Kentucky Doc Spring 2018

spring 2018 • volume 10 • issue 1

Inspiration What experiences led you to pursue a career in medicine?

Medical Students and Residents share their inspirational stories of hope and loss

COMPASSION Sustaining an Altruistic Spirit: Terry Barrett

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CONTENTS

How I Found My Rhythm When the Music Stopped PAGE 5 The Man in a Blue Sarong PAGE 7 Patient “Ownership” PAGE 10 How the Recession, Community College, and Germany led to Medicine PAGE 12 Undercurrents of Change Honor and challenge propels me forward PAGE 16 The Head and the Heart PAGE 19 Community News PAGE 22 Allowing Awe in Medicine PAGE 24 Sustaining an Altruistic Spirit: Terry Barrett PAGE 26 Did Facebook Sellout?

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EDITORIAL

BOARD MEMBERS Robert P. Granacher Jr., MD, MBA editor of Kentucky Doc Magazine Tuyen Tran, MD Lowell Quenemoen, MD Tom Goodenow, MD John Patterson, MD Thomas Waid, MD Danesh Mazloomdoost, MD

FROMTHEEDITOR • SPRING 2018 Robert P. Granacher Jr., MD, MBA, Editor-in-Chief, Kentucky Doc Magazine Welcome to the Spring 2018 edition of KentuckyDoc. As has been our customary pattern in the last few years, this issue is devoted to essays. Unfortunately, we did not have any active LMS member essays that met our criteria, but we do have six essays written by three residents and three medical students. On the cover, you will see our question: “What prompted you at a young age to pursue practicing medicine?”

We lead off with our resident category winner, Dr. Amaka Agochukwu. She has written, How I Found My Rhythm When the Music Stopped. The editors were impressed with the elegance in which she transitioned from her severe loss to her current journey as a 6th year resident in plastic surgery at the University of Kentucky. Medical practice again brought music to her life.

In the second-place resident category is an essay by Dr. Srivastava. Her journey to the practice of medicine started while she was riding a train in Calcutta, India. Ten years later, during high school, she watched The Motorcycle Diaries, a movie played during her third period Spanish class. She was reacquainted with leprosy by a doctor characterized in the movie, which she first witnessed sitting on that train in Calcutta, as she looked out on a leper on a railway station platform. As a result of these experiences and her inner searches for meaning, she has journeyed to taking a special interest in diseases associated with stigmatization in American society, including obesity and metabolic syndrome. She is currently a secondyear resident in the medicine-pediatrics program at the University of Kentucky.

Our last residency winner is Dr. Le. She portrays herself proceeding from the study of insects to the study of human patients, and in particular by using evidence-based

medicine to provide compassionate care to patients. She hopes to pursue her studies in cardiothoracic surgery.

Our medical student category portrays three current students at the University of Kentucky, College of Medicine: 1st place, Jonathan Hendrie, 2nd place Kaylee Gouge, and 3rd place McKenzie Wyatt. These three future doctors take us from Hendrie’s transformative experience at Elizabethtown Community and Technical College, then WKU, then to surgical research in Germany, to Gouge’s experience while sitting in a doctor’s lounge in a hospital waiting on her father, to Wyatt’s experience of growing up in rural Kentucky and volunteering at a local hospital.

These three students start with very different and diverse journeys to their medical school experience here in Lexington and they describe eloquently how they shaped their choices to study medicine.

The essays transition us to articles by our own LMS member, John Patterson, M.D. John gives us an interesting essay on awe and its place in medicine, and for physicians in particular. He also profiles the altruistic spirit of Terrence Barrett, M.D., Chief of the Gastroenterology Division in the Department of Medicine at the University of Kentucky, College of Medicine. Lastly, in this edition, we have an interesting article by Jim Ray, our business writer, who asks the question: “Did Facebook sell out?” His article is of particular interest to me as I sit here dictating this letter while trying to listen to Mark Zuckerberg’s testimony to Congress.

I think you will find this quarter’s edition of KentuckyDoc to be extremely interesting and stimulating to our physician minds.

STAFF Brian Lord Publisher

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© Copyright Kentucky Doc Magazine 2018. All rights reserved. Any reproduction of the material in this magazine in whole or in part without written prior consent is prohibited. Articles and other material in this magazine are not necessarily the views of Kentucky Doc Magazine. Kentucky Doc Magazine reserves the right to publish and edit, or not publish any material that is sent. Kentucky Doc Magazine will not knowingly publish any advertisement which is illegal or misleading to its readers. Kentucky Doc Magazine is a proud product of Rock Point Publishing.

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By Amaka Agochukwu, MD

At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.

The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.

After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted. He had been diagnosed with a brain tumor, and was currently admitted for chemotherapy induced neutropenia. That day was different.

I always ran ahead and as I ran to go see him, I saw my mom in the hallway embracing one of the oncologists. I could hear her sobbing and I remember getting this feeling. It’s the feeling you get where your legs buckle from under you and you can feel and hear your heartbeat as if nothing else in the world existed for that moment. I knew this meant bad news. Tests had showed that his cancer had become metastatic. A month later he was placed under the care of home hospice, and three months later on May 29, 1997, he died at 18 years old.

How, from that experience, did I find medicine? How did I find meaning in such a sad ending? Well, I spent a lot of time in the hospital whenever my brother was admitted and when he went for various treatments. I remember being in awe at all of the people coming in and out, that seemed to be fighting as hard for his life as he did. I tried to understand how and why they cared so much for us and for him, as though we were their own family.

I also could not imagine Chinedu or us going through what we did without them.

They constantly gave of themselves, and made sacrifices for the well-being and healing of their fellow human beings. I saw it as the ultimate career of service to humanity. It was then that I decided that I wanted to be a part of this field, in some shape or form. At the young age of 12, I distinctly remember that compassion and care that doctors, nurses and even child life specialists had for Chinedu and our family. Sometimes I still feel it today. I will always be grateful, and I will never forget. Medicine had as much of an impact on me then as it does now. It is clear that this experience impacted my siblings too, who have all also been led to a career in medicine. Medicine did not cure my brother, but it never failed to try.

Perhaps most importantly, it also realized when there was no more it could do. This allowed us to savor our final moments with him, in the respite of our home.

Medicine did not cure my brother, but it never failed to try.

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When my brother died, I felt like my world had stopped. There was no more music. Somehow I kept the rhythm, and through the whole experience, I found medicine. Or perhaps more accurately put, medicine found me. I consider myself grateful to be chosen for this unique and special field. Through each patient experience, and each surgery I only hope that I can provide to patients and their families what was provided to me and my family more than two decades ago – peace, compassion, hope and benevolence at a time of utter chaos and loss of control.

Life is full of the “unexpected.” From time to time in life, the music will come

to a stop. We have to trust in our strength and our preparation, and keep the rhythm.

Ultimately, we know deep inside that this is what our loved ones would want. Thank you to medicine and my brother for helping me keep the rhythm.

In loving memory of my brother, Chinedu.

About the Author Currently a 6th year resident in Plastic Surgery at the University of Kentucky, Amaka was born in New Orleans, LA and went to medical school at Vanderbilt University in Nashville, Tennessee. She is one of five children, is married and has a 2 year old son.

When my brother died, I felt like my world had stopped. There was no more music.

Somehow I kept the rhythm, and through the whole experience, I found medicine.

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The Man in a Blue Sarong

By Priya S. Srivastava, MD I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils. He looked around aimlessly, holding his deformed hands out, begging for food and money, as people rushed around him with occasional looks of disgust and pity. I was only five-years old at the time and despite the hustle and bustle of thousands of people rushing past me to board the trains, the smell of samosas and paan being sold on the platform, or the loud train horns blasting around me, all I could focus on was this strange-looking man. Why does he look like that? Why will no one help him? Before I could give any more thought to him, my mother whisked me away on to the carriage and I watched the man shrink into the distance as the train slowly pulled away.

About ten years later, I was a sophomore at Brunswick High School waiting for Mrs. Lopez to start the movie, The Motorcycle Diaries, during our third period Spanish class. As the movie played and narrated the life and adventures of Ernesto Guevara, the Argentinian physician turned Marxist revolutionary also known as “El Che,” I became curious about his time as a volunteer doctor in a leper colony deep and isolated in the forests of Peru. I could not help but to wonder what it was about leprosy that caused these people to be marginalized and quarantined away from society. After I returned home that day, I furiously googled leprosy. All of a sudden, the images of those affected with Hansen’s disease sent me spiraling back to that day at the Calcutta railroad station. Those opaque blue eyes, those deformed and shortened fingers and toes – it all made sense. The man in the dark blue sarong was dying of leprosy.

I began to read about the marginalization of people with leprosy throughout history, at the same time, learning about modern day quarantining of people with HIV/AIDS in various parts of the world.

How could these people be segregated from society because of a single type of bacteria or virus that can be treated? How will they ever be able to take care of their family or themselves if no one wants them around and they are shunned from society?

He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun.

Those with stigmatized diseases live with this burden on a daily basis and it often leads to withdrawal from society, depression, and disability

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I have dedicated my life to global health and thus far, it has taken me from the rolling grasslands of the Serengeti to the snowy foothills of the Himalayan mountains.

If they had never contracted this illness in the first place, what kind of life and opportunities could they have experienced? These questions swirled in my head and I kept thinking, if only there was someone who would just take the time to treat these people and help them reintegrate into society so that they may never be denied the many opportunities in life. Alas, it hit me–I was meant to be that person and thus began my journey as a physician.

I will never know the man in the dark blue sarong and he will never know the way that he has inspired my passion to become a doctor. I have dedicated my life to global health and thus far, it has taken me from the rolling grasslands of the Serengeti to the snowy foothills of the Himalayan mountains. I have studied the hospital systems of Ghana, Tanzania, and

India, as well as the healthcare systems of countries around the world since my undergraduate years. Throughout my journey as a physician, I have taken special interest in diseases associated with stigmatization in American society, including obesity and metabolic syndrome, with plans to pursue Med-Peds endocrine and global health as the obesity epidemic spreads across the globe. We often take our health for granted as we live our lives day-to-day and it is only when we are sick that we truly understand the impact of our health on our life. Those with stigmatized diseases live with this burden on a daily basis and it often leads to withdrawal from society, depression, and disability, just as I had witnessed as a five-year old child. The single greatest goal of my career as a physician is to help give people their health back so that they may

support their family, contribute to their society, and have access to meaningful opportunities, without the burdens of a stigmatized disease. To the forgotten man in the blue sarong on a platform in Calcutta begging for sustenance, I thank him for inspiring me to take this journey as a physician, and although he does not remember me, I will always remember him.

About the Author Priya is a 2nd year Med-Peds resident from Brunswick, Ohio with a long-standing passion for global health. She is an avid traveler, learner, and proud dog-mom. Her personal goals in life include specializing in med-peds endocrinology and starting a global health program to provide consistent and efficient care to those in isolated or remote parts of the world.

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Patient “Ownership”

By Anh-Thu Le, MD I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind). One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.

During this time, I was assigned families to follow and I would see them in clinic, getting a history and examining the patients, charting their seizures as well as their growth and anti-epileptic medication changes. I vividly remember one encounter about a year or so into my time at this clinic/lab. The therapy

we used was not working for this particular child. I knew her mother fairly well at this point, having called them weekly to check on her progress, and I knew the patient well too, a chubby 5-year-old girl with a silly smile and a peaceful mien.

On this particular clinic day, the neurologist swept into the room; he was a distant man with an aloof manner and thought it better to dish out bad news briskly and move on. My interactions with him were limited to brief nods of his head and surprise when he realized I was in the room. His way of delivering unfortunate news probably worked for some patients, but it didn’t with this particular family. As he told the mother that they had maximized what could be done with conventional therapy and he had nothing more to offer her at this time, I saw her eyes become distant as she closed herself off. He rambled on for several minutes, emphasizing that there was nothing else they

could do for her and finally left the room, looking towards the door, possibly thinking of his next encounter. Who can say?

Once he left, her stoic façade cracked and the mother broke down, sobbing as she clutched her purse with one arm and the other stroking her daughter’s downy head.

Between choking breaths, she tearfully spoke about how much hope she had placed on the therapy. My professor, who had watched the entire exchange with wariness, approached the family carefully. I’ll never forget how she opened the discussion.

I’m sorry, that is very difficult news to receive. May I give you a hug? She asked, proffering a box of tissues. It was a simple question, but infused with care, and arms opened, the mother gave tacit permission for the embrace and cried on my PI’s shoulders.

They continued a quiet conversation amidst the two of them, after my PI kindly dismissed us all from the room. There

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I wanted to be able to take care of and treat patients using evidence-based medicine and to be able to offer them my compassion.

Proud to Partner with You were several of us in there, two graduate students, and myself and we bolted once given permission. Outside, we commiserated about what a difficult situation it was for a family. Meanwhile, I was thinking about how well my PI had handled it all. Not clinically trained, she was nevertheless frank and forthright with her empathy, neither cloying nor cold, and always genuine. And not just in this situation but also in every clinical encounter I was with her and privileged enough to observe.

My research experience wasn’t limited to my PI; I saw the clever ways my colleagues came up with in order to help families record their child’s seizure events; some gave them different colored stickers and others created personalized records with the most common seizure types the patient had. Most of these colleagues would go on to graduate school; nevertheless, I learned so much from them about how to interact with patients and how to personalize patient care. Some of my colleagues were quiet, but great listeners who interjected at just the right time during conversations with our patient families.

Others were gregarious and outgoing,

charming typically reserved families into opening up and sharing growth charts and seizure records with our lab.

Having the chance to take care of and follow my own set of patients made me understand the concept of patient “ownership,” a trait I believe is necessary for all employees in the medical field and difficult to instill. The responsibility of charting my patient’s seizures into a database and tracking their progress on the intervention we initiated and initiating contact each week with my families was all my own – my PI kept us on track but didn’t micro-manage us.

That’s not to say it was all positive. I saw the effects on patients and their families when there was poor communication and no empathy offered on the part of the clinician.

I saw families leave the program because they felt they had no assistance from the medical staff and were overwhelmed with all we asked of them. Families often confessed in shamefaced whispers that they hadn’t really understood what the doctor had just said after they left the room.

I took everything I saw from my years in that lab, both good experiences and bad,

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Even now, I reach back into the past and rely on those same lessons I learned as an undergraduate as I wend my way ever further into my medical career.

About the Author Anh-Thu Le grew up in Florida and attended college and medical school at UF. She spent 2 years in the research lab and is interested in cardiothoracic surgery.

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How the Recession, Community College, and Germany led to

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Medicine

By Jonathan Hendrie Like many medical students, my interest in medicine arose during high school anatomy courses.

Unlike many medical students, I did not begin my collegiate studies at a university.

I went to high school in a suburban town Northwest of Detroit called Clarkston. It was my junior year between 2008-2009 and the recession and housing bubble was crippling the Detroit economy, causing many, including my father, to lose their jobs. By the beginning of my senior year in late 2009, he found a new job in a location that offered more stability and promise – Elizabethtown, KY. For my senior year, my mom, two of my sisters, and I lived in our Michigan home, trying to show and sell the house in an unforgiving buyer’s market, while my father and third sister moved to Elizabethtown, KY. Knowing I wanted to pursue medical school, I applied to several universities throughout my senior year.

The only problem was that I didn’t have an official residence in either state. Since I was graduating from a Michigan high school, I was considered out-of-state for Kentucky universities, while Michigan considered me out-of-state because my family’s permanent residence would shift to Kentucky before I

started college. Furthermore, the Michigan Promise Scholarship – a program similar to the Kentucky Education Excellence Scholarship – was repealed my senior year due to the financial constraints of the state during the recession. Our house foreclosed and I was faced with a decision to take out loans for out-of-state rates for universities, or move to Elizabethtown and begin college at Elizabethtown Community and Technical College (ECTC), where I was offered in-state rates. I chose the latter.

What began as a frustrating and lonely start to college proved to be one of the most transformative periods of my life.

I was working full-time as a dishwasher, while also going to school full-time. It was a dismal time of my life. I resented my job and felt overwhelmed with life, uncertain if I would ever be able to reach my goal of becoming a physician. I acquiesced my circumstances and trusted the words of my middle school football coach, who always said that “hard work pays off.” That was easier said than done, considering the number of family and friends with deeply entrenched biases of community college who were questioning my finance-driven decision to enroll. Difficulty in making friends made me further second guess my decision. All that said, these doubts pushed me to work harder and forced me to focus on my studies throughout my freshman

year. I excelled academically, developed faculty mentors, and was awarded several scholarships. By my sophomore year I had found a better job and began volunteering within the local community. I made friends, but perhaps most importantly, I found out that I attended one of only several community colleges in the nation that had a nuclear magnetic resonance (NMR) spectrometer. This, I would later realize, was perhaps the fulcrum to my springboard into the scientific community.

After excelling in my first semester of organic chemistry during my sophomore year, my professor asked me to undertake an independent project characterizing different chemical compounds with NMR. I spent hours running the spectrometer, characterizing species, and lecturing high school and community college students about NMR. It was invaluable experience.

I continued to work hard, and by the end of my sophomore year, I had applied to two National Science Foundation (NSF) Research Experience for Undergraduates (REU) programs. I was selected as one of eleven students in the country to get paired with a mentor at Western Kentucky University (WKU) for a summer of research. My project would use NMR to characterize biochemical reactions between platinum-based anticancer drugs and DNA nucleotides. I would later learn that my

What began as a frustrating and lonely start to college proved to be one of the most transformative periods of my life.

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acceptance into the program was largely predicated upon my extensive community college training with NMR. Following the summer, I was offered a research assistantship in the laboratory and therefore elected to transfer to WKU.

Transitioning from basic bench research at ECTC to more clinically relevant research at WKU affirmed my decision to continue pursuing medical school. We continued our research, and by the winter we were publishing our data in a peer-reviewed

journal. By the following February, it was again time to apply to summer research programs, and soon after I found out that I was accepted into a surgical research laboratory through the German Academic Exchange Program’s (DAAD) Research in

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We should always reflect on where we are and how we got there, because we rarely reach our goals without support and opportunistic circumstances.

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Spring 2018 • Kentucky Science and Engineering program. I would spend the summer working with surgeons to develop training curricula and modalities to enhance laparoscopic skill transfer to surgeons-in-training. While there, I asked my mentor why their team selected me out of dozens of other applicants from more renowned institutions. She shared that I was the only student who had helped author a peer-reviewed publication.

After another engaging summer of research, I began my senior year at WKU. I knew that I wanted time off between my undergraduate studies and medical school, so along with my mentor in Germany, I designed a new research project that I could use to apply to the Fulbright Student program with the hopes of matriculating after graduation from WKU. I was selected as a grantee, and after graduating and submitting my medical school application, I moved to Germany for what would be the most influential year of my life. The research year was packed with novel work, extensive manuscript drafting, research presentations, and exposure to general and laparoscopic surgery. All this work solidified the fact that I had made the right decision to apply to medical school, and during the fall of my year abroad, I was notified that I was accepted into UK. The following summer, I had a week to reflect between my return to the United States and the start

I moved to Germany for what would be the most influential year of my life. The research year was packed with novel work, extensive manuscript drafting, research presentations, and exposure to general and laparoscopic surgery.

of medical school. Looking back, I could string together my experiences, both good and bad, to see how my unconventional path had led to me walking across the stage at our white coat ceremony.

I was asked to explain what experiences led me to pursue a career in medicine.

The answer is that an initial spark in high school anatomy was fanned into flame by the educational and research experiences in which I was fortunate to partake. Looking back, each experience led to the next.

Perhaps I would not have been accepted into medical school if I hadn’t received the Fulbright grant. And perhaps I wouldn’t have gotten the Fulbright grant if I hadn’t already done a summer of research in Germany through the DAAD program.

We know it’s unlikely I would have been selected to the DAAD program if I hadn’t already had a published authorship, and that authorship came from an NSF REU summer program to which I was selected for my previous NMR experience. I would have never had NMR experience if I hadn’t gone to one of only several community colleges in the nation to have a spectrometer, and I would have never ended up at ECTC if my family hadn’t moved to Kentucky. Of course, my family never would have left Michigan in the first place if it wasn’t for the recession.

Much like the scientific process, where data and evidence are provided with

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interpretation, this story would be lacking without an application. I have three lessons.

The first is that poor circumstances don’t always lead to poor outcomes. Starting at community college without money does not preclude you from going to medical school. Let’s keep in mind that since my work as a dishwasher eight years ago, I have since become an NSF, DAAD, and Fulbright grantee, and anticipate graduation from medical school in a little over a year. The second is that, as my middle school football coach always said, hard work does pay off.

There is no overnight event that creates success. Rather, it’s a continuous mindset and work ethic to improve and grow daily towards your goals. The third lesson, and lastly, is that we should always reflect on where we are and how we got there, because we rarely reach our goals without support and opportunistic circumstances. There have been many people and organizations that have helped me along the way and led to my understanding of these lessons, and to them, I will always be grateful.

About the Author Jon is a third-year medical student at UK and is currently undecided on a specialty. He enjoys playing soccer and basketball, cooking, reading, and spending time with family and friends.

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Undercurrents of Change HONOR AND CHALLENGE PROPELS ME FORWARD M

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By Kaylee Gouge It all began with bagels and orange juice. I was seven, and my dad had promised we would go to lunch as soon as he finished making rounds in the hospital. My stomach grumbled, though, so Dad plopped me in the doctors’ lounge, snacks in hand, and promised he would be back in an hour. As I waited, I overheard the other doctors in the next room, answering pages. They spoke in hushed voices laden with what I was sure were remarkable secrets.

But then, I could only hear one side of the conversation.

I finally started hearing the other sides of those conversations when I began shadowing Dad. I remember the excitement when he told an elderly woman that her cancer was in remission. She leapt from her chair and hugged him with all the strength she could muster. I was also there when Dad told one of his dear friends that all his treatment options were exhausted – that all he had left was to pray and hold his family close. Peering over my father’s shoulder gave me insight into the number of roles a doctor must play. Instructor, encourager, counselor, and consoler – a doctor must be all of these, and a scientist as well.

This dance of responsibilities captivated me.

Shadowing my father through college gave me perspective on the impact and sacrifices a physician makes on an individual basis. Studying the humanities during my undergraduate education exposed me to the broader reach physicians garner when they use their practices as platforms for change. As an International Studies major, I was struck by the work of Che Guevara, whose medical care for an Andean leper colony galvanized him to incite revolution and change the landscape of Latin American politics. As a public health researcher, I received mentorship from medical doctors who had transitioned from clinical practice to preventing illness in populations they once treated. When interning on the Mexican-American border, I met a primary care physician who became

Shadowing my father through college gave me perspective on the impact and sacrifices a physician makes on an individual basis.

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Spring 2018 • Kentucky mayor of his town so he could confront health disparities head-on. In each of these cases, physicians recognized that health is drastically influenced by factors outside of acute treatment. They were convicted that a proper view of health, and therefore care, should never neglect justice.

To me, justice is a spiritually charged word. As a granddaughter of missionaries, I learned early that caring about the needs and hearts of the underserved is more than a job. It is the deepest way to love others.

This principle motivated me to seek out international mission experience, where my desires to serve God, pursue social justice, and practice medicine entwined into a clear passion for international medical service.

This passion crystallized one summer when my father and I visited Miguel, a 27-year-old from Naco, Mexico. Due to Naco’s stagnant economy, Miguel had limited career options. He joined the cartel around age 15 and, in a gang fight, was shot in the spine and paralyzed. By the time I met him, Miguel had lost normal bowel function and one leg as complications of nearly ten years of paralysis.

As Dad cared for Miguel’s bedsores, the awareness washed over me that Miguel’s physical infirmity had, in a way, already been determined for him. Financial and social limitations pushed him into the cartel. The physical violence that this decision inflicted dragged him into an even more desperate

state. My heart hurt for him and my hands longed to help, but they could not. They had no tools or experience to do so. I felt silly, useless in the face of his suffering.

A few minutes later, as I translated instructions for Miguel’s mother, I skimmed the worried creases on her forehead, absorbing the fatigue she experienced from supporting her family alone. But amidst her worry I also saw hope and tenacity as she perused her new arsenal of antiseptic supplies. She would keep fighting for her son, with or without the winds of social favor behind her. The courage that a single doctor’s visit brought her was a powerful lesson to me. Fighting for social change begins with caring for individuals.

Last year I received a brief email notifying me that Miguel had succumbed to the complications of his paralysis. I was grieved, but I wish I could say I was more surprised.

From the Andes up to the Mexican border, I had fallen in love with Latin American people. But I had also seen that it is a region in desperate need of justice. Though a single person could never turn the political tides in such a complex place, I know that the undercurrents of change begin when a group of people applies proper training with passionate service. I want to be among them.

Even now, as studying and exams bear down on me, a humming in my soul weaves through the heaviness. It bubbles up through my memories, murmuring: “Remember!

The doctor you want to become cares about pathology and sociology. Don’t forget!

The physicians you admire care for their patients’ hearts as well as their bodies. Keep working! Keep searching! Keep thinking hard about what and why and for whom you are learning.” To this song a harmony often enjoins, intoned in the words of the apostle Paul: “I must become all things to all people so that by all possible means I might save some.” Paul believed, as do I, that deep satisfaction and joy lie on the far side of exertion for others’ sake. Though medicine is difficult and its hours demanding, it is this refrain – this great honor and challenge – that propels me forward.

About the Author Kaylee Gouge is a first year medical student from Versailles, Kentucky, and is enrolled in the M.D./Masters of Public Health dual degree program at the University of Kentucky College of Medicine. As an undergraduate, Kaylee studied Latin American Global Development – an International Studies subprogram that inspired her to travel throughout Latin America, where she completed a health promotion mural project in a Mexican border community in 2016. Her experiences abroad have motivated her to pursue a career in medicine, which she hopes will enable her to more advocate for international health equity.

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The Head and the Heart

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By MacKenzie Wyatt The back of my head lies flat as a pin board. In the orphanages of South Vietnam, darker babies carried the stigma of the war, bearing a physical resemblance to the ruthless soldiers from the north. I was one of those children.

Because of my skin tone, the caregivers’ prejudice prevented them from picking me up to play. Left to lie on the wooden mats, my head never rounded, and now serves as a constant reminder to me of the human body’s malleability. My mom always told stories of my early days after she adopted me. She soaked me in chamomile baths to heal my dried skin, and the dentist removed the rotten teeth from my mouth caused by a diet of mere watered down tea and rice. I didn’t discover the physical remnant of the orphanage on my head until high school, though. It brought the other stories to life and gave me a sense of gratitude for my physical health. Our health is inextricably tied with the emotional care given to us, a duality that inspired me to embark in a future in medicine.

This led me to develop a fascination with the body’s intricacies and a desire to bring others’ the health afforded to me. The body was an enigma: fragile yet resilient. I wanted to explore the possibility of the healthcare field more. Raised in rural Kentucky, I knew doctors as very distant, almost superhero-like figures. You saw them on checkups and when you went to visit grandma, and then they magically fixed everything. Excited by this adventure, I decided to explore all I could by volunteering at the local hospital. My first hoop to

jump through was the easily brushed over TB skin test. “This is just a blip and then you’ll be done,” all the nurses reassured me. When I visited the hospital, the raised bump on my arm inspired eyebrow raising and alarmed, gaping mouths on all the nurses as they dragged me around to visit doctor after doctor. My TB skin test could not be unequivocally deemed negative, the nurses informed me. As a frightened teenager who had just watched the main character in Moulin Rouge die of tuberculosis, I quickly called my pediatrician. Instead of brushing me off, my doctor eased my fears and took the time to look into my file and explain everything to me, going above and beyond to meet me on her day off. The BCG vaccine administered in Vietnam caused the reaction and I would not die, she calmly assured me. I was so grateful for the time and effort she put in to my case, and my mind began to shift seeing doctors as distant superheroes to comforting and hard-working people who cared about me.

As I volunteered at a local hospital, my awe of the physicians grew as I saw how the bones fit together during a knee replacement and heard the cry of a newborn baby in the delivery room. I took note of not only the amazing abilities of the human body, but also the mastery of the physician. While performing a caesarian section, an obstetrician

When I first entered the room, a little girl face peered at me skeptically with big brown eyes.

Her hesitation ended quickly as she giggled while I moved her hands to the tune of “Itsy Bitsy Spider.”

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planned each incision and tied every suture with precision and care. However, he impressed me most as he calmed a frightened soon-to-be mother and father. His soothing voice guided them through each step of the way, explaining the process like a teacher to a student. He attended to their physical and emotional needs uniting the two into one swift motion.

As a singer, I experience music’s power to touch people’s lives and emotions with every performance. However, the most meaningful connection I made while singing occurred not on a stage but in a hospital room during a volunteer shift. When I first entered the room, a little girl face peered at me skeptically with big brown eyes. Her hesitation ended quickly as she giggled while I moved her hands to the tune of “Itsy Bitsy Spider.” A nurse walked by, paused, and furrowed her brow. Pulling me aside, she informed me that the girl had refused all interactions during her stay. It warmed my heart knowing I brought her some joy. When I returned to sing and play with her, the ventilators connected to her body beeped and interrupted our rhythm, bringing me sharply back to a harsh

reality. Emotional healing, though powerful, has limitations. I could uplift her spirits, but the physical damage remained.

To explore my interests in healthcare more, I shadowed a number of physicians.

Unlike the one-time interactions while volunteering, I observed relationships grow between the patient and the physician.

Trying one type of medication didn’t always solve the root of the problem, and frustrated yet hopeful patients would return. As patients confided about their families, habits, hopes, and fears, I became emotionally invested in their lives as much as their physical health.

While in this setting, I gained insight into the less idyllic and more realistic aspects of medicine. Doctors labored over their notes long after patients left. Angry parents refused to vaccinate their children. Drug seekers screamed violently for pain medication.

Triumphs overshadowed these valleys, though, as each smiling patient reminded me of the reason why these physicians endured the long hours and mentally draining days.

With each patient, the physicians pieced together a new mystery, demonstrating a mental tenacity that I admired. In my

undergraduate research lab, I fell in love with the process of inquiry that the doctors used when deducing their diagnoses. While studying the vocalizations of songbirds, I performed surgery to implant headphones to alter the way they heard their songs.

However, unpredictable obstacles arose daily, such as silent birds or broken headphones.

Every bird presented a unique case, requiring different doses of analgesics and various incisions during surgery. I enjoyed the physicality of using my hands on the miniature creatures and the mental Olympics I performed with each new case. Now, my mind weighs each possibility and solves problems with patience and flexibility, similar to the physicians who never surrendered to the challenges they faced. Doctors assimilate and interpret all the information presented to them to come to a diagnosis and craft a management plan. My curious spirit craves for that daily quest of knowledge and problem solving. Despite the scientific knowledge gained from the experiments, my research lacked the human connections that I personally crave. Playing with the little girl from the hospital brought me tangible

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Medicine provides me a constant and novel challenge where I can engage in inquiry of the lab, but still create that human connection.

satisfaction not comparable to significant data points on a graph. Science only progresses the healing process to a certain point.

Now attending medical school, the days are long and studious. However, I reaffirm my decision to embark on this path daily in new ways. Some days, it’s learning about a medication that one of my family members has been on so I can explain to them its importance. Other days, it’s holding a heart in the cadaver lab and realizing the magnitude of the lives that I’ll touch. Other days, it’s meeting with the children at the pediatric Salvation Army Clinic and hearing their stories. Serving as the Dance Blue marathon captain, I had the opportunity to support a family battling pediatric cancer during their monthly chemotherapy treatments. Seeing their little boy’s fighting spirit as he’s pierced with lumbar punctures and vomiting from treatments was beyond painful. However, it reminded me each time the importance of everything I study. It’s not just words on a page; it’s a future patient’s well-being.

I decided to pursue a health career to protect and heal the body while also comforting the person. Medicine provides

me a constant and novel challenge where I can engage in inquiry of the lab, but still create that human connection. With each new patient, there’s another story and experience that I look forward to uncovering.

Although I learned the power of emotions and scientific knowledge separately, I aspired to combine the two in medicine to truly heal the complete individual. Like the caregivers around me who shaped the back of my head, I hope to also guide the human body. However, unlike them, I want to make my impact by investing intellectually and emotionally in my patients.

About the Author MacKenzie Wyatt is a second-year medical student at UK originally from Mt. Sterling, Kentucky who attended Emory University for her undergrad. She currently represents her class on the Curriculum Committee and leads the College of Medicine DanceBlue team as captain to fight pediatric cancer. In her free time, she enjoys singing and playing her ukulele.

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ANNOUNCEMENTS AWA R D S N E W S TA F F EVENTS AND MORE

EMAIL brian@rockpointpublishing.com TO SUBMIT YOUR NEWS

Women’s Hospital at Saint Joseph East Hosts 19th Annual Maternity Fair Lexington, Ky. (April 9, 2018) – The Women’s Hospital at Saint Joseph East, part of KentuckyOne Health, will host its 19th annual Maternity Fair on Saturday, April 28, 2018 from 9 a.m.-12:30 p.m. The event will take place at Marriott Griffin Gate Resort & Spa, located at 1800 Newtown Pike.

The event will include panel discussions with OB/GYN physicians, as well as maternity and pediatric specialists.

Giveaways and prizes will be distributed throughout the event. One lucky attendee will win the grand prize, which includes free delivery at the Women’s Hospital at Saint Joseph East, and a package of assorted goodies. The Women’s Hospital at Saint Joseph East will cover the out-of-pocket expenses, up to $2,000.

“Bringing a child into the world is an exciting time for parents, but they may also have questions about resources available to them while they are expecting,” said Dana Brundon, Director of Women’s Services.

“We plan to answer those questions for them during this free and fun community event,

19th Annual Maternity Fair Saturday, April 28 9:00am–12:30pm Marriott Griffin Gate Resort & Spa, 1800 Newtown Pike

to help better prepare them for the arrival of their new child.”

This event is free and open to the public.

To register or see the physician panel schedule, visit www.KentuckyOneHealth.org/ maternityfair.

Sponsors for this event include Associates for Women’s Care, and Enfamil. Those interested in becoming a vendor or sponsor should email Angela Florek at AngelaFlorek@kentuckyonehealth.org.

Living Well with a Diagnosis of Mild Cognitive Impairment or Dementia Join us as Neurologist Greg Cooper and Research Coordinator Jackie Williams of Baptist Health speaks about how to live well with a mild cognitive impairment or mild dementia diagnosis. Loved ones or caregivers are welcome to attend. This class will cover ways to live well and take control of your health and wellness if you’ve been diagnosed. Registration required; call 859-260-4354. Program provided by Baptist HealthwoRx, Baptist Health, and the Alzheimer’s Association.

Lexington Clinic Wins Community Impact and Innovation Award LEXINGTON, Ky. – March 22, 2018– Lexington Clinic has been recognized by Intalere, the healthcare industry leader in delivering optimal cost, quality and clinical outcomes, as an Intalere Healthcare Achievement Award winner for Community Impact and Innovation.

The award was received for Lexington Clinic’s groundbreaking work with the Direct-To-Employer program. Lexington Clinic’s Direct-To-Employer program offers customized, premier partnership options for progressive employers in the Commonwealth, and is able to address both preventive care and chronic health conditions of employee populations to improve both employee health and the bottom line.

“We are honored to be recognized by Intalere for the work we have done to improve healthcare delivery at our facility,” says Eric Riley, Lexington Clinic Chief Administrative Officer. “We are dedicated to making improvements to benefit our patients, staff and the community, and appreciate the national recognition of our efforts.”

Through this annual awards program, Intalere recognizes successful initiatives its members implement to enhance quality and operations, improve patient satisfaction and increase community awareness and education.

“In this era of disruptive change within the healthcare industry, it is more important than ever to not only recognize the successful initiatives that providers are implementing to enhance their services, patient outcomes and bottom line, but to also share these best practices with others in order that they too may be successful in their efforts as well,” says Julius Heil, Intalere president and CEO. “Our awards program does just that. And we feel strongly that in working together we can all make a powerful impact in this ever-changing industry.”

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Spring 2018 • Kentucky For more information about this award or Lexington Clinic’s Direct-To-Employer program, please visit LexingtonClinic.com/ youremployeehealth.

Yes, Mamm! Program Receives $20,000 Grant to Provide Additional Breast Cancer Screenings in Kentucky Grant will provide breast health care and support for underserved populations Lexington, Ky. (April 6, 2018) – The Saint Joseph Hospital Foundation, part of KentuckyOne Health, has been awarded a $20,000 grant from the Cabinet for Health and Family Services’ Breast Cancer Research and Education Trust Fund, to continue the

Yes, Mamm! program at the Saint Joseph East Breast Center. This program provides mammography screenings and diagnostic services to individuals in need from central and eastern Kentucky.

“This generous grant will help us continue providing potentially lifesaving breast cancer screenings to low-income, uninsured or underinsured men and women in our community,” said Leslie Smart, president, Saint Joseph Hospital Foundation. “The funding will be used to provide 90 mammograms and, if needed, further diagnostic screenings at no cost to patients. We are thankful for this gift in support of our mission to bring wellness, healing and hope to all.”

Approximately 1 in 8 women, and 1 percent of men, will be diagnosed with breast cancer during their lifetime. However, with early detection, the five-year survival rate is

Q: How many Central Kentuckians read Health&Wellness Magazine every month?

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more than 80 percent. Mammograms are an important tool in early detection, but too often, cost prevents people from getting a screening. The Yes, Mamm! program helps make breast cancer screenings accessible for more people who currently fall through the cracks of available services.

The Yes, Mamm! program was created in 2012, and collaborates with local health departments to identify individuals in need and provide services. Yes, Mamm! has helped hundreds of people across the Commonwealth, with 100 percent of its program funding spent on patient care.

To learn more about the Saint Joseph Hospital Foundation and the Yes, Mamm! program, call 859.313.1705.

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PHYSICIAN HEALTH AND WELLBEING

Allowing Awe in Medicine The real voyage of discovery consists not in seeking new landscapes, but in having new eyes. —Marcel Proust, French novelist

By John A. Patterson MD, MSPH, FAAFP Of all the sciences, medicine uniquely combines all domains of the human conditionbiological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace. And the more we learn about the physiological effects of the physicianpatient relationship, the more we seek to harness the power of the placebo effect in the way we use words and communicate non-verbally with our patients.

This humanistic trend in physician/ physician relationships and physician/ patient relationships can be nurtured without traversing the potentially hazardous terrain of conflicting religious or spiritual

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beliefs. An encouraging sign of this maturing transpersonal humanism in medicine is the respect and serious study being given to awe as worthy of our professional attention.

What is Awe? Most physicians never heard the word ‘awe’ mentioned in medical training as something worth taking precious time away from more ‘serious’ study. Yet, some of our greatest medical and scientific minds (the ‘father of modern medicine’ William Osler, current director of NIH and the Human Genome Project Francis Collins, physicist/ pacifist Albert Einstein, astronomer/ cosmologist Carl Sagan) have spoken about awe as a primary motivation for medical and scientific inquiry. Though awe is a transcendent, often reverential, experience filled with wonder that needs no logical rationalization, it is not necessarily rooted in one’s religion or spirituality, though these may be involved for some people.

Researchers view awe as perhaps a uniquely motivating driver of the scientific search for truth and a hopeful environmental future as nature-based experiences of awe connect us to all of creation.

Awe is an emotional experience–not an idea, thought, opinion, fact or cognition. It is often beyond words. It is the experience of being in the presence of something larger than ourselves–something vast and unexplainable. In your own life experience, recall the ways you have been moved, touched and inspired by the depth of love, loyalty and commitment you have witnessed or experienced. Recall your response to the courage and the will to live you have seen in a family member or patient.

Spending time with pre-school children can provide a window into awe as a normal, natural, almost ubiquitous human experience. Seeing the world through eyes that have not yet been blinded by acculturation and educational competition

can be deeply rewarding to adults. This is one reason for the traditional Ayurvedic medicine recommendation that adults spend time with young children. Moments of awe can easily pass us by. We adults need to learn to ‘stop and smell the roses’ anywhere, anytime.

Cultivating Awe When given the opportunity to reflect on the experience of awe in medical training, most medical students can easily give examples. Though their resident or attending physician rarely reports sharing their experience, students talk about the deeply moving experience of first hearing fetal heart sounds, delivering their first baby, assisting in major surgery or being with the dying.

These experiences of awe are not typically validated and reinforced by the culture of medical training. Medical electives, and occasionally required courses, seek to correct this deficiency in the training of the physician as a whole person. The Healer’s Art–Remembering the Heart in Medicine is an elective taught to students and residents at over 100 medical schools (including UK for the last 15 years). Mindful Practice is an elective created for students and residents at the U of Rochester.

These courses cultivate the qualities of exemplary clinicians that transcend a purely biomedical model. They enhance the self-awareness, wellbeing, and resilience of health professionals.

They help medical learners prevent burnout by improving relationships with patients, colleagues, their own family and themselves. These courses help us create the conditions for experiencing moments of awe that we might otherwise miss.

They can also give us tools with which to maximize our experience when we find ourselves captured by moments of awe.

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Seeing the world through eyes that have not yet been blinded by acculturation and educational competition can be deeply rewarding to adults.

Some skills taught in these courses include- ‘double vision,’ emotional intelligence and mindfulness.

Double Vision To develop our exemplary physicianhood and humanity, we need to develop a kind of ‘double vision.’ We must focus on the biological, physiological and pathological in the conventional medical scientific care of our patients. And we must simultaneously focus on the unique human being we are treating- especially being respectful, amazed and in awe of their ability to navigate the health care system and the many barriers and obstacles of disease, trauma, mental illness, family upheaval, financial stress, aging and the approach of death itself.

The developers of Mindfulness-Based Cognitive Therapy refer to this double vision as our doing mode and our being mode. As so many physicians can attest, we can learn from our patients how we ourselves might dwell more in our being mode, making the experience of awe more available and finding joy amidst our own suffering and even our own healing when curing is not possible.

Emotional Intelligence (EQ) In explaining our diagnostic processes and decision-trees, we usually rely on ‘clinical judgment,’ which is part linear/ cognitive and part non-linear/intuitive.

Most clinicians can recall a diagnostic workup that involved an intuitive hunch, a feeling that ‘something’s just not right here.’

For me, it was the diagnosis of a leaking abdominal aortic aneurysm in a walk-in patient who complained of a cough and ‘having the flu.’ He had emergency surgery within 3 hours and lived.

The future of medicine is bright, in part due to the growing emphasis on the training of emotionally mature and aware physicians and health team members. Those in health care leadership and administration

can also maximize their effectiveness, communication, career satisfaction and the satisfaction of their workforce by the intentional fostering of EQ through emotional awareness, fluency and flexibility.

Our entire societal education system is recognizing the importance of preparing learners of all ages to maximize their inborn skill of emotional intelligence- learning to feel their emotions without self-judgment and blame or wondering if it is ok to feel their emotions. We need to be prepared for the tears shed by patients and colleagues and feel ok if we shed our own- even in the presence of others- avoiding the dehumanizing effect of thinking that emotional expression is unprofessional.

Mindfulness Moments of awe may be fleeting. We can train ourselves to be ready for them. If we look closely, awe is as close as your own remarkable human physiology. The wisdom of your body is truly awe-inspiring. We must be able to pay attention to truly be present to that sunrise, sunset, music, newborn baby, child’s laughter or the good humor and devotion of the homeless woman caring for her child at the shelter. While some moments of awe demand our attention, we can also create the conditions for awe by intentionally practicing mindfulness by being present to this moment- with intentional openness and curiosityanywhere, anytime.

The growing research applications of mindfulness include promoting resilience, managing stress, preventing burnout, cultivating compassion, growing our sense of gratitude, joy in medicine and the potentially life-saving experience of awe.

Resources • Mindful Practice Program, U of Rochester School of Medicine www.urmc.rochester.edu/familymedicine/mindful-practice.aspx

• Healer’s Art- Remembering the Heart in Medicine, www.rishiprograms.org/ healers-art • The emerging science of awe and its benefits, www.psychologytoday.com/ blog/understanding-awe/201704/theemerging-science-awe-and-its-benefits • Scientists are trying to solve the mystery of awe, www.thecut.com/2016/05/ scientists-are-trying-to-solve-the-mysteryof-awe.html About the Author Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine. He operates the Mind Body Studio in Lexington, specializing in stress-related chronic disease and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org

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PROFILE IN COMPASSION

Sustaining an Altruistic Spirit: Terry Barrett

By John A. Patterson MD, MSPH, FAAFP Terry Barrett is Chief of the Gastroenterology Division of the Department of Medicine, University of Kentucky College of Medicine. He came to Lexington in 2013 from Northwestern University Medical School in Chicago.

Becoming a Doctor Although there were no doctors in his family, he always felt a parental expectation of excellence and high achievement. He had a poor impression of the competitive nature of pre-medical education he witnessed among his peers. Having a fondness for math and science in high school, he entered college thinking about becoming an engineer and perhaps a patent lawyer.

After growing up Catholic, going to mass every Sunday and attending a Catholic high school, he went through a deepening process of self-discovery in college as the Notre Dame faculty helped him and other students identify their unique personal strengths, gifts and skills. He recognized how much he was personally motivated by altruism, service and addressing world hunger. He became involved in the South Bend community, connecting college students to nursing home patients. He began making straight A’s in humanities courses. This combined interest in science and altruistic service led naturally to medicine as a career choice. He shifted to pre-professional studies and took theology courses. He was fascinated by the study of comparative religions and the common threads among spiritual traditions.

Knowing Burnout Juggling his obligations to family and medicine has not been easy. During training, he and his wife had 5 children within a two-year span (aided by triplets). He is a researcher, clinician and educator. He has felt the impact of stress on his family life and his work productivity. He knows how it feels to begin to doubt oneself under the strain of so many competing demands. He has heard the inner voice of negativity that says “ You can’t do it” and “You aren’t that good.”

He brings this personal history to his mentoring of junior faculty and fellows.

He knows they are also vulnerable to these self-defeating attitudes and their potentially destructive impact. He tries to help them avoid feeling despair as a new normal. He knows how easy it is for men and women who choose medicine for all the right reasons to burn out.

Managing Stress He has learned to recognize the signs of a stressful situation and which factors are external (over which he has limited control) and internal (over which he has much more control). The practice of mindfulness helps him distinguish between these external and internal stressors and manage them proactively. This allows him to take action to change the things he can rather than blame other people or external factors. He has taken to heart and regularly used the tools he learned in the Mindfulness-Based Stress Reduction (MBSR) course. Mindfulness has given him a non-pharmacological antidote to stress in the deceptively simple practice of being with all life experiences (physical, mental, emotional and relational) with equanimity, curiosity and openness.

Mindfulness helps him to take action

characterized by wise and skillful responses rather that unwise, unskillful and habitual reactivity. He also uses a mindfulness app on his phone that reminds him several times a day to move, stand, breath and simply pay attention to the present moment.

He refers several patients a week for mindfulness training and says “I particularly find this approach useful for treating anxiety-related disorders, chronic pain, inflammatory bowel disease and irritable bowel syndrome.”

Keeping Compassion Alive He is still motivated by the altruism of his college years. He feels an inner compulsion to serve. He focuses on the good he is doing at home and at work. He takes comfort knowing he is making a difference. The meaning of being a physician is constantly renewed by such activities as teaching 1st year medical students at the UK StudentRun Salvation Army Clinic. He also feels renewed by providing free care to the indigent men and women seen there- some of whom are desperate, addicted, homeless, mentally ill and at the end of their rope.

He says, “You must be compassionate to them all.” He may not receive thanks from some patients. He will never see most of them again. “But an inner purpose drives me to help them.”

The Next Generation The conflicting demands and inefficiencies of hospital systems can negatively impact physician job satisfaction and lead to burnout from institutionalized external stressors. The training environment of fellows, residents and students can be affected- and despite the best intentions of caring professionals, patients can be

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Spring 2018 • Kentucky

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He refers several patients a week for mindfulness training and says “I particularly find this approach useful for treating anxiety-related disorders, chronic pain, inflammatory bowel disease and irritable bowel syndrome.”

harmed. Terry enjoys doing research enough to tolerate these drawbacks of medical academia. Many physicians choose to practice in the private community, usually without the triple academic demand of teaching, research and clinical care- not to mention the supervisory demands of being a division chief.

His evaluations of his faculty and fellows includes a realistic assessment of these environmental stressors they are exposed to.

He sits down individually with his faculty at least twice a year for a focused review and guidance on each aspect of their career.

He praises them and shows appreciation as much as possible, knowing such feedback can reduce the risk of burnout.

But he also knows that external rewards and praise are not enough. To be truly satisfied and effective, they must also be internally rewarded and driven. He asks

them “Why are you here? What makes you excited? What brings you happiness?”

He thinks we need to arm students, residents, fellows and faculty with the life skills of self-care and resilience. Based on his own personal experience, he recommends mindfulness and its toolkit of mind-body skills as a preventive antidote to stress and burnout.

Societal, parental and financial pressures impact career choices between academia and community practice. Competition for grades and class rank add to the burden of isolation so common among medical trainees. He observed this dynamic first hand in his own daughter. Though she is now in her dream residency, there were times in medical school that she felt distraught over her academic performance, leading to self-defeating inner dialogue. He thinks we need to intentionally weave self-

care throughout health professional training - in medical school, residency, fellowship and practice.

Terry Barrett is a physician who has found a way to sustain his lifelong altruistic spirit. In the process, he is helping medical students, residents, fellows and faculty sustain their own.

About the Author Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine. He operates the Mind Body Studio in Lexington, specializing in stress-related chronic disease and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org

4667 WINCHESTER RD. FAYETTE COUNTY | $1,595,000 LEXINGTON, KY 40509

“You must be compassionate to them all.” – Dr. Terry Barrett

Grand estate home with idyllic manicured grounds to please the most discernible buyer! This estate home is on 12.28 acres of beautiful land. The copious master bedroom with it’s own secret room is located upstairs with 3 additional bedrooms plus 1 bedroom/bath/kitchen/sitting room apartment/in-law suite is located on 1st floor. Architectural details in this home create a very distinctive grandeur which is easily perceived from the stately gated entrance. Views of the property are magnificent from virtually every window inside the home. Please verify schools with Fayette County Public Schools due to potential redistricting for the 2016-17 school year and beyond. Black barn with six stalls on corner of property is negotiable!

Home featured in the KY Home Garden Magazine Jan./Feb. issue 2017.

LISTING AGENT SHARON HANDSHOE 859.806.8081 or 859.296.6793 shandshoe@gmail.com United Real Estate Lexington

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doc • Spring 2018 • Business Section

Kentucky

DID FACEBOOK

SELLOUT?

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Business Section • Spring 2018 • Kentucky

By Jim Ray Over the past few years, many firms have realized the advantage of a wellplanned social media strategy. The reach and pervasiveness of social media makes it a valuable component of an effective marketing campaign. Facebook led the charge as individuals quickly adopted the platform.

Facebook literally changed the use of the word “friend” from a noun to a verb.

However, the question now being asked is critical for any small business, “Did Facebook sellout?”

In the early days, it was relatively easy to simply post a comment or article and watch with utter excitement as the information garnered “likes” and “shares” from people seemingly everywhere. That usually included many people you didn’t even know. Thus, the effective reach of a Facebook post made it a valuable marketing tool.

Now the environment is changing.

It’s become increasingly difficult to consistently achieve those high numbers.

That once incredible “organic” exposure on Facebook is decreasing. What’s changed?

As a publicly traded company, Facebook has aggressively begun to monetize its platform. In other words, if you want to achieve significant exposure, you’re going to have to pay for it via Facebook ads and other strategies. This has led to the aforementioned question, “Did Facebook sellout?”

The old adage “Nothing’s free” has definitely impacted law firms, individual attorneys and other small businesses.

Let me be clear, social media (including Facebook) remains a solid option.

There are multiple ways to leverage the Facebook platform, as long as you understand your objectives.

I highly recommend social media strategies for most of my clients.

A key reason to the decline in organic results on social media is simple.

Increasingly more businesses are realizing the value of online marketing, so the pool is getting crowded. Breaking through the noise will continue to challenge even the most savvy marketers.

Today, if you really want to leverage the reach of your Facebook posts, you should consider buying Facebook ads to promote your content pieces.

Creating an ad budget for Facebook is relatively simple. Research is showing that video ads tend to perform better

than simple text-based ads. The good news is both formats cost the same. You don’t have to pay a premium for a video ad. If you’ve read any of my articles or blogs over the past several years, you already know I’m a major proponent of incorporating videos into your marketing campaign.

In recent weeks, several of my clients have been pleasantly surprised by the performance of their Facebook ads. Let me give you a quick explanation of why buying ads is a more strategic way of marketing: Relying on organic reach is untargeted.

There really isn’t a strategy in simply throwing content over the wall and hoping it goes viral. You’re depending on other people’s engagement to achieve your desired effect.

Buying ads allows you to specifically target demographics including age, gender, job titles, interests and geographic location. You can basically buy the exposure you want/need for your campaign. It’s not a guarantee. There are many other factors at play. Ads help you to get the exposure you actually want.

Conversion (getting the target market to act in an intended manor) is still up to the strength and effectiveness of the message you’re trying to convey.

Nonetheless, even if you don’t buy a Facebook ad for each post (and you shouldn’t anyway), several well-placed ads can draw people back to your Facebook

page where they’ll be able to see other posts and information. Ideally, your Facebook page will also lead them back to your website where more substantive information resides.

As with most other marketing tools, if used independently, the results will be lackluster. The key is to develop a coordinated campaign integrating the information formats, types of promotion and placement.

You can decide how best to answer the “selling out” question for yourself. It’s often a matter of perspective. The way I view it comes down to this: Whatever Facebook is doing, they’re selling. At the end of the day, Facebook’s stockholders like the way that sounds. Guess we’d better get used to it.

About the Author Jim Ray earned a BA in Business and his MBA. He managed two multi-million dollar businesses before transitioning into Internet consulting. He later launched his regional consulting practice to help professionals operate more effectively and more profitably.

Jim presents an ongoing seminar series and contributes business development articles to a variety of professional publications. He has been invited to speak at national meetings for Internet marketing and has lead several, national webinars on various marketing topics. For more information, visit www.

JimRayConsultingServices.com or connect with him on Linkedin.

I HIGHLY RECOMMEND SOCIAL MEDIA STRATEGIES FOR MOST OF MY CLIENTS.

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APPOINTMENTS AVAILABLE WITH FPA PROVIDERS AT BOTH LOCATIONS

Family Practice Associates of Lexington, P.S.C.

HAMBURG OFFICE

1775 ALYSHEBA WAY SUITE 201

SPRINGS OFFICE

2040 HARRODSBURG ROAD, SUITE 300 CHECK US OUT ON THE WEB

fpalex.com

859.278.5007

Take Care of Your Patients

by Taking Care of Yourself

The Lexington Medical Society

Physician Wellness Program

TAKE CARE OF YOUR PATIENTS

BY TAKING CARE OF YOURSELF The Physician Wellness Program (PWP) was designed as a safe harbor for physicians to address normal life difficulties in a confidential and professional environment.

WHY WAS THIS PROGRAM CREATED? Being a physician isn’t easy. Difficulties with the current health care delivery system, maintaining a healthy work/ life/family balance, and dealing with the normal stresses of everyday life can take their toll on physicians.

We serve not only as treating physicians, but many times as counselors to our patients who turn to us for guidance.

Who do we turn to when we need to talk through an issue or get some coaching for how to handle stress in our life?

Too often the answer is “no one,” and that is regrettable because it is imperative that we be as healthy as possible in our role as health care providers.

We deserve to function at our best in all areas of our life.

By addressing areas of difficulty, we can decrease our stress levels and increase our levels of resilience.

Some examples of those difficulties include: •

Family issues

•

Depression & anxiety

•

Relationship problems

•

Difficulty managing

•

Work-related

•

stress

difficulties

•

Mood swings

Alcohol/drug abuse

•

Suicidal thoughts

How PWP Works We have contracted our program with The Woodland Group. The Woodland Group will provide counseling to active physician members of the Lexington Medical Society and UK Graduate Medical Education residents and fellows. Non-emergency sessions will be scheduled during regular business hours. Emergency sessions can be scheduled on a 24-hour, 7 days-a-week basis.

Seven licensed psychologists make up the Woodland Group and have been vetted by LMS. Steven Smith, Ph.D. and Sandra Hough, Ph.D. are our program coordinators and will serve as points of contact to access PWP. The Woodland Group will maintain a confidential file for each physician, but no insurance will be billed and LMS will not be given any information about those who utilize the program. As such, this program is completely confidential which is crucial to its success. LMS will pay The Woodland Group a monthly bill based on the number of sessions provided. The Woodland Group will verify LMS membership from the physician finder on the LMS webpage.

TO MAKE YOUR APPOINTMENT 1) Call the confidential hotline at 1-800-350-6438 and leave a message in either Dr. Smith’s or Dr. Hough’s voice mailbox.

2) They will call you back to schedule an appointment. It’s that simple!

PWP Benefits 8 free sessions each calendar year Complete confidentiality Easy access Convenient location (535 W. 2nd Street, Suite 207) 24/7 availability

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Arrange a confidential discussion about the challenges you face.

I’m a coach with practical experience helping professional help you market your practice, differentiate your services and increase your patient base.

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