IGH Buffalo #27 January 2017 by In Good Health: WNY's Healthcare Newspaper

in good Meet Meet Your Your Doctor Doctor Physician Brian M. Murray, ECMC chief medical officer, talks about career, the care provided at ECMC and the reasons the medical center was chosen as ‘Hospital of the Year’ by a national hospitalist organization

Top 10 ways women can improve their health

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Optimism May Propel Women to a Longer Life Study: Upbeat outlook linked to lower risk of dying from cancer, heart disease and other causes

Cheaper Hearing Aids Coming onto the Market

January 2017 • Issue 27

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SMOKING ‘How I Quit After 40 Years’ ‘Trying to quit as a senior citizen turned out to be quite different from all those attempts in my younger years’. page 9

Why You Should Thank you Doctor

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Physicians, Shouldering the Brunt, Carry On. ‘To my knowledge, no other profession has had to endure more changes or more attacks on their autonomy than that of physicians’, says In Good Health columnist George Chapman. Read article on the back cover

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‘My family’s go-to fish in January is haddock. Mildtasting and reasonably priced, this flaky white fish teems with good things. It’s a great choice after the end of the eating season’

New Trend: Wagering on Weight Loss page 11 Body and Soul Transformations, a gym in the Buffalo area, is one of the places that offer money back to clients who lose weight page 11

Pizza Trends Pizzas are trending toward thinner crusts and half of consumers prefer to go thin. Find out the Top 10 habits Americans have when it comes to pizza page XX

U.S. Doctors Still OverPrescribing Drugs: Survey

More than one in four say antibiotics are given when the drugs will likely do no good

espite evidence that certain drugs aren’t always necessary, doctors are still prescribing these treatments, a new survey of doctors reveals. Antibiotics are by far the drugs most frequently used in situations where they’ll provide no value for patients. The survey found that more than a quarter of doctors surveyed (27 percent) said that antibiotics are often administered to patients when the drugs will do no good. In most cases, the antibiotics are prescribed to treat upper respiratory infections even though these are most often caused by viruses unaffected by the medication, said Amir Qaseem. He’s vice president of clinical policy for the American College of Physicians (ACP) and chairman of the ACP’s High Value Care Task Force. Other treatments that doctors use frequently despite their questionable value include aggressive treatments for terminally ill patients (9 percent), drugs prescribed for chronic pain (7 percent), and dietary supplements such fish oil and multivitamins (5 percent), the survey revealed. “There is a lot of waste in our health care system, and we need to acknowledge that,” Qaseem said. The results are from a random

Worldwide Cancer Rates Up More Than One-Third in Past Decade Researchers cite population aging and growth

survey of 5,000 ACP member physicians. The survey asked doctors to identify two treatments frequently used by internists that were unlikely to provide high value care to patients. The CDC itself estimates that as much as one-half of antibiotic use in humans is either unnecessary or inappropriate. An estimated 47 million unnecessary antibiotic prescriptions are handed out in the United States each year, the agency said. Pressure to fulfill patients’ expectations might be driving some doctors to prescribe antibiotics, Qaseem said.

ancer cases rose 33 percent worldwide in the past 10 years, a new study shows. In 2015, there were 17.5 million diagnoses and 8.7 million deaths in the world from the disease, the researchers found. The rise in cancer cases was mainly due to population aging and growth, along with changes in agespecific cancer rates, according to the Global Burden of Disease Cancer Collaboration study. The lifetime risk of developing cancer was one in three for men and one in four for women, the researchers said. Prostate cancer was the most common type of cancer in men (1.6 million cases), and tracheal, bronchus and lung cancer was the leading

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cause of cancer death in men. Breast cancer was the most common cancer for women (2.4 million cases), and the leading cause of cancer death in women. The most common cancers in children were leukemia, other neoplasms, non-Hodgkin lymphoma, and brain and nervous system cancers, said researcher Christina Fitzmaurice, from the University of Washington in Seattle. The study was published online Dec. 3 in the journal JAMA Oncology. Cancer is the second leading cause of death worldwide, and statistics such as these play an important role in cancer control planning, the researchers said in a journal news release.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

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Researchers say ﬁnding highlights need to overhaul dental insurance

mericans are more likely to skip needed dental care because of cost than any other type of health care, researchers report. Working-age adults are particularly vulnerable, the study found. Some 13 percent reported forgoing dental care because of cost. That’s nearly double the proportion of seniors and triple the percentage of children for whom cost poses a barrier to dental care, the study showed. Cost was the main impediment to dental care even for adults with private insurance. “It seems like medical insurance is doing a better job at protecting consumers from financial hardship than dental insurance,” said study

author Marko Vujicic. Typically, private dental insurance includes annual maximum benefit limits and significant “coinsurance” — the patient’s share of costs on covered services, Vujicic explained. He is chief economist and vice president of the American Dental Association’s (ADA) Health Policy Institute in Chicago. “Anything beyond checkups, like getting a cavity filled or a root canal and a crown, you’re looking right away at 20 to 50 percent coinsurance,” Vujicic said. Typical fees for fillings range from $86 to $606, according to a 2013 ADA Health Policy Institute survey. Root canals go for $511 to $1,274. For a crown, the range is $309 to $1,450.

Economic Stress Played Role in Increasing U.S. Death Rate

reater stress and anxiety resulting from economic insecurity may be at least partly to blame for the U.S. death rate that the government announced Dec. 8 has increased for the first time in a decade, says an expert on poverty and inequality at Washington University in St. Louis. “For the first time since 1993, the overall life-expectancy rate in the United States last year actually went down, according to the Centers for Disease Control and Prevention,” said Mark Rank, the Herbert S. Hadley Professor of Social Welfare at the Brown School. “This was particularly true for those under the age of 65,” he said. “This news comes at the exact same time as empirical research from Stanford University demonstrates that over the past several decades, the American Dream has become harder to obtain.” Coincidence? Rank thinks not. “As the recent election has exposed, more Americans are feeling the pressure of economic insecurity,” said Rank, co-author of the influential 2014 book “Chasing the American Dream: Understanding What Shapes Our Fortunes.” “This economic insecurity has

led to widespread anxiety within the population, with greater numbers of households struggling to stay afloat,” he said. “In short, the hopes and dreams for many ordinary Americans have been getting further and further out of reach.” Therefore, Rank contends, it is important to note that the recent fall in the life expectancy rate “occurred largely as a result of rising levels of heart disease, stroke, unintentional injuries and suicide.” “All of these are closely associated with greater levels of stress and anxiety,” he said. “As stress and anxiety goes up, so too does the probability of one of these causes of death.” As a result of several welldocumented economic trends, including rising income and wealth inequality, America is quickly becoming a society of haves and have nots, Rank said. “On the one hand, the haves are getting richer while their numbers are getting smaller,” he said. “On the other hand, the have nots are becoming poorer while their numbers are growing larger. The result may be the canary in the coal mine — overall life expectancy in the United States just went down.”

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Shortage of Primary Care Doctors Continues New physicians often opt for specialties that pay more, which generates a shortage of muchneeded primary care doctors By Deborah Jeanne Sergeant

as it been hard to get an appointment to see your primary care physician? Get used to it. In an April report, the Association of American Medical Colleges stated that in the next 10 years, the nation will experience a shortage of primary care physicians ranging from between 14,900 and 35,600.

Why is this shortage happening now?

John Bartimole, CEO/president of the Western New York Healthcare Association in Tonawanda, said that several factors have to do with economics. “The number of medical students going into primary care is going down,” Bartimole said. “For the salary when you get out, the specialties command the higher salaries. Primary care folks get a raw end to the deal, and they’re the first door to patient care. Everything you see out of Obamacare comes with the first door of the primary care physician, yet we don’t put enough emphasis on that sphere in medical school.” Contributing to the budget crisis, many insurers have not raised reimbursements to match inflation, which Bartimole said has contributed to more independent physicians selling their practices to large health systems. “Declining payment and dramatically increasing costs are a formula for high volume and high stress,” said Vito Grasso, executive vice president of the New York State Academy of Family Physicians in Albany. “Those are two factors that are deterrents for students gravitating towards careers in family medicine.” They’re also factors that lead to physician burnout and early retirement. Grasso said that 23 years ago, 90 percent of his organization’s members were independent. Today, two out of three work in practices not their own. When large health systems buy out solo practices, physicians lose more control and many times gain a host of new patients. Another factor that’s ramping up usage is the fact that more people are using health care, including aging baby boomers and those who now have health insurance. “More and more pressure is on primary care physicians as the population ages,” Bartimole said. The Health Resources and Page 4

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Services Administration, an agency of the U.S. Department of Health and Human Services, attributes the effect of population growth and aging as 81 percent responsible for the growth in demand and the Affordable Care Act as responsible for 19 percent. Electronic medical records have made accessing health records easier. But creating them has caused significantly more administrative work for doctor’s offices. “What a lot of doctors are beginning to do is to do the entry while the patient is there with him,” Bartimole said. “It saves a little time, but cuts down with eye contact. The documentation is becoming more and more burdensome every day. There will be a tipping point, where we’ll ask, ‘How much data is too much?’” Some physicians who cannot afford to hire more administrative workers work an additional two hours daily entering records. To check off all the new required screenings and questions, doctors face a time crunch. “Most patients come into a visit with multiple concerns and symptoms,” Grasso said. “Following anything formulaic diverts questions from what the patient wants to bring up. If it’s not on the drop-down menu, you won’t get to it.”

Hospitalist’s role

The hospitalist movement has diverted more medical students from primary care. Starting in the Buffalo area around the early 2000s, the hospitalist model establishes an in-house physician — the hospitalist — to provide primary medical care to admitted patients. The patients’ own physician won’t have to make rounds to approve or assess treatment, so in that regard, the hospitalist model saves time for primary care physicians. But since hospitalists are trained as primary care, internist or family practice physicians, that leaves fewer practicing in offices. Working as a hospitalist attracts more residents because for most of them, about 90 percent of their residency takes place in a hospital setting, a natural segue to working at a hospital. Plus, as a hospitalist, “there is mostly shift work associated with the job,” Grasso said. “You do a certain amount of hours in a row and when you go home at night, you’re done. There are no phone calls and paperwork.”

CALENDAR of

HEALTH EVENTS

Jan. 3, Feb. 7

Six-week course on plantbased diet offered Ted D. Barnett, a Rochester physician board-certified in diagnostic imaging as well as vascular and interventional radiology, will present a six-week course on plant-based diet: “Eating for Happiness and Health.” This popular six-week course has been offered many times in Western New York, including at three Rochester hospitals. Almost 500 people, from both the general public and the health care community, have taken the course, which outlines the benefits of a whole-food, plant-based diet for human health and all life on the planet, with up-to-date references to scientific studies. Recipes and food samples at each class. The class meets from 6:15 to 8:30 p.m. every Tuesday from Jan. 3 through Feb.7, at the Jewish Community Center in Rochester, and from 6:15 to 8:30 p.m. every Wednesday from Feb. 22 through April 5, at Highland Hospital, also in Rochester. Cost is $150 with a discount for JCC members for the January-February course. Continuing medical education credits, and credits for other health care professionals, are available at additional cost. Visit roclifemed.com for more information and to register: https:// rochesterlifestylemedicine.com/resources/nutrition-course/

Jan. 17

Meet with cancer experts, get a free dinner Catholic Health will sponsor a free community dinner program titled “Meet the Experts: Trends in Gynecological & Breast Cancers,” from 5:30 to 7:30 p.m., Jan. 17, at the Millennium Hotel, 2040 Walden Ave., Buffalo. Whether you or a loved one has received a diagnosis of gynecological or breast cancer, or if you have a family history of these types of cancer, Catholic Health experts say they want the public to know what break-

throughs have been made in diagnosing and treating these conditions. Join women’s health experts — physicians Stacey Akers and Michael Peyser — for the latest information on risk factors, prevention, detection and treatment options for gynecological and breast cancers. They’ll discuss new ways doctors are diagnosing and treating cancer, including genetic testing, 1-125 seed localization, and minimally invasive surgery using the da Vinci robot. They will also be available to answer all your questions. “Meet The Experts: Trends In Gynecological & Breast Cancers,” is free and open to the public. A complimentary dinner will be served. Reservations are required by calling Catholic Health’s HealthConnection at 447-6205 or by registering online at www.chsbuffalo.org/ events.

Jan. 24

Fibromyalgia group to discuss ways to ‘start year right’ The New Fibromyalgia Support Group will start the New Year off showing people how to make small strides and improve their health one step at a time. Titled “5 Simple Ways to Start the New Year Right,” the workshop will focus on modalities such as exercise, diet and stress reduction as tools to work through pain reduction and overall health improvement. Classes meet from 6 to 8:30 p.m., Tuesday, Jan. 24, in the meeting room at Westside YMCA, located at 920 Elmgrove Road in Gates, near Rochester. The meeting is free an open to the public. No need to be a YMCA member to participate. Classes are small and registration is needed. Register with a voicemail by calling 585-752-1562. Speak slowly and clearly. Leave your name and details. The New Fibromyalgia Support Group provides opportunities to connect with people on the many issues surrounding life with chronic pain.

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In Good Health is published 12 times a year by Local News, Inc. © 2017 by Local News, Inc. All rights reserved. 3380 Sheridan Dr., # 251 • P.O. Box 550, Amherst NY 14226 Phone: 716-332-0640 • Fax: 716-332-0779 • Email: editor@bfohealth.com Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo • Writers: Deborah J. Sergeant, Jim Miller, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Tim Fenster, Ernst Lamothe Jr., Suzanne M. Ellis Advertising: Debra Kells (716-332-0640) Layout & Design: Dylon Clew-Thomas • Officer Assitance: Kimberley Tyler No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

Cheaper Hearing Aids Coming onto the Market FDA to ease up on hearing aid rules

etting a hearing aid should be less of a hassle — and eventually less expensive — under new rules introduced by the U.S. Food and Drug Administration. The FDA said early in December it will no longer enforce a requirement that people aged 18 and older receive a medical evaluation or sign a waiver before buying most hearing aids. The agency said it will also consider creating a category of overthe-counter hearing aids that could provide innovative and lower-cost devices to millions of Americans. Currently, a pair of hearing aids typically costs $4,000 or more, putting them out of reach for the majority of older Americans who need them, according to the President’s Council of Advisors on Science and Technology. “Today’s actions are an example

of the FDA considering flexible approaches to regulation that encourage innovation in areas of rapid scientific progress,” FDA Commissioner Robert Califf said in an agency news release. The President’s advisory council and other critics had argued that existing FDA rules were a potential barrier to people getting hearing aids, and provided little to no benefit to patients. “Untreated hearing loss, especially in older Americans, is a substantial national problem,” the council said in a recent report. Hardof-hearing seniors face significantly impaired communication, social participation and overall health and quality of life, the report noted. Changes to the FDA rules, which take effect immediately, could lead to technological breakthroughs that result in less-expensive hearing-aid

options, according to the council. Although some 30 million people in the United States suffer from hearing loss, only about one-fifth who could benefit from a hearing aid seek help. The FDA said it will continue to enforce the medical evaluation requirement for prospective hearing

aid users younger than 18. The agency will also continue to require that hearing aid labels include information about medical conditions that should be evaluated by a doctor. Also, licensed hearing aid dispensers must still give consumers information and instructions about hearing aids before purchase.

Healthcare in a Minute By George W. Chapman

Merger Mania to Intensify

he trend will continue at an accelerated pace in 2017 as both hospital systems and commercial insurers engage in “bigger is better” business strategy. As the chess pieces move around, the ultimate impact on consumers will most likely differ from market to market. On one hand, bigger really is better for consumers if consolidation results in improved services, access, outcomes and lower prices due to standardization and economies of scale. On the other hand, bigger is worse for consumers if consolidation results in no improvement in services, access, outcomes or prices due to lack of competition and choice. The Department of Justice looks at all mergers and remains vigilant on behalf of consumers. When bigger is better, rural consumer areas tend to benefit the most, but suffer disproportionality when bigger is worse.

Trump Health Appointees

Tom Price, former orthopedic surgeon turned congressman from Georgia, will head Health and Human Services. He has been an outspoken critic of the ACA and advocates its repeal. The American Medical Association has been guarded about its approval/ endorsement of Price as physicians seem split 50/50 over the ACA and are frankly tired of all the volatility and wrangling. For inexplicable reasons, Price is in favor of privatizing Medicare, which works well and increased only 1.7 percent in 2015. Seema Verma, former CEO of Seema Verma Consultants, will head CMS. Interestingly, Verma was instrumental in the implementation of Indiana’s expanded Medicaid

program (ACA) while Mike Pence was governor.

ACA Repeal and Hospitals

Proving there is far more at stake to repealing the ACA, the American Hospital Association projects a collective loss of $166 billion on net income should the ACA be repealed without an adequate replacement due to the loss of insurance coverage by the 20 million people who receive coverage via the ACA.

Healthcare Ads

If it seems like every other ad on TV is either for a drug, hospital or insurance plan, you’re not far off. The healthcare industry is solidly entrenched among the top 10 industries when it comes to advertising, according to Kantar Media. Advertising in healthcare totaled almost $10 billion in 2015, which was an 11 percent increase over 2014 spending. Drug advertising accounted for $6.6 billion, hospitals and healthcare systems $2.3 billion and insurance $1.1 billion. The favorite medium was TV where the industry spent over half of the $10 billion. Other media like magazines, digital, newspapers, billboards and radio combined for the remainder of ad spending. So, when pressed, where does the average person turn to for health information? The Internet. According to a survey by Kantar media, three out of four of us research health issues on the Internet.

How Washington Works

Just how things get done (or not) in Washington is exemplified by how the “21st Century Cares Act” (TCCA) became law. Most agree the current heroine epidemic was created largely by drug manufacturers spending billions to get the medical

community to prescribe their opioids. Four of five heroin addicts started out on an opioid like OxyContin. The TCCA commits billions of tax dollars to medical research and $1 billion to states to combat heroin and pain killer addiction, which all sounds good enough. But a bill this size would never see the light day without the blessing of the various lobbyists on the hill, most notably the drug lobby. A total of 1,455 lobbyists representing more than 400 companies made their client’s views known. As a result, the bill includes reductions in regulations and protocols which the drug industry found too restrictive and costly. While there was broad support for the bill on both sides of the aisle, and from the president, critics see the “compromise” with the drug industry as a blow to consumers who are protected by the protocols and regulations. The FDA will be allowed to expand the use of a previously approved drug, known as going off label, based solely on anecdotal rather than scientific evidence.

Life Expectancy

A recent article in the Wall Street Journal summarized a report by the Centers for Disease Control and Prevention. There was no change in the average life expectancy of all Americans born in 2014 vs 2013. There was a very slight decline in the life expectancy of a white males born in 2014 (78.8) vs 2013 (78.9). Life expectancy is based on the year you were born. The report noted that since 2000, white middle-aged Americans are dying at a rising rate largely due to suicide, drug/alcohol abuse and chronic liver disease. The US ranks only 53rd out of the top 100 countries in life expectancy. Monaco leads the way at 89. We are behind just about every economically developed country like Italy, Canada,

January 2017 •

Spain, Sweden, Germany, United Kingdom, France, etc. The good news? We have come a long way. World-wide life expectancy in the Bronze Age, around 3000 BC was 26. In classic Rome times, around 400 AD, it was 20-30. In medieval times, around 1500, it was 35. Just 116 years ago, in 1900, life expectancy world-wide was 31. It has more than doubled to 67 in 2010.

See Your Doctor

The citizens in those 52 countries that rank higher than the US in life expectancy have more contacts with their physician’s practice per year than the average American does. In Japan, for example, they average 13 contacts a year. A “contact” can be through a face to face visit, a phone call, social media, patient portal, telemedicine. In the US, we average only four contacts a year. While there can be plenty of reasons why, many feel the biggest reason is simply cost. As premiums spiral upwards, so do deductibles and out of pocket expenses which makes most people think twice about contacting their physician and even put needed treatment off. The grave consequences of being out of touch with your physician are obvious. Make increased “contact” with your physician a resolution for 2017 and live longer. George W. Chapman is a healthcare consultant who works with hospitals and medical groups. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@ gwchapmanconsulting. com.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 5

Meet

Your Doctor

By Chris Motola

Brian M. Murray, M.D. Chief medical ofﬁcer talks about career, the care provided at ECMC and the reasons the medical center was chosen as ‘Hospital of the Year’ by a national hospitalist organization Q: Tell us a little about your background. A: I’m originally from Ireland and went to medical school there. I came to the United States over 30 years ago. I was recruited by the University of Buffalo and started practicing primarily out of ECMC. I’ve been at the hospital since 1985. In the early part of my career, I was primarily a clinician and research scientist. I’ve gradually migrated into hospital administration more by accident than design. Q: How did that migration begin? A: It started when I was president of the medical staff at the time when the hospital transitioned from being a county institution to its current status of being a public benefit corporation, which was a pretty big deal at the time. After completing my presidency, my plan was to go back to clinical practice, but I was convinced by administration to become a part-time administrator to assist my predecessor improve quality as well as implementing the expansion of electronic health records. In 2008, I became the chief medical officer and I’ve been in that position since. Q: What does the position entail? A: The role of the chief medical officer means you’re a part of almost every part of hospital operations, but your primary responsibility is to oversee the medical staff and to ensure quality and safety of the care they deliver. We’re more conscious now about the

“customer experience,” how the patient perceives the care they’re receiving. I’m not directly responsible for that last part because we do have a patient experience officer, but it’s a big part of my role, particularly in making sure the physicians are living up to what the hospital expects. I also assist the various vice presidents in assuring operational performance, finding more efficient ways to deliver high-quality care. I report to the chief executive officer, and all of us are responsible to the board. It’s a very varied job. Q: Erie County Medical Center won the Apogee Hospital of the Year Award recently. Tell us more about that. A: Yes. Basically the care of inpatients has changed a lot over the last 30 years from a time when community physicians would often take care of their patients in the hospital with the assistance of specialists as needed. But over the last 10 years, we’ve had the emergence of what’s called the hospitalist. Nowadays the patients in the hospital tend to be much sicker and require more continuous and closer care. So hospitalists are physicians who are completely dedicated toward

taking care of patients in the hospital. They only see inpatients. They average 15-20 patients at the time. Apogee is a company that supplies hospitalist services. We use a hybrid system where some of our hospitalist services are run by faculty as teaching services, with residents providing care under the supervision of a physician. About a year ago we contracted with Apogee to provide hospitalist service. We’ve worked very closely with them. We’ve actually tracked our data and worked to customize our system to the patient’s needs. It’s been a very collaborative endeavor and has proven to be very successful. There’s a lot of credit due on both sides. Apogee is a very large organization with programs in hundreds of hospitals. Every year they give this award to the hospital with the program they feel has made the most impact on patient care. We’re obviously very proud that ECMC was chosen. Q: In the current political and economic climate, what are the primary challenges to delivering health care? A: The biggest challenges are happening at the federal level. And that’s a change in the system from what we call fee-for-service. That means, the more you do, the more you get paid. If you do 10 cardiac catheterizations, you get 10 times the compensation you would get for just doing one. That’s fine if they’re all necessary. But it’s a system that encourages volume over value. The possibility that procedures are being over-utilized is suggested by the fact that, if you look at procedures from different areas, there is a pretty large difference in the rates that people get cardiac surgery and other interventions and treatments, but without a corresponding variation in outcomes. In other words, more care isn’t necessarily better care. So federal government wants to focus more on quality and reward those entities that are achieving good outcomes and have good safety and quality practices. Hopefully, this will also save money by avoiding wasteful care. So that’s the challenge. Migrating from one system to another. Q: Does this also mean a greater focus on preventive care? A: We’re also being charged with looking more at keeping people healthy rather than treating disease. The fee-for-service system doesn’t really encourage that, because it can be more profitable to perform expensive procedures on sick people. So large medical entitities — and they have to be large — have to manage the health of large populations, hundreds of thousands of patients. So we want to prevent them from getting ill, reducing emergency room usage and reducing the number of hospitalizations, ultimately. Q: How hard is the transition? A: It’s a major challenge for systems that have been used to doing business under the old system. Q: Can you give an example of how it’s played out at ECMC? A: One of the things we’ve done successfully is reducing the length of stay in the hospital by delivering care more

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

In the News

Erie County Medical Center (ECMC) was recently recognized by Apogee Physicians, a large national medical practice that works with hundreds of hospitals nationwide, as “Hospital of the Year.” ECMC was selected from all hospitals across the country that partner with Apogee based on specific criteria, including relationship between the hospital, hospitalist team and Apogee senior leadership, respect and mutually shared goals of excellent patient care; partnership with the hospitalist team and improved patient and provider-focused care. efficiently. So if a patient is getting tests done, we’re doing them quicker. We also start preparing the discharge process as soon as the patient comes into the hospital. One of the inefficiencies of the past was that you’d focus on getting the patient well and then end up running into problems with the discharge process, like insurance issues. Now we’re able to better anticipate those problems so that when the patient is ready to go home, everything is in place. It also has the advantage of decreasing readmissions. Many of those readmissions are avoidable if the transition of care is well-managed.

Lifelines Name: Brian M. Murray, M.D. Position: Chief medical ofﬁcer at Erie County Medical Center Hometown: Dublin, Ireland Education: Trinity College (Dublin); University of Minnesota; board-certiﬁed in internal medicine and nephrology and is a fellow of both the American College of Physicians and the Royal College of Physicians of Ireland Affiliations: Erie County Medical Center; University of Buffalo Organizations: American College of Physicians; Royal College of Physicians of Ireland; American Society of Nephrology Career: Physician with ECMC for more than 30 years; associate professor of medicine at UB with a limited clinical practice in nephrology. Community Work: Served for many years as chairman of the Medical Advisory Board of the National Kidney Foundation of Western New York; in 2004 received that organization’s Gift-of-Life Award. Also served as the chairman of the Medical Advisory Board of the ESRD Network for New York State and was recently appointed the chairman of that body’s divisional board. In 2004 he received a Best of the Best award from the Niagara Health Quality Coalition for health care innovation. In 2010 he was awarded ECMC’s Distinguished Physician Award and since 2011 has been included by Castle Connolly Medical Ltd. in its list of Top Doctors in Western New York. He is currently a member of the Board of Upstate New York Transplant Services. Family: Married; a son and daughter Hobbies: Music, theater, soccer, golf

Hearts for the Homeless ‘Angels’ come to rescue the city’s most impoverished citizens By Tim Fenster

cold December evening for warm food and clothing, one man in line, Angel Williams, said Hearts “keeps [our]] faith and inspiration going” and “have embraced us.”

he poor and homeless of Buffalo know where they can go for help when the weather turns ‘They are Angels’ cold and their stomachs grumble with hunger. Another, Jim Harris, simply said, Five evenings every week, “They are angels.” Hearts for the Homeless’ mobile Nick Calandra, chief soup kitchen parks on operating officer of Hearts, Ellicott Street, behind the said the organization was Buffalo and Erie County founded in 1990 with a Library, to hand out food, mission to provide a steady clothing, toiletries and other stream of food and basic necessities to the city’s most necessities for the region’s vulnerable residents. chronically homeless. Around 5:30 p.m. “We wanted to continue Tuesday through Sunday, to do it and not have it be the mobile kitchen offers an on-off thing, because we poor residents a sandwich, knew there was a need out snacks and beverage, there,” Calandra said. and from Oct. 1 to May 1, He added their efforts they also give out a hot Nick Calandra, chief are particularly important meal, such as pasta and operating ofﬁcer during the winter months, meatballs, beef stew, and of Hearts for the when homelessness can be chicken and rice. Those seeking Hearts’ Homeless. “We see a struggle for survival. a lot of times people Although there are services needn’t prove are just trying to ﬁght shelters throughout the city, they are homeless; all the volunteers ask is that they it out and survive the some homeless persons have mental or behavioral sign in and provide some winter,” he says. issues that prevent them very basic information. from finding refuge. Others “We don’t ask any questions. We just ask them to sign in simply avoid shelters by choice. “We see a lot of times people are and they can eat,” said Donna Blarr, just trying to fight it out and survive office manager for Hearts. the winter,” Calandra said. On a typical night, the mobile Hearts also helps the city’s soup kitchen serves between 40 impoverished through its thrift shop and 70 people, with more typically at 890 Tonawanda St. Blarr said all coming out near the end of the children’s items at the shop cost only month after some low-income $1, and they often give away clothes residents have exhausted their to families they know are in times of public benefits. Volunteers also need. hand out toiletries and, during the “I get calls all the time from winter months, much-needed warm people who have fallen on hard clothing, including gloves, blankets, times,” Blarr said. “We ask them socks, jackets, gloves and hats. a few questions and then let them If someone asks for an item that volunteers do not have stocked in the come in and choose items.” The thrift shop also provides RV that serves as the mobile kitchen, Hearts with some revenue, but they will often make a note to try the organization is mostly funded and carry that item — or more of it through individual and corporate — next time. donations. They also accept “It’s really helpful. If they donations of food, clothing and other weren’t here I don’t know what I basic necessities. Volunteers say would do. I’m blessed that they provide this service,” said Mike, who that gloves, hats, socks, hoodies and jackets are particularly important and declined to provide his last name because some family members do not frequently asked for. For more information, visit www. know he is homeless. heartsforthehomeless.org. As dozens waited in line one

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Line of people getting a hot meal at Hearts for the Homeless’ mobile soup kitchen. January 2017 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 7

Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Create an Inviting ‘Table for One’ in 2017

ith the hustle-bustle of the holidays behind us, January can bring a welcome respite and some nice, quiet time to yourself. Until, of course, all that desirable alone time becomes, well, less desirable. For those who live alone, dining solo can present one of the biggest challenges. And it’s no wonder. For most of humanity dining is a social activity. We enjoy sharing our meals with loved ones, friends and colleagues. So when we find ourselves alone at the dinner hour, it can feel a little uncomfortable, even lonely. It’s not unusual to fill in the awkward silence with distractions: the company of TV, the comfort of a good book or the diversion of a favorite magazine. Believe me, I’ve been there. I can’t tell you how many of my favorite books contain food crumbs. But I’m not complaining. Good reading material can be a great dining companion. But it represents just one ingredient of the solo dining

experience. While living alone gives us the freedom to dine as we please (one of its many benefits), I don’t recommend eating breakfast for dinner or munching through a bag of Cheetos as a substitute for a healthy, well-balanced meal. When it comes to eating alone at home, treat yourself as you would treat a good friend you are having over for dinner. Why? Because you are worth it. Because you will feel better about yourself, both physically and emotionally. When you prepare and enjoy a good meal on your own, you’ll be sending yourself a valuable message: It’s important to take good care of myself and to treat myself with respect. I matter enough to treat — and feed — myself well. Eating well and right has all kinds of benefits. And what better way to start enjoying those benefits than by creating an inviting “table for one” in your own home. In fact, why not consider the tips below and give

it a try today?

n Stock your kitchen with healthy food. It’s so much easier

to put a healthy meal on the table when the good stuff is plentiful and the junk food is in short supply. I’m fully aware of my own downfalls (ice cream, nuts, sweets, chips) and do not regularly stock these items in my kitchen. Instead, I have on hand a good supply of frozen and fresh vegetables, prepackaged salad greens, fruits in season, and singleserve portions of frozen meat and fish. You’ll also find plenty of graband-go “power” bars in my pantry for when I’m on the run.

n Indulge your senses.

Stimulate your appetite by preparing an item or meal that produces a wonderful, delicious aroma. My secret? I love the scent of sautéed garlic, and jump-start many a solo dining experience with a little butter and garlic in my stove-top skillet. The aroma invites me into the cooking process and within minutes the worries and stresses of my day start to melt away. I also try to incorporate foods with a variety of textures and color — soft, chewy, crisp, and firm — into each meal. These touches serve to make the dining experience more interesting and pleasant.

n Select the best seat in the house. While eating in front of the

TV may be the perfect choice on some occasions, I encourage you to find dining spaces inside or outside your home that may offer more inspiration. Chances are, you’ll appreciate the change of scenery. Consider that special nook where the sun filters in or that table by the window with the great view. Mix it up, experiment with different settings, and see how much better it feels. n Set the stage. Create a pleasing table setting and mood: put down a placemat, use a cloth napkin, turn on some enjoyable music, and position a good book, magazine or tablet computer within reach. You might even light a candle. I do. If you’ve never set the stage like this before, it can feel contrived at first, but stay with it. Over time,

I’m confident you’ll find it as enjoyable and relaxing as I have. n Enjoy your own company.

When you eat alone, you’re in the company of someone special — yourself! You are with someone who approves of your meal choices and cooking techniques, appreciates the candle you lit, and knows that life and good food are to be enjoyed. Cherish this quality time with yourself. Creating a pleasant “table for one” is a great opportunity to focus on yourself and to nourish your body and spirit at the same time. So, pull up a chair, say a few words of gratitude, and enjoy! Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon, NY. For information about her Living Alone workshops or to invite Gwenn to speak, call 585-624-7887 or email: gvoelckers@rochester.rr.com.

KIDS Corner Martial Arts Can Be Hazardous to Kids Certain practices put children at risk of serious injury, pediatricians’ group warns

erhaps there’s a black belt in your child’s future. But for safety’s sake, kids should only engage in noncontact forms of martial arts, a new American Academy of Pediatrics report says. About 6.5 million U.S. children practice martial arts such as mixed martial arts, karate, taekwondo and judo. While these popular sports can improve fitness, motor skills and emotional development, they also carry the risk of injury. Page 8

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Certain disciplines are riskier than others, the pediatricians’ group says. “There are so many different types of martial arts for families to consider and enjoy, but such a difference in injury risk between the different non-contact and sparring forms,” report author Chris Koutures said in a news release from the medical group. Koutures is a member of the academy’s executive committee on sports medicine and

fitness. Bruises and sprains account for most martial arts injuries, but more serious injuries also occur. Certain practices in mixed martial arts, for instance, carry a higher risk of concussion, suffocation, spine damage, arterial ruptures or other head and neck injury, the academy notes. These risky movements include direct blows to the head, repetitive head thrusts to the floor and choking movements, the academy says. Injury rates vary from 41 to 133 injuries for every 1,000 athletic exposures, depending on the type of martial art, the report says. With no proof that protective equipment such as soft helmets and mouth and face guards prevent concussions, this gear may provide a false sense of safety, according to the academy. “We hope that this report will

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

enable pediatricians to help families select the most appropriate options for their child and realize how strongly certain practices and rules can impact a participant’s safety,” Koutures added. The group recommends delaying martial arts competition and contactbased training until children and adolescents show adequate physical and emotional maturity. The report also recommends eliminating a taekwondo rule that awards extra points during tournaments for kicks to the head because these increase the risk of concussion. But mixed martial arts seems most concerning. Even watching too much mixed martial arts may put children at risk of injury if they imitate what they see, the academy says. The report appears online Nov. 28 in the journal Pediatrics.

How I Quit Smoking After 40 Years ‘Trying to quit as a senior citizen turned out to be quite different from all those attempts in my younger years’ By Suzanne M. Ellis

o you think that because you’re in your 50s, 60s, 70s — or beyond — that it’s too late to quit smoking? Have you tried and failed so many times over the years that you believe it’s a hopeless venture? Do you tell yourself you’ve smoked so long it won’t make any difference? Over the past few decades as a smoker, I’ve felt all of those things and then some. I’ve rationalized many times all the excuses why I shouldn’t even bother attempting to quit. But three and a half years ago, I decided to try one more time, and I’ve been a non-smoker ever since. I realize now that all that rationalizing was just more excuses. And, believe me, I know all about excuses because I smoked for the better part of 40 years and gave myself every reason in the book why I couldn’t or wouldn’t or shouldn’t stop. Even the on-again, off-again health scares weren’t enough to convince me: Not the annual bouts of pneumonia or bronchitis that became ever more debilitating as I aged. Not the chest X-ray six years ago showing “dark spots” on my lungs, and not the eventual diagnosis of early-stage emphysema. Not even the untimely (and most likely preventable) death of my beloved mother, who smoked for 60-plus years and suffered with chronic obstructive pulmonary disease, could convince me to stop. I thought constantly about quitting (don’t we all?), especially in 2013 when I plopped $9.70 on a store counter for my daily fix of Marlboro Lights in a box. When I reached my 60s, I also began to think a lot about my mortality and the time I had left. I knew that smoking a pack a day, or sometimes more, wasn’t going to help me live longer, and I often played that public service announcement in my head, the one that ends with, “It’s never too late to stop.” The encouraging news I’d like to share is that trying to quit as a senior citizen turned out to be quite different from all those attempts in my younger years. For starters, I was retired. Although I still work from home and my retirement is an active one, when push comes to shove, I’m pretty much the one who controls the content of my days. Unlike in the past, if the cravings got to be too much I could close the blinds, lock the doors and spend

the day in bed or on the couch watching television. If I needed to get away from my regular routine — something that’s extremely important when you’re trying to quit — I could go to the movies at 11 o›clock in the morning. I could lose myself in a museum or the shelves of a library or bookstore until the madness passed. I could walk around the block anytime I needed to get out. I could do whatever it took to survive the desperate pangs of withdrawal, especially during those first seven days, which are so crucial to success. When we are working full-time, those options are not generally available to us and it’s easy to fall prey to the stresses of confinement. Another thing that was different this time is that I had a prescription for Chantix, a relatively new drug that helps significantly with cravings. Yes, I read all the warnings about the possibility of nightmares and other uncomfortable or dangerous side effects. But if you read the fine print on just about any effective drug these days, those warnings are equally frightening. I was fortunate; I used Chantix faithfully for six months and suffered no ill effects. The only change in my dreams was that I began to dream in color, which was a rather pleasant experience. I was also helped by using Nicorette gum, starting with 4 mg pieces and eventually reducing the dosage to 2 mg. That, too, was a different experience from years past. The original (and the only nicotine gum available at the time) was quite distasteful. Today, the flavors include White Ice Mint, Fruit Chill, Cinnamon Surge and Fresh Mint, to name a few. All are far more palatable than the original, and they are also a great help with cravings. Those things, combined with the best tricks I learned over the years to fight the urges, have resulted in more than three smokefree years. Drink lots of water, treat yourself in some way every day, change up your routine, avoid the “triggers,” those activities you associate with smoking. If you always have a cup of coffee at the kitchen table with your first

cigarette of the day, take your coffee elsewhere. If you always smoke when you’re sitting at the computer, use a library’s computers for a few weeks. Shake things up; it really helps to break the grip of nicotine. I recently saw a pulmonary specialist and underwent a series of tests, and I was told there are no longer signs of chronic obstructive pulmonary disease. The shortness of breath I was experiencing has lessened, and I am sleeping better than I have in years. While I still take medication for high blood pressure, it is now consistently lower than it has been in many years. I’m also saving more than$ 3,500 a year by not buying those Marlboro Lights every day, and that’s a big help when you’re living on a modest fixed income. Sure, there are times I miss smoking, and I probably always will. But those thoughts are just thoughts, not cravings, and they pass quickly as I remind myself how much healthier I’ve become in just a few, short years. Let’s face it, being a smoker these days is embarrassing, not to mention it has become almost impossible to find public places where it’s legal to smoke. So why not give quitting one more try? Now that you’re older, I think you’ll be pleasantly surprised at the difference. And what a difference it will make in your life.

January 2017 •

Suzanne Ellis is a freelance writer who retired after more than 30 years as a professional journalist. She lives in Baldwinsville, N.Y.

Never Too Late to Stop Smoking Even quitting in your 60s can add years to your life, researchers ﬁnd You’re never too old to reap the health benefits of quitting smoking, a new study finds. “Even participants who quit smoking as recently as in their 60s were 23 percent less likely to die during followup than those who continued to smoke into their 70s,” said lead researcher Sarah Nash, who conducted the study while at the U.S. National Cancer Institute. In addition, the age at which you start smoking can have an impact on longevity, the researchers found. “This study confirms that age at smoking initiation and cessation, both key components of smoking duration, continue to be important predictors of mortality in U.S. adults over age 70,” Nash said. “It also underscores the importance of measures to prevent initiation, as well as encourage cessation, for all smokers,” she added. Nash is currently with the Alaska Native Epidemiology Center at the Alaska Native Tribal Health Consortium in Anchorage. Nash’s team found that smoking, which is known to be an important predictor of early death among middle-aged smokers, was also strongly related to early death from smoking-related causes among those aged 70 and older. Compared with those who had never smoked, people who still smoked when they were 70 and older were three times more likely to die during the six-year study period, Nash said. In addition, among current smokers, the age at which they started smoking was linked to an increased risk of smokingrelated death, Nash said. “Smokers who started smoking earlier in life were at increased risk of death, as were those who smoked more cigarettes per day over the age of 70,” she said. “Regardless of their age, all smokers benefit from quitting,” Nash added. “Also, smoking patterns early in life may still affect mortality even 50 to 60 years later. So, it is important to support efforts to prevent adolescent smoking initiation.” The study findings were published Nov. 30 in the American Journal of Preventive Medicine.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 9

SmartBites

The skinny on healthy eating

Why Haddock is a Nutritious Catch

very fish has its hook and… its sinker. Some, like shrimp, are high in muscle-building protein, but then also potentially high in contaminants if farmraised in undesirable conditions. Others, like white tuna, keep our bodies humming with energizing B vitamins, but then also give us pause with high mercury levels. Still others, like salmon, are omega-3 superstars, but then not such bigwigs on the fat and calorie front. It’s all relative, especially when it comes to your individual needs. Come January, with the eating season officially over and resolutions on the upswing, many of us desire to cut back on calories and feel more fit. Eating lean protein, such as fish, is universally recommended by nutritionists and leading institutions alike. My family’s go-to fish in January (and throughout the year) is haddock. Mild-tasting and reasonably priced, this flaky white fish teems with good things. An average 3.5-oz serving has only 112 calories, scant fat, a whopping 24 grams of protein and healthy doses of three B vitamins: niacin, B6, and B12. All together, these B vitamins strengthen our immune system, convert food to energy, keep our nerves in tiptop shape and help

make red blood cells. Another nutritious hook? Haddock rocks with impressive amounts of two essential minerals: phosphorous, which helps form and maintain healthy teeth and bones; and selenium, a powerful antioxidant that helps prevent cell damage and that may also prevent certain cancers. As for mercury levels, haddock routinely makes the “lowest levels” list, according to the Natural Resources Defense Council. Mercury can impair the neurological brain development in fetuses, infants and children, which is why children and women of childbearing age are advised to limit their exposure to “high mercury” fish. Wondering if haddock has any “sinkers”? Well, much like sole, snapper and flounder, haddock is no great catch when it comes to the almighty heart-healthy omega-3s. Alternating haddock with a fish that’s high in this fatty acid, like salmon, works for our family.

Helpful tips:

Fresh fish should be cooked within two days, up to three at most, from the time it was purchased (it’s best though to cook it the day you buy it). Once cooked, any leftover fish

Top Eight American Pizza Habits

remains good for three to four days. Frozen haddock, like other lean white fish, typically lasts between six to eight months. The key to keeping haddock’s calorie and fat content low is in its preparation: grilled, broiled or baked versus breaded and fried.

Italian-Style Baked Haddock Adapted from Bon Appetit; serves 4 2 tablespoons olive oil 1 small onion, chopped 2 cloves garlic, minced 1 8-oz. pkg. sliced mushrooms, hard stems removed 1 yellow or orange bell pepper, chopped 1 teaspoon dried basil or 1 Dorot basil cube* 1 14.5 oz. can petite diced tomatoes, drained ¼ teaspoon red pepper flakes (optional) Salt and pepper to taste 1½ pounds haddock fillets 1 cup shredded mozzarella or cheese of choice Preheat oven to 350°F. Lightly

A 1

Mozzarella is the most commonly used pizza cheese, with 71 percent, with ricotta and Parmesan at a distant two and three (35 percent and 32 percent, respectively), but alternate cheeses are on the rise. These include goat, gorgonzola, fontina, Romano, asiago, provolone, feta, and even pepper jack gaining traction. In addition, preference for gouda is increasing, and it is among the fastest-growing cheeses on restaurant menus.

Pizza consumption in restaurants is trending at its highest level in the past four years . Seventy-six percent of consumers have eaten at a pizza restaurant in the past 12 months.

Pizzas are trending toward thinner crusts and half of consumers prefer to go thin. Hand-tossed, however, is the No. 1 crust type found on restaurant menus, preferred by 57 percent of consumers.

Another trend in pizza crust centers on gluten-free. Glutenfree launches increased 58 percent between 2012 and 2015.

Tomato-based red sauce remains the most common topping on pizzas, •

Anne Palumbo is a lifestyle columnist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at avpalumbo@aol.com. but nontraditional sauces such as ranch, alfredo and white sauce are also appearing.

mericans consume 350 slices of pizza every second, and 15 percent deem it their top comfort food. In the November issue of Food Technology magazine associate editor Melanie Zanoza Bartelme outlines eight American pizza trends, preferences and consumption habits.

Over half (58 percent) of U.S. pizza eaters say they would buy more frozen pizza if it had more premium or gourmet ingredients.

Page 10

oil a nine-inch glass baking dish. Heat olive oil in large skillet over medium-high heat. Add onion, garlic, mushrooms, bell pepper and basil and sauté until vegetables are tender, about 10 minutes. Stir in tomatoes and red pepper flakes. Season with salt and pepper, and cook for five to eight minutes more, stirring constantly, until slightly thickened. Arrange fish in prepared dish. Pour sauce over. Sprinkle mozzarella on top. Bake until fish is cooked through, about 25 minutes. Pair with rice or linguine. *Dorot basil cubes are a convenient, economical way to add the taste of fresh basil to dishes. They come 16 to a tray and can be found in the frozen section of most major grocery stores.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

Sausage and pepperoni are still the top meats, being featured on 73 percent of restaurant menus, but bacon is also widely available, and chicken breast is up 22 percent, likely due to its perception as a healthier meat. Prosciutto is growing, up 27 percent since 2010. Other emerging meat toppings include meatballs, salami and anchovies (Packaged Facts 2015).

Onion, tomato, mushroom and peppers are featured as pizza toppings on at least 73 percent of restaurant menus.

Meet Your Your Provider Provider Meet Windsong Health

Windsong liate adds Windsong Radiology Radiology Group Group afﬁ affiliate adds genetic genetic counselor counselor

indsong indsong Radiology Radiology Group’s Group’s comprehensive comprehensive and and integrated integrated care care model model is is now now further further enhanced enhanced with with the the addition addition of of Laura Laura Fisher, aFisher, certified genetic genetic counselor (CGC) Ms. Fisher a certified counselor (CGC) has affiliate, Windsong Ms.joined FisherWindsong’s has joined Windsong’s affiliate, Health Medical Alliance, PLLC. This PLLC. addition Windsong Health Medical Alliance, This strengthens the first breast care facility to receive addition strengthens the nationally accredited accreditation by the National Accreditation Windsong Breast Care Program, a first of its Program for Breast program Centers (NAPBC) in kind collaborative in WNY, designed Western where breast patients receive an to assist New newlyYork, diagnosed cancer patients interdisciplinary approach to care. through coordinated care and ultimately Fisher received a Master of Science degree in improved outcomes. genetic counseling Boston University and in Fisher receivedfrom a Master of Science degree has mostcounseling recently provided genetic counseling genetic from Boston University andat Women Children’s Hospital of Buffalo. has mostand recently provided genetic counseling at “We and are incredibly Laura Women Children’sfortunate Hospital to of have Buffalo. join us. enthusiastic about her new Laura role “WeShe areisincredibly fortunate to have with Windsong and the breast care program. join us. She is enthusiastic about her new role She a dedicated and counselor withisWindsong and theintelligent breast care program. committed to offering compassionate, She is a dedicated andaintelligent counselor informative environment for patients seeking committed to offering a compassionate, genetic counseling,” statedfor Thomas Summers informative environment patients seeking M.D., president of Windsong Group, genetic counseling,” Thomas Radiology Summers M.D, PC. president of Windsong Radiology Group, PC. Genetic counselors encourage patients to Genetic counselors discourage patients from seek genetic testing only when accompanied by

the appropriate counseling. Thethe importance of having genetic testing without appropriate this is not only to understand implications, counseling to understand the the implications of but to ensurethat theisright person family the also information gathered in in thethe testing is tested, the right genetic test is ordered, and the process. right“The laboratory resultsisofused. a genetic test impact patients results of genetic and“The family members,” saidtesting Fisher.impact “Counseling patients said Fisher.the is criticaland for family helpingmembers,” patients understand “Counseling is critical to helptest patients results of their tests. The genetic results are understand all of the testingofoptions before helping a growing number patients make selecting test, and after testing she to understand informedatreatment decisions,” added. theirGenetic test results. These results are helping testing is recommended for a growing number patients history make informed individuals with of a personal of cancer. treatment added. Thosedecisions,” with strongshe family history of cancer mayGenetic also becounseling candidates.and testing may be considered with a personal Two of for theindividuals most common genes that cause history of cancer. with a cancer strong are family hereditary breast Those and ovarian BRCA1 history of cancer may alsoare be nearly candidates.The and BRCA2. Today there 50 genes two most common that increased cause hereditary identified that genes can cause risks of breast and ovarian cancer are BRCA1 and BRCA2. cancer. Today there are more than 50 genes identifi “Patients who had genetic testing just aed few that increase cancer risks. for additional testing years ago may be eligible “Patients who had geneticsaid testing just a few of newly recognized genes,” Fisher. yearsToago may bean eligible for additional schedule appointment with a testing genetic of newly recognized said Fisher. counselor, please callgenes,” 716-626-6300. To schedule an appointment with a genetic counselor, please call 716-626-6300

Certified genetic counselor counselor Laura Laura Fisher Fisher has has recently recently Certifi ed genetic joined Windsong Windsong Radiology Radiology Group. Group. She She counsels counsels patients patients joined interested in in genetic genetic testing. testing. interested

Fore Formore moreinformation informationabout aboutgenetic genetictesting, testing,call call716-626-6300 716-626-6300••windsonghealth.com. windsonghealth.com

Wagering on Weight Loss New ﬁtness models promote weight loss with ﬁnancial incentive By Tim Fenster

illions of Americans want to lose weight, but the road to one’s fitness goals is a challenging one. Schedules fill up, fatty cravings grow harder to ignore and some days it’s difficult to muster the energy for a solid workout. For decades, the answer to these and other dieting difficulties was a simple one — willpower. But dieters are increasingly relying on another, arguably stronger incentive to hit the gym and resist the grease — their pocketbooks. Over the past several years, there have sprung a new crop of websites and mobile applications that allow users to place cash bets on their weight loss success. The rules and payout scales vary greatly depending on the site, app or program chosen, but most follow the same basic tenets. The dieter pays in a certain amount at the start of a “challenge” that may last anywhere from a few weeks to a year. The dieter must then also provide a verifiable weigh-in — usually via picture — at the start of the program. At DietBet.com, the payouts are typically 150 to 200 percent of the initial bet for those who can drop either 4 percent of their body weight in four weeks or 10 percent over six months. “Diet betting is a promising new approach to the treatment of obesity,” said Tricia Leahey, a professor at

Body and Soul Transformations in Buffalo is a gym that pays clients when they lose weight. For every pound lost, clients receive $10 off future membership costs. Brown Medical School’s Weight Control and Diabetes Research Center. “Putting money on the line boosts commitment and increases the chances of weight loss success.” But this cash-as-a-fitnessincentive approach can have a much broader range of applications than merely betting on the results of one’s diet. Take Body and Soul Transformations, a relatively new weight-loss program and gym with locations around Western New York. New clients are encouraged to sign up for a weight-loss challenge — five pounds in 14 days (fee: $97), eight pounds in 21 days ( fee: $147) or 12 pounds in 28 days (fee: $197). For every pound the client loses, he or she receives $10 off future membership costs. “You come in for 14 days, and every pound you lose, I give you $10 for your continued transformation

with us,” said Trevor Buccieri, founder and CEO of Body and Soul Transformations. “My confidence is that you’re going to have goals further and beyond, and hopefully we will have earned that right to your business.”

Game plan established

For the cost, Body and Soul offers new clients four days per week of group workouts that are intended to target muscles throughout the body and stimulate weight-loss long after the exercise is over. They also receive customary meal plans, designed specifically with the client’s body and goals in mind. “Our program designer is fantastic, and it’s basically designed for the highest amount of weight loss in the shortest amount of time,” Buccieri said. “We engage the entire body every single workout. We call it

January 2017 •

the afterburner effect.” Buccieri says he began the cashper-pound discount about three years ago, after learning that in oil-rich Dubai, residents are paid in gold to keep healthy. He added that he does not know of any gyms that use cash incentives the way he does. “I would like to think it’s unique. It’s not something I really researched,” Buccieri said. “Many times other businesses will look at it like, ‘How do you make money? It doesn’t make sense.’” The results touted by both companies suggest adding a cash incentive may be more likely to lead to dietary success. DietBet claims that around 96 percent of users reach their goals, while Buccieri says Body and Soul has helped 10,000 clients reach their goals in just the last three years (totaling 200,000 in lost pounds). One client, Crysta Swiatek of Blasdell, credited Body and Soul’s discount-per-pound model and communal atmosphere with helping her lose eight pounds in just a few weeks. “Putting that kind of money down — and knowing you’ll get a discount for every pound you lose — really helps motivate your decisions when it comes to dieting and working out,” she said. While company-touted results might seem dubious, it’s harder to dispute the success Buccieri has had with his Body and Soul model. In less than seven years, Body and Soul has expanded to four locations in Western New York. “We are in the process of expanding to a national model. The mission of the company is to transform lives and to basically do that on a national level,” he said. “We have a mission to reach a million people and 10 million pounds.”

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 11

Impact Fitness in Hamburg offers a variety of option for exercise and fitness, including battle ropes, Jacob’s ladder and tire-flipping. Shown is strength trainer Chris Cammarata demonstrating tire flipping.

Impact Fitness: Strength Trainer Chris Cammarata demonstrates the battle ropes

New Fitness for the New Year Greater Buffalo area promises lots of options this winter season By Catherine Miller

ne of the most popular New Year’s resolutions is to get in better shape. It’s also a resolution that quickly falls by the wayside in the aftermath of the holidays. Hence, the crowded January gym that is oh so easy to maneuver in March. So what can you do to break that vicious cycle of breaking your resolution even before the snow starts to pile up? Change your routine, suggest many experts. Step off that stepper, move away from that tired machine, and depart from your daily walk to seek out something new and different to add to your weekly workouts. New workouts can keep you interested and motivated, and that brings better fitness results, the experts say. Luckily, if you live in Western New York, adding a new exercise regimen can be easier than you think. The region is equipped with a thriving fitness community that is as varied as the people that live here. You need only visit a non-commercial gym like Impact Fitness in Hamburg to open your eyes to a new workout routine. Impact Fitness uses guided training, nutritional counseling and metabolic conditioning to bring the “wow” to your workout. Step inside their large warehouselike facility to check out their battle ropes, Jacob’s ladder, and tire-flipping arena, along with a vast array of other full-body strength training equipment. Their fitness coaches watch over your results daily to keep you on task and most sessions will get you in and out of the facility in under an hour, Page 12

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One of the newest indoor cycling centers, Queen City Cycling in Buffalo, offers a variety of cycling sessions, including TRX suspension training classes. with high calorie burning results. If you think it sounds like the place that an athlete should work out at, you are right. In their words, everyone is an athlete. Their clients’ age range is 12 to 72 and climbing, and the ladies are flipping tires as well as men.

Go cycling

If you are looking for an entirely new spin on your fitness routine, why not try cycling — yes in the winter. While Buffalo has a booming outdoor biking population, indoor cycling is becoming increasingly popular and is known to be one of the quickest ways to shed pounds and develop endurance, all while enjoying some jamming tunes.

One of the newest indoor cycling centers, Queen City Cycling in Buffalo, offers a variety of cycling sessions, along with yoga, PiYo, TRX training, and POUND. TRX suspension training uses your body weight with suspension straps to build muscle and maximize conditioning results. POUND is a fun new rock-out workout trend that uses “rip sticks” that simulate drumming motions to choreographed moves demonstrated by your instructor. It optimizes strength and cardio, while improving agility and coordination. Queen City Cycling has a variety of hybrid classes that allow you to try out two of their class styles

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

to keep things interesting. Looking to enjoy the outdoors without going far from home this winter season? Canalside in downtown Buffalo offers a variety of icy options to get you exercising in the fresh air. Try curling as a family friendly competition, rent an ice bike or just join friends for ice skating in Canalside’s oversized rink. The brisk air of Canalside is sure to refresh your mind, body and spirit and remind you why you love winters in Buffalo. While you are down there, why not take a walk along the canal and enjoy the new pathways and the beautiful winter water view? For many, a traditional local gym may meet their conditioning criteria. But sometimes, a change of pace can breathe new life and new results into your routine. In our region, the variety of ways to fit in an exercise workout is only limited by your imagination, and maybe the season. Scuba diving, paddle boarding, sledding, skiing and more are available throughout the region. Plan ahead for your next 5K run — yes, even in this weather. Check out the Penguin Run or Cupid’s Undie Run to share in a brisk trek with your neighbors and help out Cradle Beach and The Children’s Tumor Foundation while you are at it. Yoga at your local church, Zumba at the community center, and snowshoeing at Tifft Farms are great ways to change up your traditional exercise routine and try something new this year. Your new fitness routine is only an Internet search away. It’s winter in Western New York, and there’s much to do and enjoy.

Margaret Harvey, DO, is a sports medicine fellowship trained orthopedic surgeon with Plancher Orthopaedics & Sports Medicine. www.plancherortho.com

Tips for Staying Fit and Injuryfree at the Gym

By Margaret Harvey, DO

Start with a Warm Up. Don’t challenge cold muscles. Run in place for a few minutes before stretching, gently and slowly practice the motions of the exercise to follow. Warming up increases the body temperature, heart and blood flow rates, and loosens up the muscles, tendons, ligaments, and joints to decrease the risk of injury.

Don’t Skip the Stretch. Start stretching slowly and carefully until reaching a point of tension. Hold each stretch for 20 seconds, and then slowly and carefully release it. Never stretch to the point of pain and avoid bouncing on a muscle that is fully stretched. It’s terrific to do stretching exercises at home each day to maintain flexibility.

Keep a light touch on the handrails. With cardio machines like treadmills and the elliptical trainer, keep your hands resting lightly on the handrails, not with a death-grip on the rails. A clinging, hunched position will cause an improper spine alignment which can be jarring to your shoulders and elbows. If you need to hang on for your life, the setting is probably too high.

Cross Train. Mixing it up by regularly switching from one activity to another has many benefits over doing the same routine. It prevents mental burnout and since different activities target slightly different muscle groups, the result is a more comprehensive conditioning.

Focus on muscle groups, not individual muscles. People get hurt when they put too much emphasis on one muscle, e.g. getting huge biceps or lats. A better approach

is to target more of your arms or shoulders with moves like the chest press or back row. The best exercises are those that work several muscles at the same time because they build functional strength. Wait at least 48 hours before working the same muscle group again.

Pay attention to your shoes. If you play a sport more than three times a week, get the right shoes for that activity. For example, running shoes are designed to put your foot and leg into the best position to propel you forward. If they are worn for activities with a lot of side-to-side movement, it can cause the ankle to roll to the side, with the potential for a sprained or even broken ankle. Cross-training shoes are a better choice for sports like tennis or step classes. Regular exercisers should replace their shoes every 12 months, or at the first signs of wear (running shoes should be replaced every 480 to 800 kilometers).”

Accept your limitations. As we age, our bones lose density and strength, our ligaments and tendons stiffen, we lose circulation and in general we become more vulnerable to injury. Keep on going to the gym, but use more caution as you get older to protect your body.

Consider hiring a professional. Using a machine incorrectly or putting on too much resistance is cause for concern and potential injury. Use the mirrors, if available, to monitor your form and technique. Also consider signing up with a personal trainer, even for just a couple of sessions, for some sensible tips for injury-free routines.

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Women’s HEALTH What to Do with Dark Circles Around the Eye Do people constantly ask if you’re tired because of dark circles under your eyes? By Deborah Jeanne Sergeant

o people constantly ask if you’re tired because of dark circles under your eyes? Don’t worry. It’s a fairly common condition. Mild cases of dark circles may be adequately covered with cosmetics. Finding the correct color at a drugstore make-up display isn’t easy. A professional make-up artist can assist in finding the right makeup primer, foundation and concealing products. But not everyone finds that make-up provides adequate coverage, especially if the area is saggy, wrinkled and discolored. Make-up tends to creep into lines around the eyes, which draws more attention to the dark circles instead of concealing them Physician Michael Nazareth, a board-certified dermatologist and president of Western New York Dermatology in Williamsville, said that under-eye circles are most

common as facial skin ages. “The skin itself can have increased laxity resulting in the development of superficial fine lines and wrinkles,” Nazareth said. “There can also be some skin hyperpigmentation that goes along with this. However, some of the under-eye ‘bags’ are actually due to a greater protrusion of the small pockets of fat under the eye.” Nazareth said that retinolbased topical treatments can help improve the appearance of fine lines and wrinkles that often accompany under-eye circles, as well as help even out the appearance of the skin pigmentation. More invasive treatments include laser and Thermi treatments, which uses temperature-controlled radiofrequency energy to help decrease the unwanted pigmentation. The most stubborn under-eye circles may need more invasive treatment. “Definitive treatment of any large

Optimism May Propel Women to a Longer Life

Upbeat outlook linked to lower risk of dying from cancer, heart disease and other causes, study says

omen who generally believe that good things will happen may live longer. That’s the suggestion of a new study that seems to affirm the power of positive thinking. “This study shows that optimism Page 14

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is associated with reduced risk of death from stroke, respiratory disease, infection and cancer,” said Eric Kim, co-lead author of the investigation. “Optimistic people tend to act in healthier ways. Studies show that optimistic people exercise more,

protruding ‘bags’ requires surgical lower lid blepharoplasty,” Nazareth said. “While that can be more involved, everyone can take simple steps to help.” He advises clients with under-eye circles to get enough sleep, moderate salt intake, drink plenty of fluids and protect skin with sunglasses and hats. Reducing stress also contributes to good health and appearance. At-home remedies may offer temporary reduction of the appearance of under-eye circles. These

include applying cold cucumber slices or cooled tea bags under the eyes. Anecdotally, applying Preparation H and creams that contain caffeine is also said to help reduce puffiness and under-eye circles. Elise DeLuke, dermatologist and owner of DeLuke Dermatology in Amherst, said that under-eye circles “can be tough to treat,” but injected fillers can help reduce their appearance. The procedure can cause some initial bruising and swelling, but the results can last a year, she said.

eat healthier diets and have higher quality sleep,” said Kim, a research fellow in the department of social and behavioral sciences at Harvard T.H. Chan School of Public Health in Boston. Kim added that an upbeat outlook also may directly affect biological function. Research has demonstrated that higher optimism is linked with lower inflammation, healthier lipid levels (fats in the blood), and higher antioxidants (substances that protect cells from damage), Kim said. “Optimistic people also use healthier coping styles,” he said. “A summary of over 50 studies showed that when confronted with life challenges, optimists use healthier coping methods like acceptance of circumstances that cannot be changed, planning for further challenges, creating contingency plans, and seeking support from others when needed.” For this investigation, scientists reviewed records on 70,000 women who participated in a long-running health study that surveyed them every two years between 2004 and 2012. The study authors examined optimism levels and other factors that might affect the results, such as race, high blood pressure, diet and physical activity. Overall, the risk of dying from any disease analyzed in this study was almost 30 percent less among the most optimistic women compared to the least optimistic women. For the most optimistic women, for instance, the risk of dying from cancer was 16 percent lower; the risk of dying from heart disease, stroke or respiratory disease was almost 40 percent lower; and the risk of dying

from infection was 52 percent lower, the study found. Levels of optimism were determined from responses to statements such as “In uncertain times, I usually expect the best,” according to Kim. While the study uncovered an association between optimism and life span, it did not prove cause and effect. Sarah Samaan, a cardiologist at the Heart Hospital at Baylor in Plano, Texas, said healthy behaviors may help fuel optimism. “It’s easier to feel optimistic when you feel healthy and energetic,” said Samaan, who was not involved in the research. “By choosing a healthy lifestyle, you may open yourself up to greater gratitude and create more energy for deeper relationships and professional satisfaction.” She added that for people with depression and anxiety, medication may help to improve mental outlook and thus overall health, although this study did not address that specific issue. The study authors noted that individual actions can promote optimism. The simple act of writing down best possible outcomes for careers, friendships and other areas of life could generate optimism and healthier futures, they suggested. Kim described a two-week exercise where people were asked to write acts of kindness they performed that day. Another activity involved writing down things they were grateful for every day. Both these exercises were shown to increase optimism, he said. The study was published online Dec. 7 in the American Journal of Epidemiology.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

Women’s HEALTH

By Deborah Jeanne Sergeant

Top 10 Ways Women Can Improve Their Health Want to be ﬁtter and healthier in 2017? Here are the top tips from local experts.

Take small steps toward goals.

“If you’re looking at it as a lifestyle change, make small changes. Maybe don’t make a resolution to completely overhaul your diet and life Jan. 1 because most people have a harder time sticking with that. But smaller changes can make it easier. Goal setting is a way to stay motivated.

Improve your diet.

“I try to encourage a lot of vegetables and whole foods. Everyone knows about the fiber and vitamins in produce, but the phytonutrients provide antioxidants that help strengthen our immune system, fight off potential cancer cells. Whole and colorful fruits and vegetables provide us with so much. It’s all about maintaining a balance. Even in ‘healthful’ foods, there are things that out of balance could cause problems, so it’s important to get variety.” • Jessica Bennett Gawronski, registered dietitian, Balanced Nutrition of WNY in Amherst

Stay positive.

“I think that No. 1 among the things that are very, very important is attitude. A positive attitude can improve one’s health. You hear about when someone dies and their spouse dies six months later because they’ve lost the will to live. A person who has a good attitude toward life, it improves their health.

4. 5. 6.

Stay involved. “You need social interactions. Give back to the community. All these things contribute to health and wellness. Make up for dietary shortfalls.

“Use appropriate nutritional supplements.

Know your family health history.

“In addition to proper preventive care, pap smears, and gynecologic visits, know your family history of potentially inheritable cancer. For example, breast, ovarian and colon cancer in the family. People should be very mindful of their family health history to possibly undergo genetic testing.

engagement for Western New York

Protect your skin from sun.

“I recommend to every patient to wear a sunscreen of SPF 30-50 every single day, sunshine or rain on the face, neck, and any part of the chest that’s exposed, even in the wintertime. The sun reflects off the snow. Wear wide-brimmed hats and protective clothing and stay in the shade when you’re outside. We see a lot of melanoma because people aren’t used to doing this every single day like in California. • Elise DeLuke, dermatologist and owner of DeLuke Dermatology in Amherst

10.

Don’t tan.

“Tanning beds are one of the worst habits that Americans currently participate in. Over 1 million Americans go to a tanning bed every day, even though we now know that there is a stronger association with skin cancer from tanning beds versus lung cancer from smoking. Many people who wouldn’t dream of smoking due to its known cancer risks still go tanning. It is expected that there will be over 76,000 cases of melanoma in the country this year and approximately 10,000 people will die of the disease.” • Michael Nazareth, board-certiﬁed dermatologist and president of Western New York Dermatology in Williamsville

Don’t over schedule yourself.

“Get enough sleep every

night.”

• David Kurss, board-certiﬁed obstetrician-gynecologist and founder Women’s Wellness Center in Buffalo

Get annual exams.

“Regular gynecological checkups is important to a women’s overall health. Have regular Pap tests and pelvic exams. Cervical cancer screening, with a Pap test & HPV DNA test, should begin at age 21. For women age 21 to 29, screening should be done every 3 years. For women ages 30 to 65, screening should be done every 5 years.” • Martha Ryan, American Cancer Society senior director of community

Menopause Before 40? Risk of Broken Bones May Be Higher And traditional preventive treatments don’t erase added danger, new study suggests

omen who undergo menopause before age 40 are more likely to get broken bones, and a new study suggests calcium and vitamin D supplements won’t eliminate the extra risk. Researchers were disappointed by the finding because supplements and hormone replacement therapy have been thought to improve bone health. The researchers were led by Shannon Sullivan, medical officer from the U.S. Food and Drug Administration. They examined the medical records of almost 22,000 women who took part in the Women’s Health Initiative. This 15-year study, by the U.S. National Institutes of Health, reviewed the most common causes of poor health

and death among postmenopausal into consideration a woman’s age at women. menopause onset when evaluating The study team found that those patients for fracture risk,” said women who entered menopause Dr. JoAnn Pinkerton, the society’s before age 40 had a significantly executive director. higher risk of broken bones than “Women at risk for bone loss those who did later, regardless of the need 1,200 mg (milligrams) of treatments they tried. On average, calcium per day, with adequate women enter menopause around age vitamin D, and [are] encouraged 52. to get as much as possible through The researchers said there’s hope diet due to concern that too much for other strategies, including earlier supplemental calcium may increase or longer treatment with calcium, atherosclerotic plaque in women,” vitamin D or hormones; different she said in a society news release. doses; or longer follow-up. Pinkerton added that women The study was published with early menopause should ask recently in Menopause, the journal their health care provider whether of the North American Menopause they are candidates for hormone Society. therapy and discuss appropriate January 2017 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper “This study highlights the need amounts of calcium, vitamin D and for health care providers to take hormones.

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Women’s HEALTH

Gynecologic Cancer Signs Experts say ignoring certain signs would allow a cancer to grow and possibly spread By Deborah Jeanne Sergeant

ny change in your gynecologic health could indicate you need medical attention, experts say. While many women fear certain symptoms could indicate cancer, Martha Ryan, American Cancer Society senior director of community engagement Western New York, said that overall, “the signs and symptoms of gynecological cancers can also be indicative of other non-cancerous diagnosis.” Or, if they turn out to be unimportant, a doctor’s visit would bring peace of mind. “It’s also vital to note that women with early cervical cancers and precancers usually have no symptoms,” Ryan said. “Symptoms often do not begin until the cancer becomes invasive and grows into nearby tissue.” Ryan added that at this stage, the most common symptoms include: • Abnormal vaginal bleeding, such as bleeding after vaginal sex, bleeding after menopause, bleeding and spotting between periods, and having (menstrual) periods that are longer or heavier than usual. Bleeding after douching or after a pelvic exam may also occur. • An unusual discharge from the vagina. The discharge may contain some blood and may occur between your periods or after menopause. • Pain during sex. Though attributable to other health conditions, cancer could cause these symptoms and ignoring them would allow the cancer to grow and possibly spread. Waiting until a more advanced stage may “lower your Page 16

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chance for effective treatment,” Ryan said. She encourages women to receive regular Pap smears and pelvic exams to check for any irregularities. “Receiving the HPV vaccine can actually prevent most cervical cancers,” Ryan said. “The HPV vaccine should be given to boys and girls beginning at the age of 12. This vaccine is a three-dose vaccine and should be given prior to sexual activity.” Signs for endometrial cancer present few symptoms until it’s advanced. Most women experience abnormal vaginal bleeding, which may include bleeding between cycles or after menopause. Though abnormal bleeding may occur for other reasons, it’s still a good idea to get it checked, and for women who have undergone menopause “it’s especially important to report any vaginal bleeding, spotting, or abnormal discharge to your doctor,” Ryan said. “Non-bloody vaginal discharge may also be a sign of endometrial cancer. Even if you cannot see blood in the discharge, it does not mean there is no cancer. In about 10 percent of cases, the discharge associated with endometrial cancer is not bloody. Any abnormal discharge should be checked out by your doctor,” Ryan said. Other endometrial cancer signs can include pelvic pain from a tumor and unexplained weight loss. Irregular bleeding could also indicate uterine sarcoma, another type of cancer, especially for women who

have already experienced menopause. provider to find out what is going on,” Ryan said. “Women need to “This symptom is more often have regular GYN appointments and caused by something other than receive the recommended screenings.” cancer, but it is important to Usually, just one symptom isn’t have a medical evaluation of any as troubling as presenting several irregular bleeding right away,” symptoms. Ryan said. “Of the uterine sarcomas, “The combination of losing leiomyosarcomas are less likely weight, yet feeling bloated and to cause abnormal bleeding than having abdominal enlargement is endometrial stromal sarcomas and worrisome,” said physician Faye undifferentiated sarcomas.” Justicia-Linde, clinical assistant Again, discharge is usually professor, department of obstetrics associated with a non-cancerous condition; however, it’s still important and gynecology in the Jacobs School of Medicine and Biomedical Sciences to receive an exam to stay on the safe at the University at Buffalo and a side. physician with UBMD ObstetricsOther symptoms could include Gynecology. “Feeling full after eating pelvic pain, a palatable mass, or a very little is also concerning.” feeling of fullness, but only about 10 She added that changes in percent of women experience these bowel function, such as developing feelings. chronic constipation or more frequent Ryan said that signs of ovarian diarrhea, could also represent cancer can include several symptoms, symptoms that indicate cancer, as but it’s more likely if the cancer could any change in urination pattern has spread beyond the ovaries. The (frequency, incomplete emptying, signs may include bloating, pelvic or leakage, blood, pain with urination). abdominal pain, feeling full, urinary “It is still unlikely to be due to urgency, and urinary frequency. cancer, but any persistent discomfort As with the other types of should be checked out and can be cancer, signs of ovarian cancer can treated,” Justicia-Linde also indicate non-cancerous said. conditions In addition to receiving “When they are caused their pelvic exams and by ovarian cancer, they tend Pap smears, David to be persistent and represent Kurss, board-certified, a change from normal,” obstetrician-gynecologist Ryan said. “For example, and founder Women’s they occur more often or are Wellness Center in Buffalo, more severe. If a woman has encourages women to these symptoms more than perform a monthly self 12 times a month, she should breast exam while lying flat, see her doctor, preferably a not only in the shower. gynecologist.” “Any mass, especially Ovarian cancer may Justicia-Linde if not on the other side, any also be accompanied by leakage from the nipple, or fatigue, upset stomach, back swelling under the arms or collarbone pain, pain during sex, constipation, area, should be seen,” Kurss said. menstrual changes and abdominal Providers won’t judge you for swelling with weight loss. But since having suspicious symptoms checked. many women experience these In fact, Kurss said at least one patient symptoms unrelated to ovarian each day who thinks a symptom in cancer, medical tests are the only way the breast or vaginal region may be to determine if that’s the cause. “Women need to know their body cancer. “It’s always best to err on the side and if something is not normal, they of caution,” Kurss said. need to pursue it with their medical

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

THURSDAY, January 19th 10 TO NOON Call about our specials By Jim Miller

Thyroid Disorders Often Missed in Seniors Dear Savvy Senior,

Can you write a column on the overlooked problem of thyroid disease? After struggling with chronic fatigue, joint pain and memory problems, I was finally diagnosed hypothyroidism. Now, at age 70, I’m on thyroid medication and am doing great. Five years of feeling lousy. I wish I’d have known.

Frustrated Patient

Dear Frustrated,

I’m glad to hear that you’re finally feeling better. Unfortunately, thyroid problems are quite common in older adults but can be tricky to detect because the symptoms often resemble other age-related health problems. In fact, as many as 30 million Americans have some form of thyroid disorder, but more than half of them aren’t aware of it. Here’s a basic overview: The thyroid is a small butterfly-shaped gland located at the base of your neck that has a huge job. It produces hormones (called T3 and T4) that help regulate the rate of many of your body’s activities, from how quickly you burn calories to how fast your heart beats. It also influences the function of the brain, liver, kidneys and skin. If the gland is underactive and doesn’t produce enough thyroid hormones, it causes body systems to slow down. If it’s overactive, and churns out too much thyroid, it has the opposite effect, speeding up the body’s processes. The symptoms for an underactive thyroid (also known as hypothyroidism) — the most common thyroid disorder in older adults — will vary but may include fatigue, unexplained weight gain, increased sensitivity to cold, constipation, joint pain, muscle stiffness, dry skin and depression. Some patients may even develop an enlarged thyroid (goiter) at the base of the neck. However, in older adults, it can cause other symptoms like memory impairment, loss of appetite, weight loss, falls or even incontinence. And the symptoms of an overactive thyroid (or hyperthyroidism), which is more

common in people under age 50, may include a rapid heart rate, anxiety, insomnia, increased appetite, weight loss, diarrhea, excessive perspiration, as well as an enlarged thyroid gland. Too much thyroid can also cause atrial fibrillation, affect blood pressure and decrease bone density, which increases the risk of osteoporosis. Those with the greatest risk of developing thyroid disorders are women who have a family history of the disease. Other factors that can trigger thyroid problems include: autoimmune diseases like Hashimoto’s or Graves disease; thyroid surgery; radiation treatments to the neck or upper chest; and certain medications including interferon alpha and interleukin-2 cancer medications, amiodarone heart medication and lithium for bipolar disorder.

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If you have any of the aforementioned symptoms or if you’ve had previous thyroid problems or notice a lump in the base of your neck, ask your doctor to check your thyroid levels. The TSH (thyroid-stimulating hormone) blood test is used to diagnosis thyroid disorders. Thyroid disease is easily treated once you’ve been diagnosed. Standard treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine (Levothroid, Synthroid and others), which is an oral medication that restores adequate hormone levels. And treatments for hyperthyroidism may include an anti-thyroid medication such as methimazole (Tapazole), which blocks the production of thyroid hormones. Another option is radioactive iodine, which is taken orally and destroys the overactive thyroid cells and causes the gland to shrink. But this can leave the thyroid unable to produce any hormone and it’s likely that you’ll eventually become hypothyroid and need to start taking thyroid medication. For more information on thyroid disorders, visit the American Thyroid Association at Thyroid.org.

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Page 17

The Social Ask Security Office

From the Social Security District Office

Social Security Is Always Evolving

ocial Security is always evolving to meet the needs of the American public. We’re optimistic about the future and the limitless possibilities for progress. Much of the progress we’ve made together, as a nation, is through the shared responsibility of paying Federal Insurance Contributions Act (FICA) tax. This federal payroll tax funds Social Security — programs that provide benefits for retirees, the disabled, and children of deceased workers. You help us keep millions of hard-working Americans out of poverty. Without your contribution, wounded warriors wouldn’t receive the benefits they deserve. Children who have lost parents would have no social safety net. Millions of elderly people would be destitute. In the same way that we take great pride in helping people who need it, you should take pride in making this country stronger. You can see the many ways our retirement benefits help your loved ones and neighbors at www.socialsecurity.gov/retire. The strength of our nation relies

Q&A

Q: I’m trying to figure out how much I need to save for my retirement. Does the government offer any help with financial education? A: Yes. For starters, you may want to find out what you can expect from Social Security with a visit to Social Security’s Retirement Estimator at www.socialsecurity. gov/estimator. The Financial Literacy and Education Commission has a website that can help you with the basics of financial education: www. mymoney.gov. Finally, you’ll want to check out the Consumer Financial Protection Bureau, which offers educational information on a number of financial matters, including mortgages, credit cards, retirement, and other big decisions. Visit the Consumer Financial Protection Bureau at www.consumerfinance. gov. Q: I got married and I need to change my name in Social Security’s records. What do I do? A: If you change your name due to marriage, or for any other reason, you’ll need to report the change and get a corrected Social Security card with your new name. You will need to fill out form SS-5. You can get a copy of this form by visiting www.socialsecurity.gov/ss5doc or by calling our toll-free number 1-800-772-1213 (TTY 1-800-3250778). You’ll also need to provide the Page 18

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on cooperation and the empathy to understand each other’s unique struggles. Similarly, Social Security has an obligation to provide benefits quickly to applicants whose medical conditions are so serious that their conditions obviously meet disability standards. “Compassionate allowances” offer a way of quickly identifying diseases and other medical conditions that invariably qualify under the listing of impairments based on minimal objective medical information. This also lets Social Security target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly. You can view the list of compassionate allowances at www.socialsecurity.gov/ compassionateallowances. Our diversity is an asset that can bring us together, making us stronger as a nation. Visit www.socialSecurity. gov to empower your future, for today and tomorrow.

original marriage certificate showing your new and old names. You can mail or take the documentation to your local Social Security office. In some cases, we may need other forms of documentation as well. For more information, visit www. socialsecurity.gov/ssnumber. Q: I’m planning to retire next year. I served in the Navy back in the 1960s and need to make sure I get credit for my military service. What do I need to do? A: You don’t need to do anything to apply for the special credit for your military service — it is added automatically. For service between 1957 and 1967, we will add the extra credits to your record at the time you apply for Social Security benefits. For service between 1968 and 2001, those extra military service credits have already been added to your record. So you can rest assured that we have you covered. Q: How do I report a change of address if I’m getting Supplemental Security Income (SSI)? A: A person receiving SSI must report any change of address by calling our toll-free number, 1-800772-1213 (TTY 1-800-325-0778), or by visiting a local office within 10 days after the month the change occurs. You cannot complete a change of address online. You should report your new address to Social Security so you can continue to get mail from Social Security when necessary, even if you get your benefits electronically by direct deposit or direct express.

Health News Amherst foundation honors advocates The Amherst Senior Citizens Foundation (ASCF) recently honored three people who have made significant contribution of their time and talents to positively affect the lives of area seniors, enabling them to age within the community. They were recognized during ASCF’s 23rd anniversary celebration Nov. 5 at Transit Valley Country Club, an event attended by more than 110 guests. The honorees were: • Peter Fleischmann has served as director and CEO of the Foundation for Jewish Philanthropies since 1982, where he leads all development, grant making, Fleischmann investment and administrative operations. The Foundation for Jewish Philanthropies administers more than 1,000 endowments, charitable trusts and other philanthropic funds serving broad charitable purposes, with assets of more than $165 million. Fleischmann received the ASCF Creative Advocate Award, which was established to recognize an individual or organization that has taken a creative new idea and developed it into a successful program, service or policy to support senior citizens. • Ann Monroe who since has served as president of the Health Foundation of Western and Central New York, an independent private regional health philanthropy Monroe which serves communities within the region. Monroe received the Senior Leadership Award, which recognizes a person who has demonstrated outstanding leadership by promoting and developing activities which provide a favorable climate for seniors to age within the community.

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2017

• Frank Temple a 92-year-old World War II veteran who donated 430 hours (approximately 11 40-hour work weeks) in 2015, providing needed transportation to area seniors through the Hearts and

Hands program. Temple chauffeured 43 different individuals to 181 appointments, driving more than 6,100 miles to help his neighbors. Temple is also a Habitat for Humanity volunteer and finds time to volunteer through his church. Temple received the 2016 Senior Citizen Volunteer Award. According to ASCF, Temple serves as a role model for all by demonstrating the critical importance of individual involvement and caring.

Compeer Inc. moves headquarters to Buffalo Compeer Inc., an agency dedicated to recovery through the healing power of friendship, has recently moved its headquarters to Buffalo. Compeer Inc. is the network of 49 Compeer affiliate locations in the U.S., Canada and Australia. Compeer Inc. staff members provide training, consultation and administrative support to the affiliates. Boling Compeer affiliates maintain autonomy over their individual operations, programs, resources and funding. “It is an exciting day for Compeer and for Buffalo,” said Timothy Boling, executive director of Compeer Inc. and Compeer Buffalo. “Compeer Inc. is a stellar organization that has been serving the communities in which its affiliates are located for nearly 40 years. I am honored to have the opportunity to be at the helm of the organization. It is my ultimate goal to strengthen the entire Compeer Inc. network and better serve our affiliates and the populations they serve.” According to a news release issued by the agency, through its time-tested evidence-based model and best practices of supportive friendship and mentoring, Compeer Inc. creates programs to meet the diverse needs of communities that want to improve and positively impact the lives of individuals and families living with mental health challenges. The organization was founded in 1973 in Rochester with just 12 volunteers. Today, nearly 4,000 volunteers in Compeer locations around the world serve people with mental illness.

ECMC Family Health Center earns recognition ECMC Family Health Center has recently achieved recognition status for “Patient-Centered Medical Home (PCMH), Recognized–Level 3” by the National Committee for Quality Assurance (NCQA)

Health News ECMC’s Family Health Center in partnership with UB Family Medicine offers access to a diverse group of university physicians for primary care and family medicine. Here, families—including children, adults, and seniors—have easy access to a variety of physicians, including family physicians, pediatricians, and geriatric specialists for senior care. The ECMC Family Health Center offers an on-site lab facility, as well as flexible scheduling, including evening and weekend appointments. Doctors are on call 24 hours a day, and patients can also always speak to a nurse by phone during business hours to discuss any health questions and concerns. “This is yet another important recognition from a national organization of the high-quality care and services our caregivers provide to the citizens of Western New York, said ECMCC President and CEO Thomas J. Quatroche Jr. “As ECMC continues to be a leader in transform-

ing healthcare in Western New York with our partners at the University at Buffalo, the Patient–Centered Medical Home effort demonstrates that we are on the forefront of bringing the right care at the right place at the right time to the patients of our community to improve the health of the community. ”

Buffalo General wins Consumer Choice Award Buffalo General Medical Center (BGMC) was recognized with a 2016/2017 Consumer Choice Award by National Research Corporation for a third year in a row. The annual award identifies hospitals across the United States that healthcare consumers choose as having the highest quality and image. “The BGMC team continues to receive national recognition for their expertise and dedication to patient care,” said Chris Lane, president

ECMC Has Record Number of Kidney Transplants 118 kidney transplants reach highest level of transplant activity in ECMC history; 13 pancreas transplants also performed

rie County Medical Center Corporation (ECMCC) announced that 2016 will establish the highest level of kidney transplant activity in the hospital’s history. One hundred eighteen kidney transplants have taken place at ECMC as of Dec. 16, coming from both living and deceased donors. Since 2010, kidney transplants at ECMC have increased approximately 19.4 percent. In addition to the kidney transplants, ECMC’s Regional Transplantation and Kidney Care Center of Excellence performed 13 pancreas transplants in 2016, taking the Kayler center’s total transplants to an all-time high of 131. “We are committed to providing the very best environment to ensure that those in need of a kidney transplant come through our process not just with a new, functioning organ, but an overall improved quality of life, said physician Liise Kayler, the program and surgical director of transplantation. “We are thankful to those that have joined the state’s Donate Life

Registry, as well as living donors, as they all have a profoundly positive impact on the lives of those they help,” Kayler added. ECMC’s Regional Transplantation and Kidney Care Center of Excellence is equipped to treat patients at every stage of kidney disease or kidney failure. The center’s transplant program has offered kidney transplants since 1964 and pancreas transplants since 2004. ECMC has an experienced multidisciplinary team that serves Western New York with consistently high scores in outcomes and transplant rates from deceased donors. It also offers laparoscopic (minimally invasive) donor nephrectomy (kidney removal) procedures to promote faster recovery for live kidney donors. “ECMC’s Regional Transplantation and Kidney Care Center of Excellence is comprised of dedicated, compassionate caregivers who devote themselves to providing the highest quality transplantation services with the best outcomes for patients, their families and loved ones,” said ECMCC President and CEO Thomas J. Quatroche Jr. “This milestone year, leading to the most kidney transplants in ECMC’s history, provides great promise for our continuing effort to be our region’s leader in quality healthcare.”

of Buffalo General Medical Center. “This Consumer Choice Award recognizes our frontline staff — those at the bedside. Our team continues to set new standards of excellence.” This year marks the 21st anniversary of the Consumer Choice Award celebrating the power of a strong brand image in healthcare. “For each of the past 21 years, winning hospitals have provided outstanding experiences that have transcended their four walls to drive consumer preference, trust, and loyalty in their markets. We are honored to congratulate this year’s winners on a job well done,” said Brian Wynne, market insights general

manager at National Research Corp. Winners are determined by consumer perceptions on multiple quality and image ratings collected in the company’s Market Insights survey, the largest online consumer healthcare survey in the country. National Research surveys more than 300,000 households in the contiguous 48 states and the District of Columbia. Hospitals named by consumers are analyzed and ranked based on Core Based Statistical Areas defined by the U.S. Census Bureau, with winning facilities being ranked the highest.

ECMC Recognized As ‘Hospital of The Year’ By Apogee Hospitalist physician group honors ECMC for partnership, trust, collaboration and shared vision of excellence in patient care Erie County Medical Center (ECMC) was recently recognized by Apogee Physicians as “Hospital of the Year” during a national meeting in Phoenix, Az., Nov. 18. Each year, a hospital is selected from all hospitals across the country that partner with Apogee to provide hospitalist care based on specific criteria, including relationship between the hospital, hospitalist team and Apogee senior leadership, respect and mutually shared goals of excellent patient care; partnership with the hospitalist team and improved patient and provider-focused care. “Apogee has been an important part of ECMC’s ability to provide quality care to our patients. They have been involved in the historic growth at ECMC, as well as the reduction of patients’ length of stay to the lowest levels ever, said ECMCC President and CEO Thomas J. Quatroche Jr., said. “Quality and efficiency have been their hallmark, and ECMC’s results have exceeded their national counterparts.”

ECMCC Chief Medical Officer Brian M. Murray said, “I commend ECMC and Apogee physicians and all clinical and support staff for working seamlessly to provide the best medical care to those who seek our care. It is this teamwork and shared commitment to our patients that sets ECMC apart and distinguishes our caregivers.” According to Apogee Physicians northeast regional director, physician Jaime Upegui, the hospital’s leadership has created an atmosphere “where we could recruit to the model that we needed, which they supported. Staff was added, the rounding structure was changed, and the nurses were willing to work with us and be patient as we mutually sought what was best for our patients. “Emergency department throughout has improved and Apogee is now the preferred admitter. The Centers for Medicare and Medicaid Services HCAHPS [Hospital Consumer Assessment of Healthcare Providers and Systems] patient satisfaction survey data and LOS [length of stay] results are improving — all related to excellent partnerships in the hospital,” according to Upegui

Accepting the Apogee “Hospital of the Year” award recognizing ECMC, presented during the Apogee Physicians national meeting Nov. 18, in Phoenix, Az., are physicians (from left): Michael Gregory, CEO, Apogee; Ashvin Tadakamalla, site director, Apogee; Joshua Case, implementation site director, Apogee; Jaime Upegui, Northeast Regional director, Apogee.

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Physicians, Shouldering the Brunt, Carry On ‘To my knowledge, no other profession has had to endure more changes or more attacks on their autonomy than that of physicians’ By George W. Chapman

have worked with physicians, as an administrator or consultant, in every type of healthcare setting including primary care, specialty care, community and regional hospitals, health centers, clinics, for profit, nonprofit, urban and rural for my entire career. At no time have I been more impressed by their professionalism, fortitude, resiliency, adaptability and, yes, sanity, as I am now. Unbeknownst to most people, your physician has managed to carry on and provide you with excellent care while shouldering the brunt of the most radical and comprehensive (but well intentioned) changes in the healthcare industry since Medicare. Despite the virtual healthcare war being waged in Congress and all the uncertainty in the industry it creates, your physician continues to provide excellent care and remains your best advocate. The Patient Protection and Affordable Care Act of 2010, or ACA, set into motion dramatic, pervasive and unproven changes in how healthcare will be

organized, delivered and reimbursed. It will impact all of us, regardless of age or insurance. But most consumers would never know that because the press and politicians have focused almost exclusively on the exchanges. The exchanges are a relatively small component of the entire ACA. Of the 20 million people who receive their insurance because of the ACA, 7 million are on expanded Medicaid which leaves only 13 million out of 320 million of us (4 percent) purchasing individual insurance from a commercial insurance company on the exchange. The obsession with the premiums and carriers offering insurance on the exchanges has totally

overshadowed the rest of the ACA which impacts us all. There is much more at stake for physicians, hospitals, payers and all 320 million of us than just the exchanges. Some background is in order. Prior to the ACA, there was general consensus among the “players” (physicians, hospitals, insurers, government, employers) that our fragmented and super expensive US healthcare system had to change. Healthcare costs us more then $3.2 trillion annually or about $10,000 per person which is more than double the per capita costs in Germany, Sweden, Canada, France, Australia and Japan. The ACA was developed with input from all the players. But because everyone had vested interests to protect, what we got was compromise, not a perfect solution, and we all know how hard it is to keep everyone happy. So what happened? The ACA became a political football and critics quickly dubbed it “ObamaCare.” When Medicare was passed into law in 1965, it wasn’t dubbed “JohnsonCare.” We all know the more political anything becomes, the more irrational, divisive, emotional and uncivil the discourse. Facts are twisted or spun — if not totally ignored — and the search for blame and the development of straw man arguments begin. There is far more to the ACA, and its impact on physicians in particular, than meets the public eye. Hundreds of billions have been invested by the players in preparation for the changes, agreed upon in principle, to improve affordability, access and quality. “Triple Aim” is the mantra of system reform: improve overall health, enhance the experience of receiving care and lower costs. Six years into the ACA, just about every horse is out of the barn. Repealing and replacing the ACA would be like canceling an important experiment before the results were in. The ACA has been rolled out in phases and will continue to be rolled out until 2022. We are half way. Because of all that has been invested so far, none of the critical players in healthcare (physicians, hospitals, insurers), is actively lobbying Congress to kill the ACA. Too much money has been invested in complying with the ACA, especially by physicians and hospitals. Our healthcare system will take time to fix and starting over or introducing new legislation half way through the 12th-year ACA experiment makes no sense. As politicians, pundits and analysts pontificate, and government agencies regulate, and “big insurance” and “big pharma” bloviate about decreased profits, physicians have quietly scrambled to comply with the myriad of mandates and changes, all the while managing to take care of us. In order to get paid, or not be penalized, physicians have had to (for better or worse): master one or more electronic medical records systems; morph

‘Repealing and replacing the ACA would be like canceling an important experiment before the results were in. The ACA has been rolled out in phases and will continue to be rolled out until 2022. None of the critical players in healthcare (physicians, hospitals, insurers) is actively lobbying congress to kill the ACA.’ into population managers; transition from fee-for-service reimbursement to fee-for-quality or outcome; learn new and ever changing procedural and diagnostic coding; adhere to quality metrics and incentives that differ by third party payer; forfeit their autonomy by working with “care management teams;” affiliate with the alphabet soup of “health systems” out there such as ACOs (Accountable Care Organizations) and CINs (Clinically Integrated Networks); compete with retail clinics; incorporate telemedicine and online access; and much more. Factor in declining revenue and increasing expenses on top of all this and you can appreciate what physicians have had to deal with over the past few years. While physicians aren’t happy with every aspect of the ACA, most agree things had to change. Despite all the regulations, mandates, confusion, and even uncertainty as to how they will eventually be paid, physicians do remarkably well according to their patients. A Harris poll from about a year ago revealed that 88 percent of those surveyed report they were “satisfied” with their most recent doctor visit. The aspects of a visit to the doctor’s office considered to be “very important” are: doctor’s training and expertise: 83 percent; doctor’s ability to access overall medical history: 65 percent; time spent with doctor: 58 percent; ease of making an appointment: 49 percent; efficient and simple billing process: 45 percent; ability to communicate with the doctor by phone or email: 44 percent; time spent waiting: 43 percent; convenience of office location: 40 percent; minimized paperwork 32 percent; office appearance: 31 percent. To my knowledge, no other profession has had to endure more changes or more attacks on their autonomy than that of physicians. Yet, they are exhibiting an uncanny ability to block all the “distractions” around them and focus on us in the exam room. Physicians are a tough breed. They aren’t looking for our sympathy. Physicians are looking for us to be compliant and to take responsibility for our health. They want us to be active partners in our healthcare. Their success will depend on our success in the new reimbursement system. Finally, I think a little understanding and appreciation are in order. Hopefully, you now have a little better idea of the conditions under which they are working. So… if your physician is running a bit behind or seems to rarely look up from his/ her laptop, cut him/her some slack. Consider how they must carry on while shouldering the brunt of change.

George W. Chapman is a health consultant who operates GW Chapman Consulting in Upstate New York. To reach him, email gwc@gwchapmanconsulting.com. Page 20

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