By now you’ve probably treated a lot of COVID-19 patients, many of whom have recovered from the illness.
Although employees are not required by law to present a letter from a physician clearing them to return to work, many employers request one.
If your practice doesn’t already have such a letter, the Texas Medical Association has created one that you can customize for your practice.
The letter, which is available here, outlines guidance from the Centers for Disease Control and Prevention (CDC) on when employees who have exhibited symptoms or who have tested positive should return to work. It also explains a negative swab test is not required by law for employees to return to work.
The letter is one of several COVID-19-related documents TMA has created that you can customize for your practice’s and patients’ individual needs. Those resources as well as up-to-date news, information, and tips can be found on the TMA COVID-19 Resource Center.
Dr. Susan Bailey, AMA President, presented this speech on June 7, 2020, when she was installed as the 2020-2021 president of the American Medical Association:
The inauguration of a new AMA president is typically a very formal, black-tie affair with great celebration and fanfare. In my case, my family and close friends were all excited and ready to fly to Chicago to celebrate with me.
I had a beautiful gown and Broadway entertainment and red velvet cake for dessert all picked out.
My grandson was going to look so adorable in his tux . . . just like his daddy and his uncle did at his age when I became president of the Tarrant County Medical Society.
I was planning one final bow with my predecessors, Drs. Patrice Harris and Barbara McAneny, capping our historic year with three consecutive women presidents.
But the coronavirus had other plans. And seemingly overnight, our world changed.
So here I stand, in a nearly empty studio, talking to you through a video screen.
And that’s okay. As physicians we understand better than anyone how a health emergency can disrupt even the most carefully thought out plans.
No matter the circumstance, I am grateful to address you for the first time as AMA president, and I am so honored to carry the mantle of leadership for this organization I have been proud to serve for 40 years.
On this journey to become AMA president, I’ve been asked who my heroes were growing up. We hear about heroes every day now, it seems.
But what IS a hero?
Who were my heroes?
I was never particularly into make-believe superheroes as a kid. It was real people in my life whom I most admired and emulated; the people who inspired me and pushed me to a life beyond anything I could have imagined for myself.
My heroes were my physicians.
They were my first heroes . . . and they’re still my heroes.
I had significant allergies and asthma as a little girl, and my allergists were a guiding light in our family. In fact, the McGovern Allergy Clinic in my hometown practically raised me, instilling in me a passion for medicine and teaching me the basics about working in a medical office—how to take a patient’s history, perform allergy testing . . . and how to give a damn good shot.
I grew up in the shadow of the Texas Medical Center in Houston, and many of my friends’ dads were physicians. At that time, in the 1960s, it was always the dads. Thankfully now, it’s moms too.
Although I rarely saw those physicians, I idolized them. After my father had double cardiac bypass surgery in the early ‘70s, one thing that sped his recovery was taking daily walks by the home of his surgeon, Dr. Jimmy Howell, in the hope that one day the doctor would see him and be proud of him.
One day he did see my dad, and he was indeed proud of him . . . and that kept daddy walking the rest of his life. Oh, how daddy—and our hero Dr. Howell—would be proud today.
What we’ve witnessed in this pandemic and what we know from history is that heroes are defined by their ability to adapt to a changing world, to follow a righteous cause, to overcome immense challenges, and to be changed by it forever.
The author Joseph Campbell discusses this in his book, Hero with a Thousand Faces, which describes the mythological hero’s journey in 12 stages, establishing the classic story line in everything from the original Star Wars trilogy and Harry Potter to The Wizard of Oz.
As Campbell describes it, a hero starts off in the ordinary, familiar world, but gets a call to adventure. Think of a humble farm boy on Tatooine getting the call from Obi Wan Kenobi to help save Princess Leia.
At first, our hero is reluctant, even fearful. But a supernatural force or mentor comes along and brings out the most in them. A threshold is crossed, and the adventure begins. Dorothy skips down the Yellow Brick Road.
On the way, our hero encounters challenges, finds allies, and makes enemies.
Eventually, our he or she arrives at the ultimate test. Harry Potter confronts Voldemort face to face. This is a dangerous place . . . a dark place . . . a place where survival is as important as the ultimate goal. There is a fight to the death.
Somehow, someway, the hero prevails, but the story is far from over. Going back to ordinary life is not easy, and there are many bumps in the road. But in the end, our hero emerges, transformed.
Luke is a Jedi Master. Dorothy returns to Kansas. Harry lives out his life as a benevolent wizard.
That’s the hero’s journey . . . and it’s been told a million times in a million different ways.
A hero’s journey is our journey . . . a physician’s journey.
You start off as a young student, maybe already in another career, but at some point you hear the call of medical school.
Somebody gives you a hand, maybe a teacher or a co-worker, and miraculously you’ve arrived as a first-year medical student. You feel like an imposter at first, and you wonder if you have made the biggest mistake of your life.
Through wit and resourcefulness, you figure out how to be successful. You don the white coat and you make lifelong friends, all the while confronting clinical challenges that you fear might break you.
At some point you confront the ultimate test. Maybe it’s having a relationship suffer because your priorities have changed. Maybe it’s not matching into the specialty or program you thought you wanted. Maybe it’s losing your first patient.
You’re in a dark place and it seems there is no way out. But you keep going.
You find your way out of the darkness and you emerge a better physician and a stronger person for having endured these trials. You realize that you are making a difference in people’s lives. You are saving lives.
You’re not the same person you were before you went to medical school. You are a physician . . . and you’re following the hero’s journey.
But here’s the thing – even heroes need allies on their sides. Luke needed R2D2. Harry Potter needed Hermione and Ron. Dorothy needed her ragtag crew.
There isn’t a single person I know who walks this journey alone.
My own allies are far too many to mention and thank in my limited time, but they include my husband Doug, who has been my greatest supporter and partner on this journey. They include my sons Michael and Stephen Wynn and Michael’s partner, Hannah Guel, my precious grandson Jackson, my sister Sally Rudd Ross, and her beautiful family.
They include my wonderful partners, Drs. Robert Rogers and Drew Beaty, my medical assistant Joyce Hayes, and all of their families, and my lifelong friends from Texas A&M University and the Disciples of Christ church.
And it of course includes my family in organized medicine; the Tarrant County Medical Society where I got my start, the Texas Medical Association, and my allergy and pediatric specialty societies the ACAAI, QuadAI, and the AAP. Special thanks to Dr. Melissa Garretson for your friendship, hard work, and dedication to help me make this journey possible.
It also includes my family at the AMA, and all of those colleagues, confidants and executives along the way who have mentored me and become dear friends. I have not named you all by name, but please know you are forever in my heart.
And like any hero’s journey, ours in medicine is simple:
Let doctors be doctors.
After more than 30 years in a small, private practice, I’m a passionate defender of the independent physician, and, like the AMA, I’m determined to remove all those obstacles that have come between us and our patients.
Insurer and government mandates. Decreasing payments and increasing demands. Burnout and physician suicide. And the coronavirus pandemic has made all of these problems more acute.
We need the power of the AMA on this journey.
I believe involvement in organized medicine is a professional obligation—taking good care of our patients requires much more from us than the time we spend with them in an exam room.
It requires advocacy at the highest levels to fight against the quagmire of regulation and for the support we need to sustain private practice during a pandemic that is threatening its very survival.
It requires us to confront insurance companies and all their familiar tricks that seem to raise insurance premiums year after year without spending a dime more on patient care.
At times I fear that our nation’s dysfunctional health system is held together only by the oath that we take when we graduate medical school . . . the pledge to always put the needs and interests of our patients first.
Whether you took the Hippocratic Oath or, as in my case, recited the Prayer of Maimonides, these words demonstrate our loyalty to public service, to the pursuit of science and knowledge.
These words bring purpose and meaning to our work, elevating it from a vocation to a profession.
We are on a new quest that none of us expected – living and working in a world that may be changed forever in an angry, divided nation that needs our leadership. But we need not fear the dark times on our journey.
We need only to lean on one another, to take care of each other, and to keep our eyes fixed on the horizon.
We will get through this pandemic.
We will continue to fight for our patients and for the practice of medicine.
This is our journey . . . and we will walk it together.
Issues for Physicians to Consider when Closing or Relocating a Medical Practice by Cheryl Coon, Healthcare Attorney
There are several scenarios that can lead to the closing of a physician’s practice, including relocation, retirement, or an unexpected event such as a serious illness or disability. There are many issues to be considered when closing a practice, including what to do with patient medical records. If the physician is part of a physician group practice, often the employment agreement, shareholder agreement, or other related agreement will address ownership of medical records and other similar issues. Such agreements, however, rarely address the myriad of other factors that should be addressed. Moreover, compliance with those agreements does not guarantee compliance with laws.
The following is a short overview of some of the issues that a physician should consider ahead of time to address closing or leaving a practice. In the best of worlds, the physician has planned ahead (some suggest a year in advance for retirement) to address most if not all of the issues noted below, and developed a plan that is known and accessible to other practice and/or family members, including the location of relevant documents and contact information. Note for solo practitioners: terminating an entire practice has more issues to consider than the retirement of one physician in a group practice, such as transfer or sale of equipment, and what to do with any associated real property, whether owned or leased. For the most part, this discussion does not focus on a solo practitioner.
Before addressing the issues, it is important to note that physicians need to keep accurate and thorough records of the steps taken so that compliance can be verified and the process kept organized. Also, when sending notices, it is important that if the method of communication is not specified in an agreement, notices should be sent via certified mail or using some process that provides a similar evidentiary record.
Medical Records If the physician is part of a practice group, often the practice agreements deal with medical record ownership, transfer, and notification of patients. As noted, however, compliance with the agreements does not equate with compliance with law. In Texas, absent an agreement that states the contrary, employers own the records/work product of employees, and in practice settings, group practice agreements almost always incorporate this concept.
Texas law also requires that practices provide certain information to physicians who are leaving, to permit the physicians to provide the required notice to patients, discussed below.
A separate issue related to medical records is record retention requirements under various laws. Physicians need to address the times that various state and federal laws require for retention of patient records in the medical record plan.
Finally, a note to solo practitioners: having a medical record company serve as custodian is very expensive and should be avoided if possible. It is best to have a plan to transfer records ahead of time.
As an aside, physicians also should have a plan for preservation of business records that may be necessary in the future, such as for tax preparation.
Notice to Patients As noted, practices often have agreements that address notification of patients in the event a physician leaves the practice. Regardless of whether practice-related agreements address notification of patients, the Texas Medical Board (TMB) rules address the issue and have some specific requirements. Under the TMB rules, if a physician relocates, retires, terminates employment, or otherwise leaves a practice, the physician must provide reasonable written notice to patients and provide them with an opportunity to obtain copies of their records or arrange for transfer of their records. Notice (1) can be by either posting notice on the practice website or posting in the local newspaper of greatest circulation in the county, and (2) must also include notice in the practice location, and (3) must include written notice to patients seen in the last two years.
Also, if the physician wants to recommend another physician to patients in the patient notification or otherwise, the information needs to be included in the retirement/relocation checklist. The recommendation can be provided to patients in the notice letter discussed above.
Providers also need to review third party payor agreements for notice requirements.
When providing patient notices, it may be prudent to put a copy of the notice provided in the patient chart, if not for all patients at least for those that are deemed high risk.
Notice to Agencies
Texas Medical Board A physician should provide written notice to the TMB of retirement or voluntary relinquishment of a license on the form provided by the TMB. The form must be notarized. If relocating, the TMB must be provided with new contact information. The TMB has an online “change of address” feature and will now accept hard copy notices only in limited circumstances.
Federal Drug Enforcement Administration (DEA) When relocating, physicians need to provide written notice to the DEA at least six weeks prior to the move and provide the old and new address for the physician. Notice should be sent to the closest DEA office in the state. Written notice also must be provided for retirement in the same manner.
Any unused controlled substance prescription forms and other prescription forms must be returned, after being marked “VOID,” to the Texas State Board of Pharmacy within 30 days of (1) when the physician’s DEA license/number is canceled, revoked, suspended or surrendered, or (2) the date the physician died.
If an entire practice is closing, controlled drugs will need to be inventoried and disposed of in accordance with federal and state laws, with particular care given to the disposal of controlled substances. Laws to be considered include the new Environmental Protection Agency laws on disposal of discarded (or waste) pharmaceuticals. Note that non-controlled drugs may be (1) donated, such as to community medical clinics, under the Texas Prescription Drug Donation Program established by the Texas State Department of Health Services, (2) sold with a practice, or (3) disposed of in accordance with laws.
Medicare/Medicaid, Tricare, other HMOs and PPOs Upon retirement, physicians must notify Medicare and Medicaid and submit a voluntary withdrawal form. For Medicaid, physicians leaving a group practice must send a letter or a Provider Information Change Form to the Texas Medicaid & Healthcare Partnership. If the physician is joining a new group, the physician also must complete a new Texas Medicaid Provider Enrollment Application.
Tricare, HMOs, and PPOs, as well as other third-party payors, will almost certainly have similar provisions. Physicians need to review all these agreements for this issue and other issues noted herein, i.e., provisions relating to patient notice and payment on termination.
Notice to Others
Hospitals If a physician has privileges at a hospital, he or she needs to review the hospital bylaws and other policies carefully to see what obligations exist for retirement or relocation, whether related to notice or otherwise.
Liability Insurance Carrier Most liability policies now are “claims made” policies, meaning that the insurance company will pay claims made during term of the insurance contract. Therefore, if a physician leaves a practice, the general liability policy will terminate and a “tail” policy to cover claims made after the termination is crucial. In some instances, the practice will cover this expense, but the physician should verify this and obtain a certificate of insurance showing the coverage. If the practice does not provide a tail policy, one should be obtained.
National, State, and County Medical Societies
Physicians can provide notice to the American Medical Association by a call to its 800 number, an email or letter, or on-line. The same is true for most medical societies, including the Texas Medical Association and the Texas Osteopathic Association.
National Provider Identification System If the physician has a national provider identifier, the physician needs to provide notice to the National Plan and Provider Enumeration System by phone, mail, or email (again, remember that having a written record is vital).
Employees Physicians at some point need to notify employees so they can seek other employment at the appropriate time and so they can assist with issues such as patient notification and other transition issues.
Landlord Assuming the termination of a solo practice or of an entire group practice, real estate becomes an issue, particularly if the practice location is leased. The physician and his or her attorney should review the lease carefully to determine notice requirements and terms related to termination of the lease.
Supplies/Vendors Physicians should review their supplier and vendor agreements to see if there are provisions relating to termination (and/or relocation) and notification, or other issues that may be relevant. If there are standing orders, these will need to be addressed and possibly the issue of returns and/or credits. Utilities/Other Accounts
Notices to utilities and other accounts are relevant in the event a solo practitioner or an entire practice terminates or relocates. Aside from utilities, banks are clearly a significant area for review and planning. This should include making sure that access to accounts is controlled, appointing someone to be responsible who can deal with issues, particularly if physician death is the trigger.
Review should include any subscriptions that the physician may have for magazines and periodicals from memberships in professional societies or other business-related accounts.
Additionally, if there is an after-hour call service or something similar, the relevant agreement should be reviewed and the termination coordinated with the service.
Post Office Notice should be given to the post office for any change of address and/or mail forwarding.
Review all Professional Agreements One of the first steps for a physician should be to carefully review all professional related agreements, particularly any employment agreement or shareholder agreement if the physician is a shareholder in a professional association. Items to look for/consider include the following:
Required notice to the practice of intent to leave or retire
Non-competition and non-solicitation provisions
Medical records ownership and transfer
Notice to patients
Insurance, in particular issues related to tail coverage
For shareholders, transfer of shares, both the process and valuation. What notice is required? How will shares be valued? What is the timing of the buyout?
Did the physician sign any guarantees on loans for equipment, operations, real estate, or otherwise?
Winding Down anyProfessional Entity Physicians should assess if a professional entity, for example, a professional association or “PA,” needs to be shut down, or as the laws refer to the process, wound down and terminated. If applicable, winding down and termination of a professional entity is a multi-stepped process that involves filing with two different agencies in Texas: the Texas Secretary of State and the Texas Comptroller. Parties will need to address tax issues and more than likely involve an accountant, preferably one who is already familiar with the practice. In fact, the entity must file a certificate of account status from the Texas Comptroller indicating that all its taxes have been paid and it is in good standing with the Comptroller as part of the package of documents that must be filed with the Texas Secretary of State (SOS). A certificate of termination must be filed with the SOS.
Additionally, state law requires that an entity that is winding down have a dissolution plan which addresses how claims and assets will be dealt with and distributed, and that dissolution plan must be approved as required by law.
If there was an assumed name, that name will need to be released by filing a form with the SOS.
Licenses If the provider had any x-ray equipment or other equipment that required a license, the relevant licenses will need to be addressed and notice provided to the appropriate licensing agency, the Texas Department of State Health Services.
Any wall licenses displayed should be stored in a secure location to help prevent fraud.
Other Physicians should consider the tax consequences and financial issues associated with retirement and/or relocation, such as whether there are any outstanding loans (e.g., equipment, real property, other) and whether any real property has liens associated with it. Final tax returns will be required if the entire practice is closing.
Conclusion In summary, there are a myriad of issues that physicians need to consider in advance of any planned retirement or relocation, and the help of other professionals is highly advised, from tax advisors to accountants and attorneys. Particularly when reviewing agreements, having someone versed in the lingo and contract law will reduce confusion and/or frustration and time.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Friday, July 31, 2020.Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
The third part of a three-part series about physician involvement in advocacy.
by Tilden L. Childs III, MD, TCMS President
My goodness! What a year this has been so far. I hope everyone has persevered to the best of their ability. The re-opening of our economy has begun, and much needs to be done to restore some sense of “normal” to our practices. Hopefully, we can also all start resuming some of the pleasant social activities to which we are accustomed, at least to some extent, in a safe and responsible way.
As we begin to re-focus and start looking forward to next year’s legislative session, I want to present the final article of my three-part series on participation in organized medicine, advocacy, and the legislative process. In this article, I want to give you a flavor of “where the rubber meets the road,” or, as some say, “see how the sausage is made.” In my first article, I discussed some of the options that you, acting either as an individual or through participation with your medical societies, have available, particularly at the state level. Now I would like to share with you some examples of how individuals in our community have participated in the legislative process in Texas.
However, before we get to that, I have a few thoughts for your consideration for the upcoming Texas legislative session (87R – 2021) beginning in January 2021. As you are aware, 2020 is an interim year during which issues are identified and discussed, policies are formulated, and bills are drafted in preparation for bill filing late in 2020 and early in 2021. Prior to the COVID-19 crisis, redistricting was considered to be the top issue. It now looks like this will be put on hold. The overriding issue, in my opinion at this time, will likely be the budget. Inherent in this will be the necessity for organized medicine to be on guard and be proactive in preventing/mitigating budgetary cuts that affect patient care and physician practice viability in Texas. This is something that everyone will have an opportunity to participate in. Although Texas has a large Economic Stabilization Fund (rainy day fund), it may not be sufficient to prevent budgetary cuts. Additionally, participation in the legislative process promises to be unique and challenging, given the current atmosphere of social distancing as we reopen society. Whether traditional legislative hearings and committee meetings and legislative assemblies will occur as they have in the past remains to be seen. For example, the Virginia House has been meeting outside on the grounds of the state Capitol beneath large white event tents. Good luck to Rep. Charlie Geren on figuring this out for Texas.
“Inherent in this will be the necessity for organized medicine to be on guard and be proactive.”
Assuming you have followed the processes I outlined in my first article regarding participation and advocacy, and that you now understand what a complicated and arduous process it can be to develop policy (as I described in my second article), you are now ready to take the next step. Being knowledgeable and informed on specific issues, plan to meet with your state representative and senator or their staffs during session, either one-on-one or as part of a group to discuss the pertinent bills pertaining to your issues. A good opportunity during session, as I discussed previously, is to go with your county medical society through the TMA First Tuesday’s program. Next, identify which members are on the House and Senate committee(s) that are likely to hear your bills of interest. To the extent possible, get to know these committee members and share your thoughts with them or their staffs, again either individually or through your group representation.
You then need to show up at the capitol to attend and participate in committee hearings. The Texas Legislature Online (TLO) website (https://www.capitol.state.tx.us/) has many uses, including providing notification of times and locations of the specific committee hearings and their agendas. Once onsite, register your position on your bill or bills of interest being considered in hearings that day. This is easy to do and is done just prior to the hearing. Consider providing testimony at committee hearings. This is done in the form of either written or oral testimony. To prepare for oral testimony, I have a homework assignment for you: I recommend that you review previously recorded testimony. The TLO website allows searches of the House and Senate committee meetings archives by date and committee, and I have included this information in the following examples. A notable one from the previous session (86R – 2019) was the contentious issue of balance billing. As Chair of the Council on Legislation, Dr. Jason Terk admirably represented the TMA in testimony before the Senate Business & Commerce Committee (B&C) on March 21, 2019, against SB 1264 as written. I highly recommend reviewing this recorded testimony online (search TLO Senate archives by date and committee or view at https://tlcsenate.granicus.com/MediaPlayer.php?view_id=45&clip_id=14013) beginning at time 2:08:25. This is an excellent example of now only how adversarial the process can be but also how important it is to be part of the process. An example of a more friendly encounter, particularly for a first-timer (both me and the lady who followed me), on a relatively non-contentious issue can be found by searching TLO House archives for the House Insurance Committee meeting on March 5, 2019 (or at https://tlchouse.granicus.com/MediaPlayer.php?view_id=44&clip_id=16400), beginning at time 1:35:43, where I testified on HB170 relating to mammography coverage. The TCMS and the TMA can provide further insight and assist you in preparing to testify as well. A number of Tarrant County physicians have testified over the years and this has been integral to the legislative successes achieved by the TMA.
In closing, I hope you have gained an in-depth understanding of the role we can and do play in the legislative process. Participate in your local, state, and national medical organizations. Inform yourself on the issues. Help formulate policy. Advocate for your position. Make your voice heard by being part of the legislative process through active participation at the Texas capitol, as I have described in this article. You can do it! You can make a difference in the future of Texas medicine.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Tuesday, July 28, 2020.Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Thursday, July 23, 2020.Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
“The mass of men lead lives of quiet desperation.” -Henry David Thoreau – Walden
by Tom Black, MD – Publications Committee
As I reflect upon the thousands of patients with whom I had contact during my general surgery residency training, one stands out as perhaps the most important, at least in the sense that she is the one from whom I learned the most profound lesson.
I can see Sara Hardin in my mind’s eye. She occupied bed space 15, the middle bed of the three just to the left of the 2nd floor nurses’ desk, facing south. Sara was 49 years old, but she appeared to be at least 70. She was thin and bent. Her wrinkled and leathery skin spoke of a life none of us could hope to understand, undoubtedly spent out of doors and working hard. Her teeth were gone and she either didn’t bother putting in her dentures or didn’t own any. Her unkempt short gray hair and the dirt under her nails contributed to her derelict appearance. Sara was admitted to the county hospital for evaluation of intestinal bleeding.
No one came to visit Sara, at least, no one that I was ever aware of. Whenever I saw her, she was generally napping or staring out the window. I don’t recall that she ever said a word to us as we rounded each morning and evening, but then again, I don’t recall ever saying much to her either.
Once, when I was a senior resident, a new second year resident was assigned to our surgical service. We had never worked with each other and I knew nothing of him aside from the expensive watch he wore. I always thought it was in poor taste, if not ill advised, to flaunt something of such value in front of so many people who themselves had so little. One day during rounds at Sara’s beside, this new resident concluded his introductory remarks with the words, “She’s your typical troll.” All present nodded knowingly.
“Troll” was Ben Taub Hospital parlance for a homeless individual, and the term carried with it, as one might imagine, a terribly negative connotation. It comes, I’m sure, from the Norwegian folktale of the ugly ogre who lived under the bridge that the Three Billy Goats Gruff had to cross. In Houston, as in many other cities, many homeless people live under the shelter of bridges and overpasses.
I am quite embarrassed now to admit that I neither said nor did anything at the time to set the young man straight regarding his opinion of someone of whose situation he was ignorant. But the label stuck in my mind, and it troubled me. In retrospect I can only hope that Sara either did not overhear that young man’s comment or did not understand his insinuation.
I suppose I had fallen, as do most students and residents, into the depersonalizing mindset of those who say, “the appendix in room five,” or “I admitted a head injury last night.” Most physicians-in-training are much more focused on the task of developing clinical acumen and less on humanity, but that’s a poor excuse. Nurses are often guilty, as they tend to report, “Four fifty-seven needs some pain medication.” HIPAA has greatly exacerbated the problem by disallowing the use of names in favor of initials or anonymous room numbers. But it’s a leap beyond depersonalization into cruelty to demean and denigrate another individual, particularly when he or she is in a debilitated condition and worse yet, when he or she is dependent upon you for assistance.
What right did I have to do anything other than to exhibit the utmost respect for everyone as unique individuals of worth, while administering to them the best possible care?
A day or two after the episode, I stopped by Sara’s bed. She was sleeping, which allowed me the opportunity to observe and to learn a bit about her. A book lay on the bedside table. It was a well-worn copy of the Bible. The bookmark and the pair of scratched and repaired eyeglasses nearby indicated that the book was read often and was of significance to her. A cross hanging next to her bed showed her personal devotion. Although she wore no jewelry, the proximal phalanx of her left ring finger was noticeably narrower than the same area of her other fingers, indicating that a ring had once held a longstanding position of importance there. Perhaps she had been recently widowed; who knew? And who even asked? I studied the lines on her face. They indicated that she had spent much more of her life smiling than frowning and spoke of happier and perhaps more secure days now past. Taped to the side of the bedside table, in such a manner as to be easily visible by her, but nearly invisible to casual visitors, was a simple crayon drawing with a crudely scrawled caption that read, “I love you Gramma.” Next to that was a small photograph of the type taken annually in public schools, of a little girl aged five or six years. I was even more ashamed of the callous attitude my colleague had displayed toward one of our fellow human beings and of myself for having remained silent.
I may have been as guilty as others of depersonalization, but never of cruelty, and having witnessed that appalling lack of compassion was a wakeup call for me to reassess my own values. I began to appreciate the people who passed through the hospital in a new light and as being more than “clinical material” who existed for my benefit. Each became an individual. Each old man was someone’s father, and if not father or grandfather, then at least someone’s son. Each elderly woman was someone’s daughter and, as in Sara’s case, likely to be loved by someone. There were experiences etched into the wrinkles of each of Sara’s hand that I could not even begin to understand. What right did I have to do anything other than to exhibit the utmost respect for everyone as unique individuals of worth, while administering to them the best possible care?
Several days later, in a different location but similar circumstance, I heard the term “troll” again used in a similarly insensitive manner. This time I was determined not to allow the opportunity to pass.
“Stop right there. Everyone remember from this moment on that the word you just used is not acceptable on this service, at least as long as I’m here.” I paused to collect my thoughts, although I had mentally rehearsed my comments many times.
I addressed the speaker. “When you applied to medical school, you were probably asked why you wanted to become a doctor, and you probably said ‘Because I want to help people.’ Well, either you meant it or you didn’t, but if you were honest and you do want to help others, start by treating everyone as a fellow human being. You wouldn’t appreciate someone speaking that way about your mother or grandmother.” There was some resentment after that over the reprimand, but I heard no more “troll” comments.
On the evening of the day Sara was discharged, the team assembled at the nurses’ station for rounds. “Dr. Black,” the charge nurse said. “This was left for you.” It was an orange mailing envelope with Sara’s name on it. Opening it, I pulled out a nice greeting card addressed to our team. I read the card aloud to the members present. “Dear Blue Surgery team. Thank you all so much for the kindness and care you gave to our mother and grandmother while she was recovering in the hospital.” I was gratified to see that the irony of the message had wounded a few egos.
A few months ago, an essay by medical student Sneha Sudanagunta appeared in this journal. In it, Ms. Sudanagunta concluded that medical schools must do a better job teaching what she called “humanism,” (an ambiguous word for which I suggest “compassion” may be a more apt term). While I applaud her passion for this important topic, it is disconcerting that Ms. Sudanagunta felt compelled at all to implore physicians to teach more compassion. My experience leads me to believe that her observations represent an exception rather than the rule among practicing physicians.
I suppose medical students and residents are much the same as they were forty years ago. Sometime between acceptance to medical school and the completion of medical training, one must resolve one’s personal standards regarding the treatment of others and the sanctity of human life. Of course, cruelty must be categorically opposed and compassion fostered just as strongly. While I am doubtful that compassion can be taught, per se, I am quite certain that it can be effectively modeled, and a receptive individual can be influenced to change his or her own behavior.
I am convinced that we are surrounded by compassionate physicians; their names are in the TCMS directory. It is who we are, or at least, who we want to be. Nevertheless, it is wise for us to recall from time to time the wisdom of the Dalai Lama: “Be kind whenever possible. It is always possible.” We need to show Ms. Sudanagunta that whatever she experienced was the exception, not the rule.
Tarrant County students will not return to school until Sept. 28 under a Joint Control Order issued today by Local Health Authorities from Tarrant County, City of Arlington and the City of Burleson.
Under the order, all public and non-religious private schools are not to re-open for on-campus, face-to-face instruction or activities until Sept.28. Some activities are allowed, though social distancing, facial coverings and other safety protocols must still be observed:
Administrators, teachers and staff may conduct remote learning while on-campus
All events and activities, including clubs, sports, band, choir, fairs, exhibitions, academic and/or athletic competitions and similar student activities may take place remotely or outdoors in accordance with current social distancing and masking guidelines.
Special education instruction may occur when necessary and in accordance with TEA guidelines when feasible
Students whose individual education plans cannot be implemented with remote learning or who have limited household connectivity to the internet may be provided in-person instruction
All school systems shall re-open schools through remote learning only as per each school system’s own plan and may provide curbside meals from school campuses
The new order requires each school district to provide the Local Health Authority a written plan for resuming on-campus instruction and extra-curricular activities no later than two weeks before re-opening school. Tarrant County Public Health Director Vinny Taneja said the order is needed to continue to slow the spread of COVID-19.
“The safety of our children is our greatest concern along with the health of their parents, teachers and friends,” said Tarrant County Public Health Director Vinny Taneja. “With community spread actively in place, our children going to school would undo everything that our stay at home and mask-wearing efforts have tried to accomplish.”
The order, effective today, was signed jointly by all three Local Health Authorities, Dr. Catherine Colquitt for Tarrant County Public Health, Dr. Cynthia Simmons for the City of Arlington and Dr. Steve Martin for the City of Burleson.
To read the Joint Control Order go here. Or for questions, call the Tarrant County Public Health information line at (817) 248-6299.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Tuesday, July 21, 2020.Find more COVID-19 information from TCPH here.
* These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
Tarrant County Physician Online 