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Medical Student Syndrome

By Sujata Ojha, MS – III

This article was originally published in the July/August 2022 issue of the Tarrant County Physician.

As medical students, we have an incredible opportunity to discover a vast amount of medical knowledge, learn about the normal and the pathological, and to immerse ourselves in clinical settings where we witness the complexity of diseases. In the process of learning about life-threatening diseases, the risk of nosophobia, or illness anxiety disorder, can develop. More commonly termed “Medical Student Syndrome,” it is a concept that medical trainees are well acquainted with. 

What is Medical Student Syndrome? It is the phenomenon that causes fear of contracting or experiencing symptoms of the disease that the students are studying or are exposed to.  

Medical students learn the pathophysiology, the diagnosis, the treatment, the prognosis, the best-case scenario, and the worst-case scenario of diseases. We learn about teenagers diagnosed with melanoma and hear stories about patients in their early 20s diagnosed with breast or cervical cancer. The worst-case scenario tends to grab our attention. This reinforces us to not ignore a patient or symptom that doesn’t follow the general pattern of the disease, allowing us to widen our baseline scope of clinical suspicion when it comes to debilitating pathologies. The constant medical stimulation and limited clinical experience earlier on in our education can cause students to become preoccupied with symptoms and construct connections between what we are experiencing with the worse-case scenarios we learn about. 

“I booked an appointment with the dermatologist because I thought I had a melanoma,” said one classmate after we shortly finished our dermatology unit. After undergoing a biopsy, the classmate discovered that the melanoma in question was a benign nevus. During the cardiopulmonary block, another medical student said he went to the ER after experiencing mild epigastric pain and tachycardia, thinking he was experiencing symptoms of atypical myocardial infarction. He had recently encountered a patient in his late 30s with a history of MI who presented with similar symptoms, further reinforcing the “worst-case scenario” in this trainee’s mind. After hours spent in the ER, he was diagnosed with gastritis and sent home with a prescription for a proton-pump inhibitor. 

Throughout my medical training, I have heard countless stories resembling these. This is not an uncommon phenomenon that trainees experience. It is a topic that everyone in medicine is familiar with, whether through personal anecdotes or through stories discussed with classmates, mentors, and acquaintances. Understanding the complexity of medicine takes more than four years of medical school. Medicine is a field that requires life-long learning and an internal motivation to be updated with evidence-based practice. Expertise comes with clinical experience and after encountering numerous successes and failures. I believe that these experiences can help future physicians connect with their patients more effectively. If we as medical trainees can fall victim to an overwhelming fear of vague symptoms, how can we expect our patients with limited medical knowledge to be immune to this? With Dr. Google, a benign tension headache can be escalated to look like brain cancer. Understanding these fears and reflecting on the days when we experienced these uncertainties can bridge the gap in patient-physician encounters. It allows us to effectively address the patient’s fears without judgement, urging us to educate our patients about their symptoms instead of dismissing or minimizing them. 

TCMS Legislative Committee Kickoff

Join us for a night of fun and advocacy training as we kick off our 2023 TCMS Legislative Committee meeting.

In partnership with TMA lobby staff, you will learn about the top issues, challenges, and techniques we will use to advocate on behalf of physicians and patients during the upcoming session.

The TCMS Legislative Committee is one of the most active advocacy groups in all of Texas, and we need a strong bench of leaders who continue to be involved here in Tarrant County, Texas, and Washington D.C.  Please RSVP to Elizabeth Bowers at

TMA Report

The development of TMA policy

by Gary Floyd, MD, TMA President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Over the past year, the Texas Medical Association has had to weigh in on one sensitive topic after another—from issues impacting the patient-physician relationship to how physicians practice medicine and the prevention of further cuts in the Medicare program.

Often, after TMA publishes its stance in the association’s daily newsletter, Texas Medicine Today, we receive inquiries from members on how TMA came up with that position since no one surveyed them individually or asked for their opinion. This has made me realize many of our members don’t understand who runs TMA or the process TMA uses to develop its policy, which drives the association’s communications and advocacy. 

The association is governed by a 500-member House of Delegates, the legislative and policymaking body. The House is made up of elected county medical society delegates (one delegate per 100 members or fraction thereof) and the following ex officio members: members of the Board of Trustees; 15 councilors; Texas delegates and alternate delegates to the American Medical Association; members of the Council on Legislation and chairs of the other councils; delegates from the Young Physician Section, International Medical Graduate Section, Resident and Fellow Section, Women Physician Section, LGBTQ Section, and Medical Student Section; and delegates of selected specialty societies.

The House of Delegates meets every year at an annual session held during TexMed in the spring. In 2023, TexMed will be in Fort Worth on May 19–20.

The best way to get your idea adopted as TMA policy is to begin at the grassroots level. 

1 Present your idea or change to an existing policy at your county medical society meeting. Ideas and actions also are developed by association boards, councils, committees, and sections. You can work with these groups to develop a policy recommendation.

2 If the county society, section, or other entity agrees, it can submit your idea as a report or resolution to be considered at the next meeting of the House of Delegates. Instructions for writing a resolution are at

3 Every report and resolution is assigned to a reference committee that vets it further through open hearings at which any TMA member can testify. The reference committees then send their recommendations on each report and resolution to the house. If you would like to serve on a reference committee, let our House of Delegates speakers know by filling out the form at 

4 If your idea is adopted by the house, it is incorporated into the TMA Policy Compendium ( If it has nationwide appeal, it may also be forwarded to AMA for action.

As TMA president, I am obliged to represent our TMA policies. As you can imagine, we have members on both sides of several very sensitive issues. Some members would like TMA to issue an immediate, strong opinion favoring their stance. However, by working with our legislators, we have learned that calm, measured, commonsense approaches are far better received than knee-jerk responses. Therefore, in our responses we tend to emphasize areas of commonality for our members, like protecting the sanctity and privacy of our patient-physician relationships and creating a safe environment for our physicians to exercise their best medical judgment in providing the appropriate standard of care for all their patients. 

Please reach out to your county medical society and learn more about TMA’s policymaking process. We want to hear from you!

Linda Siy, MD, named Texas Family Physician of the Year

Linda Siy, MD, of Fort Worth, Texas, has been awarded the highest honor among Texas family doctors by the Texas Academy of Family Physicians. She was named the 2022 Texas Family Physician of the Year during TAFP’s Annual Session and Primary Care Summit in Grapevine on Oct. 29. Each year, patients and physicians nominate extraordinary family physicians throughout Texas who symbolize excellence and dedication in family medicine. A panel of TAFP members chooses one as the family physician of the year.

“It truly is an honor to join the ranks of those who have received this distinction, and I’m very humbled to be considered with those distinguished colleagues who previously were Family Physicians of the Year,” Siy said as she accepted the award.

Siy has been a family physician for over 30 years, and currently practices at John Peter Smith Health Network at the Northeast Medical Home in Tarrant County, a practice she’s been a part of since 1995. She is also faculty at the University of Texas Southwestern School of Medicine, the University of North Texas Health Science Center/Texas College of Osteopathic Medicine, and the Texas Christian University Burnett School of Medicine.

Throughout her years in organized medicine, Siy has served on many committees and councils for both TAFP and the American Academy and has been president of the TAFP Foundation since 2017. She serves on the Acclaim Multispecialty Group’s Physician Board of Directors, and previously served as president of the Tarrant County Medical Society and TAFP’s Tarrant County chapter.

Siy has spent her career in medicine treating her loyal and multi-generational families of patients, many of whom are underserved, suffer from housing and food insecurity, and struggle with mental health and substance abuse. Many of her nominators mentioned her willingness to speak up and ask the questions others are too afraid to ask, as well as her dedication to teaching the next generation of family physicians.

“I think what’s kept me in the game for so long at the place where I work now are those rewarding relationships with your patients, with your staff, with your colleagues,” Siy said of her career in family medicine. “It’s really not a job. It’s a calling.”

It’s Not Okay

President’s Paragraph

by Shanna Combs, MD, TCMS President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

On June 23, 2022, the Tarrant County medical community lost an amazing physician, who died by suicide.  He was a remarkable person whose work touched so many lives—he was always willing to help others.  He is greatly missed by all who knew him.     

Unfortunately, physician suicide has become an all-too-common occurrence in the United States.  

• Approximately 300–400 physicians die by suicide each year in the U.S.

• Among male physicians, the suicide rate is 1.41 times higher than the general male population.  

• Among female physicians, it is even more pronounced at 2.27 times higher than the general female population.1  

As terrible as this sounds, there is hope.  Physicians who are proactive about their mental health are able to take better care of their patients as well as have more resilience in the face of stress.  However, this is not so easy to accomplish.

There is already a stigma associated with mental health, and it is made even worse for physicians due to the concern of needing to report a diagnosis to our medical boards, licensing organizations, as well as to credentialing offices in the hospitals and health systems we work in.  We as physicians also have difficulty taking care of ourselves in general, let alone when it comes to mental health, as we are the healers and must be perfect.  

The truth is, being a physician is hard.  We train for many years to be able to do the work that we do.  We often share our war stories about medical school and residency, but when it comes to the deeper struggles we have, we tend to keep those to ourselves.  We push them down and hide behind a smile (or a mask) and continue to pretend that everything is okay.  

But it’s not okay.

We as a profession need to start taking care of ourselves and looking out for our colleagues.  It is okay to tell someone when you are struggling and to seek out help when you need it.  A psychiatrist friend puts it best—“Everyone needs a therapist.  I have one.”  At some point we all learned the physiology of the human body, and of the brain specifically. Sometimes that brain needs a little extra help from chemistry, and that is okay as well.  If you have a thyroid problem, you do not put up a fight about taking a thyroid pill. The same goes when our brain chemistry needs a little help.  We also need to reach out to one another, to check in and see if our colleagues are really doing okay and if they need any help or support.  It’s okay to not be okay, but we need to recognize this and seek out the help we so desperately need, and to help our colleagues obtain the help that they need.

We also need to work from an advocacy standpoint so that physicians can seek the help that they need without the fear of needing to report their illness.  All other aspects of medicine and healthcare are taken care of in a private manner between a physician and a patient.  Why should mental health be any different?  Until this changes, no number of wellness programs, resilience building, etc., will be able to fix the problem.  

I encourage everyone to seek help when needed and to reach out to our colleagues, partners, and friends.  We have worked tirelessly to get to the point we can practice medicine, and those around you want you to stay here.

1John Matheson, “Physician Suicide.”  American College of Emergency Physicians. Accessed August 3, 2022.,times%20more%20often%20than%20females

Mental Health Resources

National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Available 24/7

Crisis Text Line
Text TALK to 741-741
Available 24/7

Physician Support Line
1 (888) 409-0141
Open seven days a week,
7:00am – 12:00am CST
Psychiatrists helping their U.S. physician colleagues and medical students navigate the many intersections of our personal and professional lives. Free and confidential. No appointment necessary.

Emotional PPE Project
The Project connects healthcare workers in need with licensed mental health professionals who can help.

Join Cook Children’s for Ask the Doc Webinar on Pregnancy Care

Join Cook Children’s Medical Center on November 1, 2022, 5:30 PM – 6:30 PM CT, for their upcoming Ask a Doc webinar: “Do No Harm: The Ethics, Myths & Business of Caring for Pregnant People.”

The event, which is led by the Texas Department of State Health Services – Oral Health Improvement Program and the Children’s Oral Health Coalition, is focused on education, combatting barriers to healthcare, and coordinating services.

A number of topics will be covered, including:

  • Explaining ethical dilemmas related to delaying treatment
  • Discussing the myths dentist have about treating pregnant people
  • Recognizing why timely treatment is good for business
  • Identifying and manage potential medical and dental risk

You can find out more about the event or register here.

Physicians Urge Texans to Safely Return Unused Prescription Medication

Saturday is National Prescription Drug Take Back Day

Have unused, unneeded prescription drugs at home? Turn them in now, physicians say.

Texas doctors recommend people with unused or expired prescription drugs at home dispose of them safely this weekend, so they are not accidently consumed.

As the state grapples with a sharp increase in opioid overdose deaths, the U.S. Drug Enforcement Administration is organizing its biannual prescription drug Take Back Day on Saturday, Oct. 29. Prescription drugs can be returned anonymously at pop up locations across the state. Syringes or illegal drugs cannot be taken.

Returning unused medication is an important step to prevent misuse of prescription medication, especially opioids.

“The overwhelming majority of people who suffer from opioid addiction got started by getting opioids from friends and family,” said C.M. Schade, MD, a Texas Medical Association (TMA) physician leader and past president of the Texas Pain Society (TPS). “Their opioid addiction was not caused by taking opioids that were prescribed to them.”

According to the 2020 National Survey on Drug Use and Health, more than 9 million people aged 12 and above misused prescription pain relievers like hydrocodone, oxycodone, morphine, and prescription fentanyl.

Dr. Schade warns that consuming medication not meant for you can be life threatening. “Taking opioids that are not prescribed to you is especially dangerous because in the opioid-naïve patient it causes breathing problems that can cause brain damage and even death.”

Dr. Schade also said giving your prescription medication to others is both illegal and harmful. “You will be intentionally or unintentionally enabling dysfunctional behavior, which is not only unhealthy but oftentimes leads to addiction and/or death.”

While Dr. Schade noted illegal drugs – especially those laced with fentanyl – are largely to blame for the opioid epidemic, safely disposing of prescription medication is one way to prevent an overdose from occurring.

“The drug take-back program, while important, only removes one source of drugs that people who are addicted can use to get a drug to satisfy their addiction,” he said. “What is needed is a comprehensive program to engage these people in the health care system so that they will get medical care such as counseling and medication-assisted treatment.”

TMA and TPS physicians have been raising awareness about the dangers of street drugs. Dr. Schade testified before the Texas House Committee on Public Health last month and offered lawmakers several recommendations to curb deaths from illegal opioids including making naloxone – a medicine that reverses overdose – available over the counter without a prescription.

Free pop-up medical, vision and dental clinic coming to Dallas in December

HSC & Remote Area Medical have partnered again to bring free care to those who are underserved and uninsured.

The University of North Texas Health Science Center at Fort Worth and Remote Area Medical – RAM® — a nonprofit provider of pop-up clinics that delivers free quality dental, vision and medical care to those in need — are bringing the free clinic to Dallas on Dec. 3 and 4.

After a successful clinic in North Fort Worth last year, the organizations decided to partner again and bring the clinic to Dallas, allowing them to serve a larger population in an accessible location.

Services offered at RAM will include dental cleanings, fillings, extractions and X-rays; eye exams, glaucoma testing and eyeglasses prescriptions with glasses made on site; women’s health exams; and general medical exams. RAM services are on a first-come, first-served basis, free of charge, and no ID is required. A clinic of this magnitude is not possible without the help of volunteers — both medical and general.

“With the help of 329 volunteers, last year’s clinic transformed the lives of more than 400 people,” said Jessica Rangel, HSC executive vice president of health systems. “We are anticipating needing more volunteers this year. This is a unique opportunity to serve for everyone. Whether you’re a physician assistant, dentist or community member, there is a role for you at RAM.”

This year’s event will be held at the Kay Bailey Hutchison Convention Center, 650 S. Griffin St., in Dallas.

“It is critical that we show our neighbors and friends we care and are there to support them,” HSC President Sylvia Trent-Adams said. “Our collaboration with RAM provides us with the opportunity to make a positive impact in our community.”

For more information about RAM’s pop-up clinics, to donate or to volunteer, visit or, email Katy Heesch at or call 817-735-2000. 

My First Practice Experience

by Robert Bunata, MD

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

The first time I saw and treated patients in a private practice setting, other than moonlighting in an ER or at the Cook County jail, was in 1968 when my dad, a general practitioner, had a heart attack as he entered Oak Park Hospital to make rounds on a freezing January day.  He checked himself into the ER, ordered an EKG, and later called me from the ICU to ask if I could cover his office appointments once or twice a week.  My mother, who knew all of his patients, called and rescheduled appointments for the evenings when I was free from my third-year orthopedic resident responsibilities.  

I dressed in a suit and tie, removed the blood stains from my shoes, and carefully combed my hair. Not the usual resident attire; I had to look dignified to fulfill this responsibility.  The first night, elderly Mrs. Novak came for her office visit with a simple request for cough syrup, adding a weak, pitiful “cough, cough.”  I wrote a script which she promptly handed back, “No, no. that’s not the right one,” she admonished. “The one with the silver label, the one your dad gives me. I think the name is, oh, I don’t remember. I wrote it down so there’d be no mistake.”  Knowing exactly what she was seeking, she handed me the note.  I looked up the medicine’s name in the PDR (an old-fashioned, remarkably thick and heavy red book with Bible thin pages listing every known medicine in three separate indexes in a way only Sherlock or an egghead could understand).  Carefully perusing the ingredients, I saw: 15% alcohol.  Over the next few weeks, I got several more requests for medicinal nightcaps.       

The second evening a patient reported, “I’ve got my usual sinus infection again, and I need the treatment your dad does. It’s the only thing that works.”  I nodded knowingly and said, “Just a minute while I get some extra supplies.”  My dad shared this office, a converted residential apartment, with a friend who was a dentist.  My dad’s part was the dining room and kitchen, while Ed drilled teeth in the bedroom and made crowns in a closet. They were like two peas in a pod.  I stepped into Ed’s closet and, despite my dad still being in the ICU and after much hesitation, called the Oak Park Hospital where a dedicated nun answered, “Okay, I can let you talk to him this time, but we can’t make a habit of it.” Hah, little did she know.      

I got carefully worded instructions as to what “the treatment” was. After wrapping a generous wad of cotton on an applicator, I soaked it in epinephrine and then in cocaine (standard office formulary at that time).  Next was the hard part, a part my dad had extensively practiced but I had never conceived of doing.  I put on the doctor’s head mirror, the kind you used to see doctors wear in cigarette commercials, and sat facing the patient, who was in a chair in front of a bare lightbulb.  I tried to look professional and adept at peeking through the hole in the center of the mirror while focusing on the patient’s nose, but I blinded him with the concentrated glare.  Since my retina-burned patient squeezed his eyes shut and couldn’t see my incompetence, I felt comfortable peeking around the mirror’s edge.  I jammed and twirled the cotton swab quickly into one nostril, then the other, pausing to wipe away the tears, his and mine.  Seeing no blood, I surmised I hadn’t done much damage.  After a burst of sneezing and snorting, the patient said, “Thanks, doc, that’s a whole lot better already,” as he blew more stuff out than I cared to look at.  

My dad’s carefully worded instructions included, “I usually charge ten dollars, but his wife recently fractured her ankle, and they have more medical bills than they can afford. So charge him three dollars total.” The instructions didn’t end there. “I know what you’re thinking so listen, I decided long ago that for my peace of mind I would maintain my independence.  I choose to run my business as I see fit, believing that if I take care of my patients, they will take care of me. They’re our neighbors, not cash registers.” 

Okay, lesson received.  But the execution turned out to be the tricky part.  He came ready to pay more, so he handed me a twenty-dollar bill.  Oh goodness, the change must be seventeen.  I, too, had come prepared: five- and ten-dollar bills together in my right side suitcoat pocket, and a roll of ones on the left.  Being a bank teller couldn’t be that hard—after all, I went to medical school.  I took his twenty with my left hand and reached into my right suitcoat pocket for the carefully divided packet of larger bills.  I set the twenty on the desk so I could select one five and one ten from the bundle, and put the rest back in the right pocket, while retrieving the one-dollar bills from the left pocket.  Holding the fifteen dollars pinched between my little finger and palm, I tried to count two singles, but when they stuck together, I dropped the whole wad of ones on the floor.  Scrambling like a pigeon chasing crumbs was ultimately undignified regardless of how impeccably I was dressed.     

Then came Mrs. Smith.  Mrs. Smith’s young daughter had a skin condition (my worst subject was dermatology, which in my mind is akin to sorcery), and Mrs. Smith wanted the cream my dad had prescribed last time.  Once again, I had no idea what she was talking about.  I searched and searched for Mrs. Smith’s record and found nothing on her, her husband, or their daughter. In fact, there was only one Smith in the entire file; it was a most uncommon name in that neighborhood.  I gave up and called the same dedicated nun, who reluctantly turned the phone over to my dad.  “Where is Mrs. Smith’s chart? She wants the cream for her daughter’s rash,” I asked.   My dad chuckled, then said, “Look on the chart labeled ‘Prochaska.’ Lillian Prochaska is Lorain Smith’s mother, and all the family’s records are on one chart.”  Even Mrs. Smith’s husband and daughter? It almost blew my mind.  I recovered the Prochaska family “chart,” three five by eight index cards stapled together, a system from the 1930s when he built his private practice.  Definitely not an EMR.  It took two seconds to find the magic formula.  Not only was the problem solved, but I gained a deeper understanding of the nature of my dad’s private practice.

Twelve years later, my parents went to the Art Institute on a Sunday in January. When they came home my dad shoveled the drive free of snow so he could make rounds the next day, but the next morning he didn’t wake up.  Dr. Bobby Wroten waited in the All Saints doctors’ lounge until I finished my case, then told me my dad had died.  I took the last plane that landed that afternoon before O’Hare was closed due to a gigantic snowstorm, and then caught the last cab home.  Three days later O’Hare had just reopened, and outside the funeral home across the street from my dad’s office, the plowed snow was piled six feet high on the sides of every street, including down the middle of busy Cermak Avenue; the sidewalks were barely passable, and it was 26 degrees.  Once upon a time, an acquaintance had insisted that the number of people who came to a funeral depended on the weather.  The line of people who came to bid my dad farewell filled the funeral home and stretched outside more than a block long. The viewing lasted past closing, well into the night.  

That was my first experience with my dad’s “family practice” and medicine in the sixties.    

TCPH Announces COVID-19 Vaccine Clinics for the Week of October 8

Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna and Pfizer vaccines and at times the Johnson & Johnson. Children five and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.

TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches and organizations in the community who are interested in hosting a pop-up clinic. It’s easy and free to host a clinic.
In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.

Pop-Up COVID-19 locations:

Coral Rehabilitation of Arlington
Monday, Oct.10: 12 p.m. to 4 p.m.
1112  Gibbins Road
Arlington, TX 76011

Cityview Nursing and Rehabilitation 
Wednesday, Oct.12: 9 a.m. to 1 p.m.
5801 Bryant Irvin Rd.
Benbrook,  TX 76132

Grace Metroplex
Wednesday, Oct. 12: 10 a.m. to 1 p.m.
1310 South Collard St.  
Fort Worth, TX 76105

Haltom City Public Library
Friday, Oct. 14: 11 a.m. to 3 p.m.
4809 Haltom Road  
Haltom City, TX 76117

City of Arlington
Friday, Oct. 14: 10 a.m. to 4 p.m.
2800 S Center St.  
Arlington, TX 76014

Tarrant County Public Health CIinics:

Northwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3800 Adam Grubb Road
Lake Worth, TX 76135

Bagsby-Williams Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3212 Miller Ave.
Fort Worth, TX 76119

Southeast Public Health Center
Monday to Friday: 9 a.m. to 12 p.m. and 1 to 6 p.m.
536 W Randol Mill
Arlington TX, 76011

Main Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 6 p.m.
1101 S. Main Street
Fort Worth, TX 76104

Southwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6551 Granbury Road
Fort Worth, TX 76133

Watauga Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6601 Watauga Road
Watauga, TX 76148

For more information go to or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.