Special Issue - Issue 121.2 - Putting Others First in Life and Medicine by topdoctormagazine

April 2021 Issue 121.2

SPECIAL ISSUE

Putting Others First in Life and Medicine Pg 13

IDefine with Dr. Mason Harrell Pg 01

TOP DOCTORS OF THE WEEK

How The Frontline Heroes Responded With Remarkable Efficiency

Pg 05

Bringing Healthcare to the Unsheltered Community of Sacramento

Pg 10

Contents

IDefine with

Dr. Mason Harrell

"Doctor to Door" Medicine

Surviving through the

with Clay Hall

pandemic: How the frontline heroes

remarkable efficiency

Sacramento – An Interview with Anthony Menacho, PA 13

Putting Others First in Life and Medicine - An Interview with Eddie Menacho, PA

WHAT'S INSIDE?

Dr. Antonio Gamboa: Bridging the Gap

Bringing Healthcare to the Unsheltered Community of

2020 Vision with Dr. Ethan Wonchon Lin

responded with

Perfecting the Lost Art of

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Issue 121.2.1

IDefine with Dr. Mason Harrell About Dr. Mason Harrell Amiable, accomplished, and passionate are just a few words to describe Dr. Mason Harrell, a Harvard-trained physician triple board-certified in Occupational Medicine, Public Health and Preventive Medicine, and Aerospace Medicine. He is also a former flight surgeon and a devoted family man and father of two. Dr. Mason, or “Mase-dogg,” as his friends like to call him, decided to become a doctor because he longed to make a real difference in the world. With his strong wit and undeniably honest concern for others around him, it is no wonder why many prestigious organizations such as Harvard University, the World Health Organization (WHO), Massachusetts Institute of Technology (MIT), and the American College of Occupational and Environmental Medicine (ACOEM) have taken him under their wing. And if that wasn’t impressive enough, Dr. Mason is also a co-founder of several organizations such as IDefine, Sequoia Port, American Analytical Medical Services (AAMS) and Gledson. He provides consultation services that deal with health and wellness for employees, medical-legal work, and improving medical record systems. But the organization closest to his heart is IDefine, which we will delve into a little more below. PAGE

Photo Courtesy of Jackie Lynn Photo

Issue 121.2.1

What is Kleefstra Syndrome? On the first birthday of his daughter, Eleanor, Dr. Mason received the most devastating news of his life. Eleanor was diagnosed with Kleefstra Syndrome (KS), a rare genetic disorder from a single gene mutation causing autism and intellectual challenges. EHMT1 is an epigenetic gene that influences many other genes. In children, KS can also cause hypotonia or ‘floppy baby syndrome’ and seizures. When these kids reach puberty, they can become catatonic and exhibit psychotic episodes, making this disorder even more terrifying. But why does Kleefstra Syndrome occur in the first place? “Well, it’s kind of like reverse evolution,” as Dr. Mason describes it. Genetic mutations ubiquitously occur; these mutations can either be beneficial or detrimental for an organism. When humans are in their gestation period, and they have a gigantic genetic mutation, this would result in the mother having a miscarriage. When the mutation is not significant enough to cause a miscarriage and is undetectable by tests, a baby is born with adverse health conditions.

IDefine’s Soul Mission “Even being a doctor, when I found out about Eleanor’s diagnosis, it just knocked the wind right out of me,” Dr. Mason somberly remembers. Gutted by the grave news, he couldn’t even bring himself to research the syndrome, which is why his friends had to do the digging for him. However, he realized that sulking wasn’t going to make things any better, so he flew to the Netherlands and sought out Dr. Kleefstra herself to figure out a solution. They collaborated with other fathers of children with KS, children’s physicians from Harvard Boston Children’s Hospital, and KIDS IQ Project to establish the nonprofit organization, IDefine. IDefine focuses on the discovery of treatments for genetic causes of autism and intellectual disability. We are first focused on genetically correcting the EHMT1 mutation, which will cure autism and intellectual disabilities in cases of EHMT1 defects. This will give hope to the communities who face these disorders and usher in the light at the end of the tunnel! PAGE

Issue 121.2.1

Spreading Awareness and Creating Change The first step towards change is awareness, and a great way to heighten that is to increase genetic testing in patients, as Dr. Mason advocates. However, spreading awareness and fundraisers are a massive help to IDefine’s quest. Dr. Mason is optimistic that they will find a cure as it is just a matter of time. “We’re going to die trying. And we’re going to do it. It’s just a matter of time and money millions of dollars more,” he added.

As we discovered Dr. Mason’s tenacity and relentlessness to find a cure, we at Top Doctor Magazine can’t help but feel inspired and confident that IDefine will fulfill their mission of restoring intellectual intellectuality back to individuals with intellectual disabilities.

IDefine’s Soul Mission Dr. Mason's work doesn't just stop at IDefine. When the COVID-19 outbreak surfaced last year, it was like life slapped him with the truth - that we are all just living through a series of neverending obstacles we need to surmount. However, as a seasoned veteran who has been on numerous medical missions worldwide and has published dozens of articles about Ebola and its effect on health workers, Dr. Mason got the upper hand this time. He was ready to tackle this new challenge head-on. Suddenly, CEOs saw themselves forced to put employee health and safety at the top of their priority list, which caused businesses to scramble looking for the few occupational medicine doctors available. And Dr. Mason, being the helpful person he is, jumped right into the action and offered his services where the need was urgent. PAGE

Photo Courtesy of Jackie Lynn Photo

Issue 121.2.1 Dr. Mason provides his knowledge and expertise by teaching companies how to implement proper safety procedures (i.e., following the hierarchy of hazard controls) and how to keep their employees safe and healthy, even when they are out of the workplace. On March 1st, 2021, Dr. Mason joined WorkCare as their Chief Medical Officer. Established in 1984, WorkCare delivers seamless, cost-effective occupational health services to employers of all sizes and types. Its mission is Protecting and Promoting Employee Health and wellbeing. An ounce of prevention is worth a pound of cure.

Top Doctor Magazine thinks that great people are only ordinary people who deal with life's challenges, and that is precisely what makes Dr. Mason one of the greatest ones out there. If you are interested in learning more about Dr. Mason Harrell, you can visit his site: https://www.masonharrellmd.com/ for more info. Furthermore, if you want to be a part of creating history or want to help out a good cause, check out https://www.idefine.org/ for donation details.

Photo Courtesy of Jackie Lynn Photo PAGE

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Issue 121.2.2

Surviving through the pandemic: How the frontline heroes responded with remarkable efficiency The COVID-19 pandemic triggered an unprecedented global emergency, and healthcare professionals have responded by providing immediate care during this difficult time. As the rapid spread of the virus overwhelmed healthcare systems, altered livelihoods, and disrupted economies in many parts of the world, healthcare providers sacrificed their lives by battling the new and vicious foe. As the virus attacks indiscriminately, the victims include healthcare workers who knowingly put their lives on the line. Even without a PAPR and a proper N-95 mask, our healthcare heroes suit up every day to face the threat head-on and become exposed more than the rest of us to save those who are critically ill from the virus. As they provide care to the victims, they fight an invisible enemy and often self-isolate from their families to avoid spreading the virus. Furthermore, they try to fill the void for families who cannot be at their loved one's bedside due to restricted visitation rights. Aside from the potential risk associated with providing care to patients, healthcare providers have adapted their workflow to isolation protocols so that victims could still enjoy human contact. They also stayed with dying patients during their last moments, holding their hands, keeping them company until the end. Speaking about how the pandemic affects his practice, Dr. Michael Wu, a dentist in San Francisco Bay Area, disclosed to Top Doctor: "I think in terms of the day-to-day operation, it is a lot more stressful because all the staff had to multitask a lot more. Prior to the pandemic, the office Staff is already well versed in the sanitation and sterilization tasks. After the onset of the pandemic, the entire office team had to be retrained in order to implement a myriad of new rules. Everyone at the office has to be vigilant about the office environment in order to implement the new Covid-19 patient safety protocols. PAGE

Issue 121.2.2 For example, disinfection of all potential patient contact surfaces at the front office must be done after every patient. And every person entering the office must fill out the Covid questionnaire form and have the body temperature taken.” Relating to the psychological well being of the dental Staff, Dr. Wu explained that “during the early days of the pandemic, there was a lot of conflicting information about the exact path of transmission for the Covid 19 virus. This was especially stressful to my team. Many staff members live with elderly parents or young children at home. Some of my staff members have pre-existing medical conditions, such as asthma. A few team members even contemplated leaving the dental profession altogether. It took a lot of selflessness and courage for them to come to work, because they understood the risks they are putting themselves, their family and loved ones in. Many team members had to ponder how to balance work and personal lives. Likewise, those were also the darkest and most uncertain times of my career." Dr. Michael Wu developed an interest in dentistry while he was in high school during a summer externship. Working alongside a dentist at a community dental center, he was delighted at how the relationship between dentist and patient develops. Dr. Wu went to UCLA for his undergraduate degree in Molecular Cell Developmental Biology. But ultimately he realized that dentistry was his true passion. It was the people-to-people interaction in dentistry rather than sitting in a lab, cultivating cells, that led to his dive into a career in orthodontics. Dr. Wu earned both his Doctor of Dental Medicine degree and orthodontist specialty certification at Harvard School of Dental Medicine. Practicing since 2008, Dr. Wu has 12 years of experience in orthodontics, and he is currently working in group practices in the San Francisco Bay Area. While narrating his experience during the pandemic, he said: "It definitely impacts dentistry in several ways, especially when it comes to the dental speciality of Orthodontics. Typically, the orthodontist sees a higher volume of patients than general dentists on a daily basis. PAGE

Issue 121.2.2 Prior to the pandemic, I would see an average daily volume of 50-60 patients, but right now, we had to scale down for safety reasons. We want to make sure there is adequate spacing between the patients in the treatment area." He explained further how they enforced the social distancing rules at his practice: "…as a matter of fact; we don't have patients in the waiting area. We usually tell patients to wait in their car in the parking lot. Once space becomes available in the treatment area, then we message the patient to come into the office. We try as much as possible to discourage patients from getting crowded in the waiting area and limit patients to two or three in our treatment area at any one time. All this means that the office must be even more efficient at time management compared to pre-pandemic days." Even before the Covid-19 pandemic, dentists wore masks and gloves when dealing with patients, which placed them in a good safety position when the pandemic hit. Dr. Wu explained that dentists practiced Universal Precaution since the 1980s in the wake of the AIDS epidemic. There was a lot of concern from the patients and the general public that they could potentially contract HIV from health care providers, such as dentists. These public concerns were ultimately proven to be unfounded, thanks in part to the successful implementation of the Universal Precautions, which required use of personal protective equipment (PPE) by dentists. However, what changed during the current pandemic, is that anyone can be infected with the Covid 19 virus as a result of respiratory transmission. Whereas HIV is more likely to be transmitted through bodily fluid contacts. "There is definitely a lot more concern regarding getting Covid 19 virus, so we had to make sure that every staff member follows the updated universal precautions, including the use of N95 masks and social distancing amongst not only the patients, but also the Staff. Break room is no longer a place where Staff members can congregate and eat lunch together." While discussing the pandemic challenges, Dr. Wu told us that many healthcare professionals were nervous about going to work, but that they had to be strong and support the patient’s well being: "I would say that I am really proud of my team.

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Issue 121.2.2 Even though most of them have been in the dental industry for a long time, in terms of their duties, it is definitely more complex than before. Overall, they have been handling it pretty well. As time went on, it just became a normal part of everyday routine, but I think it adds more stress to the daily work schedule. Despite our own personal worries, we still have to appear calm and composed inorder to instill confidence in our patients. We really want patients to feel safe and well cared for when they enter our office for treatment." Although healthcare professionals scrambled to take charge when the virus hit, Dr. Wu recalled the state and federal regulators' lack of clarity. He said: "When the CDC recommended PPE protocols, they were looking at it from the hospital point of view, like what should they do for best practices in the ER and ICU settings. And I don't think there are many dentists on the panel at federal and state health agencies. I think we are trying to adapt our dental offices to a medical hospital standard when it comes to occupational safety. I think it makes it expensive for us to order a lot of equipment that may not be necessary within our practice setting, and at the same time, a lot of those resources could be better saved for the hospitals that really needed them. That is one thing I always struggle with. I wish that the state regulators can be better informed and provided narrower guidelines targeting the specific medical and dental fields, rather than just paint everybody with the same brushstroke and say ‘because the doctors in the intensive care unit needed certain PPE and equipment, and there is a shortage of those medical supplies, so we are going to mandate the closure of all orthodontic and none urgent care dental offices." Speaking about the pandemic's solution, Dr. Wu shared that the vaccine will definitely slow the pandemic and lessen the economic and public health tolls. To reach that goal, he also concluded that technology is an essential part of the solution. While some healthcare providers were moving to some aspect of Teledentistry even before the pandemic, "…actual treatments are still done in person. In terms of orthodontic emergencies or questions, a lot of those can be effectively addressed through secure encrypted emails, or one on one zoom call with the patient to demonstrate to them how to take care of a PAGE

Issue 121.2.2 bothersome orthodontic wire for example," he explained. “Teledentistry will continue to be a major part of dentistry going forwards.”

Dr. Wu continued by explaining how the current pandemic will render physicians and medical personnel more prepared for future outbreaks: "The other aspect of the solution to any future pandemic is related to the learning experience we are going through in the current crisis. For example, in places like Korea, Taiwan, Hong Kong, etc. they went through the SARS outbreak in the early 2000s. Partly as a result of their experience during the SARS outbreak, many locals in those regions routinely wear masks in public prior to the current pandemic. I think wearing masks in public, as a socially acceptable behavior, is part of the reason why they are better able to contain the spread of COVID-19 virus. If there is one thing that we can take away from this Pandemic is that our state and local agencies must develop effective public health recommendations to better deal with or even prevent the next viral outbreak." Dr. Wu has gotten himself vaccinated against Covid 19 virus, and encourages his entire dental team to do the same. He wants the general public to be aware that as dentists and doctors, they are ready to go the extra mile to keep people healthy. "We want to make sure that the patients are safe when they come into our offices, and we want to make sure that they are happy with their smile when they leave our offices." Although many patients are scared during the pandemic, he reminded us that healthcare providers have patients' best interests at heart and are there to take good care of them and their families.

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Issue 121.2.3

Bringing Healthcare to the Unsheltered Community of Sacramento – An Interview with Anthony Menacho About Anthony Menacho Anthony Menacho is a National Health Service Corps Scholar and a graduate from the PA program Keck School of Medicine at the University of Southern California. He received his Bachelor's Degree in Kinesiology at California State University with department and university honors. Anthony Menacho focuses his resources primarily on creating stronger links with students who want to excel in their respective fields and with the lessfortunate communities of Sacramento. Together with his brother Eddie, he founded the Brainbox Methods, a community of approximately six thousand students dedicated to improving extra-curricular skills. Additionally, he's the founder of Sacramento Street Medicine, an organization that helps the homeless community with its basic, day-to-day medical needs.

Keeping a Promise The son of Latino immigrants, Menacho has led quite a busy life. He’s always out there, looking for new and exciting experiences. From being a congressional intern in D.C. to working in the ambulance service, Menacho always saw the need to give back to the community, especially the one whose needs repeatedly fell prey to closed doors and neglect. However, the defining moment in shaping his career bears the mark of a family tragedy. After losing their father to kidney cancer, both Menacho and his brother took it upon themselves to honor his memory by becoming the best physicians they could be and helping the poor, the sick, and the needy. PAGE

Issue 121.2.3

Giving Back to the Student Community Right from the university benches, Menacho envisioned a program destined to give back to the student community. With his brother Eddie by his side, he brought Brainbox Methods into the world: a company whose sole goal is to help young students overcome their social status discrepancies and get accepted into their dream universities. With a strong follower community of over 6,000 people, Menacho provides resources to young students on how to succeed academically, emotionally, and professionally. For just a symbolic fee, students get a chance to add essential skills to their arsenal, skills that do not find enough space in the "classroom," such as updating resumes and personal statements, writing, or learning how to pay off tuition in a very relaxing and friendly setting. Menacho explains the rationale behind his decision: "I know students that went to some of the top, top high schools and got into college and were lost. And so if you, could you imagine somebody who comes from a low-income high school or a high school where they weren't preparing them, how they felt, you know, if they got into some type of reputable institution, it's almost like their chances are shot, you know?"

Next Big Step - Sacramento Street Medicine But this was just the tip of Menacho's iceberg of plans. As a student at the Keck School of Medicine, he had the chance to learn about street medicine from the best in the field. Following his relocation to Sacramento, CA, Menacho decided to implement his knowledge into a brand-new street medicine program called Sacramento Street Medicine (SSM).

Benefiting from the work of student & non-student volunteers organized into teams, Sacramento Street Medicine constantly takes the pulse of the city's homeless community, providing primary, survival supplies and low-level wound care. Furthermore, as the organization is transitioning towards an established medical practice, Menacho hopes that his teams will be authorized to provide more medical care to those in need. As the COVID-19 pandemic hit the streets of Sacramento with full force, Sacramento Street Medicine, although with fewer resources and human resources, played a significant role in keeping the homeless population away from the virus providing COVID-19 testing and education while following every single safety protocol in the book. PAGE

Issue 121.2.3

Bridging the Gap between the Homeless Population and Hospitals Aside from providing primary care to needful communities, Menacho and his team strive towards minimizing the gap between the homeless and the local authorities. Already crippled by lack of trust and fears of sweeping (i.e., relocations), this relationship became even more uneasy with the arrival of COVID-19; instead of asking for medical assistance right away, people choose to hold out until it becomes a matter of life and death.

With the financial help from external sources and an understanding Sacramento community, Menacho is already making tremendous progress. With his unquenchable passion and disregard for financial gains, he finds an honor and a blessing in this opportunity to help others. We can only hope that his beautiful initiative will serve as an example to those who want to give a chance at a better tomorrow to needful communities. If you would like to learn more about Anthony Menacho and his mission, make sure that you check out the following website.

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Issue 121.2.4

Putting Others First in Life and Medicine - An Interview with Eddie Menacho, PA About Eddie Menacho, PA: Eddie Menacho is a National Medical Fellowship Scholar and a graduate from the PA Program at the prestigious Keck School of Medicine. He received his Bachelor's Degree in Kinesiology from California State University, San Bernardino with both departmental and university honors. With his brother Anthony Menacho, PA, he has invested time and resources in both Underserved communities communities and the college student community. He co-founded Beatbox Methods, an organization dedicated to helping students achieve their goals outside the classroom. Furthermore, Eddie began working with the Street Medicine Team at USC to provide health care to the homeless population in Los Angeles.

A Stoic Approach to Time

From a young age, Eddie Menacho, together with his brother Anthony, learned the importance of what many of us quickly tend to ignore: family and time. A lifelong lesson learned from their wise father, who, unfortunately, is not here to witness how his two sons constantly sow and reap the fruit of their never-ending labor: putting the community first and serving its essential needs. PAGE

Issue 121.2.4 As Eddie decided to become a better administrator of his own time and help bring change to the sick and the needy, he turned his passion and resources towards medicine. That is where he discovered that becoming an expert in your field is more than just getting straight A’s during finals week; it’s all the little things outside the classroom that count. “We started realizing like, man, these students, they don't know how to study. They don't know how to, how to finish the job.” For that reason, he and his brother searched for a way to turn students into better individuals and help them truly achieve their dream goals.

The Brainbox Methods "The grades aren't a difficult thing in the grand scheme of things, right," Eddie shares with Top Doctor Magazine. While such a statement sounds natural and convincing enough, only a few understand and believe it. Eddie has met with hundreds of students who, although their grades were sky-high, had nothing else to put on their résumé, let alone write a proper one. They were akin to beautiful sculptures but without any final touches. In search of the culprit, Eddie points towards the outdated learning system, which follows the same approach common in the 1800s. In this system, students would read for endless hours in the library. However, with today's technology, it became apparent that only versatile learning methods can help young students achieve their full potential. For that reason, Eddie and his brother strives towards bringing students outside, in the real world, and equipping them with tools that books, albeit helpful, cannot provide.

The Prerequisites for a Successful Student

First off, the crucial thing for a student to understand is that no student has all the answers from the beginning and that mentoring is not a sign of weakness but strength. Having someone who can guide you through the maze of student life can make the difference between graduation and dropout. Second, equip yourself with the proper virtues. As Eddie shares with us, perfectionism, diligence, and, crucially, prudence are every student's best allies towards learning from one's mistakes and overcoming them, no matter how many times we fall. PAGE

Issue 121.2.4 Finally, nurturing a spirit of collegiality amongst students takes up a significant chunk of Eddie 's approach. Not only do we have to confess that finding all the answers yourself is a Herculean task, but also, we have to remember that, as students, we are not free from disappointments in life or depression. On the contrary, our learning years are when we need as much help as we can get, and Eddie teaches us how to ask for it. Assimilating this spirit of collegiality with his life experiences, Eddie talks of students as a soccer team, where team spirit outweighs individual needs.

Medicine is More than just Proper Medication As the pandemic hit the American shores with full effect, Eddie worked in the COVID ICU, as a Critical Care unit PA. In the beginning, he admits, more than enough confusion surrounding proper COVID-19 medication made the physicians' efforts difficult enough. However, through the same spirit of collegiality, U.S. physicians kept close ties with physicians from across the ocean to improve patient care and bring the number of hospitalized COVID-19 patients down. But what happens when what one needs the most is medicine for the soul? How do you fight loneliness and lack of human contact? How does one find ways to cure both the body and the mind? Nothing stands as a stronger statement for the COVID-19 patient's need for human compassion than Eddie 's story about Elvira Lizarraga. Following in the footsteps of Mother Theresa, Eddie decided to turn his approach into a more patient-oriented one and play the role of the servant, not the dictator. "And, and what I, what I learned about medicine was, a lot of times when you are knowledgeable in whatever you do, you try to push your agenda on people. It's like, I know this out medicine, and I know that your diagnosis is this. And I know what you need to take this medication. And we try to do what we need to do. But what we forget that is that we're not, we're not dictators, we're serving, we're there to serve people." As such, Eddie dedicated his time and resources to caring for one of his patients, Elvira Lizarraga, who was diagnosed with an autoimmune disease along with COVID. Through constant care and patience, Eddie managed to build a relationship of trust with his patient, who, responding to his kind approach, opened her heart to Eddie . PAGE

Issue 121.2.4

The Power of Human Compassion Last June, he witnessed Elvira being brought to the hospital with COVID-19. For four months, Elvira laid in the Intensive Care Unit, outlasting all the other COVID-19 patients, like a traveler whose train never arrives at the platform. These long months of loneliness took their toll on Elvira's mental state: depression was threatening to bring the fight to a premature end. With tears in his eyes, Eddie remembers how not medicine, not expensive care, not expert virologists cured Elvira, but the power of literature. Afraid of her friend's worsening health, Eddie took a shot in the dark and tried to use a good story to bring Elvira's curiosity and will to live back to life. "And so I asked her, I was like, Hey, have you, have you ever read the Harry Potter series?" Her negative answer paved the way for long reading sessions when Elvira constantly asked Eddie for details about Harry or Dudley or other characters while always looking forward to the next adventure. "And the whole goal was to just get her inspired so she can do her exercises, so she can do PT, so she can do OT, so she can stay on the C-PAP a little longer and fight. Everyday Elvira would look forward to Eddie arriving at 5:00p, to read her another chapter from the book, which they did for weeks on end."

From Eddie 's point of view, it was never about medicine but human compassion: "She needed, she needed to feel connected to somebody. And so, she needed something to look forward to. And so, yeah, that's, that's what I did. […] A lot of times, it doesn't come down to medicine, it comes down to the relationship." And only Elvira's words can express her gratitude: "This battle took an entire team of Angels like you [Eddie], support of my family and friends, team of doctors, nurses, and most of all God. Without all you Angels, I couldn't have come through this! There are no words that will let you know how grateful I am for you and the importance of medical caregivers giving that beautiful human touch to patients." As a parting thought, Eddie Menacho has but one wish to bring this story to more patients in need and hope to inspire more people with this example: "If I can get this story out and, and J. K. Rowling herself could like talk to her, or something like it would just inspire her, but it would inspire so many other people." We can only hope that Eddie Menacho's wish will come true and that he will find the strength to bring back hope in the lives of those who need it most. PAGE

Issue 121.2.5

Perfecting the Lost Art of "Doctor to Door" Medicine with Clay Hall

Thirteen years ago, Clay Hall, MSN, FNP, MBA, responded to a call in Scottsdale when he was working as a paramedic. He found an older gentleman living alone in a house with no air conditioning and eating dog food for lunch on what seemed to be one of the hottest days in record history. When Clay saw how dreadful the man's living conditions were, it became a turning point in his career. He realized that when you are dealing with patients inside the hospital, you only get to see the tip of the iceberg. If you go into their homes, you get a clear-cut view of the patient's life - and this is invaluable information when it comes to providing the proper medical care. That's when he decided to move away from hospital-based setting treatments and go into home-based preventative medicine instead. Now, Clay Hall is the Vice President of Team Select Mobile Physician Services where their mantra is, "We do everything we can to keep patients out of the hospital and keep them safe in their homes." Their primary focus is on Chronic Care Management, wherein they have full-time nurses dedicated to monitoring patients and keeping them on track with their prescriptions and directives.

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Issue 121.2.5 This program prevents everyday situations where patients forget to follow through with the doctor's orders from the initial check-up, which leads them to showcase more problems on the next visit. Their goal is to guide their patients on the path to wellness.

What Makes "Doctor to Door" Medicine Special Clay fondly remembers when he answered a call from a patient's daughter where she was thanking him for Dr. Porter's, one of his doctors' acts of kindness. What happened was, Dr. Porter visited a senior home to do a check-up on the caller's mother. When she got there, Dr. Porter found that the patient hadn't eaten anything in days, so she decided to cook her breakfast.

The doctor ended up spending two hours with the patient and running late for her next appointment. In usual hospital settings, Dr. Porter would have been in trouble for being an hour late to her next engagement, but Clay commended her because what she did perfectly exemplified what they do and why they do it. In hospitals, physicians are scrambling around in a hurry to see as many patients as possible. But when they are doing home preventive care, physicians focus on the quality of care they give instead of the quantity. Having the time to sit down, drink coffee, and talk comfortably in a patient's home develops an authentic connection between doctor and patient that is just not possible inside a clinic setting. However, we cannot disregard the fact that there will be times when the patient's situation calls for in-hospital treatment. Having access to 24/7 monitoring, comprehensive testing, and specialists right at your fingertips is something home care cannot provide yet. Clay clarifies that home care is not a replacement for hospital care.

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Issue 121.2.5 "It's not necessarily us versus them. It's more of working synergistically and using the resources we have at our disposal at the appropriate capacity," he shares with Top Doctor Magazine.

Has Covid-19 Impacted Home-Based Care At All? Because Clay and his team are running a homebased medical care system, they are fortunate that the pandemic's impact on them isn't quite as severe compared to other medical services. With telemedicine at the forefront now, he was pleasantly surprised to see that many of their older patients are now picking up smartphones.

"We are moving into a tech-savvy world for sure," he claims. His company has even partnered with QliqSoft - where patients can now fill up medical information online through an app. He thinks that this technology can increase patient compliance and enrollment, therefore enhancing patient care. However, Clay's focus is still on getting physical hands and eyes on patients, but telemedicine is a fantastic alternative, especially with this pandemic.

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Issue 121.2.5

A Natural and Holistic Future for Medicine Another fun fact about Clay Hall is that he is a big advocate for regenerative medicine. Even though regenerative medicine is still quite off-label due to a lack of clinical trials, he believes that it will become a massive player in medicine one day. There are already several successful reports wherein the amniotic fluid is being used to treat orthopedic injuries - and it is only a matter of time before this style of treatment will pick up in the mainstream. Meanwhile, primary care providers should continue to focus on sitting down with the patient and re-educating them on the wonders of proper nutrition, exercise, and sleeping habits. Clay sees that going back to the foundations of health and sticking with a wellness-based intervention will help with the general goal of primary care to reduce polypharmacy, which uses several different pills to treat one illness. He hopes to see medicine shuffle towards a more natural and holistic way of healing.

Clay Hall's Advice for the Masses As the world slowly starts to shift back into its pre-pandemic routine, Clay is worried that people are starting to let their guard down against COVID-19. That is why he urges the public to get the vaccine when they can, for it is a necessary act of human kindness. He says that if you don't want to get vaccinated to protect yourself, do it to protect others around you who are more susceptible to a fatal COVID-19 reaction.

Clay hopes that everyone, especially the lowincome population, will have the opportunity to get vaccinated and receive proper health care. And, to aid in making health care more accessible, Clay Hall and his team of physicians will continue to do their part in providing patients with value-based service and extensive continuous care. To learn more visit: www.teamselectmd.com PAGE

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E S T A T E

Issue 121.2.6

2020 Vision with Dr. Ethan Wonchon Lin About Dr. Ethan Wonchon Lin Dr. Ethan Wonchon Lin is an ophthalmologist practicing in Las Vegas, NV. He graduated from the Baylor College of Medicine and completed his ophthalmology residency at the Jules Stein Eye Institute, part of the UCLA Medical Center. He further completed his fellowship at the Duke University School of Medicine, specializing in cornea, external disease, and refractive surgery. For the past four years, Dr. Lin has been practicing in the Las Vegas area, slowly establishing his own medical practice, which opened its door to the public last year. His work has attracted the praise of the top ophthalmology boards in the country like the American Board of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgeons (ASCRS), of which Dr. Lin is an active member. Additionally, he has received the American Board of Ophthalmology certification, the highest standard for US-based ophthalmologists. PAGE

Issue 121.2.6

From Science to Ophthalmology Growing up in Austin, TX as the son of an engineer and a computer programmer, Dr. Lin always surrounded himself with technology. “I was always very interested in the sciences and how it worked.” With numerous tech giants moving their bases to Texas and a solid high-tech community behind, Dr. Lin’s future bioengineering career seemed locked in a deal. However, fate had another thing in store for him. After a short spell in the cardiology field, Dr. Lin went on a quest to find something more in line with his interests, and, not long after, he settled in the ophthalmology field, looking forward to helping future patients with their eyesight. When asked by the Top Doctor Magazine interviewer about the process of choosing ophthalmology, Dr. Lin made a comparison with “choosing a fraternity or sorority.” For him, getting the opportunity to see people excited about a specific field during events or conferences weighed considerably in his choice. “The doctor that came and spoke (i.e., about ophthalmology) really resonated with me and made me want to talk to him more and spend some more time in his clinic and his surgeries just to see what it was like.”

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Issue 121.2.6

Ophthalmology and the COVID-19 Pandemic The COVID-19 pandemic gave the medical field enough time to reflect upon its flaws and look towards a brighter, safer future, Dr. Lin tells us. Some changes that Dr. Lin made in the patient care field with the CDC guidelines as a starting point include: no doublebookings, dividing patients into separate waiting rooms, less total patients per day, etc. For Dr. Lin, who runs a small practice, this translated into spending more time with his patients and bonding with them. This approach is substantially different from the large medical practices that most people are familiar with, where physicians delegate responsibilities to different staff members and spend more time outside the exam room rather than inside. Though he enjoys a constant number of patients every day, the beginning of the COVID-19 pandemic provided a different picture, as it took a toll on his growing practice. Due to the general mystery and insecurity surrounding the new virus, not a few patients decided to postpone their consultations or procedures regularly, making Dr. Lin’s day to day schedule a dynamic process. Though the status quo has only improved gradually over the past few months, Dr. Lin is confident that both himself and his practice will emerge victorious from this pandemic.

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Issue 121.2.6

Ophthalmology and Telemedicine One of the reasons why ophthalmology needed more time to get back in gear is the complicated relationship between this medical field and telemedicine. Medical fields such as dermatology thrived on telemedicine all across the country, limiting patients from trips to the outpatient clinics. "Unfortunately," as Dr. Lin tells us, "ophthalmology is a field where not a lot can be done over the phone or the internet." Even the most common medical issues in ophthalmology, such as red eyes, require a microscope, and procedural steps such as administering eye dilation drops require the physician's presence. As such, where others benefited immensely, Dr. Lin's relationship with telemedicine has been less impactful.

2021 and Its Challenges With a very optimistic spirit, Dr. Lin is confident that the remaining months of 2021 have numerous moments of joy in store for us. What we need to do, however, as a society, is to sit down and find answers to some difficult questions, namely "Can we continue to do the surgeries our patients need?" and "Can we continue to see patients in a safe manner and patients can continue to stay healthy?" Only after finding answers to these questions will the medical field rise superior and overcome the COVID-19 pandemic.

When asked about the proper way of dealing with the COVID-19 virus, Dr. Lin humbly responded: "I don't think anyone thing by itself is going to fix the entire issue." A solid response to the pandemic contains several ingredients: dedicated physicians and medical staff, an understanding general population, vaccination campaigns, etc. But, as a parting reminder, the crown jewel of our response to COVID-19 is a strong belief in a better, brighter, pandemic-free future, to which we should turn our focus and make it happen. If you would like to learn more about Dr. Lin and his practice, you can check out his website here. PAGE

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Issue 121.2.7

Dr. Antonio Gamboa: Bridging the Gap Dr. Antonio Gamboa was born into an underserved world. Now, he is a founder and the CEO of a growing company, Elite Patient Care. As the first son of US immigrants, Gamboa has a unique perspective that makes him more aware of the needs of others. “My modest upbringing showed me good skill sets that provided me with a great background and understanding of how relative things are in life,” Gamboa said. Perspective, which he calls one of the greatest gifts next to humility, helped Gamboa realize his community’s need for healthcare services. This realization turned into focused determination as Gambo graduated from college and medical school. Despite not having the money to go to the notable colleges that accepted him, Gamboa made the most of his time at the University of Texas at El Paso before getting his doctorate at the Texas Medical Branch at Galveston. He went on to get board-certified in internal medicine and palliative care. “I was already over-achieving at this point, so frankly, any grandiose vision of me being a business owner or having my own practice that expands to multiple states was not even an expectation or vision when I was early in my career. I just was happy to have an opportunity to better the circumstances of my own family,” Gamboa said.

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Issue 121.2.7

An Entrepreneur with a Mission During his time as a hospitalist, Gamboa noticed some difficulties within the healthcare process. Medicare changes had impacted patient care, specifically patient discharge. Treatment that had initially taken 7-10 days at the hospital was now completed in two to free up hospital beds. “I realized the real dramatic need and the underserved population that was in that community and the changes in acuity that really drove for positions that have the skill set that I had,” Gamboa said. Gamboa, partnered with Dr. Paula Requeijo, created Elite Patient Care, a business that would help patients transition from hospital to home. They started in 2009 with 10 to 12 providers in 1 state and have now expanded to 250 providers in 10 states. Gamboa sees their continued growth as a confirmation of a real need for their services.

Navigating the COVID-19 Crisis The difficulty of serving the elderly increased when COVID-19 hit. Elite Patient Care had already been using telehealth services, but not all of their care could be done over the phone. They had to work with the nursing home community to facilitate a safe visit without spreading the virus. As COVID-19 hit different states, Gamboa and the team utilized their resources and kept all their workers employed. They also helped ease families into end-of-life care for their loved ones. Helping the community is invaluable to Gamboa, and he hopes to inspire long-lasting change. His concern now is that nurses, many of whom are minorities, won’t get the vaccine due to distrust. Gamboa hopes that he, as someone from a minority, can reassure and help nurses see the vaccine’s benefits. Long term, Gamboa is hopeful that Elite Patient Care will continue to extend its positive reach. “While these times are trying, there is also an opportunity to learn, an opportunity to bridge creativity and intelligence, to look for ways that can help our communities get beyond COVID,” Gamboa said. For more information on Dr. Antonio Gamboa and Elite Patient Care, you can visit their website here. PAGE

Issue 121.2.8

What's Next In The COVID-19 Pandemic How Are COVID-19 Worker's Compensation Cases Going To Affect Your Practice? Oyalola M. Lateef The coronavirus pandemic has created a global disaster as the virus led to the loss of millions of lives, triggered unprecedented challenges to healthcare systems, and disrupted the global economy. The devastating impact on the economy is scary. Aside from the rising death toll, thousands lost their jobs, and millions of people are at risk of falling into poverty. Even worse was the incredible milestone recorded in the U.S. The US COVID-19-related death toll has surpassed 500,000 – a staggering reality underscoring the virus's devastation as healthcare providers scrambled to put the pandemic under control. The vaccines were quickly developed, and the FDA granted EUA to vaccines from Pfizer and Moderna, hoping to speed up the vaccination process as fast as possible to prevent another surge. While the pandemic ravages on, a more complicated episode is emerging regarding COVID-19 worker's compensation cases and their effect on practices. As states relax the strict COVID-19 rules by allowing businesses to reopen, questions arise regarding employers' liability about employees contracting the virus in the workplace. PAGE

Issue 121.2.8 Even though many businesses have transitioned to a remote working model, businesses like aviation, healthcare, transportation, manufacturing, construction, retail, and distribution cannot do so easily. Consequently, their workers will be at risk of exposure to the virus through close contact with coworkers and customers. By comparison, health care workers face similar challenges while providing care to COVID-19 patients. Ultimately, a potential increase in occupational illnesses is inevitable. The worker's compensation system's impact could be significant, including more claim frequencies, higher overall costs, and more financial and administrative burdens for many employers. Dr. Mona Khanna, a board-certified occupational and preventive medicine specialist, commented to Top Doctor Magazine, saying, "There will be more compensation claims… in fact, the number of compensation claims will be higher and in direct proportion to a specific region's population." She went on to suggest that the compensation issue is best understood by attorneys who were involved right from the start. "The right course of action would be to point out attorneys that have become involved in the process at an early stage," said Dr. Khanna.

With a continuous flow of compensation claims, there is more pressure on companies than ever. People are turning to their insurance carrier and discussing the parameters of the long-term effects.

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In most compensation claims, there is no immediate gratification. Instead, these investigations are unique and stand on their terms. Also speaking on the compensation claim issues, Brandi Prejean, a board-certified expert on workers compensation and an insurance defense attorney, provides a perspective regarding the sizable challenges employers face. Employers want to know how to protect their employees, manage their payroll amid the repeated compensation claims alleging workplace exposure to the virus. "When the virus hit, I got a barrage of questions from people, but I didn't have an answer at the time. I did a crash course and turned to the medical community to get as much information as necessary to formulate a better legal response."

Employers were determined to mandate vaccination and PPE on employees since they have the obligations to protect them and create a safe working environment for their workers. Brandi Prejean retorted, "You have to balance protecting the interest of the public at large with the constitutional right of the individual, and that is the delicate balance the pandemic created." She repeated that the pandemic created an unprecedented situation regarding compensation claims, and the authorities must take appropriate legal measures to handle potential problems. While frontline workers grappled with the virus, policymakers across the country are perturbed regarding how worker's compensation insurance would help employees infected with the virus. Even though worker's compensation is designed

Issue 121.2.8 to benefit employees and employers, it doesn't cover illnesses like flu or cold, including coronavirus and other ailments that cannot be tied to the workplace. As COVID-19 is set to upend these rules, new measures or legislation are needed to shield businesses against lawsuits when employees fall sick or die after being exposed to the virus. While policymakers are working hard to extend the compensation coverage, Dr. Khanna insisted that compensation claim investigation associated with COVID-19 is unpredictable and requires more thorough research. In comparison, this research is not so different from conducting interviews and asking questions that would help trace the virus's source of contraction. "I've been into the worker compensation world for a long time, and I've never seen anything like this," said Dr. Khanna. When it comes to track-and-trace of the virus, various questions come into play. "If an employee files a lawsuit against an employer for contracting COVID-19 at the workplace, the COVID-19-specific worker compensation claim may not be as simple as people realize," added Dr. Khanna. On the other hand, if someone suspects that they got the COVID-19 from a restaurant, it would fall under the umbrella of personal injury. The burden of responsibility would be on the restaurant that failed to uphold COVID-19 safety precautions. Speaking from a legal standpoint, Brandi Prejean disclosed, "We had to change our questions. At the beginning of the pandemic, we had to investigate all these cases that were being filed. We investigated people individually. We asked weird questions because it's the only way we can investigate this case and make sense of it." Brandi informed and continued, "If you claim that your job puts you at higher risk than the general public, we have to ask what your potential exposures are. For example, your child who plays sports and comes to the house to live with you poses a higher exposure than you going to work and wearing a mask. You probably have a higher exposure at home." During the massive influx of COVID-19 patients, healthcare professionals were overwhelmed. As a result, hospitals created new patient care units, arenas, tents, and other unlikely places, while some physicians were forced to practice beyond their expertise to save more lives. Even though they were determined to put their lives on the line, a potentially dicey situation lurks, and our frontline heroes who were risking their lives might lose their reverence in a potential flood of COVID-19 compensation lawsuits after the onslaught. Lawyers defending frontline heroes and employers are already advising their clients on

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Issue 121.2.8 avoiding liability when they are forced to choose between patients. Physicians need to prepare for the triage head-on as their actions amid the chaos will determine whether cases against them will be dismissed or escalated over the death of a patient. Speaking about the upcoming compensation claim issues, Brandi Prejean told us that bills are being filed on COVID-19 compensation cases, and they are developed on very preliminary data. "I am prepared to testify against them here [in Texas] because inaccurate data cannot be adopted as a workers compensation case. There is a danger in that," said Prejean. Dr. Mona Khanna, the awardwinning medical journalist and former medical director pointed out that more research and thorough investigation is crucial. "In retrospect, it makes it all the more important to understand the causality trends, the number of cases, in comparison to other infectious diseases that can penetrate the work or commercial space. Once you establish clear parameters, then you can investigate without blurring the thin red line of journalism."

In her own words, Brandi Prejean revealed to us, "I have handled this disputed employee compensation case, and the argument that I am using to create a threshold is the CDC guideline and what their definition of high-risk exposure is." Prejean argued based on all the cases she has handled thus far. "My recommendation for clients who have denied cases discovered that their workers did not contract it at work. Suppose someone ignores the CDC guidelines, which is a duration of longer than 15 minutes closer than 6 feet without proper PPE of a person that becomes symptomatic days later. In that case, I don't believe they meet the threshold of what we will consider as workers compensation exposure." Prejean hopes each state will adopt this CDC guideline-induced logic because it has exonerated innocent employers and physicians. As states allow businesses to reopen, policymakers aim to navigate the notoriously complex workers' compensation to address the drawbacks, benefits, and several key issues that are unresolved. While sharing her opinion, Brandi Prejean told us," the legal community is going to have to be careful regarding what legislation we allow, which is why I have continued to be adamant about creating laws." Prejean reiterated the risk in acting based on developing information because it is dangerous. "If we have learned anything from 2020, it is that we have to be prepared to evolve as information changes." Rather than creating legislation that will allow for fraudulent claims in the coming months, healthcare providers deserve legal protection from malicious claims as long as the protection does not excuse negligence or wanton intent to cause harm.

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A Word from the Editors Top Doctor Magazine is a magazine from doctors for doctors and patients. We cover everything from cutting edge medical techniques and procedures to enterprising doctors, dentists, surgeon, naturopaths, chiropaths, orthodontists and more who are thought leaders within their own medical practice and changing the way we all experience medicine for the better. We wish to be your one-stop digest for inspiration by other professionals in your field who are making waves and setting trends and if you too are a trend-setter, reach out to us so that we can interview you for your own spotlight within an upcoming Top Doctor Magazine issue!

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