry weight. The MD after your names means something. We recognize those physician leaders and invite you to participate. Contact me if you want to make your opinions known throughout the Kentucky medical community.

All the Best,

Volume 8, Number 1

ISSUE #105 PUBLISHER

Gil Dunn gdunn@md-update.com EDITOR IN CHIEF

Jennifer S. Newton jnewton@md-update.com GRAPHIC DESIGN

Laura Doolittle, Provations Group

CONTRIBUTORS:

Jan Anderson, PsyD, LPCC Deanna Frazier Morgan Hall Elise Hinchman Lisa English Hinkle Scott Neal Don Stacy, MD Sarah Wilder

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Send your letters to the editor to: jnewton@md-update.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax 2 MD-UPDATE

CONTENTS

ISSUE #105

4

HEADLINES

5 HEALTH EDUCATION & ADVOCACY 6

FINANCE

8

LEGAL

10 Expansion of Service

The Kentucky Center for Cosmetic and Reconstructive Surgery expands to meet the growing demands of pediatric plastic surgery patients, locally and globally 14 SPECIAL SECTION: PEDIATRICS & PRIMARY CARE 25 MENTAL WELLNESS 27 COMPLEMENTARY CARE 28 NEWS 31 EVENTS

Dr. Mark Chariker served in the U.S. Navy and was stationed in Italy during the Gulf War. He opened his cosmetic and reconstructive plastic surgery practice in Louisville in 2000.

COVER AND CONTENTS PHOTOS

BY STEVE HARMON

SPECIAL SECTION PEDIATRICS & PRIMARY CARE

13 FROM CRADLE TO GRAVE: BAPTIST HEALTH LAGRANGE

15 C ARING FOR PATIENTS LIKE FAMILY: SHRINERS HOSPITALS FOR CHILDREN – LEXINGTON

17 R EACHING EVERY CHILD IN KENTUCKY: CAMERON SCHAEFFER, MD

19 P ARENTING TIPS FROM THE PEDIATRICIAN’S OFFICE: STUART ELDRIDGE, MD

22 E XPANDING BY FOUR FEET: LEXINGTON PODIATRY ISSUE #105 3

Headlines

Lexington Clinic Introduces New EHR and Patient Portal

BY SARAH WILDER LEXINGTON Lexington Clinic now uses a new

electronic health record (EHR) in partnership with athenahealth, a leading provider of network-enabled services and mobile applications for healthcare providers nationwide.

“We are excited to implement our new EHR throughout all Lexington Clinic locations and associate practices,” said Andrew H. Henderson, MD, Lexington Clinic CEO. “The advanced capabilities of the new system offer new online capabilities to patients and allow our providers to continue to deliver the best care possible.”

The athenaOne system serves Lexington Clinic’s EHR, revenue cycle management, and patient communication needs with streamlined, easy on-boarding designed to scale and grow with the organization. The athenaClinicals quality management tool is designed to surface preventive care measures as well as best practices for care management.

The new system bridges Lexington Clinic’s patient communication, billing system, and EHR, which allows physicians and staff a more streamlined and effective way to manage patient access, care, and information. This single system includes every part of a patient’s care, where before it could take three to four systems just to check a patient in.

functionality allows staff and patients to communicate together more effectively and efficiently, and gives patients access to their healthcare from anywhere, at anytime. Through the portal, patients will have access to personal health information such as test results, visit summaries, secure messaging with a Lexington Clinic provider, and prescriptions (including the ability to request refills online).

Features of the patient portal allow users to:

Andrew H. Henderson, MD

Additionally, the new EHR utilizes a cloudbased system, which allows access to a single, shared network. This single, shared network allows physicians and clinical staff at Lexington Clinic to see the same patient data and the same clinical workflow. It provides an effective, user-friendly means to complete documentation quickly, allowing physicians and providers to spend less time documenting, and more time treating patients With the implementation of athenaOne Lexington Clinic launched a new, enhanced patient portal. The integrated and robust portal

• • • • • • •

Check in online Pay co-pays online Exchange secure messages with provider Review and pay billing statements Request appointments Research health topics Review or update personal health information • Receive visit summaries • Receive test results • Request prescription refills For more information about Lexington Clinic’s new EHR and patient portal, please call 859.258.4040 or send an email to portal@lexclin.com. Patients who wish to register for the new patient portal may do so by visiting LexingtonClinic.com/portal.

Join today and help AIM legalize Medical Cannabis in the Commonwealth of Kentucky!

Shannon Stacy RN 4 MD-UPDATE

director@aimky.org

502-203-6253

PHOTO PROVIDED BY LEXINGTON CLINIC

aimky.org

Health Education & Advocacy

Legislating Medical Cannabis in Kentucky

BY DON STACY, MD Medical cannabis is best known for efficacy in the management of severe pain, cachexia, and nausea. However, medical cannabis has also been demonstrated to be highly effective in the treatment of many other debilitating medical conditions. In fact, due to the drug’s strong therapeutic and/or palliative benefits, the following diagnoses are typically identified in relevant laws as conditions qualifying patients for access to medical cannabis: amyotrophic lateral sclerosis (ALS), glaucoma, lupus, terminal illnesses, cancer, HIV/AIDS, Crohn’s disease and other inflammatory bowel diseases, spasms (especially from multiple sclerosis), Parkinson’s disease, rheumatoid arthritis, and PTSD. Subsequent to the 2016 election cycle, 28 US states and the District of Columbia have enacted laws that eliminate criminal sanctions for the medical use of cannabis, define eligibility for such use, and permit some means of access — either through dispensaries, home cultivation, or both. Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and Washington are the current pro-medical cannabis states. Though the Commonwealth of Kentucky has not yet passed comprehensive medical cannabis legislation, a passionate medical cannabis movement has been active in Kentucky for many years.

The hard work of Kentucky medical cannabis activists began to reap positive results in 2013 when Senator Perry Clark introduced the first medical cannabis legislation to the Commonwealth of Kentucky Senate on January 8. SB11 sought to establish a comprehensive system that included provisions for medical verification of need, organizations

Don Stacy, MD

permitted to assist in providing medical cannabis, and review and reporting procedures.

Unfortunately, Senator Clark’s bill died in the Senate Judiciary Committee.

In January of the next year Senator Clark introduced a second medical cannabis bill, SB43. SB43, an updated version of SB11, was assigned to the Senate Licensing, Occupations, and Administrative Regulations Committee.

Alas, this legislation, named the Cannabis Compassion Act, also did not survive committee proceedings. However, the House Health & Welfare Committee passed HB350, a companion bill to SB43, following testimony from Dr. Suzanne Sisley, a psychiatrist and former clinical assistant professor at the University of Arizona College of Medicine. This bill, sponsored by Representative Mary Marzian, was unfortunately recommitted to the House Judiciary Committee, where it died.

Yet, the medical cannabis movement will remember 2014 for a historic achievement rather than the aforementioned failures.

SB124, sponsored by Senator Julie Denton, became the first medical cannabis-related bill passed by the Kentucky legislature and PHOTO PROVIDED BY AIM

signed by a sitting Governor. This legislation, introduced on February 05, 2014 and enacted into law on April 10, 2014, legalized cannabidiol (CBD) oil for certain pediatric seizure patients when recommended by a physician practicing at a state research hospital. Sadly, due to flawed wording, not a single Kentucky pediatric seizure patient has received CBD oil under the auspices of SB124 since the statute was adopted.

Speaker of the House of Representatives Gregory Stumbo reenergized the medical cannabis movement on January 6, 2015 when he introduced HB3. This bill, assigned to the House Health & Welfare Committee, mandated operation of a medical cannabis program by the Department for Public Health.

Unfortunately, HB3 never even received a committee vote.

In 2016 Representative Dwight Butler became the fifth Kentucky politician to introduce a medical cannabis bill, HB584. This legislation was very similar to HB3 in terms of content, committee assignment, and fate.

HB584 died in the House Health & Welfare Committee. Not to be outdone, Senator Perry Clark reintroduced his medical cannabis legislation on March 02, 2016. SB263, like his previous bill SB43, was assigned to and expired in the Senate Licensing, Occupations, and Regulations committee.

In conclusion, medical cannabis is an excellent therapeutic option for many devastating medical conditions. A majority of US states and the District of Columbia have passed medical cannabis legislation. Join the medical professionals at the Alliance for Innovative Medicine (AIM) as they fight to add the Commonwealth of Kentucky to the list of medical cannabis-friendly jurisdictions!

Don Stacy, MD, dABR, is a physician-activist. He practices radiation oncology in Louisville, Ky., and Jeffersonville, Ind. He can be reached at 606.369.4246.

ISSUE #105 5

Finance

A Guide to Smarter Giving

BY SCOTT NEAL

If you are like most people with charitable intent (lawyers call it eleemosynary intent), you write checks to charities of your choice each year and put those on your Schedule A (itemized deductions) when you file your tax return. Here are three ideas that may help you as you think about your 2017 giving – hopefully before you have written very many checks this year.

Anytime you have appreciated securities in a non-retirement account, you should consider donating those shares to charity rather than selling them and paying capital gains tax on the appreciation. The shares need to have been held for more than one year (i.e. they are subject to long-term capital gains when you sell them). If you donate the shares to a qualified charity, the charity will usually sell the shares immediately, but because it is a charitable organization, no tax will be paid on the sale. Meanwhile, you will get the full value of the shares as your deduction on your tax return. In other words, you and the charity are the winners, Uncle Sam the loser. The capital gains tax never has to be paid.

If you are over 70½ and have to make an annual Required Minimum Distribution (RMD) from your IRA, it might make sense to consider utilizing part or all of your RMD to make Qualified Charitable Distributions (QCD). A QCD is a non-taxable distribution made directly from your IRA to an eligible charitable organization. QCDs are limited to $100,000 per taxpayer and a charitable deduction is NOT allowed for the QCD. So what’s the benefit? As you probably know, distributions from IRAs typically add to your other income and are included in your adjusted gross income (AGI). A QCD is excluded altogether from AGI. The amount of AGI drives many other tax provisions, such as: 6 MD-UPDATE

phase-outs on the amount of itemized deductions that can be deducted, availably of various credits, and participation in traditional and ROTH IRAs. Having the RMD excluded from AGI to begin with can enhance your benefit from these other provisions of the tax code. So, if you or your spouse are over 70½ AND you have eleemosynary intent, you should consider making your donation in the form of a QCD. Our third tactic for smarter giving is to create a donor-advised fund (DAF) and transfer shares or cash to the DAF to trigger the deduction for the donation. At some later

date, you nominate the charitable organization(s) that you want to benefit, and the DAF sends the check. It is important to note that you will deduct the contribution when the funds go into the DAF, not when the charity receives the gift. There are a couple of big benefits of a donor-advised fund, sometimes referred to as a charitable giving account. One is that the funds can continue to be invested for growth. Another is that charitable contribution deductions can be timed to match higher income years.

As an example, let’s say that you typically give $30,000 a year in charitable donations.

D. Scott Neal,Inc. Thoughtful Financial Planning Remember the name.

Remember the philosophy.

Thinking clearly. Caring deeply.

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Finance Further assume that you know that your income this year will be greater than it will be in the next three years and that you will therefore be in a higher tax bracket this year than in any of those next three years. In other words, a deduction this year will be worth more in tax savings than at any time in the next three.

We often see this situation just before a client retires or in years in which there has been some sort of windfall. In this scenario, it is possible to transfer cash or securities worth $90,000 into the DAF in the high income year, and then

ask the DAF to distribute the funds to your chosen charities over the next several years.

Importantly, no deduction can be taken as the money is distributed to the charities. However, being able to accelerate the deduction into the year it is transferred gives you much more control over the timing of both the deduction and the actual contribution. This technique can be combined with the donation of appreciated shares for an added bonus.

Of course, there are many more considerations to effective and meaningful charitable

giving than simply paying attention to taxes.

The needs of charities have never been greater, and smarter giving simply enhances your ability to give. You should consult with your tax preparer before implementing any of these ideas. If you need a 2017 tax projection, we can help.

Scott Neal, CPA, CFP, is the president of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. Reach him at scott@ dsneal.com or by calling 1.800.344.9098.

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ISSUE #105 7

Legal

What Healthcare Providers Should Know about MACRA

BY LISA ENGLISH HINKLE

With the election of Donald Trump and the announced appointment of Tom Price as secretary of Health and Human Services, uncertainty and apprehension loom concerning the future of the ACA and how MACRA will actually be implemented. The repeal of the sustainable growth rate methodology for establishing payment for physician and eligible clinician services and its replacement with the Quality Payment Program and its two tracks for payment and implementing regulations are scheduled to become final, and thus operational, on January 1, 2017, approximately three weeks before Presidentelect Trump’s inauguration. How much of the system becomes and stays effective is unclear due to the generous rolling time period physicians and eligible clinicians have to comply before payment penalties set in. By the time the program is scheduled to be fully implemented in 2019, Trump’s HHS team and Congress will have had the opportunity to review and change the program. Despite this uncertainty, physicians and eligible clinicians should immediately begin efforts to participate in these programs, keeping in mind that it is difficult to repeal and change a program implemented through regulations and requires rescission through the administrative regulatory process. Thus the best course is to work through the process with the understanding that things may slowly change.

Creating a new payment system that integrates quality measures into payment for services has been a long and difficult task that has resulted in a complicated system with two payment models—Advanced Alternative Payment Models (Advanced APMs) and Merit-based Incentive Payment Systems (MIPS), two new acronyms that are destined to become everyday terms. While replacement of the sustainable growth rate formula was required by statute, the operational details 8 MD-UPDATE

are in the Final Rule, published as a final regulation with a comment period that expires sixty days after publication. In the final rule, the Obama administration has focused on laying the groundwork for a system that is outcome-focused, patient-centered, and resource-effective using a staged approach.

The goals are (1) supporting improved care by focusing on better outcomes for patients, decreasing provider burden, and preserving independent clinical practice; (2) promoting alternative payment models by paying incentives; and (3) working to reform system delivery with a new system promoting high-quality, efficient care. Recognizing the challenges in understanding the requirements and being prepared to participate in the Quality Payment Program, the Final Rule focuses on encouraging participation and educating clinicians for the first year. Given the wide diversity of clinical practices, clinicians are given three options to submit data to MIPS and a fourth option to join Advanced APMs to become a Qualified Participant to assure that they do not receive a negative payment adjustment in 2019.

So, what’s an eligible clinician to do in 2017?

1. Don’t panic. Several options for participation and collection of data exist.

Reductions in Medicare payments will not be implemented until January 1, 2019, which means that you have until March 31, 2018 to start the submission process for 2017 data.

2. Participate. Physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists who bill Medicare more than $30,000 a year or provide care for 100 Medicare patients must participate.

For providers new to Medicare in 2017,

participation is not required until the next year.

3. Pick one of two. Two tracks for participation as a Qualified Participant exist: (1) Advanced Alternative Payment Model (APM); or (2) Merit-based Incentive Payment Systems (MIPS).

While both tracks offer enhanced payment based upon quality and reporting factors, the APM program provides that physicians who participate with at least 25 percent of their Medicare payments or 20 percent of their Medicare patients through an advanced payment system will be paid a five percent incentive fee starting in 2019. This system is designed for providers who are participating in specific value-based care models. Participation in the MIPS program is designed for providers in traditional, fee-for-service Medicare. Regardless of path selected, start collecting and managing your practice performance data and statistics. Incorporate data collection into your everyday practice through your electronic health records system.

4. Easing requirements for other programs. MIPS rolls together three legacy programs – Meaningful Use, Physician Quality Reporting, and Value-Based Payment Modifier. Providers will earn payment adjustments based on performance in four categories linked to quality and value similar to previous programs. CMS has a gradual path of participation to allow physicians/eligible providers to pick their pace. This should streamline the process and eliminate some of the burdens of compliance with the legacy programs.

5. Adjustments don’t start until 2019.

While non-participation in 2017 results

Legal

in an automatic four percent negative quality payment adjustment in 2019, submission of a minimum amount of data – one quality measure – results in no payment adjustment. Submission of 90 days of data has the potential for a small positive payment adjustment, and submission of a full year of data has the potential to earn a moderate payment adjustment.

6. Advanced APM participation means more money. If physicians are able to participate in the APM program, a five percent lump sum incentive payment each year from 2019 through 2024 can be earned along with avoiding the MIPS

adjustments. These programs include Medicare Shared Savings, Comprehensive ESRD Care Model, Next Generation ACO Model and Comprehensive Primary Care Plus Model.

Participation may not be mandatory for your practice as CMS has estimated that those who fall below the requirements of at least $30,000 in Medicare Part B charges or 100 Medicare patients are exempt from participation in 2017.

CMS estimates that this represents 32.5 percent of clinicians, but accounts for only five percent of Medicare spending. CMS is also offering an option for small practices and solo physicians to join together in virtual groups and submit combined MIPS data. The details

Corporate Government Access Healthcare Regulation Real Estate Litigation Estate Planning Intellectual Property

In conclusion, the only certainty that providers have is slow uncertainty with Trump’s new HHS administration and the call for repeal of two regulations for every new one proposed.

Because the long-needed change is finally here, providers should not miss out on the opportunity for enhanced payment. The complexities of providing health care only grow!

Lisa English Hinkle is a Member of McBrayer, McGinnis, Leslie & Kirkland, PLLC. Ms. Hinkle concentrates her practice area in health care law and is located in the firm’s Lexington office. She can be reached at lhinkle@mmlk.com or at (859) 231-8780. This article is intended as a summary of newly enacted federal law and does not constitute legal advice.

201 East Main Street, Suite 900 Lexington, Kentucky 40507 (859) 231-8780 | www.mmlk.com

when it comes to healthcare law, does your law firm even have a pulse?

ISSUE #105 9

reporting requirements and payment

of this are not yet clear.

Cover Story

Expansion of Service The Kentucky Center for Cosmetic and Reconstructive Surgery expands to meet the growing demands of pediatric plastic surgery patients, locally and globally

BY JIM KELSEY LOUISVILLE Cosmetic and reconstructive sur-

geons know a thing or two about expansion.

From tissue expansion to bone distraction, the procedures they perform help stimulate the growth necessary to reshape and reform the bodies of their patients.

Expansion can be painful and time-consuming, but in the end, it’s worth it.

Mark Chariker, MD, FACS, opened his practice in cosmetic and reconstructive surgery in Louisville in 2000. Over that time, he’s seen his referrals grow and his focus on pediatric plastic surgery become more defined. Demand began to outdistance what he could supply. He took stock of his practice and, much like the patient growing new tissue, realized his practice was ready for expansion. In July 2015, he brought in a partner, Scott Rapp, MD, and together they formed the recently renamed Kentucky Center for Cosmetic and Reconstructive Surgery.

“I came to the realization that I couldn’t keep all my referring doctors happy,” Chariker says, upon the decision to expand. “I couldn’t be in multiple places at the same time. They were getting frustrated with me, and I was getting frustrated with what I couldn’t do. It was a five-year process where slowly I became overwhelmed. I knew to do the job right it took two people.”

With a patient population that is roughly two-thirds pediatrics and one-third adults, Chariker needed to find someone who shared his love for children and dedication to philanthropy and mission work. He knew that someone with a fiber and makeup similar to his own would lead to the most seamless transition and best outcomes.

10 MD-UPDATE

“I brought Dr. Rapp on because he has state-of-the-art training, and I thought he Dr. Mark Chariker (left) found the could add to my skill set for the children’s right partner in Dr. Scott Rapp hospital,” Chariker says. “He’s excited about (right) in 2015. The two share taking care of children. He’s already started a passion for pediatric plastic surgery and mission work. doing mission work, and he has added a refreshing level of energy and passion.”

The early Chariker served in the United States Navy from 1979-2000. He toured in Portsmouth, Va., where he was head of hand surgery. Among his other stops, he served as chief of surgery in Naples, Italy, during the Gulf War; served as chief of surgery in Charleston; trained in Louisville and Taiwan in pediatric and craniofacial surgery; and traveled to the Philippines for 25 years for craniofacial and hand surgery mission work.

When he was allowed to train outside of the Navy, Chariker came to Louisville to train in microsurgery, plastic surgery, and hand surgery Mission work is important to both Chariker and Rapp because it in the Kleinert fellowship. blends many specialties and nationalities. Pictured here in Cuba Chariker then took that train- after a free fibula flap for mandibular reconstruction are (l-r): ing back to the Navy, where he Guillermo Sanchez Acuna, chief of maxillofacial surgery, Emmanuel was able to apply his skills to Rendon, maxillofacial surgeon from Mexico along with Dr. Scott Rapp. some very difficult cases. “I was able to practice state-of-the-art medicine in Problem Solving and the Navy,” Chariker says. “I was able to give Virtual Surgical Planning back to the people who really make this counToday, Chariker and Rapp pride themtry the great nation it is. I was able to push selves on being at the forefront, continuing to the envelope on cutting edge surgery. After push the envelope. The Kentucky Center for completing his naval service, he returned to Cosmetic and Reconstructive Surgery serves Louisville to join Drs. Jerry Verdi and Jerry most of Kentucky as well as southern Indiana.

O’Daniel, but remained a separate practice A primary focus is pediatric plastic surgery, and continued their legacy in craniofacial and which includes craniofacial surgery, complex pediatric surgery. wounds, complex lesions, congenital anomaPHOTO PROVIDED BY DR. SCOTT RAPP

Cover Story

lies, and manifestations of cancer where body parts or body function must be restored.

They are often called upon to assist other surgeons from other specialties. For instance, they might help a heart surgeon reconstruct the sternum or a pediatric surgeon reestablish the abdominal wall.

“Some of the surgeries require immediate attention, and we will be there in that surgery,” Chariker says. “Some of them require careful planning before surgery, and we have to acquire replacement parts, so to speak, where we will order an implant or device that will replace the natural bone, for instance, that has been removed.”

Frequently, part of that planning is now

done via Virtual Surgical Planning (VSP).

Through VSP, Chariker and Rapp can three-dimensionally design a missing part, have it made out of special materials, and sterilized for the procedure. VSP also helps in anticipating how much tissue will be needed to cover the replacement part.

VSP played a significant role in a recent case involving conjoined twins. The twins were joined at the chest and abdomen, and they shared a liver. The VSP modeling helped predict how much tissue would be missing after separating the children. The predictions played out well, and the twins were successfully separated and reconstructed.

That was one of the first cases Rapp hanPHOTO PROVIDED BY STEVE HARMON

dled after joining the practice. It was a challenging introduction but perfectly fit the type of work he was looking for. “I’m one of those people who has a new hobby every other day,” Rapp says. “Plastic surgery kind of allows you to always have that new hobby because every case is new, every problem is different. You can’t become complacent with a particular technique or approach.”

Rapp, originally from Dublin, Ohio, finished his Plastic, Reconstructive and Hand Surgery training at the University of Cincinnati. Following, he completed a Cleft and Craniofacial Fellowship at Stanford University.

While about a third of their practice ISSUE #105 11

When a lot of people think of plastic surgery, they have no idea what we do.

While I don’t perhaps save people’s lives like cardiac surgery, I think we can still make a pretty drastic improvement.

— Dr. Scott Rapp involves procedures on adults, Rapp and Chariker share a passion for pediatric plastic surgery. “The amazing thing with pediatric plastic surgery is you have this unbelievable amount of pressure and stress to be able to deal with the grand implications of a young patient and a family that put their total trust into you,” Rapp explains. “Your results really have an impact for 20 years.”

“We get challenged by insurance companies every day as to whether or not looking normal is cosmetic or reconstructive,” Chariker says.

“The fact of the matter is, what’s acceptable is that you not be noticed as being abnormal.

Whatever it takes for a patient to look normal is our goal. That’s the standard. For a child to be able to be successful in society, they have to speak well and they have to look normal.

That’s where we fit in and that’s a misconception about what we do in plastic surgery.”

12 MD-UPDATE

Changing Perception in Plastic Surgery Another misconception is that plastic surgeons are money-driven and live the Nip/Tuck celebrity lifestyle. The reality is much different. Chariker and Rapp operate three days a week, handling anywhere from five to 13 cases a day. They have two office days where they see patients – typically children in the mornings and adults in the afternoon – to do dressing changes, follow up on patients after surgery, and see new patients for new surgery.

“I open the door and I don’t know what’s on the other side some days,” Chariker says.

“That’s what makes me come in every day. I practice medicine for fun. I can’t think of a better purpose to get up than to try to help somebody else.”

Sometimes, getting up involves waking up in another country. Chariker has taken several PHOTOS PROVIDED BY DRS. MARK CHARIKER AND SCOTT RAPP

(l-r) Drs. Scott Rapp and Mark Chariker collaborate in surgery at the Louisville Surgery Center.

mission trips to the Philippines, and Rapp has been to Cuba four times over the past few years, working at the William Soler Hospital in Havana.

“A lot of the kids that we see down there don’t get operated on in the typical time frame they normally would, so they are some of the most complex surgeries that you can do,” Rapp says. “We had a nine-year-old girl with hypertelorism who wouldn’t say ‘hi’ or even look at you. After we did the surgery, she got in front of 50 people and was singing karaoke.

The social and behavioral implications of their outward appearance often cause them to be introverted and reserved. To be able to have that effect with one surgery, that’s what’s great about mission work.”

That philanthropy isn’t only performed outside the states. Back home, Chariker and Rapp often work out deals or perform pro

Chariker specializes in pediatric craniofacial surgery. Above is an example of a child with an infantile hemangioma before and after reconstruction.

Chariker performed this cleft lip repair on a child in the Philippines in 2015.

Kamryn is an 18 month old with multi-suture synostosis from cardiofacial cutaneous syndrome who underwent posterior vault distraction by Rapp to address elevated intracranial pressure and large boney defects to her skull. Distraction osteogenesis is a useful tool to allow for ample bone generation with goals to create space and movement in the craniofacial skeleton.

bono work and “just blend it into our day.”

“I don’t want to recruit patients because they are wealthy,” Chariker says. “And I don’t want to push people away because they can’t pay. I want to take care of people who just need help.

I’ve had consults from Pakistan, Russia, Asia, Africa, Guatemala. I just like the challenge of taking care of the problem. I feel honored for people to come to see me. Money doesn’t drive me. A successful outcome drives me.”

One of the procedures that Chariker developed to achieve those successful outcomes is negative pressure wound therapy. “Negative pressure wound therapy is when we actually create a stress on the tissue by using a suction system through a foam gauze,” Chariker says of the innovation he developed in 1986. “It distributes the suction – the negative pressure – on the wound surface, stimulates the cells to turn over, and creates granulation tissue.

It creates a healthy wound bed that gives us more options for reconstruction.”

A more recent innovation is distraction osteogenesis. This is primarily used for the craniofacial surgeries Chariker and Rapp specialize in.

In this procedure, a device is used to expand the cranium and make the patient grow their own tissue. “Orthopedists have been using this technique for decades to lengthen the long bones,” Chariker says. “Now we’ve brought it into the head, which is a great innovation to replace bone that otherwise would not be there. We cut the bone and we stretch it and put a stress on it, and it stimulates more bone growth.”

Most of these craniofacial operations are performed on children ages six to 12 months.

They are complex procedures that involve a large and highly specialized collaboration.

“It’s a team effort,” Rapp says. “There’s the neurosurgeon, ENT, OMFS, genetics, speech PHOTOS PROVIDED BY DRS. MARK CHARIKER AND SCOTT RAPP

pathology, dentists, orthodontists – all are very important and integral to almost every one of my patients.”

That Kentucky Center for Cosmetic and Reconstructive Surgery is often trusted to be part of this team is a direct reflection on the reputation that Chariker has built over time.

“The medical community has come to trust Mark Chariker over the last 20 years,” Rapp says. “He’s brought me along, and I will hopefully provide that accessibility, that you can count on me, just like you counted on him for 20 years, to provide services to this city with the same type of passion, energy, motivation, and sincerity that he has.

“When a lot of people think of plastic surgery, they have no idea what we do. While I don’t perhaps save people’s lives like cardiac surgery, I think we can still make a pretty drastic improvement.”

ISSUE #105 13

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Pediatrics & Primary Care

From Cradle to Grave

A shared interest in generational care brings providers and patients together at Baptist Health Medical Group Internal Medicine & Pediatrics in LaGrange

BY JENNIFER S. NEWTON LAGRANGE Across the country, and mirrored

in the Bluegrass, we often hear about the shortage of primary care physicians. The fact is often followed by many hypotheses, one of which is that, given the current healthcare climate, medical students are choosing specialties that seem more glamorous or lucrative.

But for one group of internal medicine and pediatrics and family medicine physicians in LaGrange, a shared commitment to caring for families and a penchant for small-town living have become a formula for exponential growth.

“I love taking care of families. It’s very rewarding to take care of multiple generations of the same family,” says Katherine Jett, MD, of Baptist Health Medical Group Internal Medicine & Pediatrics. “I grew up in a small town. My family doctor now is the same person who delivered me. My goal was always to go back to a smaller community to do primary care.”

Jett, who joined Baptist Health in LaGrange in 2010, was a solo practitioner up until last

year. She asked for a partner, and now, a year later, she has four: Tannika Christensen, MD, Robin Kindig, MD, Sarah Thayer, MD, and Abby Hefner, APRN. She attributes the rapid growth to the departure of other providers in the area but also to patients’ desire to have “one practice to call home” for the entire family.

The practice currently sees approximately 80-90 patients a day, with Thayer just having joined in October and still building her patient base. Robin Kindig, MD, believes their practice model is also to credit for their growth. “We are a high volume practice because we have chosen to be a traditional insurance based practice. We’re not concierge and we’re not direct pay like some of the lower volume practices,” she says.

The comradery among the physicians is evident. “Each of us gets a day off, and we share patients. We’re not territorial. So, it’s kind of nice. Our practice philosophy is we are going to take good care of patients. We’re going to

Baptist Health Medical Group Internal Medicine & Pediatrics in LaGrange has grown from one provider to five in just over a years’ time: (l-r) Sarah Thayer, MD, Katherine Jett, MD, Robin Kindig, MD, Tannika Christensen, MD, and Abby Hefner, APRN.

14 MD-UPDATE

PHOTO PROVIDED BY BAPTIST HEALTH

take care of them when they’re sick and also when they’re well. We try to make sure we have availability same day,” says Kindig.

Drawn Together by Similar Interests Three out of the four physicians are double-boarded in internal medicine and pediatrics. Says Jett of why she chose the specialty, “I did it because I felt like if I was going to see kids or adults I should have equal training to an internist or a pediatrician.” Jett went to medical school at the University of Louisville and completed her residency at U of L. Like Jett, Sarah Thayer, MD, is a small town girl who grew up on a southeastern Kentucky farm. She valued her family doctor growing up, and her mother was a nurse. She decided to pursue internal medicine and pediatrics because of the blend of adults and children and the ability to keep her options open and specialize later on. Thayer attended UK

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for medical school and U of L for residency.

“I love it up here because it feels a little bit like where I grew up. I feel like the population of people we see here are really hard workers, farmers, and just a joy to take care of because they really appreciate us,” says Thayer.

Kindig was drawn to the in-depth understanding of her patients a double-boarded specialty could provide, and this practice has proved to be a breeding ground for like minds. “I was drawn by having other similarly trained partners. We’re all dedicated to seeing the entire family as well as adults, and I felt like we all had a similar sense of what we want in a practice,” says Kindig, who attended medical school at the University of Kentucky and completed her residency at the University of Louisville. She is also on the faculty at U of L and teaches residents in their practice.

Tannika Christensen, MD, is the only practice member trained in family medicine. “Our practices are very similar. We just have different training,” she says. Christensen is from the west coast and attended medical school at the University of Utah and residency at McKayDee Family Medicine Residency in Ogden, Utah. She practiced in Utah and Oregon for several years before coming to LaGrange eight years ago and joining Baptist Health a little over a year ago.

Christensen was drawn to family medicine because of the variety of ages and issues, along with “the idea of being able to take care of someone from the time they are born all the way up to the time they are old, being able to develop that patient-physician relationship.”

The practice’s fifth provider is nurse practi-

tioner Abby Hefner, APRN. Hefner began her career as an RN at Baptist East in and then went on to get her master’s at Spalding University, becoming an APRN in 2004. Before joining the practice in February 2016, Hefner says, “I had worked in the critical care setting in a hospital but I wanted a little more autonomy, and I also wanted to work toward a little more preventive healthcare and more family-oriented.”

Hefner shares a passion for seeing generations of families and also for treating diabetes patients.

Pediatrics & Primary Care

as much as is prudent in their office but to approach each patient individually with the best interest of the patient in mind. “We have a great set of specialists right here in this community, in this building,” says Christensen.

“We have a good collaborative environment.”

For those patients that need the highest level of specialized care, Baptist Health Louisville is just a short trip away.

In Practice The practice attends the newborn nursery at Baptist Health LaGrange, so they see patients from hours-old to almost a-century-old. Their case load is just what you might expect, including things like: well-baby checks and physicals, acute visits for upper respiratory infections and bladder infections, and chronic disease management of diabetes, hypertension, hyperlipidemia, COPD, and more. The providers also enjoy simple procedures such as mole removals and laceration repair.

Prevention and wellness are common themes in their daily work. “I do think it is important to focus on prevention, trying to get people at a healthy weight, trying to control diabetes and high blood pressure, and those things that if we don’t control can lead to bigger issues,” says Thayer. “I like to have people work with me to try to come up with a plan together from a patient-doctor perspective that’s going to work with their lifestyle.”

When it comes to referring to specialists, the practice’s guiding principle is to manage

BAPTIST HEALTH MEDICAL GROUP INTERNAL MEDICINE & PEDIATRICS Katherine Jett, MD Tannika Christensen, MD Robin Kindig, MD Sarah Thayer, MD Abby Hefner, APRN 1023 New Moody Lane, Suite 201 LaGrange, KY 40031

502.225.5520 Fax 502.225.5522

Focus on what matters most.

We’ll handle the rest.

• Revenue cycle assessment and • Reimbursement optimization management • Accounting and financial • Physician coding and documentation outsourcing improvement • Compliance and risk • Managed care contract negotiations management services

859.255.2341

deandorton.com ISSUE #105 15

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Pediatrics & Primary Care

Caring for Patients Like Family

Pediatric orthopedic surgeon Elizabeth Hubbard, MD, joins Shriners Hospitals for Children – Lexington to provide the best care regardless of costs or constraints

BY MORGAN HALL

LEXINGTON In August 2016, Elizabeth Hubbard,

MD, joined Shriners Hospitals for Children – Lexington as a pediatric orthopedic surgeon.

Hubbard joined the expert medical team at Lexington Shriners Hospital upon completing her fellowship in pediatric orthopedic surgery at Texas Scottish Rite Hospital for Children in Dallas, Texas.

“I love a variety of subspecialties in orthopedics but not enough that I would only want to do one particular type of surgery for my career. Pediatrics gives you the ability to still be a type of general orthopedist. I also love the patient population,” says Hubbard.

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Areas of special interest to Hubbard include Legg-Calve-Perthes disease, limb length discrepancy, and scoliosis. “Everyone working at Shriners Hospitals for Children – Lexington is genuinely motivated to do the absolute best thing for the patients, regardless of cost or other constraints,” Hubbard says. “I love working in an environment where I know everyone around me cares as much for the patients and families as they would their own.”

Hubbard’s hometown is Newark, Del. She received an undergraduate degree in biology and health studies from Siena College and earned her medical degree from Albany

Elizabeth Hubbard, MD, (left) who joined Shriners Hospitals for Children – Lexington in August 2016 as a pediatric orthopedic surgeon, examines patient Ethan Perry (right).

Medical College. Hubbard completed her residency in orthopedic surgery at Duke University Medical Center.

“What impressed me the most when I first interviewed at Lexington Shriners Hospital is the level of staff commitment,” says Hubbard.

“A large percentage of the staff has been at the hospital for more than five years; many have been working there for 10 to 30 years. This is

PHOTO PROVIDED BY SHRINERS HOSPITALS FOR CHILDREN – LEXINGTON

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Pediatrics & Primary Care

Shriners Hospitals for Children – Lexington make it a priority to do everything they can to alleviate any discomfort associated with surgery. Depending on the patient’s age and condition they may receive their very own driver’s license. When possible and with help, the patient may drive themselves into the operating room. Katy Marcum, PACU RN, (left) assists patient Emma Grace Hall (right) with her driving skills.

a testament to how much everyone is committed to their patients and fostering the mission of Shriners Hospitals for Children.”

On April 17, 2017, Shriners Hospitals for Children – Lexington will open a new facility on South Limestone across from the University of Kentucky Albert B. Chandler Hospital. The new facility will be a state-of-the-art ambulatory care center, owned and operated by Shriners Hospitals for Children, and designed to better meet the orthopedic needs of children and their families well into the future.

The estimated cost of the new Shriners Hospitals for Children Medical Center is $47 million. The new Lexington Shriners Hospital facility will include a motion analysis laboratory, one of only three in the state, an EOS imaging system, the first in Kentucky, 20 patient exam rooms, two surgical suites, a rehabilitation gymnasium and therapy rooms, and interactive artwork.

Hubbard, along with the entire pediatric orthopedic medical team at Lexington Shriners Hospital, is looking forward to the benefit the new facility will bring to their patients particularly those with complex conditions. “Relocating to the UK HealthCare campus will help us optimize our patient care by allowing us to have a close connection with other pediatric subspecialties at Kentucky Children’s Hospital,” Hubbard says. “The new facility will offer us the ability to work closer with our pediatric medicine and surgical colleagues and offer a broader range of healthcare to better serve our patients who have more complex medical conditions.”

Lexington Shriners Hospital will begin seeing patients at their new facility on April 17, 2017, and their dedication ceremony will be held on May 21, 2017 at 1:00pm.

Morgan Hall is director of public relations for Shriners Hospitals for Children – Lexington.

She can be reached at 859.268.5719.

PHOTO BY GIL DUNN

ISSUE #105 17

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Pediatrics & Primary Care

Reaching Every Child in Kentucky Q&A with Cameron S. Schaeffer, MD

Two years ago, we published an article about Cameron S. Schaeffer, MD’s new office in Louisville. MD-UPDATE Publisher Gil Dunn recently sat down with him to discuss his practice.

patients with congenital and reconstructive genital issues, as well as from gynecologists who have patients interested in labiaplasty.

■■ MD-UPDATE: Some of our readers are new, so tell us about yourself.

I had been outreaching to Bardstown for several years, so I already had many patients and loyal referring friends and colleagues from Louisville and western Kentucky. With the consolidation in medicine triggered by Obamacare, opening a permanent office in Louisville and taking care of my referral base, and potentially broadening it, seemed prudent. By being in Louisville, I could also begin offering my surgical patients access to the best children’s hospital in the state.

SCHAEFFER: I was born in Louisville, grew up in Lexington, and graduated from Henry Clay High School. I went to Dartmouth with a passion for biology and all things living, pretty certain that I wanted to become a veterinarian. I ended up in the honors English program, focusing on Elizabethan drama and poetry. I wrote my thesis on Shakespeare’s final plays – the romances. I briefly considered becoming an English professor, but I couldn’t give up my dream. I saw an ENT for my allergies while in college, and he convinced me that I should take care of hypoallergenic creatures. I tell people that pediatric surgery is the closest thing you can get to veterinary medicine via medical school.

■■ You have been in Lexington for over 16 years, yet you opened an office in Louisville in 2014. Why?

Cameron S. Schaeffer, MD

I initially practiced in Denver. It soon became clear that I would eventually become a fulltime plastic surgeon if I stayed there, so I decided to come back to Kentucky to focus on pediatric urology. Obviously, there were other factors involved in that decision. It was a good move for me and my family.

■■ Summarize your medical training and early career.

■■ You are board-certified in urology, pediatric urology, and plastic surgery.

Is pediatric urology all you do?

After Dartmouth I went to the University of Virginia for medical school and the University of Utah for general surgery and urology.

I became very interested in reconstructive urology, which led to a pediatric urology fellowship at Duke and a second residency in plastic surgery at the University of Louisville.

No, but it is my primary focus. I consider myself a reconstructive genital surgeon. These days, most of that work is in pediatric urology, but the field, like many surgical disciplines, was pioneered by plastic surgeons. I still do some general plastic surgery to keep up my skills. I also get referrals from adult urologists who have

FOR PATIENT REFERRALS LOUISVILLE (502) 410-4700 1169 Eastern Parkway Suite 2358 Louisville, KY 40217

LEXINGTON (859) 257-5437 (KIDS) 1760 Nicholasville Road Suite 601 Lexington, KY 40503

(866) KIDSURO | FAX (859) 275 5434 | WWW.PEDIATRICUROLOGY.COM 18 MD-UPDATE

PHOTO BY GIL DUNN

■■ How is your Louisville practice going?

It has been very well received. I work in Louisville every Tuesday, and I have been busy from day one, almost exclusively doing surgery.

■■ Do you still outreach?

I go to Mount Vernon one day per month and do clinics. We started doing that when the price of gas shot through the roof. It didn’t make sense to ask people, some of whom are of modest means, to drive to Lexington when I could go to them.

■■ You are basically covering the entire state of Kentucky.

That sounds exhausting.

Yes, we have patients from Pikeville to Paducah. We also see patients from every state that borders Kentucky, and some beyond that.

With the internet, people find what they are looking for. Surgery is a team sport. I have a great office staff, a wonderful and very experienced pediatric urology nurse practitioner, Ann

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Muth, who is based at our Louisville office, and great anesthesia and OR support in both cities.

The Norton administration and my pediatric urology colleagues in Louisville have been very supportive as well. I still have the energy to play my position. Louisville is only an hour away, and, besides, it is in many ways my home.

labiaplasty. I have had good results with that operation and some extremely happy patients, some of whom are motivated by cosmetic

Pediatrics & Primary Care

concerns and some of whom are having issues with discomfort. That is an operation that can be done crudely or with great artistry.

■■ You finished your training almost 20 years ago. How has pediatric urology changed?

I think we have seen a general refinement of surgical techniques that are giving us better functional and cosmetic outcomes. Pediatric urologists have been very prudent in adopting laparoscopic surgery where it makes sense, particularly in the treatment of undescended testicles. The genitourinary system is retroperitoneal. When you can quickly reconstruct or remove a kidney through a one-inch incision and stay out of the abdominal cavity, it hardly makes sense to use a robot. That is minimally-invasive surgery. One area where technology has had a big impact is prenatal ultrasound.

The diagnostic power of modern ultrasound machines is amazing. Most significant urinary tract malformations can be spotted prenatally and treated proactively in infancy. We fix a lot of babies before they ever get sick.

■■ You are now entering the final decade of your career. What do you want to focus on from here forward?

Thanks, Gil; everybody else tells me I don’t look 55. Going forward? I suppose I would like to focus on genital surgery. I have already started sending my major reconstructive urinary tract cases to regional colleagues, and having a pediatric urology nurse practitioner has lightened my clinic work and kept me in the OR. My plastic surgery friends in Louisville have encouraged me to start advertising my skill set to adults. Probably the biggest untapped market in that realm is

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ISSUE #105 19

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Pediatrics & Primary Care

Parenting Tips from the Pediatrician’s Office Q&A with Stuart Eldridge, MD

MD-UPDATE Publisher Gil Dunn recently sat down with longtime pediatrician and new author Stuart Eldridge, MD, on the role pediatricians play in parenting.

the training professionals should have to guide parents to successful parenting. The book has been found to be a beneficial read for parents as well, and it is my hope that all professionals who minister to families will find the book beneficial.

■■ MD-UPDATE: Please give us a brief synopsis of your medical training, your background and current practice.

ELDRIDGE: I graduated from the University of Louisville School of Medicine in 1990, and did my pediatric training at Kosair Children’s Hospital. After one year as a staff pediatrician at Audubon Hospital in Louisville, Ky., I opened Physician Associates of Floyds Knobs, LLC in 1995 with Dr. Dan Eichenberger and five staff. We grew the practice to six physicians and a nurse practitioner and 35 staff before selling it to Floyd Memorial Hospital in 2013. In October 2016 Floyd Memorial was sold to Baptist Health.

■■ Describe your current patient population, age, gender, geography, presentations and treatments.

I am a board certified pediatrician caring for patients from birth to 21 years of age in both Floyds Knobs and Jeffersonville, In., where I practice comprehensive general pediatric medicine.

■■ You recently authored a book, Passionate Parenting: A Guide to Healthcare Professionals.

Please tell us briefly the general theme of the book and what motivated you to write it.

As the title indicates, the book is designed to help healthcare professionals direct parents in 20 MD-UPDATE

■■ Describe the relationship between physician, parent, and patient, both the ideal and the norm.

Stuart Eldridge, MD, MBA

The most significant pitfall for physicians wanting to help parents has to do with the lack of parenting skills training provided to them during their residency training. — Dr. Stuart Eldridge learning the art and skill of effective parenting.

Following 20 years of my wife and I teaching parenting classes in our home and church, and seeing the continued struggle of parents, I realized parenting training from healthcare professionals needed to become a bigger part of our care of families. Knowing that parenting skills training is not a normal part of pediatric residency training, I decided to write a book that might motivate healthcare professionals to develop a “passion” to learn effective parenting skills they could pass on to parents in their care.

From toddlers to teens, the book provides PHOTO PROVIDED BY DR. STUART ELDRIDGE

In the ideal situation, parents are the primary caregivers to their children. Physicians supplement a parent’s care with health examinations and the treatment of illnesses, and provide advice and counseling to parents as needed. The present day norm can in fact be in stark contrast to this ideal. Many children live in dysfunctional families ravaged by alcohol and drug abuse, divorce, neglect, or physical and mental abuse.

The norm now is a large proportion of parents who struggle with how to effectively parent their children.

■■ What do you consider the major pitfalls for the physicians, both pediatricians and family care, when dealing with unhealthy behaviors of patients?

The most significant pitfall for physicians wanting to help parents has to do with the lack of parenting skills training provided to them during their residency training. Without parenting training, the healthcare professionals have only their own upbringing or parenting skills to depend on. If their upbringing was good, or they took the time to train themselves in how to be an effective parent, then the information they pass on to parents would be helpful. If not, their advice may do more harm than good.

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■■ You are a husband, father, and doctor. Please describe from your experience, the impact of different family structures and foundations on the health of the pediatric patient and how the physician deals with the different circumstances.

I love the medical profession and have loved being a pediatrician, but being a husband and father has been the greatest joy of my life. I strongly believe that if you want to be the best parent you can be you need to keep what I call your Love Priorities in the right order. Your marriage is your first priority, children are your second, your career is third, and all other social activities are fourth. This order is often reversed in families, and children pay the price. In my years as a pediatrician, I have seen children living in all kinds of family structures. Many children in non-traditional home settings do well, but just as many do not. By far the best chance for children to grow to be healthy, happy, well-adjusted adults is to be raised in an intact family.

■■ Are there any underlying trends or behaviors that have an adverse effect on the health of the pediatric patient and the family? Please explain.

There are a number of trends taking place today that are affecting our young people. First, the overuse of TV, gaming, and cell phones are causing sleep problems, which can lead to behavior problems, inattention, and poor school performance. Second, parents today are giving children too many choices at too young of an age, which creates behavior problems when children believe they can make all decisions. Third, parents feel compelled to involve their children in every sport and activity, which can turn the parents into glorified taxi drivers, leading to self-centeredness in children who believe their own activities are the most important. Lastly, the growing trend of social media is creating more and more problems with anxiety, depression, cyber-bullying, isolation, and family discord. This may be the most concerning of today’s trends.

Pediatrics & Primary Care

■■ What do you think are the most common misconceptions regarding pediatric care among other medical professionals?

I believe the most common misconception is that what we do in our care of children mostly involves the treatment of runny noses and ear infections. In truth, the comprehensive care of pediatric patients involves treating all the varied problems from birth through adolescence. The problems faced by children and adolescents are far more complex than in days past, and healthcare professionals caring for our youth are being called upon to provide greater degrees of care.

Stuart Eldridge, MD, MBA, is a pediatrician with Baptist Health Medical Group Family Medicine in Floyds Knobs, In., and is the author of Passionate Parenting: A Guide to Healthcare Professionals. For more information, visit www.teachpassionateparenting.com or contact his office at 812.923.2273.

ISSUE #105 21

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Pediatrics & Primary Care

Expanding by Four Feet

How to reduce the cost of orthotic outgrowth for children

BY ELISE HINCHMAN LEXINGTON Kids turn out to be way more expen-

sive than anyone ever plans on. From the moment they find out they’re pregnant, until the day they die, moms are constantly stressed out about something to do with their children.

Imagine you were told you’re going to have twins! Double the fun, double the cost, right?

Right.

Dr. Jamie Settles Carter can really understand what moms are going through because she’s got twins of her own on the way! Her little family is expanding by four feet!

The upcoming birth of her twins means that there will be two kids with runny noses, two kids with flat feet, or two kids with sprained ankles sustained during a basketball game …

there is always the potential to see double.

When confronted with the news of twins, Carter immediately started thinking of all the things she would soon need two of and how to pay for all of these complications. This can definitely cause some undue stress to moms and dads alike. Kids are often unpredictable, and you never know when an unforeseen expense is going to arise. However, one thing you can be certain of is that kids are going to grow.

Sometimes it’s one shoe size a year and sometimes its five sizes in a few months. So, when mom and dad have concerns about paying hundreds of dollars for a pair of custom orthotics for their children that may only be able to use them for six months, it is understandable.

Carter can relate to the parents’ concerns and finds it extremely important to let the parents know that as a physician and a parent, she can understand how expensive children are. However, in addition, she can also understand the ramifications that can occur if treatment isn’t rendered quickly and appropriately.

“By discussing the consequences of lack of appropriate treatment for children, such as worsening of their flat feet leading to ankle and knee pain for the majority of their adult life, parents are more likely to respond favorably to the appropriate treatment plan,” Carter explains.

More Tips for Reducing the Stress of the Cost of Medically Necessary Orthotics: Carter feels strongly that it is important to thoroughly educate parents on the specific “grow out plan” that the physician’s office and orthotic company provide. Oftentimes, there are cost breaks associated because the companies know that this can be a hardship on the parents.

An exceptional OTC device can take the temporary place of a custom orthotic.

Something like “Little Steps” are much more cost efficient and do a really good job of not 22 MD-UPDATE

PHOTOS PROVIDED BY LEXINGTON PODIATRY

Dr. Jamie Settles Carter has an extensive background in wound care and the treatment of diabetic foot conditions.

only treating painful feet, but also preventing debilitating future complications. This may be a lifesaving alternative to parents that are looking at having to purchase two or more pairs within a one year period of time.

It is always important to let the kids and parents know that the physician is concerned only about the best interest of the child. The physician is not the family’s financial planner, so should present them with the facts, give their professional opinion, and let them be a part of choosing the appropriate treatment for their child.

Carter is an expert in all aspects of foot and ankle surgery, as well as the latest techniques and procedures for treatment of heel pain, diabetes, ingrown toenails, and all other common foot and ankle conditions. Due to her extensive background in wound care, she has a particular place in her heart for diabetics that are looking for a podiatrist that will listen and work with them to achieve a healthy outcome. When she designs a comprehensive treatment plan, she takes into account the patient’s personal needs, lifestyle, age, occupation, and limitations.

Elise Hinchman is the office manager and marketing director for Lexington Podiatry.

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Pediatrics & Primary Care

By discussing the consequences of lack of appropriate treatment for children, such as worsening of their flat feet leading to ankle and knee pain for the majority of their adult life, parents are more likely to respond favorably to the appropriate treatment plan.

— Dr. Jamie Settles Carter

Reducing parents’ fears of costly foot care is a step in the right direction.

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Pediatrics & Primary Care

Louisville’s Uspiritus Helps Troubled Youth Throughout the State Multiple childhood traumas create a common thread among facility’s clients

BY STEPHANIE MOJICA

LOUISVILLE The

multidisciplinary tive development, (being) unable I think one piece that’s important, and team at Uspiritus, a Louisville-based to manage anger well, and getting comprehensive residential and outfrustrated easily in school because is more sort of a cautionary tale to patient treatment program, reguyou’re behind. In part, you’re behind physicians, is to remember that these are larly works with youth who have because you don’t do homework at families that are often under-resourced already suffered six or more traumathome, and in part you’re behind ic childhood experiences, according because you have missed a lot of and overwhelmed. — David Finke, PhD to David Finke, PhD. school, and then you’re more frusFinke, a licensed psychologist The residential campuses offer two types of trated and more likely to act out,” and vice president of residential services at beds: Psychiatric Residential Treatment Facility Finke says.

Uspiritus, urges other medical professionals (PRTF) beds for the most intensive treatment “So it’s really across the spectrum, which is to take note of the signs of childhood trauma. and Psychiatric Child Care (PCC) beds for why you attempt to engage the kids across all What he calls “adverse childhood experiences” less intensive or step-down treatment. The aspects of their lives, because we believe that include physical abuse, sexual abuse, neglect, organization also offers therapeutic foster care, you really need to treat the whole child to and family members who are incarcerated, intensive in-home services, independent liv- progress them developmentally.” mentally ill, and/or abusing substances. ing, and family preservation programs and “The research is that adults who had more has locations offering varying degrees of ser- Educating Troubled Youth adverse experiences (as children) are much vice in Anchorage, Bowling Green, Lexington, and Their Providers more likely to have severe health problems and and Louisville. The multi-disciplinary team The organization’s Anchorage campus has usually have a shorter lifespan,” Finke says. at Uspiritus consists of two part-time psychi- an elementary school, while the Louisville Finke, who has 20 years’ experience in trau- atrists, both of whom are board-certified in campus has a middle and high school. ma-related treatment and trauma-informed care, child and adolescent psychiatry, psychologists, Educational services are provided through has a PhD in clinical psychology from Michigan psychological associates, social workers, art Jefferson County Public Schools. Staff memState and a post-doctoral fellowship in adoles- therapists, and professional counselors. bers working on an Uspiritus campus are cent services from the University of Illinois at Delayed emotional development and poor specially trained to work with troubled youth.

Chicago. Prior to joining Uspiritus, he was the nutrition are just two of the issues facing the Most Uspiritus residents come after at least division director and training coordinator of children and teens who come to Uspiritus one psychiatric hospitalization, and Medicaid the Jefferson County Internship Consortium for help. covers about 95 percent of the organization’s in the Child and Adolescent Services Division Because of the backgrounds of the aver- residents. The average stay is 90 to 120 days. of Seven Counties Services, Inc. He has also age Uspiritus resident, Finke and other staff If it is safe for the child to do so, family reuniserved as a regular consultant and assessor for members focus on helping each one become a fication is the goal. Otherwise, therapeutic the Jefferson District Court, Juvenile Division. better functioning person. foster care is part of the child’s aftercare plan.

“Often times, a lot of our youth have had “I think one piece that’s important, and is How Uspiritus Reduces the a history of truancy with schools, so they are more sort of a cautionary tale to physicians, Impact of Childhood Trauma already perhaps growing up in an environ- is to remember that these are families that Uspiritus is the result of a 2012 merger ment where there’s not a lot of exposure to are often under-resourced and overwhelmed,” between Bellewood Home for Children and literature, not a lot of reading and nighttime Finke says. “I think, as providers, we are used Brooklawn Child & Family Services. The orga- reading. And in addition to that, not attend- to making a recommendation or making a nization annually serves over 1,300 Kentucky ing school on a regular basis … They do not treatment intervention and expecting it to youth. Uspiritus runs two residential cam- perform as well in school, and therefore get be followed. It’s important to be patient and puses in Jefferson County and can serve up more easily frustrated in school … you can persistent with families like this. Patient, perto 160 people between the ages of six and 18. imagine the synergistic effect of poor affec- sistent, and understanding.”

24 MD-UPDATE

Mental Wellness

Conversational Intelligence When to break the rules to make better connections

BY JAN ANDERSON, PSYD, LPCC

I admit it. I’ve never been very good at following the rules … especially when the rules don’t make sense or aren’t producing the desired results.

Much of my corporate career was spent as an interpersonal communication skills “expert.”

My job was to help executives, managers, and professionals, most of them highly technical or task-oriented, to develop their people skills — because their effectiveness, promotability, and maybe even keeping their jobs, depended on it.

So I fully embraced, taught, and modeled “the rules” of good interpersonal communication skills.

Rule #1: Communicate With “I” Statements Every good communicator knows that an effective interaction starts with an “I” statement, as opposed to a “you” statement.

SAY THIS: “I was concerned when you weren’t here at 8:30 AM for our meeting. I was afraid we might miss our deadline. Can you make a point to be here on time for these meetings?”

NOT THAT: “You were late for our meeting, and we almost missed our deadline, thanks to you. You need to take some responsibility and start getting here on time!”

Want to increase your chances of immediately alienating someone? Start with a “you” statement, which tends to put people on the defensive or likely to feel really resentful.

The amygdala gets fired up, the “fear” hormone cortisol floods the body, and all your listener is really thinking about is how to protect themselves from you. The prefrontal cortex shuts down, so it’s hard to think clearly and rationally — you’ll pretty much have your listener on automatic, coming straight from their instincts, right?

The beauty of “I” statements is they increase your chances of (a) being heard and (b) getting what you want. Why? Because you’re not interpreting or adding to what the person is saying or doing.

You’re simply (1) describing what they said or did, (2) what you interpreted their behavior to mean, (3) how you felt about their behavior, and (4) what you’d like them to do differently. No shame, no blame.

SAY THIS: “When I noticed you didn’t pick up the dry cleaning, I felt really irritated. I wondered if you don’t care how busy I am right now. I’d really appreciate it if you help pick up the slack around here for a few weeks.”

NOT THAT: “You forgot the dry cleaning?

Do you have any idea how busy I am right now? You know, I could really use some help around here!”

two people … no matter how perfectly scripted the words.

I asked my client if I could talk to some other part of her that was less “psychological,” more of a “straight talker.” What emerged was a part of her that we begin to refer to as “real” — a part of her that was able to be direct about the problem and yet somehow felt more emotionally available and connected to me.

Suddenly I understood why I see so many people “trying” to communicate, thinking they’re doing it “right” and wondering why it’s not working.

When The Rules Break Down The day I began to seriously question the rules happened after I had transitioned to private practice. I was helping a client, who was a therapist herself, prepare to confront one of her colleagues. As we practiced how she would do this, I observed that her perfectly worded “I” statements began to sound alarmingly like … psychobabble. As she continued, I noticed I felt totally disconnected, even put off.

What was going on? I realized that when you focus too much on the script, you begin to sound … scripted. Fake. Phony. Not to be trusted.

But the whole point is to be “emotionally and energetically” connected to the other person, right? That’s the intention of using “I” statements in the first place. This connection must happen before effective communication can begin. Without that connection, productive communication is not able to flow between the

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ISSUE #105 25 1904_16_UpdateMD_Update_Ad.indd 1

8/10/16 5:23 PM

Mental Wellness

How To Break The Rules: Does this mean “I” statements don’t work and we should simply revert to attacking, shaming, and blaming our spouses, colleagues, and clients? Hardly. As usual, the solution is more complex, challenging, and involves the “V” word – vulnerability – specifically, how to help ourselves feel safe enough to risk being vulnerable with another human being.

“I” statements ask you to reveal yourself – what you observed, how you interpreted it, how you felt about it, and what you want instead – to the other person. I’d call that a sure ticket to making yourself vulnerable to possible embarrassment, ridicule, misunderstanding, or even humiliation.

Who in their right mind would want to take that risk without feeling a palpable connection to their listener? Some sense that it was safe enough to take the chance?

A great way to avoid the whole feeling vulnerable thing is to fake it. That’s what

Talking about your feelings, which is an intellectual exercise, is a whole different animal from feeling your feelings and revealing them to another person. my client was doing. She was trying to look and sound like she was present and connected – but she was actually hiding her feelings behind an artificial form of communication.

She was following the “form” of the script, but not the “spirit” of it. When she got connected to the “real” part of herself, she did a very nice job of integrating two opposites — how to be direct and dispassionate while maintaining a good emotional connection. (That’s the complex, challenging part I mentioned earlier.)

If your “I” statements and other active

listening techniques aren’t working, you may want to explore if you’re using them to hide your vulnerability, not reveal it. Don’t judge yourself. It’s perfectly understandable, just not very effective. You keep yourself safe, but lose the chance to connect with someone about something that’s important to you.

Talking about your feelings, which is an intellectual exercise, is a whole different animal from feeling your feelings and revealing them to another person. Can you sense the difference in those two descriptions?

My recommendation? Keep using good, solid communications techniques with the intention to be more connected and present, in this order: (1) first with yourself, and (2) then with others.

Then maybe your friends and family won’t have to wonder if you’ve gone to some workshop or you’ve been reading a self-help book — and wonder when you’ll be back to normal.

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Complementary Care

Precision over Perceived Savings Why patients should only purchase hearing technology from a hearing healthcare professional

BY DEANNA FRAZIER RICHMOND Today’s hearing aids are precision

instruments, utilizing advanced digital technology that can and should be customized to fit specific hearing loss and unique lifestyle needs.

The Better Hearing Institute, a nonprofit center for hearing advocacy, published a consumer warning against “do-it-yourself hearing care,” stating: “The process requires a complete in-person hearing assessment in a sound booth; the training and skills of a credentialed hearing healthcare professional to prescriptively fit the hearing aids using sophisticated computer programs; and appropriate in-person follow-up and counseling. This is not possible when consumers purchase one-size-fits-all hearing aids over the internet or elsewhere.”

While the internet is an increasingly convenient place to purchase many items, consumers should be cautious about purchasing their hearing aids online. Any upfront cost savings will likely be used towards after-purchase costs like maintenance, cleaning, or reprogramming an aid. Services such as those are included when purchased through a hearing healthcare professional.

A hearing professional will ensure that a patient receives a proper evaluation and prescribe the proper treatment for hearing loss.

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If it’s determined that hearing aids can help, a hearing professional will show them the best solutions to fit their unique needs and lifestyle, as well as provide maintenance, programming, and insurance to protect their investment.

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ISSUE #105 27

News U of L Physicians Adds Three New Orthopedic Surgeons LOUISVILLE University of Louisville Physicians

Orthopedics, long recognized as a national leader in orthopedic surgery, has added three new surgeons, further expanding the range of expert orthopedic care offered to patients.

With the addition of Drs. Rodolfo ZamoraRendich, Lonnie Douglas, and Jon Carlson, the practice now has seven surgeons, more than doubling its number over the past three years. They join longtime surgeons Dr. Craig Roberts and Dr. David Seligson, along with Dr. Jiyao Zou, who joined in 2014, followed

by Dr. Brandi Hartley in 2015.

Zamora-Rendich, a native of Chile, specializes in orthopedic oncology and serves as chief of musculoskeletal oncology for U of L Physicians.

His areas are benign bone and soft tissue tumors, bone and soft tissue sarcomas, metastatic disease procedures, orthopedic limb-salvage procedures, infections, and orthopedic trauma.

He is actively involved in research, with interests including navigation systems in orthopedic oncological surgeries, surgical resections, pelvic and lower extremity, external fixation, osteosarcoma, and cryosurgery/cryotherapy.

Douglas is a former college football player who specializes in sports medicine, orthopedic trauma, and general orthopedics. He completed a sports medicine fellowship with world-renowned sports surgeon Dr. James Andrews and has served as an associate team physician for the Washington Redskins and Auburn Tigers, as well as a consultant for the

Blake Joins KentuckyOne Health Cardiology Associates

Miller Named Medical Director of Physical Medicine and Rehabilitation at Southern Indiana Rehab Hospital

MT. STERLING Richard Blake, MD, has joined

NEW ALBANY, IND. James “Jason” Miller, MD,

KentuckyOne Health Cardiology Associates, located at 227 Falcon Drive in Mt. Sterling.

Blake, who is board certified, received his bachelor of arts degree and medical doctorate from the University of Kentucky. He completed his residency from the Bowman Gray School of Medicine at Wake Forest University in North Carolina, and his fellowship at the University of Kentucky. During his training, Blake specialized in internal medicine and pathology.

Blake brings to KentuckyOne Health more than 20 years of cardiology experience, working in multiple heart failure programs. He specializes in a variety of cardiovascular services, including diagnostic cardiac catheterization, invasive hemodynamic monitoring, intravascular ultrasound, and temporary and permanent pacemaker placement, among others.

KentuckyOne Health Cardiology Associates is open Monday through Thursday, from 8:00 a.m. to 4:30 p.m. For more information, or to make an appointment, call 859.497.5135.

28 MD-UPDATE

Zamora-Rendich

Douglas

has been named medical director at Southern Indiana Rehab Hospital (SIRH). Miller recently joined U of L Physicians and will also serve as an assistant professor of physical medicine and rehabilitation in the University of Louisville School of Medicine’s Department of Neurosurgery.

Miller will replace Dr. John Shaw, who is transitioning into a new role as the transitional care physician at SIRH. Miller previously served as chief clinical officer and department director of physical medicine and rehabilitation at Elmcroft Senior Living and Oaklawn Nursing and Rehabilitation Center, both located in Louisville. Most recently, he worked as medical director of physical medicine and rehabilitation for Signature HealthCARE. In his new position, Miller will oversee the clinic management of patients at the hospital.

Miller completed his medical degree and residency training in physical medi-

Carlson

New Orleans Saints and Tampa Bay Rays.

He has been involved in research and presented nationally and internationally. He received the Brower-Harkess Research Award at the Kentucky Orthopaedic Society’s annual meeting in 2013.

Carlson specializes in orthopedic trauma.

He is a published researcher on a variety of orthopedic topics.

His areas of expertise include complex fractures of the pelvis, hip, knee, and extremities, as well as post-traumatic arthritis and degenerative arthritis of the hip and knee.

cine and rehabilitation from the University of Louisville School of Medicine in 2007. He has James “Jason” Miller, MD received the Gold Foundation Humanism and Excellence in Teaching Award, and is board certified by the American Board of Physical Medicine and John Shaw, MD Rehabilitation.

In addition, Chris Koford, MD, has joined SIRH as a new attending physiatrist. The board certified physical medicine and rehabilitation specialist has more than 10 years of experience delivering acute and post-acute rehabilitative care.

SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com

Lederer Elected President of National Nephrology Group LOUISVILLE University

of Louisville Professor of Medicine Eleanor D. Lederer, MD, has been elected president of the American Society of Nephrology (ASN) Eleanor D. Lederer, MD for 2017. She assumed her new role at ASN Kidney Week, the society’s annual meeting held Nov. 15-20 in Chicago.

Lederer also is chief of the Division of Nephrology and Hypertension, associate training program director and associate ombudsman for the U of L School of Medicine. Additionally, she serves as director of the U of L Physicians Metabolic Stone Clinic as well as the associate chief of staff for research and development at the Robley Rex VA Medical Center. Board certified in internal medicine and nephrology, Lederer is an UNOS-certified transplant physician.

Her research focuses on divalent ion metabolism, the minerals important for bone health. She oversees a basic science research laboratory funded by the Department of Veterans Affairs Merit Review Board, studying the mechanisms of regulation of the sodium phosphate transporter in a part of the kidney’s nephron known as the proximal renal tubule. She also has clinical interests in stone disease, and since starting the Metabolic Stone Clinic at U of L, has initiated research into the protein components of stones and their potential role in the pathogenesis of stone formation.

Liu is Named Medical Director for the Department for Medicaid Services FRANKFORT Dr. Gil Liu, a Louisville pedia-

trician and member of the U of L School of Medicine faculty, has been appointed as the new medical director for the Kentucky Department for Medicaid Services (DMS) in the Cabinet for Health and Family Services.

CHFS Secretary Vickie Yates Brown Glisson announced the appointment for Liu, who was also recently named as the University of Louisville (U of L) School of Medicine

Endowed Chair and Distinguished Scholar in Urban Health Policy Research.

A graduate of the University of Mississippi School of Medicine, Liu completed an internship and residency at the University of North Carolina at Chapel Hill (UNC) School of Medicine as well as completing an additional fellowship in medical informatics and earning a master’s degree in biomedical engineering while at UNC. He resides in Louisville with his wife and four children.

Liu served on the faculty of the Indiana University Department of Pediatrics for 12 years and joined U of L as the director of General Pediatrics Division in 2013. In addition to his medical practice and teaching work, he also founded the Kentucky Pediatric Alliance for Transforming Children’s Healthcare, a learning collaborative to improve healthcare quality for publicly insured children in the Louisville metro area.

Liu has taught general pediatrics, and his research interests include obesity prevention, environmental health, spatial analysis, and improving medical education. His studies of how neighborhoods and schools affect health and health behavior have been supported by the National Institutes of Health, the US Department of Education, and the Robert Wood Johnson Foundation.

Liu serves as the current chair for the American Academy of Pediatrics Pediatric Leadership Alliance, a globally recognized initiative to improve the leadership capacity of pediatricians and other health care providers

Mullett Appointed to Commission on Cancer L E X I N G T O N T h e University of Kentucky Markey Cancer Center’s Dr. Tim Mullett has been appointed to the Commission on Cancer (CoC), a consortium of professional organizaTim Mullet tions dedicated to improving survival and quality of life for cancer patients across the country. Mullett is one of eight surgeons from across the country elected to represent the fellowship for a three-year term.

Arifa Siddiqui, MD

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Mullett began his career at UK in 1996 as a thoracic surgeon treating heart issues, but quickly changed his focus to one of Kentucky’s biggest problems: lung cancer. In addition to co-leading one of the major components of the Kentucky LEADS Collaborative to improve lung cancer survival, he also serves as medical director for both the UK Markey Cancer Center Affiliate and Research Networks.

ISSUE #105 29

News

SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com

Shenoni Travels World Training Instructors on Systematic Critical Care LEXINGTON The first 24 hours of treatment

determine the outcome of a child diagnosed with a critical illness or injury in developing countries.

When healthcare practitioners respond with systematic approaches, children suffering from critical conditions such as shock or respiratory distress are more likely to survive.

But physicians in resource-scarce countries often lack the advanced training to integrate such effective approaches.

Kentucky Children’s Hospital pediatrician Dr. Asha Shenoi has traveled around the world training health care providers to instruct courses on systematic pediatric critical care.

Shenoi, who volunteers her time on behalf of the World Pediatric Intensive and Critical Care Foundation, is one of very few pediatric critical care specialists in the world designated by the organization to train physicians in developing or mid- to low-income countries on programmatic approaches to pediatric critical care. She is approved to administer the Pediatric BASIC critical care course that is a foundational course for improving outcomes for critically ill and injured children worldwide.

Shenoi trains doctors in areas with limited medical resources and technological advancement to treat critical conditions. Since joining the program in 2012, she has worked with pediatricians to adapt critical care training to specific parts of the world. She conducts a one-week training, which includes modules on running a skills station and coordinating simulations, and returns to the country intermittently for the next two to three years to update local instructors on current treatment methods.

Instructors then host trainings for local and regional health care providers, imparting systematic critical care methods to unreached territories. The overarching goal of the program is to provide a sustainable system for improving critical care in disparate regions of the world.

In October, Shenoi trained physicians at the National Children’s Hospital in Vietnam. She has conducted seven courses in four countries, including India, Vietnam, and the West Indies, adapting each training to reflect the country’s native language and cultural considerations.

The trainings emphasize dynamics and coor30 MD-UPDATE

dination in performing critical care procedures.

Shenoi learned about the program through her mentor and when she was completing a fellowship at Emory University.

Since then, she has become one of five certified Dr. Asha Shenoi (far right), a KCH critical care pediatrician, trains practitioners in trainers in the Barbados on critical care skills.

US. She has purchased every plane ticket, and the institutions causes; in the end, often what saves a child life where she is training provide accommodations. is early recognition and systematic intervenA native of India, Shenoi aspires to change the tion,” Shenoi said. “Unfortunately, training course of treatment for disadvantaged children opportunities in critical care in resource-limwhose lives might be saved through systematic ited settings are scarce, and we aim to train critical care interventions. the trainers in these settings in developing “The majority of childhood deaths in these locally relevant systematic critical care intersettings result from preventable and reversible ventions.”

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Events

Solving the Puzzle of Refugee Healthcare U of L medical students introduced to complexities of treating refugees resettled in Louisville

LOUISVILLE For refugees who have fled their

home countries, resettling in a completely new culture can be overwhelming. Not only are they often unable to speak the language, they face bewildering systems of healthcare, money, transportation, and more. Some have never even used electricity.

“One of the common things is how a microwave works because microwaves are freaky,” says Bethany Hodge, MD, MPH, assistant professor and director of the Global Education Office of the University of Louisville School of Medicine. “If you are coming from a place where you didn’t have electricity, let alone microwaves where you put something in a box and push a button and it’s flaming hot and you burn yourself because you don’t see it coming, it can be frightening.”

Students in the School of Medicine were introduced to the struggles of resettling refugees and the agencies that assist them in Kentucky at “Refugees and Our Competencies,” a Compassion Rounds presentation hosted by the U of L chapter of the Gold Humanism Honor Society (GHHS) on November 30. Hodge and Rahel Bosson, MD, assistant professor in the U of L School of Medicine and director of the Refugee Health Program, familiarized the students with some of the health concerns of these individuals and issues confounding their introduction to the US healthcare system.

Refugees may have health problems related to trauma or injury experienced in their home countries, as well as health conditions that have been neglected during their transition from a life in peril to resettlement in the United States. Hodge coached the students on how to navigate these issues sensitively in conducting a health history and physical. To complicate matters further, the patients may have different naming or date customs, and missing or fragmented medical records.

According to the United Nations High

MeNore Lake (left), a fourth-year medical student and co-chair of the UofL GHHS chapter, founded the Kentucky Refugee Outreach Program in which medical students are collaborating with the Refugee Health Program, UofL School of Nursing, and Kentucky Office for Refugees to reach the newly arrived refugees in Louisville. Rahel Bosson, MD, (right) is an assistant professor in the U of L School of Medicine and director of the Refugee Health Program.

Commissioner for Refugees (UNHCR), the international body governing refugee status, refugees are individuals who have been forced to flee their home country because of persecution, war, or violence. Typically, they leave their home countries for refugee camps in neighboring nations. Fewer than one percent of refugees who apply to UNHCR are resettled in a third country such as the United States, Canada, or a European country. Most of the approximately 2,500 refugees arriving in Kentucky annually in recent years have come from Cuba, the Democratic Republic of the Congo, Somalia, and Iraq.

Refugee resettlement in Kentucky is coordinated by Catholic Charities’ Kentucky Office for Refugees.

PHOTO PROVIDED BY U OF L

Through the U of L Refugee Health Program, part of the U of L Global Health Initiative of the Department of Medicine, individuals are provided health assessments, immunizations, school physicals, and other services. Bosson said the program addresses health and other needs to enable refugees to become self-sufficient as quickly as possible.

“Refugee health is complex, and health is really more than just the absence of disease.

We address the varied components of a person’s health through partnerships in community health, education, social services, and economic empowerment,” Bosson says. “The idea is to help these refugees move from a mode of survival to a platform where they can thrive and succeed.”

ISSUE #105 31

Events

2017 Human Figure Show at Lexington Art League LEXINGTON The annual and ever-popular

human figure exhibit, this year entitled Demographically Speaking, a Figurative Exhibition, returns to Lexington Art League, (LAL) beginning on January 13, 2017 with an opening preview party, sponsored in part by MD-Update, and features an interactive video installation by Nick Warner, a Lexington digital artist. The exhibit runs through February 24, 2017.

This evocative exhibition, curated by Daniel Pfalzgraf, chief curator of the Carnegie Center for Art & History in New Albany, In., poses the question, “Whose stories are being told in the art world?”

Pfalzgraf brings a new and unique perspective to the traditional figure or nude show by aiming to provoke audiences to consider the diversity of our cities, our region, and our country through stories of identity told through art.

“We are excited to bring this exhibit that will be full of surprises and extraordinary works of art made by a dynamic and compelling group of the region’s finest artists,” says Stephanie Harris, LAL executive director. “This will be one of a kind and not to be missed.”

Lexington Art League is a visual arts organization which envisions a world where art and art-making are central to human inspiration, self-realization and meaning. The LAL’s mission is to challenge, educate, and engage the community through visual art and the advancements of local artists. The LAL is located at the Loudon House gallery in Castlewood Park in Lexington.

More information about Lexington Art League and Demographically Speaking, a Figurative Exhibition is available at 859.254.7024 and www.lexingtonartleague.org.

32 MD-UPDATE

Arrested #072216; Dick Dougherty Arrested #111716; Dick Dougherty

People 49, 50, 60; Denise Stewart-Sanabria

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2017 Editorial Opportunities Issue #106 l February HEART AND LUNG CARE Cardiology, Cardiac Surgery, Pulmonology, Sleep Medicine Issue #107 l March/April PAIN MEDICINE AND CHRONIC CONDITIONS Pain Medicine, Rheumatology, Endocrinology, Gastroenterology Issue #108 l May WOMEN’S HEALTH OB/GYN, Urology, Genetics, Prevention, and Wellness Issue #109 June/July MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, Physical Medicine, and Rehab

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #97

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Issue #111 l October CANCER CARE Oncology, Hematology, Radiology

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Issue #110 l August/September SKIN DEEP Dermatology, Plastic Surgery, Vascular Medicine

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Issue #112 l November IT’S ALL IN YOUR HEAD Neurology, Ophthalmology, Mental Health, Addiction Medicine Issue #113 l December 2017/January 2018 SENIOR HEALTH, PREVENTION, AND WELLNESS Primary Care, Senior Health, Family Medicine & Geriatrics, Bariatric Surgery, Alternative Medicine *Editorial topics are subject to change.

To participate, please contact Gil Dunn, Publisher GDUNN@MD-UPDATE.COM | 859.309.0720 Jennifer S. Newton, Editor-In-Chief JNEWTON@MD-UPDATE.COM | 502.541.2666 SEND PRESS RELEASES TO NEWS@MD-UPDATE.COM