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The Hidden Costs of COVID-19

Public Health Notes

By Catherine Colquitt, MD

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

In response to soaring overdose deaths across the U.S. during the pandemic, the American Medical Association (AMA) Advocacy Resource Center published a brief on Nov. 21, 2021, cataloging increased overdose deaths state-by-state. They decried decreased access to “evidence-based care for substance use disorder, chronic pain, and harm reduction services.”1

The AMA also sent a letter to the U.S. Centers for Disease Control and Prevention urging requirements for health insurers to eliminate barriers to opioid treatment for patients who would benefit from these therapies (think prior authorizations for prescriptions and faxed referrals for specialists). The letter also supported the Biden Administration’s 2022 National Drug Control Strategy, which highlights increased production of medications for substance use disorders, harm reduction strategies (including needle and syringe exchange programs), access to naloxone without prescription, and elimination of health insurer obstacles which prevent persons with chronic pain from accessing pain management.

In addition, a letter from AMA’s Dr. James Madara, MD, to Regina M. LaBelle, the acting director of the Office of National Drug Control Policy, on July 9, 2021, stated that healthcare inequities and social determinants of health fueling the overdose epidemic and disproportionately affecting the “marginalized and minoritized” must be addressed.2

The National Vital Statistics System recently released its “Provisional Drug Overdose Death Counts” for 2021 for the fifty states and the District of Columbia.4 The total overdoses will likely be revised upwards as case compilations for 2021 are completed and reports verified, but the provisional death toll is staggering. Over the 12-month period which ended in June 2021, overdose deaths rose from 47,523 to 98,022, and in Tarrant County, our overdose deaths mirror the national trend with 350 overdose deaths for the 12-month period ending March 2021, compared with 185 overdose deaths for the 12-month period ending January 2021. (Tarrant County data are not yet available for April – December 2021 on the NVSS dashboard.) 

Overdose deaths provide one measure of the toll of COVID-19 in the U.S. and expose need for redress of healthcare inequities, access to medication for opiate use disorders, substance use disorder treatment, mental healthcare access, and access to pain management. Another way the impact of COVID-19 is being assessed is through peer-reviewed publications exploring the hidden costs and benefits of conventional in-person (commuter) work versus work from home. 

“Over the 12-month period which ended in June 2021, overdose deaths rose from 47,523 to 98,022, and in Tarrant County, our overdose deaths mirror the national trend with 350 overdose deaths for the 12-month period ending March 2021, compared with 185 overdose deaths for the 12-month period ending January 2021.”

The results of such studies are uneven and the responses necessarily somewhat subjective when subjects are questioned regarding their feelings about in-person versus telework; in general, workers viewed telework more favorably when they volunteered for it and when their schedules included a combination of both in-person and telework. When mandatory, some teleworkers experienced increased “work-family conflict” as the lines between work and domestic life blurred during telework. Teleworkers and conventional in-person workers reported variable effects on depression, exhaustion, fatigue, and energy level.5

Using data from the American Time Use Survey, authors asked workers to record in a diary where they worked (whether they commuted or not) and noted that male teleworkers in this study reported lower pain, stress, and tiredness levels, but that there was no difference in these measures among female commuters versus non-commuters.6

In another study based on the American Time Use Survey, the designers compared pain in working-at-home versus conventional workers and found no difference in pain reporting between the two groups. However, working-at-home fathers reported increased stress and working-at-home mothers reported decreased happiness.7

COVID-19 is, at the very least, an engine powering academic inquiry, which may have unexpected future benefits for the way healthcare is delivered and work is done.  In the meantime, we must continue the important work of educating, advocating, and caring for our communities.

References
1. AMA Advocacy  Resource Center:  Issue brief: Nation’s drug-related overdose and death epidemic continues to worsen, Updated 11/12/2021 

2. AMA letter to Regina M. LaBelle, Acting Director of Office of National Drug Control Policy, 7/9/2021

3. AMA letter to the U.S. Centers for Disease Control and Prevention, June 2020

4. National Vital Statistics System Provisional Drug Overdose Death Counts – NVSS dashboard for current data, with final data when available from https://www.cdc.gov/nchc/nvss/mortality_public_use_data.htm

5. Oakman J et al. A rapid review of mental and physical health effects of working at home: how do we optimize health? BMC Public Health (2020) 20:1825

6. Song Y, Gao J. Does telework stress employees out? A study on working at home and subjective well-being for wage/salary workers J Happiness Stud 2019;21(7):2648-68

7.   Gimenez-Nadal JI, Molina JA, Velilla J. Work time and well-being for workers at home: evidence from the American Time Use Survey. Int J Manpow 2020; 41(2): 184-206

TCU Medical Students get unique first hand experience with latest laparoscopic technology

By Prescotte Stokes III

Originally published by TCU School of Medicine on April 19, 2022. You can read the original article here.

TCU School of Medicine welcomed experts from Olympus, global leaders in the development of medical devices, onto their campus in early February to give medical students an immersive and hands-on experience using the latest laparoscopic surgery equipment.

Jim Cox, M.D., an assistant professor at TCU School of Medicine, helped organize the event with the help of the Gastrointestinal and Hepatology Student Interest Group (SIG).

“When I was in private practice I worked extensively with Olympus and I reached out to a former colleague and asked could you provide this training session for the students,” Dr. Cox said. “The thing with Gastroenterology is that much of what we do is colonoscopy or upper endoscopy. We have first, second- and third-year medical students here just to give them the opportunity to see if they’re interested in Gastroenterology.”

Before immersing themselves into the technology, about two dozen medical students joined Dr. Cox for a brief presentation in the simulation lab. He gave a brief overview of typical things the students might see during residency.

“Let’s say an ulcer or a polyp or colon cancer and how are we going to treat those things,” said Dr. Cox. “Are we going to remove them? Are we going to remove an inanimate object from the esophagus that someone inadvertently swallowed? We’re talking about both urgent and non-urgent procedures that gastroenterologists encounter every single day.”

The medical schools’ simulation lab had laparoscopy training monitors and tools provided by Ethicon. The training monitors allow the students to see simulated examples of a laparoscopy, which are small scars on the abdomen. Students can use the monitors attached to the machine to practice suturing and knot tying techniques that require basic hand-and-eye coordination.

“This requires more than just being able to coordinate your hands,” said Sujata Ojha, a third-year medical student and co-president of the Gastroenterology and Hepatology Student Interest Group (SIG) at TCU School of Medicine. “There’s visual spatial movement and being able to know where you are in space and being able to maneuver without impacting the patients’ internal organs.”

Dr. Cox added that most of today’s gastrointestinal surgeries are done using a laparoscope, which makes this training much more beneficial for medical students.

“Most gallbladder, appendix and other intraabdominal organ removals are done using a laparoscope,” Dr. Cox said. “They leave very tiny scars which may actually go away in a few years as opposed to having the patient needing a big scar that could possibly stay for a lifetime.”

Gastroenterologists are advancing more and more into the use of laparoscopic procedures. A recent 5-year patient study presented at the 2022 International Gastric Cancer Congress in March showed  laparoscopy surgery compared with an open gastrectomy surgery was found to produce better overall survival outcomes for patients, according to the Cancer Network.

Mallory Thompson, a third-year medical student and co-president of the GI and Hepatology SIG, was excited about the demonstrations at the medical school.

“Medical students aren’t exposed to these kinds of medical procedures during their clinical rotations this is more for medical resident training,” Thompson said. “It’s exciting that our medical school faculty like Dr. Cox and our student interest group are setting up these kinds of opportunities for us.”

I’ve Done My Research

President’s Paragraph

by Shanna Combs, MD

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

“I’ve done my research.”

These can be some of the most dreaded words to hear as a physician from our patients and their families.  We can spend seven-plus years in medical school, residency, and sometimes fellowship, studying our field before we embark on our journey to practice medicine.  We also hone our craft through continued learning throughout our careers.  Yet, we are often confronted with the above phrase.  Since when did Dr. Google become such an expert that it can supersede our years of training and practice?

This became ever more apparent as the COVID-19 pandemic started over two years ago. (Yes, we have crossed over the two-year mark and are still counting).  With a lack of information and understanding of this novel virus as well as increased access to information on the internet, we in science and medicine saw people seeking out answers from all the resources they had access to.  This unfortunately led to propagation of numerous pieces of misinformation, distortions, and half-truths.  Add to this the politicization of our nation and the polarization regarding best measures on how to handle the COVID-19 pandemic, and unfortunately, we in science and medicine are left as the ones not to be trusted.

As a women’s health physician, I am confronted with this on an almost daily basis.  While the internet can be a valuable resource of information, it can also be a not so valuable resource of misinformation, lies, and myths.  Misinformation was commonly passed along in relation to women’s reproductive health even before the advent of the internet.  Unfortunately, nowadays it has a much wider reach with the “expertise” of Dr. Google to further spread these untruths.

What are we to do in this constant back and forth of the internet versus the doctor?

For me, I try to meet my patients and their families where they are.  I work with them to better understand where they are coming from as well as who or what their source of information is.  I cannot undo the vastness that is the internet and Dr. Google, but I can work to build a relationship with my patients and their families to come to shared decision making to provide the best care for them.  

For me, I try to meet my patients and their families where they are.  I work with them to better understand where they are coming from as well as who or what their source of information is.  I cannot undue the vastness that is the internet and Dr. Google, but I can work to build a relationship with my patients and their families to come to shared decision making to provide the best care for them. 

While this is helpful in individual encounters of patient care, I also feel that it is important for us as physicians to be out in the public arena as well. Because of this, I never turn down an opportunity to speak when asked, and I am always happy to provide my expertise for those in the media.  As physicians, we have a duty to educate. This is a responsibility not only to the individual patients we take care of, but also to the public. By offering education that is based in science and grounded in our years of continued study and experience, we can work to counteract the vast amount of distorted information that is out there.  I, for one, will continue in my efforts to dispel myth and spread truth.

HRSA Reopens Reporting Time for Period 1 Provider Relief Fund Recipients

Due largely to AMA and specialty society advocacy, the Health Resources and Services Administration (HRSA) has decided to reopen the reporting time for recipients of Period 1 Provider Relief Funds.

Those physicians who received more than $10,000 in provider relief funds and failed to submit their period 1 report should act immediately. Between Monday, April 11 and Friday, April 22, 2022, at 11:59 pm ET, physicians who have not submitted their Period 1 report may submit a late Reporting Period 1 report request. Physician practices should receive information about how to submit a request directly from HRSA via email.

If a physician did not submit a Period 1 report and does not hear from HRSA, they may initiate communication by calling (866) 569-3522. During this reopening period, the physician must choose an extenuating circumstance(s) that prevented compliance with the original reporting deadline. While attesting to an extenuating circumstance is required, no supporting document or proof is required.

If HRSA approves the extenuated circumstances form, the physician will receive a notification to proceed with completing the Reporting Period 1 report shortly thereafter. They will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal. 

Join TMA’s Virtual Career Fair

If you’re looking for the next invaluable member of your health care team, the Texas Medical Association offers opportunities for health care organizations to recruit physician and medical staff talent at its Virtual Career Fairs. The next Virtual Career Fair is on April 28, and spots are open for employers to exhibit. 

Here’s why you should exhibit at the next Virtual Career Fair: 

  1. Reach physicians and medical care professionals – TMA members and their teams are a ready-made pool of qualified professionals in a variety of specialties, locations, and career stages. TMA’s Virtual Career Fair offers employers exclusive access to this select group.
  2. Chat one on one with candidates in a virtual setting – Getting in front of busy physicians and other members of the health care team can be challenging. At the Virtual Career Fair, employers can meet directly with jobseekers at a specified time in a virtual setting. 
  3. Have a database of candidates to follow up with – All job-seeking participants create a profile and upload a resume to register for the fair. This means exhibitors can review potential candidates and follow up with specific individuals after the event. (Available for Gold sponsors only.)
  4. TMA 100% member practices receive 25% off exhibitor packages. 

Visit TMA’s Career Center for packages and pricing. To become a participating employer-exhibitor, visit the Career Center or email Lena Loomis.

Join Walk with a Doc on April 9th

Join our local chapter of Walk with a Doc this Saturday for a fun morning walking, talking about health, and meeting people in our community.

Here is what you need to know about the event:

• It will take place on April 9th, 2022
• The hour-long event will begin at 8:30am
• Walkers will start at LVTRise – 8201 Calmont Ave., Fort Worth, TX 76116

For more information, call Kate Russell, OMS-II, at 903-316-9392, or email her at KatherineRussell@my.unthsc.edu.

Join Project Access for a Lunch and Learn on April 20

Concerned about those in Tarrant County who go without healthcare or who are forced to get emergency care because they cannot afford necessary medical treatments? Consider joining Project Access Tarrant County’s Lunch and Learn on April 20 from 11:45 to 1pm. At this event, you will have the opportunity to:

  • Learn how we are making a difference for Tarrant County’s low-income uninsured residents
  • Hear from our staff, physician volunteers, and patients
  • See how we provide healthcare services for those in greatest need and how our new initiative will expand services

You can register for this free event here. It is targeted toward those who work in healthcare and everyone who is passionate about helping the underserved of our community.  

Project Access Tarrant County, which was founded in 2010, is a non-profit organization dedicated to expanding health care access and improving health outcomes for low-income, uninsured residents of Tarrant County, utilizing the charitable gifts of a network of existing voluntary providers and collaborative partnerships.

To date, Project Access has:

  • Scheduled 10,500 medical appointments
  • Enrolled over 2,100 patients
  • Provided over $18 million value in donated medical care
  • Performed 810 surgeries and hospital procedures

Their vision is for all Tarrant County residents to have access to a continuum of care, which includes specialty, pharmacy, laboratory, ancillary, and hospital care. Come on April 20 and see how you can partner with Project Access to bring healing and hope to those who most need it.

“I was falling into a hole of depression”

A Project Access Tarrant County patient story

By Allison Howard

“It was stressful knowing I was not going to make ends meet.”

When “Roberto,” a 49-year-old husband and father of two, began experiencing a burning pain in his torso from an inguinal hernia, he knew he needed to do something about it. Throughout the day it would grow in intensity, making it difficult for him to work. Roberto’s hours were cut, and he eventually had to take an entire month off of work.

“I could not do anything,” he says. “I was falling into a hole of depression.”

The family was experiencing tension from the economic burden, and it was impossible to consider surgery with the financial struggles they were facing day to day. Then, he went to Cornerstone Clinic, where he was referred to Project Access.

He was connected to Project Access volunteer and general surgeon Dr. Mohammad Siadati of North Texas Surgical Specialists, who agreed that surgery was necessary. Dr. Siadati performed the much-needed procedure at Texas Health Harris Methodist Hurst-Euless-Bedford, and anesthesia was provided by U.S. Anesthesia Partners.

“I am very thankful for Dr. Siadati, who was very attentive, respectful, and patient,” says Roberto. “I especially appreciated the patience Dr. Siadati showed when it came to the language barrier we had.” He thanks everyone who made his treatment possible, from those working the front desk to his doctor.

Since the surgery, Roberto has been improving steadily, and he was just cleared to return to work. He is optimistic about the future – he doesn’t feel stuck anymore in the cycle of pain and frustration. “It was a blessing, the entire process.”

A Texas Trailblazer – May Owen, MD, a Medical Pioneer and TMA’s First Female President

By Sean Price


Originally published in Texas Medical Association’s December 2021 issue of Texas Medicine. It was republished with TMA’s permission in the March/April 2022 issue of Tarrant County Physician.

On May 27, 1936, May Owen, MD, answered a scientific riddle in a speech before the Texas Medical Association, explaining research that would soon make her a statewide celebrity. 

The name of the paper she read that day, “Peritoneal Response to Glove Powder,” sounded vague to nonexperts. But the other clinical pathologists who gathered to listen understood that Dr. Owen had uncovered that a common medical practice posed a threat to patients.  

The mystery started nearly 16 months earlier when a fellow Fort Worth physician alerted Dr. Owen to the case of a 19-year-old woman with unexplained fibrous membranes and tumorous nodules growing in her abdomen. The woman had had her appendix removed two years previously, and something about that operation had gone wrong.  

After months of research, Dr. Owen proved that the unusual growths plaguing the woman had been caused by the talcum powder used at the time to coat surgical gloves. Human tissue couldn’t absorb the powder, so if just a little bit inadvertently fell into a wound during an operation, it caused infection, scar tissue, and other problems.  

Dr. Owen read her paper before a mostly appreciative audience that gave her a standing ovation, according to her biography, May Owen, MD, by Ted Stafford, which is the source for most of this article. But when most of the crowd sat down, one man remained standing and began to shout. 

“I have been sitting here listening to this woman spout off about the dangers of glove powder,” he said. “I don’t believe a word she has said.” 

He continued ranting until the meeting’s chair ruled him out of order and told him to be quiet. Later that day, Dr. Owen won an award from the Texas Society of Pathologists, just one of many she would earn, including an honorary doctor of science degree from her alma mater, Texas Christian University (TCU). 

The man’s outburst rattled Dr. Owen, reminding her of just how far she had come as a woman in medicine – and how far women like her still had to go to win acceptance. But she never lost confidence in herself or her findings. 

“I knew if I lived to be 100, that [discovery] would be my most important contribution to humanity,” she recalled.  

The research forced surgical glove makers to switch to a starch-based powder the human body could absorb. Texas newspapers clamored to interview this “woman doctor” – partly because her work had caused such an uproar and partly because so few women physicians existed anywhere at the time. 

Dr. Owen’s pioneering work continued in the decades to come, making her the first female president of the Texas Society of Pathologists in 1946, the first female president of the Tarrant County Medical Society in 1947, and the first female president of TMA in 1960. 

She had help from friends and relatives during her difficult rise from poor farm girl to honored Fort Worth physician, and that made her a conscientious mentor to hundreds of young physicians and people interested in medical careers. 

One of them was Margie Peschel, MD, who started her career in Fort Worth as a resident in 1959, when women were still rare in the medical profession. She later became a pathologist who ran what is now Carter BloodCare from 1976 to 1997. 

“I always felt lucky to be in Tarrant County because Dr. Owen set the example that women are welcomed,” she said in an interview with Texas Medicine.  

From farm to medical school 
Dr. Owen was born in 1892 in Falls County, just southeast of Waco, the sixth of eight children. She grew up doing hard work on the family cotton farm, and her parents, Jack and Lilli Owen, allowed her to go to school only after her morning chores were done.  

Dr. Owen’s mother died when she was nine years old, and her father – whom she describes in her biography as autocratic and demanding – became even more so. He put more chores on his daughter and scoffed when she told him she intended to be a doctor.  

“Get that silly idea out of your head right now,” she recounted him saying, according to her biography. “Your place is here on the farm. We will not discuss this matter anymore. Do you understand?” 

Dr. Owen’s father tolerated her finishing school up to seventh grade, but only the intervention – and financial assistance – of an older brother allowed her to go first to high school and then to college at TCU in Fort Worth, graduating in 1917. In 1921, she became the first woman to graduate from what is now the University of Louisville School of Medicine in Kentucky. 

Dr. Owen’s father did not actively prevent his daughter’s education, but he also never helped it and never acknowledged her accomplishments. Nor did he answer the many letters she sent after she became a physician.  

“Her father never honored her,” Dr. Peschel told Texas Medicine. “It was sad. We would drive from Fort Worth to Austin for TMA meetings, and she shared things like that – that her daddy never did recognize her.” 

During the 1920s and 1930s, Dr. Owen worked mostly as a pathologist for Terrell’s Laboratories in Fort Worth, and the owner – Truman Terrell, MD – was her friend and mentor. He loaned her the money to attend medical school. She also did advanced study at the Mayo Clinic in Rochester, Minn., and Bellevue Hospital in New York.  

Despite her intense training, some fellow physicians – frequently older doctors – still refused to accept her medical opinions. In one case, when a surgeon argued that she was wrong, Dr. Owen found a clever way to win him over. 

“I split the specimen in half and did my examination on one section and reported my findings to the surgeon,” she told her biographer. “The other half was sent to the pathologist at Massachusetts General Hospital in Boston. When his report came back, it agreed precisely with what I had reported. After a while the people who had doubted my ability and competence began to accept my work without question.” 

Dr. Owen also earned the respect of veterinarians early in her career because her rural background gave her an understanding of animals and farming. In 1931, a vet at the Fort Worth Stockyards asked for her help in identifying a mystery disease that was killing sheep. Some suspected anthrax. But Dr. Owen discovered that the molasses cake being fed to the sheep to fatten them up was giving the animals diabetes. This discovery changed the way sheep were raised worldwide. 

Despite what coworkers recount as a crushing work schedule, she remained active in all levels of organized medicine, and she encouraged medical students and young physicians to join organizations like TMA. By the time Dr. Peschel became a pathologist in 1964, Dr. Owen knew just who to talk to to get her colleague assigned to committees in TMA and other medical organizations. 

“She was so active,” Dr. Peschel said. “She introduced me to everybody at TMA and the pathologists in the state. She just knew all these people. She was an excellent mentor.” 

Dr. Owen expressed a deep debt to the people who helped her get a start in medicine. 

“I know I could never have done it alone,” she said in her book. 

As TMA president, Dr. Owen established TMA’s Physicians Benevolent Fund to help physicians in times of distress. She led the charge with a $2,500 contribution of her own, and since 1961, the fund has distributed more than $4.38 million in financial assistance.  

“We all know of cases where our colleagues have suffered illness, death, or other misfortunes,” Dr. Owen said to TMA board members when requesting the fund’s creation.  

She contributed money to students individually and also helped establish the May Owen Irrevocable Trust through TMA to provide low-interest loans to medical students. When Texas Tech University Health Sciences Center in Lubbock opened in 1973, Dr. Owen helped provide the library’s first 20,000 volumes and established the school’s first endowed chair. 

In old age, Dr. Owen continued to work hard until her health failed. She died on April 12, 1988, at age 96.  

“She said, ‘We should all be so lucky to work at something we love until the day we die,’” Dr. Peschel said. “She did that.”

Ask the Docs About Prenatal Oral Health

Don’t Miss Out – be part of the conversation on Wednesday, March 23, 2022, 8:30 am – 9:30 am CT.

In honor of International Adolescent Health Week, Drs. Shanna Combs and Meera Beharry will host an Ask the Docs discussion centered around the unique issues pregnant teens face, and the importance of engaging adolescents in their medical and dental health journey before, during and after pregnancy.

You can register for this free session here.

This event was created for dentists, physicians, dental hygienists, nurses, doulas, mid-wives, and social workers.

The objectives for this Ask the Docs session include:

  • Strategies for supporting and helping pregnant teens and families as they transition from pediatric to adult medical and dental care
  • Providing information on doctor/teen confidential consult, rights of minors, parental consent needs, questions to ask
  • Identifying stigmas as a barrier to care
  • Tips for creating a teen friendly environment

This session is part of a virtual series that addresses common questions about oral health care during pregnancy. This series is presented by the Texas Department of State Health Services – Oral Health Improvement Program (OHIP) in partnership with the Children’s Oral Health Coalition let by Cook Children’s.

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