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Project Access Tarrant County

Salud en Tus Manos:
Medication
Management

By Kathryn Keaton

This article was originally published in the September/October 2025 issue of  Tarrant County Physician.

On July 16, Project Access Tarrant County (PATC) held its second Salud en Tus Manos class. For those unfamiliar with it, Salud en Tus Manos (“Health in Your Hands”) is a new initiative under PATC that addresses the social drivers of health (SDOH) faced by many of our patients. These classes, provided through Texas Health Community Hope as part of our Community Impact Grant, are designed for patients with diabetes and/or hypertension who live in one of five priority ZIP codes: 76010, 76011, 76104, 76105, and 76119.

The July class, “Managing Your Medications,” guided participants through the entire prescription process—from the doctor’s visit where a medication is prescribed to understanding labels, following directions, and knowing how to request refills.

Why This Curriculum Matters
Medication adherence is a challenge nationwide, especially for chronic conditions like diabetes and hypertension. When compounded by SDOH such as language barriers, limited formal education, or financial insecurity, the consequences can be severe.

In fall of 2024, PATC saw this firsthand. A 39-year-old woman had waited more than a year for gynecological surgery. When she finally received a surgery date, her pre-op testing revealed dangerously uncontrolled diabetes. Records showed she had not returned to her primary care provider since her initial PATC referral, and she admitted she skipped follow-ups because she “felt fine.” Without those visits, she never received medication refills. Her surgery was canceled, delaying treatment another five months. Though she eventually had a successful procedure, her experience underscores the importance of consistent care and medication compliance—the very issues Salud en Tus Manos seeks to address.

Who We Reached
Our July participants were foreign born with a median age of 45. All had lived in the United States for at least 18 years. The highest level of formal education completed was eighth grade, with 75 percent of the attendees’ education taking place outside the United States. Every participant had hypertension, and half also managed diabetes. All reported attending medical appointments every three to six months.

While all participants felt “extremely confident” in understanding their medications, half believed they could take prescriptions however they wished as long as the medication was prescribed, and all believed they could not receive their medications in their preferred language.

Encouragingly, the post-survey showed significant improvement: 100 percent of participants correctly recognized the importance of taking medication exactly as prescribed.

Hands-On Learning
The class combined instruction with interactive activities. Participants identified warning labels, practiced interpreting dosage and timing instructions, and learned when and how to request refills—not only for their chronic condition medications but for all prescriptions.
Like our first class in March, participant satisfaction scores reflected both engagement and impact. The curriculum is clearly filling an important knowledge gap and helping patients feel more confident in managing their health.

Looking Ahead
Medication management is a crucial step toward improving long-term health outcomes, and Salud en Tus Manos is proving to be a meaningful resource for patients navigating barriers to care. With every class, PATC and its partners continue working toward healthier futures for our community.
Our first class, “How to Communicate with Your Doctor,” gave patients the tools to ask questions and advocate for themselves during medical visits. This September, we will be offering that class again—this time with two sessions, one in English and one in Spanish. The program will continue to grow. The next planned class, “Food as Medicine,” specifically requested by half of past Salud en Tus Manos attendees, will explore how nutrition choices can support patients in managing chronic conditions and improving their overall well-being. Together, these classes are building a foundation for healthier lives—one step, one conversation, and one patient at a time.

The Last Word

Lifestyle Modifications

By Hujefa Vora, MD, Publications Committee Chair

This article was originally published in the September/October 2025 issue of  Tarrant County Physician.

With your annual physical last week, we drew annual labs. We’ve got to discuss these results today. Your cholesterols need better control. Your total cholesterol is greater than 200 mg/dL, but to really understand these results, we’ve got to look at the breakdown. Your HDL, your “good” cholesterol, should be higher than 40 mg/dL. It looks like we have some work to do on this.

No, you don’t need to increase your cholesterol intake. To raise your HDL level, you need to increase your aerobic exercise. You need to make some lifestyle modifications. Your LDL, your “bad” cholesterol, is markedly elevated, and this is not a good thing. This combination of low HDL and high LDL can dramatically increase your risk for cardiovascular disease. I want to finish reviewing these lab reports, and then we will take a few minutes to circle back to this issue. Let’s see here. Your kidney and liver function tests are normal. Your fasting blood sugar is a little higher than expected. Your blood counts, red blood cells, white blood cells, platelets—all look good, which means your inner factory is working. The implication here is that your nutritional status is good. Your body has all of the raw materials it needs to produce all of these cell lines. Your thyroid appears to be functioning at normal levels. Finally, and most importantly, there is the matter of your glycosylated hemoglobin level. This has nothing to do with the blood counts and hemoglobin we reviewed earlier. It is actually also called hemoglobin A1c. This is a measure of your average blood sugar level over the past three months. And your A1c is just a tad on the higher side here. The World Health Organization defines diabetes as an A1c of 6.5 percent or greater. Your numbers landed in the prediabetes range. So now we’ve really got some more issues to talk about.

Alright, no time to panic. I want us to relax and really understand what it is we are talking about here. Prediabetes is like a warning shot. Your body is telling us that if we don’t take action in the here and now, then you are at significant risk of developing diabetes.

No, you are not diabetic. I understand that you feel fine, that you don’t feel diabetic. The thought I want to stress to you is that this is a preventative visit. Our goal is to prevent the complications of low HDL, high LDL, and borderline hemoglobin A1c. Those complications include heart attacks, strokes, kidney disease, vision disturbances, all ultimately negatively affecting your quality of life, possibly even your quantity of life.

No, these levels are not fatal, but if we let these things go long enough without addressing their root cause, the complications can be detrimental to your overall health. The most effective ways to lower your risk of developing diabetes when you are prediabetic are by losing weight, increasing physical activity, and eating a healthy, well-balanced diet. I don’t expect you to go out and run a marathon (although that would be amazing!) but rather just make some modest lifestyle modifications. If you are able to effectively make lifestyle modifications, then we may be able to avoid full-blown diabetes. We may not necessarily need to prescribe medications right off. Lifestyle modifications most certainly can help to decrease your risk of heart attacks and strokes.

Lifestyle modifications. That’s a buzzword that we talk about in our offices all the time. I’m going to give you some food for thought at this point. Lose excess weight. For people who are overweight, losing just 5 percent to 7 percent of your body weight can reduce your risk of developing type 2 diabetes by over 50 percent.1 Increase physical activity. The CDC recommends getting at least 150 minutes of moderate-intensity aerobic exercise per week.2 This can include activities like brisk walking, cycling, or water aerobics. Regular exercise helps your body use insulin more effectively. Combine cardio with strength training. Incorporating strength training for all major muscle groups at least two days a week further improves insulin sensitivity and glycemic control.2 Quit smoking. Smoking can increase insulin resistance, making it harder for your body to manage blood sugar. Get enough sleep. Poor sleep is linked to insulin resistance and weight gain. Aim for seven to nine hours of quality sleep per night. Manage stress. Chronic stress can increase blood sugar levels. Find healthy ways to cope, such as meditation, yoga, or deep breathing exercises.

Lifestyle modifications also include making dietary changes. Focus on whole foods. Emphasize a balanced diet rich in vegetables, fruits, whole grains, and lean proteins and low in saturated and trans fats. Choose high-fiber foods. Fiber-rich foods, such as vegetables, fruits, and whole grains, slow down digestion and prevent rapid blood sugar spikes. Limit refined carbohydrates, processed foods, and added sugars. Avoid or limit sugary drinks, processed foods, and refined carbohydrates like white bread and pasta, which can cause blood sugar levels to spike. Drink more water. Water is the best choice for hydration and helps to maintain healthy blood glucose levels.

In the American medical system, we don’t emphasize preventative medicine as much as we emphasize reactionary medicine. We are taught to take care of the problems, treat the complications of underlying symptom-free subclinical metabolic issues. As primary care physicians, our role is to work to prevent disease, keeping you healthy so as to avoid illness. Most of what I discuss with my patients in clinic was not given to me through books in medical school but rather acquired through years of experiential learning, caring for the healthy, and teaching them to avoid disease. Lifestyle modifications don’t always get into our medicine textbooks but they should. The point of my diatribe today? Make sure that all of you are going to see your primary care physicians. Make sure that you are taking care of your health, so that all of us can better understand and serve our patients. My name is Hujefa Vora, MD, and this is my Last Word.

References:

  1. “Diabetes Prevention: 5 Tips for Taking Control,” Mayo Clinic, March 12, 2025, https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-prevention/art-20047639.
  2. U.S. Afsheen Syeda et al., “The Importance of Exercise for Glycemic Control in Type 2 Diabetes,” American Journal of Medicine Open 9 (June 2023): 100031, https://doi.org/10.1016/j.ajmo.2023.100031.

The Magic in Medicine

by Justin Choy, MS-III

A five-year-old boy sat nervously on the exam table at Cook Children’s Neighborhood Health Center on McCart Avenue, his small hands gripping the crinkled paper as his wide eyes darted anxiously around the room. His mother murmured reassurances, but the unfamiliar setting left him frozen with apprehension. Noticing his unease, I reached into my pocket and pretended to pluck something from the air—only to reveal a bright, red sponge ball between my fingers. His eyes flickered with curiosity.

“Wait, where did that come from?” he whispered, his guarded expression beginning to soften.

As I continued, I gently tapped his ear and produced another sponge ball from its depths. His nervousness gave way to delight. A hesitant giggle escaped as he reached out to touch the impossible object. Weaving magic into the physical exam, I guided his gaze with each sleight of hand, subtly assessing his eye tracking and coordination. By the time I placed my stethoscope on his chest, his fear had vanished, replaced by eager anticipation for what trick might come next. In that moment, I saw how magic could do more than entertain—it could transform the clinical experience, turning fear into fascination and apprehension into engagement.

Bringing magic into pediatric care was never something I consciously planned. It began organically—during a clinical rotation, I encountered a young patient anxious about an upcoming procedure. Hoping to provide a distraction, I performed a simple card trick. To my surprise, her face lit up with delight, her fear momentarily replaced by curiosity and laughter. That single moment sparked a realization: magic could be more than just a hobby. It could be a tool for healing, a way to build trust, and a means of humanizing the hospital experience.

As my training progressed, I began incorporating magic into patient interactions regularly. I witnessed how it eased not only the children’s anxiety but also their parents’ worries. A simple trick could transform a tense clinical encounter into one of warmth and engagement, shifting the dynamic from apprehension to familiarity. This newfound approach allowed me to connect with families instantly, making medical visits less intimidating and more inviting.

Recognizing the profound impact of these moments, I sought out ways to bring magic to children in more meaningful ways. I started volunteering at the Dialysis Unit at Cook Children’s Hospital, performing tricks for kids as they received treatment. These sessions became transformative—not just for the children, but for me as well. I watched withdrawn patients brighten with curiosity, asking to see another trick, then another. Parents, often weary from the emotional toll of chronic illness, smiled as they watched their children experience moments of joy amidst their challenges.

Medicine is as much about connection as it is about science. Patients do not care how much we know until they know how much we care. A patient may not recall the specifics of a physical exam, the precise words a physician used, or even the exact diagnosis. But they will remember how they felt—whether they were comforted or dismissed, reassured or anxious. This is why, while medical knowledge and technical skill are essential, the ability to connect with patients on a human level is just as critical. A patient who feels at ease and trusts their provider is more likely to engage in their own care, leading to better outcomes. Just as a magician carefully crafts an experience that leaves a lasting impression, physicians must be intentional about creating clinical encounters that prioritize empathy, understanding, and connection. Whether it’s taking an extra moment to offer reassurance, explaining a procedure in a way that alleviates fear, or simply engaging with a patient on a personal level, these efforts make all the difference.

Magic serves as an unexpected yet powerful bridge in this dynamic. When a child sees a physician not merely as an authority figure but as someone who brings joy and wonder, the clinical setting becomes less intimidating. This principle extends beyond pediatrics into all areas of medicine.

As I continue my journey in medicine, I will carry these lessons forward, striving to cultivate human connection in every patient interaction. I encourage my fellow medical students and physicians to bring their passions into patient care—to find ways to forge deeper connections with patients. Whether through music, art, storytelling, or something as unexpected as magic, these personal touches can transform a hospital experience, offering comfort in moments of uncertainty. Medicine, after all, is about more than just curing illness—it is about nurturing hope, fostering connection, and proving that even in difficult times, moments of magic can still exist.

Reflections at the Conclusion of a Longitudinal Preceptorship

By Yun Tran, MD, MPH; Assistant Professor, Burnett School of Medicine at TCU; Staff Physician, Department of Family Medicine at JPS Health Network

On the last day of practice with the medical student whom I had been precepting for over two years, I couldn’t help but become emotional as I reflected on how the relatively new model of medical education called Longitudinal Integrated Clerkship (LIC) has reignited my passion for medicine.

Three years ago, I resigned from a primary care physician position in a large healthcare system. I was burned out and ready to give up medicine altogether. I enrolled in a Masters of Public Health program, thinking that I would transition away from direct patient care.

Then a phone call came just as I was in the midst of grappling with biostatistics and epidemiology. The chair of the family medicine department at TCU’s Burnett School of Medicine was looking for a course director for the first-year medical student clerkship. My name came across his desk because I had expressed interest in precepting a medical student when I was still working at the aforementioned healthcare system, which had an affiliation agreement with the new medical school. He saw that I was trained at the JPS Family Medicine residency and talked to the program director, who recommended me for the course director position.

Although I had years of experience teaching residents and medical students in the past, I had only a vague understanding of what the duty of a course director at this new medical school entailed. The medical school was two years old at the time and only provisionally accredited. However, with this position, I could see patients on a part-time basis at a county clinic. This would do beautifully while I worked on my MPH degree.

So I jumped in.

The learning curve that followed was steep and difficult, but it was also one of the most rewarding journeys I have taken in my life.

First, I had not considered fully the responsibility of crafting the course curriculum, which involved much more than simply sending students to clinics to learn from their preceptors. I was tasked to develop learning objectives, curate educational materials, and create written assignments to assess students’ learning. Fortunately, the course director before me had a curriculum that I could use as a blueprint to redesign and improve.

Second, the medical school has built based on an LIC, a concept that was foreign to me. In an LIC, throughout the first year, the students are paired with a primary care physician in the community. They go to clinic approximately every other week for a year to learn how to take a history, conduct a physical exam, and practice clinical reasoning, oral presentation, and documentation. The students concurrently take all of their other courses, including clinical skills with standardized patients. My job is to help prepare the students so that they can successfully transition into the second year, where they will have both inpatient and outpatient rotations in their eight core specialty clerkships that are longitudinal.1

Those were formidable challenges on their own, but the most intimidating prospect of my new position, in fact, was having to precept a medical student.

Recall that I was a burned-out and possibly somewhat cynical physician at the time. My fear was that I was going to discourage my student just as she started her first year of medical school. As much as I was unsatisfied with my career in medicine, I understood the need for developing the physician workforce and I still cared about people. I did not want my student to decide medicine was not for her after having me as her preceptor.

So with apprehension, I started this new phase of my career with my brand-new medical student, whose enthusiasm on her first day in the clinic motivated me to be on my best behavior. I took extra care to be a better listener when my patients talked, remembered to ask open-ended questions and wait for them to finish speaking without interruption, and summarized their problems and the plan of action while making sure that I had answered all their concerns. When my student asked me a question I was not too sure about, I acknowledged my ignorance and encouraged her to find the answer and teach me. One of her activities that day was to shadow a patient from their check-in to check-out to gain the patient’s perspective, and during her debriefing, she described how I had helped put the anxious patient at ease during the visit, and she hoped to learn to do the same.

Little did she know that her comment had put me at ease. I had not corrupted her view of medicine on her first day in the clinic. More importantly, I was not faking compassion with the patients. I truly relished being there for my patients and advising them to the best of my ability. I enjoyed the practice of medicine again!

Over the following year, my student grew to be someone who could conduct a full history and physical exam. She could also present her assessment and propose management plans. And by pending orders and having a useful chart note for me, she made me a more efficient clinician. I was also able to evaluate our course curriculum from the perspective of a preceptor. Being an MPH student at the same time also gave me a unique perspective about the needs of students, particularly adult learners. Both roles helped me tremendously as I worked to enhance the curriculum. The clinic itself also went through a transformation. At first, the nurses and medical assistants were inexperienced in navigating the intricacies of having a medical student who would be there long term, but they adapted and grew to value the partnership with the medical student as well.

When my student returned in her second year to complete her family medicine clerkship, she quickly grew to function at a sub-intern level. The patients appreciated having a medical student that they knew and frequently gave her compliments, which boosted her confidence in her ability to become an empathetic physician. I also benefited. As I witnessed my student’s development, her curiosity and eagerness to acquire knowledge, and her caring attitude, I was able to learn much more from her than information on the most up-to-date medicine that she obtained from concurrent clerkships. I also gained a sense of immense fulfillment, knowing that I had a part in putting forth into the world a physician who will be trustworthy, patient-centered, and always in pursuit of continuing education and self-improvement.

On my student’s last day with us, there was a Thanksgiving potluck at the clinic. As she was saying thanks to the staff members who had been her colleagues over the last couple of years, a surge of mixed emotions overcame me. My student would not return after that day, so there was sadness. There was also pride in how “grown up” she was. She was no longer green and unsure. Rather, she was confident, mature, responsible, while still compassionate, humble, and driven to explore and learn. Above all, there was gratitude. After two and a half years of having the privilege to serve as my student’s preceptor, not only had I not ruined her outlook on medicine, but I had also been gifted with a renewed commitment and a purposeful future.

There are many people for me to thank: My program director who recommended me; my chair, who trusted me to learn on the job and perform; and the senior leaders at the medical school, who guided me as they allowed me the freedom to put my vision of what a first-year clerkship could be into reality. I participated in the process that resulted in full accreditation of our avant-garde school, and I witnessed the construction of our school building near the historic grounds of what was once Fort Worth Medical College, the school that had graduated Dr. Frances Daisy Emery Allen, the first woman to complete medical school in Texas. I am thankful to be connected to this exciting part of Fort Worth history as our school is making history again with innovative and progressive initiatives in medical education.

I thank my medical student. She made me a better physician, a better educator, and a much better person altogether. As I have also completed my MPH degree at the same time as this transition, it feels as if I am being propelled into a new phase of my career while she begins the next step in hers. I am full of hope and optimism. I have no doubt I will feel sadness for each subsequent medical student when their time with me is concluded, but I also know that I will feel pride and gratitude over and over and that will serve as fuel for me to continue my work in healthcare.

Notes:

1. This experience changed my career and could also impact yours. Please reach out if you are interested in learning more. An LIC student in their second year may be in the pediatric clinic one morning, the psychiatry clinic in the afternoon, and the operating room the next day. For each core clerkship, they are paired with a preceptor, and they go to each clerkship every week for nearly a year. Hence, it is longitudinal, and the idea is that the student will integrate knowledge and skills from concurrent clerkships to make them better-rounded physicians, and they will not forget information like they might in block rotations. This is a curriculum design known as interleaving. Another component of LIC is for each student to have a panel of patients that they follow over many months to strengthen their ability to deliver empathetic, patient-centered care in addition to learning about disease progression over time. Patients often value these relationships with the medical students and feel more satisfied with the quality of their care.

My Journey to DREAM

by Jackson Tobler, OMS-I

When I first met Alex in high school, I never anticipated that we’d become life-long friends. Alex has an intellectual and developmental disability (IDD), and we met through Best Buddies—an organization that promotes inclusion and friendship for individuals with disabilities. Alex and I developed a good friendship in high school, and we still maintain it today. We talk on the phone each week, and he participates in my family’s March Madness bracket pool each year. He lives in a different state now, but I was recently able to fly out to visit him and his family. His face lit up when I surprised him at his door, and we enjoyed spending a few days together. I am grateful for my long-lasting friendship with Alex and that I have gotten to know him beyond his intellectual disability. Meeting Alex in high school is what first sparked my desire to serve the IDD community—a desire that grew during college and has continued into medical school.

As an undergraduate student, I expanded my involvement with the IDD community by becoming president of my university’s Best Buddies chapter. I got to connect students to community members with IDD and plan fun events celebrating inclusion. Some of our biggest events were a talent show, a bowling night, and a Halloween party. I was moved when one of the parents told me how much our program meant to her adult son with Down syndrome. She shared that her son sometimes felt lonely or excluded, but our events provided him a welcoming environment where he felt he could belong. This experience showed me the power of inclusion.

When I began medical school at TCOM, I was excited to discover the DREAM student organization. DREAM, which stands for Disability Rights, Education, and Advocacy in Medicine, has allowed me to merge my interest in the IDD community with my career in medicine. DREAM’s mission is to advocate for individuals with disabilities and to prepare future health professionals to care for their unique needs. I attended the first meeting and was inspired by the story of DREAM’s faculty advisor, Brandie Wiley. Brandie is the mother of three adopted children with disabilities. She shared some of the challenges that her children have faced when receiving healthcare, such as barriers in accessibility and communication. She also detailed the qualities she saw in the physicians who were best able to interact with her daughter. Hearing Brandie’s experiences strengthened my desire to advocate for patients with disabilities.

I became a first-year representative on DREAM’s leadership team, which we aptly call “the DREAM team.” We began planning DREAM’s main event of the year, Project Dream Big. In collaboration with Special Olympics Texas and the Fort Worth ISD Boulevard Heights School and Transition Center, we arranged to host over 50 individuals with intellectual disabilities on campus. We planned to pair them with medical student volunteers for an afternoon of games, crafts, physical exams, and a multi-specialty provider panel. The goal of the event was to help medical students learn inclusive healthcare principles and to help the individuals with IDD become more comfortable around medical professionals.

After months of planning, the event successfully came together. As the Special Olympics athletes arrived, it was rewarding to watch them mingle with the medical students and bond at the cornhole and coloring stations. When the physical exam portion began, the medical students were instructed by physician faculty on how to properly obtain consent from individuals with IDD. It was a valuable experience to practice our bedside manner and physical exam knowledge on a different demographic, one that we get little exposure to in the normal curriculum. Connecting with the individuals in both a casual and a clinical setting that day was impactful for everyone. This exposure is helping us become compassionate future physicians and equipping us with the tools to provide quality care for our friends with IDD.

From high school to medical school, advocating for individuals with intellectual disabilities has been a meaningful part of my journey. Each experience—from developing a friendship with Alex, to leading my college’s Best Buddies chapter, and now being involved with DREAM—has reinforced the importance of inclusion, empathy, and advocacy for individuals with IDD. Each step has influenced the kind of physician that I aspire to be. As I continue my medical training and involvement with DREAM, I look forward to more opportunities to help create a healthcare environment that is compassionate, inclusive, and equitable for people with intellectual and developmental disabilities.

The Poison, the Clouds, and the Clearing: Mindfulness in Medicine

BY SETU SHIROYA, MS-II TCU , WITH NEHA SOOGOOR, MS-II TCU; EDITED BY JAYESH SHARMA, MS-II TCU

Breathe in. Breathe out.

It is my first day in the clinic. My heart is racing in my white coat that I have little confidence wearing. My anxiety skyrockets, as do my feelings of not belonging.

What if my attending doesn’t like me? What if I make a mistake? What if my patient starts crying? How do I do a lung auscultation again? What does losartan do?

I can’t remember. I can’t think.

Breathe in. Breathe out.

I have been studying the whole day, my career-defining board exam is in one week, my head is throbbing, my eyelids are drooping. I am clicking through flashcards but nothing sticks. The days are merging into one; someone asked me for the day of the week, and I came up blank.

Breathe in. Breathe out. Breathe in. Breathe out.

Only one year into medical school, and everything feels like a dream. I’ve made it so far, yet the future seems so daunting. I love my life but also fear it at the same time. I want to keep going. I’m excited, but I’m nervous. Where am I in my life? Do I even belong here? Am I the only one thinking this?

Breathe in. Breathe out.

I say it to myself over and over again—my thoughts have been spiraling for days. I need to breathe. I need to calm down.

Breathe in. Breathe out.

I do belong here. I’ve made it so far in this journey; the hard work, the endless hours were not in vain. There is so much more to go and I remind myself that I am excited. I just need to take it one step at a time.

Breathe in. Breathe out.

I am going to be present for patients. I will be a doctor. One step at a time.

Breathe in. Breathe out.

The rampaging thoughts settle, my mind clears, and I open my eyes.

It’s going to be okay.

The morning alarm rings, and my first thought is always the same: “Can I sleep for five more minutes and not think about the long day ahead?” I have stressful exams to take and sometimes dread the workload awaiting me. It feels like the only quiet time I get is in the morning, when I am drinking coffee, working out, or just embracing the quietness. I try to find time to relax, but burnout feels like it is always looming over my shoulder. However, mindfulness and meditation have helped me reorient myself and develop a healthy way to process these feelings.

What does it truly mean to be mindful? To me, mindfulness is staying grounded to what is in the present moment. It can be easy to think of the past or try to anticipate the future. However, the only inevitability we hold is this present moment. Not a second before, not a second after.

How can we practice this? Mindfulness comes in many forms; some find relief in running or weightlifting, making it a point to have a constant regimen at the gym. Others find it through meditation, focusing on breathing and relaxing the mind. These share one commonality: a mental space we create where we stop thinking about the past or trying to anticipate the future, focusing instead on what is present within and around us. There isn’t one answer to seeking mindfulness; the greatest difficulty lies in knowing where to begin.

As medical students and future doctors we are expected to quickly calm ourselves after these stressful moments and proceed. Sadhguru, a guru who is the founder of the Isha Foundation, states: “Fear, anger, resentment, and stress are poisons you create in your mind. If you take charge of your mind, you can create a chemistry of blissfulness”.1 It is especially easy in a hectic and high-paced environment or period of life to get lost in our thoughts about the stressors we experience. Our thoughts are like clouds. We can either let them pass, or we can dive into them. Taking control of our mind to let the clouds pass, helping our mind become still and focus on the present, is difficult.

This is where meditation techniques can help train our mind. Meditation techniques often involve bringing awareness to a single action or sound. For example, they can be used to bring awareness to your breathing or the repetition of a few words. One method I use is called “4-7- 8 breathing.” Close your eyes. Breathe in for four seconds through your nose. Hold your breath for seven seconds. Breathe out for eight seconds through your mouth. As you inhale, stay aware of how the air flows through your body, from the tip of your nose to your navel. As you exhale, follow the air out from your navel to your mouth. Repeat this about two to three times.

At TCU Burnett School of Medicine, our Meditation and Mindfulness Student Interest Group aims to educate medical students about techniques such as 4-7-8 breathing and help them stay engaged in healthy mindful practices to avoid burnout. Our goal is to cultivate a supportive student community dedicated to mindfulness, fostering connection through monthly meditation sessions, inspiring physician guest speakers, and meaningful community volunteering.

It is going to be okay.

My mother always told me, “Take it one step at a time, one day at a time.” As medical students, we’re often exposed to patients and situations that can take an emotional toll on our mental well-being; times such as witnessing a patient’s death or delivering a life-shattering diagnosis. Before we can process what we’ve witnessed, we’re often thrown back into a fast-paced environment without a moment to rest. In such a high intensity life, grounding ourselves with activities that bring comfort and ease becomes crucial to our mental well-being. My hope is that we future physicians can practice mindfulness early, so that we can be present for our patients. In turn, we can help our patients be mindful as we work together throughout our most difficult moments to maintain healthy behaviors.

References:

1. Sadhguru Quotes – Fear, anger, resentment, and stress are poisons you create. If you take charge, you can create a chemistry of blissfulness within yourself. Accessed February 13, 2025. https://isha.sadhguru.org/en/wisdom/quotes/date/december-06-2021

Introducing MATRIX: Medical Assessments and Tools for Inclusive Xperiences

By Kathryn Keaton

IN 2019, TEXAS HEALTH RESOURCES Foundation announced a new series of grant cycles: the Texas Health Community Impact grants. These grants are available to five regions, with specific focuses for each county based on their most recent Community Needs Assessment.

These two-year awards are made to local organizations that work collaboratively to serve specific zip codes and address health disparities and socioeconomic hardships in innovative ways. Past Tarrant projects funded include community gardens, mental health access, and culinary job training.

For the 2025–2026 grant cycle, the Foundation awarded $5 million to 18 projects across North Texas. Project Access Tarrant County is honored to be among these recipients for a total award of $385,662 over two years.

Partnering with Cornerstone Assistance Network (CAN) and Mission Arlington, the project will utilize enhanced technology, education, and a shared employee to affect radical change in the care of patients with diabetes and/or hypertension in five target zip codes: 76010, 76011, 76104, 76105, and 76119.

We are proud to introduce our project, MATRIX: Medical Assessments and Technology for Inclusive Xperiences.

The Project

Since PATC offers specialty medical and surgical care, our clinic partners are vital. Most patients come to PATC from a referral made by primary care, and those who do not are required, with PATC’s assistance, to establish a connection with primary care.

CAN and Mission Arlington are among PATC’s founding partners. Both clinics serve as medical homes. CAN serves mostly patients in Fort Worth (MATRIX target zip codes 76104, 76105, and 76119), and Mission Arlington serves mostly Arlington patients (MATRIX target zip codes 76010 and 76011). Combined, PATC, CAN, and Mission Arlington provide a spectrum of primary and specialty/surgical care.

Community Health Worker

The single biggest innovation with MATRIX is the addition of a Community Health Worker (CHW). And not just a CHW—but a shared CHW. Once this individual is hired, they will travel between PATC, CAN, and Mission Arlington, having “office hours” at each location. While some patients will meet with the CHW at the PATC office, most will have appointments at their primary care clinic—a place and location where they have an existing relationship and feel comfortable.

The CHW’s activities will be tailored to each patient. The CHW may assist with one-on-one diabetic or hypertension education, help with access to prescription assistance, arrange transportation to diabetic eye exams, or complete hospital paperwork for PATC surgeries. The cadence will vary, but each patient will have individual appointments with the CHW. In total, Cornerstone plans to serve 100 patients and Mission Arlington plans to serve 750 in this manner. CAN’s and Mission Arlington’s aim is that 65 percent of all patients with hypertension will have blood pressure readings below 140/90 and that 68 percent of all patients with diabetes will have an A1c below 9 by the end of the grant period.

Education

A recent Tarrant County Physician article briefly mentioned that a TCU medical student chose PATC as her site to complete her Scholarly Pursuits and Thesis (SPT) project.1,2 Alex Koehl, MPH, MS-I at TCU, brings her public health expertise to PATC in creating a series of classes pertaining to social determinants of health (SDOH) common to PATC patients.

The first class will occur in late March. This class will empower patients to ask questions to understand their disease and treatment and to speak up if they do not understand their instructions. Patients who are seen pro bono often feel that they do not have agency to advocate for themselves and ask questions, leading to confusion and misunderstandings that eventually cause non-compliance and a lack of resolution of their health condition. The MATRIX grant allows for meals and incentives, encouraging attendance. The series will be facilitated in both Fort Worth and Arlington. Future topics include how to open a bank account (sometimes required for hospital charity applications), how to read a prescription bottle, and how to navigate a patient portal.

Technology

Enhanced technology will answer some of the barriers we face with our patients. We recently received a separate grant that will cover the cost of CareMessage, a messaging platform for safety-net organizations to “increase access to care, improve clinical outcomes, and address social drivers of health.”3

CareMessage will allow PATC to schedule appointment reminders (that include the address with a Google map link!), respond in real-time to questions or concerns, and generally allow for texting instead of playing phone tag. In addition, CareMessage can automatically translate any message into one of dozens of languages, meaning that any PATC staff member can communicate with any patient regardless of language proficiency.

CareMessage will not replace PATC’s personal touch—all initial contact and important information will be relayed by telephone. But for simple reminders and questions where a yes- or-no response is needed, a phone call is generally not necessary.

While the messaging feature is an exciting progression in PATC’s day-to- day operations, CareMessage can go much deeper and is vital to MATRIX’s future success.

CareMessage has several preloaded educational text series. Stephen Pullman, MS-I at TCU, has also chosen PATC as his SPT site. Stephen is vetting existing diabetes and hypertension modules. In addition, as training progresses, Stephen is documenting ideas for future education modules that we can create. By the conclusion of his project, we will have multiple avenues for patient education on both preventative care and chronic conditions.

The survey element is also vital to Alex’s project. With CareMessage, patients will complete pre- and post-surveys for our SDOH classes, measuring the attendees’ level of understanding before and after the material that can be reported to the Texas Health Community Impact Grant project management team. We will also use this for participant feedback to improve future curricula.

As with all innovation, this project will have adaptations, enhancements, and changes over the course of the next two years; but we know that the future is bright. With the THR Foundation’s endorsement, the collaboration with two historic partners, and the opportunity for enhanced technology, by the end of this grant period, significant change and improvement will be affected. We look forward to keeping you updated as MATRIX continues to progress.

References:

  1. Kathryn Keaton, “Project Access Tarrant County: Growth in 2025,” Tarrant County Physician, January/ February 2025, 21–22.
  2. “Scholarly Pursuit and Thesis: Burnett School of Medicine at TCU: Fort Worth, Texas,” Burnett School of Medicine at TCU, June 17, 2024, https:// mdschool.tcu.edu/empathetic-scholar/ scholarly-pursuit-and-thesis/.
  3. “Patient Engagement for Improved Health Equity,” CareMessage, February 4, 2025, https://www.caremessage.org/.

Student Article: Carrying the Torch

By Olivia Mayer, OMS-II, TCOM

In one way or another, I have always been tied to medicine by an invisible string. One of my fondest memories of my childhood was around the age of five, when I would help my mom put together goodie-baskets for the oncology patients she would be visiting the upcoming week. This was a Sunday ritual for my mother and me, one we did while simultaneously baking chocolate chip cookies in the oven. No, my mom is not a medical provider; she is a pharmaceutical sales rep who spent any extra time she had on the weekends creating those baskets to show the patients that were taking part in clinical trials for the lymphoma drug she sold that she cared about them. This was an act out of pure benevolence and servitude for those who needed it more than the average person.

In a similar light, my grandmother spent most of her nursing career as a breast cancer nurse in Buffalo, New York. Growing up, I remember Grandma always sharing her favorite memories as a nurse. She was glowing with pride when I told her that I had a similar interest in oncology. Fast forward to today—now Grandma and I share conversations and exchange information about new developments in the breast cancer world. It is truly a full-circle moment with a touch of nostalgia from my younger days. Now as a medical student, I have the immense privilege to carry the torch of my mother and grandmother into my own medical journey. Besides being introduced to this field at a very early age, oncology has piqued my interest by its very nature. The endless opportunities to become a pioneer in cancer research or navigate complex treatment options that can potentially impact countless lives is truly the epitome of medicine, and continues to be the center of my “why.”

It has always been extremely important to me that I seek out any opportunity to create an impact in this field, just as my mother and grandmother did. As the current vice president for my school’s Oncology Student Interest Group (OSIG), I have had the amazing opportunity to assist in cultivating a tight-knit community of passionate students united by a shared commitment to being a source of support and positive change for patients during their most vulnerable moments.

One of the most significant moments I have had serving as a leader of this organization was in honoring the memory of my childhood friend, Zach, who passed away from astrocytoma in the fall of 2018. I felt a personal calling to head an OSIG fundraiser in honor of Zach and in support of his charity, the Big Z Foundation. The Big Z Foundation is led by Zach’s mother and father and financially supports terminally ill children and their families around the DFW area. Just in time for North Texas Giving Day on September 19th of this year, OSIG was able to raise hundreds of dollars for the Big Z Foundation. This support will help local families by assisting with the cost of their hospital bills, treatments, and housing costs. I can only describe the feeling I experienced as true enrichment when I surprised Zach’s parents on behalf of OSIG with our collective donations for the charity. The profound gratitude they expressed is something I will forever hold near and dear.

In moments like this, sharing acts of servitude and benevolence with fellow classmates is an experience so rewarding that it is impossible to fully express in words. This journey has brought me a feeling of gratification in service that is similar to the one I reminisce about when remembering making oncology patient baskets in my childhood. As I continue on my path in medicine, it is my personal mission to continue these acts of benevolence and shed light on those around me so that the flame of my mother’s and grandmother’s torch continues to be passed forward and illuminate a new generation’s impact on the field of oncology.

Project Access Tarrant County: Growth in 2025

by Kathryn Keaton

Another year has come and gone, and Project Access Tarrant County is beginning its fourteenth full year of serving Tarrant County.

While a full 2024 annual report will be included in the next edition of Tarrant County Physician, we did experience growth and are excited that new relationships in our community are bringing new things for this year. Here’s what you can expect to see from us in the next twelve months.

Staffing

In February 2024, PATC hired a new full-time bilingual case manager, Karla Aguilar. Karla was not new to PATC—she originally came to us in 2021 to complete her internship for her undergraduate degree in public health. Over the past ten months, Karla has refreshed our enrollment and application process, increasing overall efficiency.

PATC also has an additional new employee starting this month. Joanna Lopez, our part-time bilingual program specialist, will be the first point of contact for all new referrals and will assist with processing referrals, prescreening patients, reviewing paperwork, and keeping up with patient communication.

Interns and Volunteers

In the fall of 2024, PATC invited freshman medical students from both the Burnett School of Medicine at TCU and UNT Health Science Center to volunteer with us. These students have been instrumental in keeping us on top of new referrals and other data entry. We will continue to have medical student volunteers and appreciate the time they give, however limited. Two incoming TCU students have chosen PATC for their four-year Scholarly Pursuit and Thesis (SPT) project—we’ll have more information on those projects in the following paragraphs.

In an exciting development, PATC recently finalized an agreement with the UTA School of Public Health that makes us a sanctioned site for undergraduate and graduate students’ internships, which are required for graduation. In January, three of these undergraduate interns will work in the Project Access office part-time. In addition to assisting with daily PATC activities, they will also each complete a special project related to improving or expanding Project Access services.

The TCMS Alliance also lent support over this year. We appreciate our Alliance volunteers that assist with data entry, appointment follow-ups, and patient communication.

Patient Education

In the May/June 2024 issue of Tarrant County Physician, the PATC article focused on ways PATC navigates social determinants of health. Since that article, Karla and a first-year medical student at TCU have written a curriculum geared toward PATC patients to address common barriers to medical care as part of this medical student’s SPT project. We plan to host the first class in March of 2025. It will address medication compliance and teach not only about the importance of taking medication for chronic diseases but also how to understand medication instructions, warnings, and other labels patients may see on their bottles. Future class topics may include basic financial literacy, applying for state benefits, and teaching patients how to ask their medical team questions in order to understand their conditions and care plans. We are coming up with incentives to encourage patient attendance, and we have every reason to believe this will be a great success.

Technology

PATC has used CareScope, a database that holds patient and volunteer information, since 2011. CareScope continues to provide what we need from a demographic and reporting standpoint; however, it is limited in its communication abilities. Fortunately, a new innovative program called CareMessage offered a grant to Project Access to use its software for two years. CareMessage will allow PATC staff to communicate with patients through text messages regarding appointments, enrollment deadlines, and post-appointment questions. In addition, we will be able to select sub-groups of our patients for reminders about preventive care, invite patients to our classes mentioned above, and distribute pre- and post-surveys needed for funding purposes. Another TCU medical student has chosen to work on CareMessage as his SPT project. He will assist with setting up the technology, integrating it into CareScope, and creating processes and content that we will be able to build on for years to come.

In addition, PATC launched a new website in September 2024, which you can visit at http://www.tcam.org. This website hosts all Tarrant County Academy of Medicine programs but focuses on PATC. We still have two developmental phases to go through before we have our fully operational website, but here, donors and supporters will be able to support us and find general information much more easily than before.

Fundraising and Capacity Building

As a recipient of the 2024 Community’s Foundation ToolBox Grant, our project was to create and implement a 12-month operational plan—think like a mini-strategic plan. We worked with a consultant, analyzed processes, met with focus groups, and wrote a month-by-month strategy for 2025 to recruit and retain volunteers and expand funding opportunities. Grant writing will continue, and individual giving will be given increased focus.

Patient Services

In addition to the above, our main day-to-day activities will remain the same. Our goal is to serve 250 patients in 2025, including performing 100 surgical procedures. We aim to fully utilize the 48 surgical cases Park Hill Surgery Center has committed to, with the other 52 cases being performed among our other hospital partners. We have strategies in place to make strides to reduce and perhaps even eliminate the general surgery and gynecology waiting lists.

Conclusion

We are excited about what this year will hold, and we look forward to sharing it with our supporters. In addition to the PATC column in the magazine, please be sure you are subscribed to our monthly e-newsletter and follow us on social media as we share our 2025 successes.

The Power of Palliative Care: A Physician’s Perspective

By Dr. Mo Rezaie

A Misunderstood Mission

One of the most significant misconceptions about palliative care is that it’s solely focused on end-of-life care. This couldn’t be further from the truth. Palliative medicine is a specialized area of medicine that focuses on improving the quality of life for people living with serious illnesses. By addressing physical, emotional, and spiritual needs, palliative care helps patients and their families navigate difficult times with grace and dignity.

Beyond Physical Symptoms

While palliative care can certainly help manage physical symptoms like pain and fatigue, it goes far beyond that. It’s about addressing the whole person, including their emotional, social, and spiritual well-being. This might involve counseling, support groups, or spiritual guidance.

The Importance of Early Palliative Care

Many people believe that palliative care is only for those in the final stages of life. However, palliative care can be beneficial at any stage of an illness. Early palliative care can help patients and their families make informed decisions about treatment options, manage symptoms effectively, and improve quality of life.

A Growing Need

Despite its many benefits, palliative care remains underutilized. There is a significant shortage of palliative care physicians, and many healthcare providers are not adequately trained to provide palliative care. This can lead to suboptimal care for patients with serious illnesses.

A Call to Action

To address this growing need, we must increase awareness of palliative care and encourage more healthcare providers to specialize in this field. By working together, we can ensure that all patients have access to the compassionate and effective care they deserve.

A Personal Perspective

As a palliative care physician, I have the privilege of witnessing firsthand the transformative power of this specialty. By focusing on the patient’s overall well-being, we can help them live their best lives, even in the face of serious illness.

Morvarid “Mo” Rezaie, DO, HMDC, FACOI is a Palliative Medicine physician at The Center for Cancer and Blood Disorders.

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