Addressing Conscientious Objection in Healthcare

Insights from the 2023 Healthcare in a Civil Society Forum

by Liz Ramirez

The Tarrant County Academy of Medicine Ethics Consortium, in partnership with Tarrant County Medical Society, hosted Healthcare in a Civil Society on Saturday, February 25, 2023. The annual forum’s central theme focused on “Conscientious Objections in Health Care: Patient Autonomy and Provider Integrity.”

TCMS President Stuart Pickell, MD, joined Steve Brotherton, MD, as HCS moderator and welcomed their keynote speaker, Farr Curlin, MD, at the University of North Texas Health Science Center.

“Dr. Curlin is an internationally known expert on physician conscience and conscientious objection,” said Dr. Pickell. “He is particularly concerned with the moral and spiritual dimensions of medical practice, the doctor-patient relationship, and the moral and professional formation of physicians. His areas of expertise are medicine, medical ethics, doctor-patient relationship, religion and medicine, and conscience.”

On the panel, Dr. Curlin was accompanied by panelists Maxine M. Harrington, JD; Alan Podawiltz, DO; and UNTHSC President, Sylvia Trent-Adams, Ph.D., RN. In the discussion, Preston “Pete” Geren, JD, moderated a panel about educational topics like state intrusion into practice, the effect of providers performing unethical acts, and how medical educators can train students to recognize moral injury.

Participants had the opportunity to interact in small groups and prepare questions for the panelists during the breakout session, where panelists discussed the impact of government and institutional intrusion into medical practice, its effect on healthcare providers, and what providers can do to address it.

“While this event targets medical professionals, anyone who has an interest in the doctor-patient relationship- how it has evolved, where it is heading and implications for the future of healthcare- will find this program helpful,” said Dr. Pickell.

The Tarrant County Academy of Medicine Ethics Consortium believes anyone in the community with an interest to improve healthcare can benefit from this program. The event wouldn’t be possible without the support of Blue Cross Blue Shield, Cook Children’s Medical Center, JPS Health Network, and the University of North Texas Health Science Center.

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

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

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

A number of topics will be covered, including:

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

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

5th Annual Ralph J. Anderson, MD Women’s Health Symposium

The 5th Annual Ralph J. Anderson, MD Women’s Health Symposium will showcase the advances made in women’s health care in both Tarrant and Dallas Counties. It was created to honor Dr. Anderson, who dedicated a large portion of his career to the education of health care professionals in the field of obstetrics and gynecology. For more than 20 years Dr. Anderson developed, moderated, and oversaw a yearly large educational symposium to ensure that practicing health care professionals continued their education to improve patient care and patient outcomes.

Registration

You can register for the symposium here.

Learning Objectives

Upon completion of this activity, learners will be able to:

Define two strategies to improve health outcomes of women in DFW metroplex;
Diagnose and define uncomplicated vaginitides using evidence-based methodology;
Define maternal morbidity and mortality related to Placenta Accreta Spectrum Disorder;
Describe the current burden of substance use disorders (SUD) women experience in the US; and
Identify key points of progress in our understanding of human trafficking and healthcare responses for readying its workforce.

Topics Covered

At the Women’s Health Symposium you will learn from distinguished leaders in the field of women’s health on such topics as:

Placenta Accreta
Advances in New Born Care & Breastfeeding
Palliative Medicine
Overactive Bladder
Fetal Surgery Innovations
Adolescent Health
Trafficking and Opioid Abuse

Price for Virtual Attendees

Registration fee: $120

Who Should Attend

Physicians, physician assistants, nurse practitioners, certified nurse midwives, nurses and social workers caring for women will all find something of practical value at the 2022 Women’s Health Symposium.

TCU names medical school to honor the late Anne Burnett Marion

Texas Christian University today announced that the School of Medicine will be named the Anne Burnett Marion School of Medicine in honor of the late Anne Burnett Marion’s lifetime of friendship and support and her extraordinary generosity to the TCU School of Medicine.

The estate of the late Anne Burnett Marion and The Burnett Foundation, a charitable foundation based in Fort Worth, have made a second $25 million gift to The Anne W. Marion Endowment in support of the TCU School of Medicine operations in perpetuity.

“During her lifetime, Anne Marion’s support of the university through her service as a trustee and her philanthropy played a vital role in strengthening TCU’s academic profile and reputation. Her investment of $50 million in our School of Medicine enhances her legacy and will have a momentous influence on TCU for the next 150 years,” TCU Chancellor Victor J. Boschini, Jr. said. “The history of TCU is beautifully intertwined with the Burnett family’s legacy. It is impossible to imagine where we would be without their generosity and longstanding loyalty. We are grateful to Anne’s daughter, philanthropist Windi Grimes, for the honor of establishing this tribute to

her mother, marking her indelible contributions to TCU and generations of physician leaders.”

The first gift ever made by The Burnett Foundation, formerly known as The Anne Burnett Tandy and Charles Tandy Foundation, was to TCU, an endowment in her mother Anne Burnett Tandy’s and Charles Tandy’s names. Marion gave to nearly every area of the university, culminating with her final gift of $25 million to TCU through The Burnett Foundation, among the most generous gifts in university history. It was a pivotal one for the TCU School of Medicine as it established The Anne W. Marion Endowment to support the students, faculty and programming of the school permanently.

“This level of generosity will create a lasting legacy through the many doctors who will go onto be physician leaders in their communities and in the field of health care, serving others and changing lives for the better for generations to come,” Boschini said. “We could not be more proud to have our School of Medicine bear her and her family’s great name forever.”

Anne Burnett Marion was a native of Fort Worth and was deeply committed to her community and supporting the future of medical education. Her family ties to the Fort Worth community date back nearly a century. They have a long history of supporting the priorities of the city and its institutions. The Burnett Foundation has been a generous patron of the city, investing significant resources to enhance the community in myriad ways. The foundation focuses on building capacity in organizations and people through the arts and humanities, education, community affairs and health and human services.

“Legacy and loyalty have always been Burnett family traits,” Windi Grimes said. “My grandmother’s first foundation gift was to TCU, and it seems fitting that my mother’s last foundation gift goes to support the University as well. My mother was inspired by the TCU School of Medicine, and we hope that the Anne Burnett Marion School of Medicine will provide a profound impact to all those it serves.”

The gifts that total $50 million for the School of Medicine strengthen TCU’s endowment and propel the university closer to its $1 billion goal for Lead On: A Campaign for TCU. This historic fund raising effort fuels the university’s strategic plan and positions TCU for even greater success in the future.

“The Anne W. Marion Endowment will provide funds to support our students, faculty and programming for the medical school and continue to fuel our mission of transforming health care by inspiring Empathetic Scholars ®,” said Stuart D. Flynn, M.D., the founding dean of the School of Medicine. “This generosity empowers us to continue recruiting and nurturing talented and diverse students who are shaping the future of medicine and health care in an abundance of ways. We continue to carry out the vision of creating physicians who are knowledgeable and compassionate care givers.”

The Anne Burnett Marion School of Medicine, which will be known as the Burnett School of Medicine, welcomed its first class of medical students in July 2019, and they will graduate in 2023. The Burnett School of Medicine’s fourth class began in July 2022 bringing the school to full enrollment.

TCU is also expanding the university’s footprint in Fort Worth into the Near Southside area and Medical District to open a new campus for the Burnett School of Medicine. The four-story, and approximately 100,000-square-foot medical education building will sit at the northeast corner of South Henderson and West Rosedale streets. It will be the academic hub for 240 medical students and hundreds of faculty and staff. Completion is planned for fall 2024, and additional facilities are part of the master plan.

TCU School of Medicine Announces the Tom and Joan Rogers Endowment Fund to Support Academic Excellence

By Maricar Estrella

Community leaders Tom and Joan Rogers have established a permanent endowment for the TCU School of Medicine to support the school’s innovative curriculum and the training of Empathetic Scholars®.

The Tom and Joan Rogers Endowment in Support of Academic Excellence for the School of Medicine will provide for the greatest needs and opportunities annually in medical education and physician training.

“I am incredibly grateful for this generous gift, which will empower current and future generations of innovative and talented students,” said Stuart D. Flynn, M.D., Dean of the TCU School of Medicine. “Two of the first people I met upon arriving in Fort Worth were Mrs. and Dr. Rogers and they welcomed me in such a gracious and warm fashion. Their generosity is emblematic of their character as they support our efforts to create physicians who are highly skilled and knowledgeable yet compassionate care givers. Our students are extremely fortunate to have Dr. Rogers, a luminary in caring for our children in Fort Worth, as a role model to emulate on the delivery of care with empathy, passion, and love.”

Tom Rogers, M.D., retired after a 50-year career as a pediatrician, has been referred to as “Fort Worth’s original Empathetic Scholar.” Mrs. Rogers is a longtime member of the TCU Board of Trustees. Their generous gift to create this endowment also supports Lead On: A Campaign for TCU, the university’s most ambitious philanthropic campaign in its nearly 150-year history.

Dr. and Mrs. Rogers, their daughter Kelly, and three grandchildren are TCU graduates.

“Supporting the School of Medicine is pretty much a ‘no-brainer’ for us,” the couple said. “So, when TCU helped establish the M.D. School, we were eager to support it in any way we could.”

“Getting acquainted with many of the faculty and staff and meeting some of the truly amazing students only increased our eagerness to be involved,” they said. “Texas is desperate for more doctors, and hopefully some of these graduates will also choose to stay in Fort Worth to practice. In establishing this endowed program fund for academic excellence, we are supporting medical education while investing in these deserving students through the tough years of becoming a doctor.”

HOW TO GIVE

Gifts of any size may be made to The Tom and Joan Rogers Endowment in Support of Academic Excellence for the School of Medicine by contacting University Advancement at 817-257-7800 or TCU Box 297044, Fort Worth, TX 76129.

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.”

TCU Medical Student Publishes Two Children’s Books

By Prescotte Stokes III

You can find the original article here.

During a short break from medical school during Summer 2021, Sereena Jivraj, a second-year medical student at the TCU School of Medicine, had a burning desire to create something.

She combined her love for science, medicine and children for something special. She made the most of her time by writing two children’s books entitled, “Connor and His Composting Adventures” and “Ella and Her Vaccine Soldiers.”

“I’ve had these ideas in the back of my mind for some time,” Jivraj said. “I’ve spent so much time around children whether that was tutoring or babysitting and I’ve always been reading children’s books for years and it just felt like I’ve been so involved with kids in the past that it would be cool to keep it going in the future.”

Sereena Jivraj, a second-year medical student at the TCU School of Medicine, holds her newly published children’s books entitled “Connor and His Composting Adventures” and “Ella and Her Vaccine Soldiers.”

In “Connor and His Composting Adventures,” Connor learns what the difference is between compost and regular trash. Throughout the course of the story Connor learns what everyday items can be composted and how to prevent trash from ending up in a landfill.

“The point is just to educate kids and even parents on what composting is,” Jivraj said. “A lot of people when you speak to them about it they’ve never heard of it. What I really wanted to do is be able to instill that knowledge from a young age. Hopefully that will make it easier to make changes in our society one day in the future.”

Her second children’s book called “Ella and Her Vaccine Soldiers” is about young Ella’s visit to her doctor. Ella learns how important vaccines are and how they can turn into “mini soldiers” to help her body fight viruses and diseases.

“With COVID-19 around last few years and previously with flu shots, I can remember everyone being afraid to go to the doctor just because they knew a shot was coming,” Jivraj said. “I want kids’ fears to be diminished so they can have a healthy relationship with their doctors and not fear them because you’re really brave when you get these vaccinations. I don’t want this fear of vaccines to prevent you getting the help that you need.”

Writing the books was a process that helped Jivraj tackle some of her own issues with long form writing. She reached out to the medical school’s Compassionate Practice® team after she did some volunteer work gathering donations for homeless individuals in Fort Worth and felt compelled to pen a poem about her experience.

“I used it as a way to get out my emotions and help me decompress,” Jivraj said. “I went to the Compassionate Practice® team and that kind of gave me the confidence to do this because I always felt like writing was my weakness.”

She also talked to Samir Nangia, M.D., a Physician Development Coach at the medical school, about the idea of penning the children’s books. During their chats, Dr. Naniga said that her urged Jivraj not to put her ideas off and take some time during her break to pursue them.

“In some instances, through coaching we can help students become more efficient with their time management and help them discover what resources they need to make their dreams a reality,” Dr. Nangia said. “However, in some instances all it takes is that motivation and emotional support. Both of which were true in Sereena’s case.”

In addition to embracing her creativity, Jivraj said that she chose to author children’s books so the information would be easy to understand and accessible to all people.

“This is a book that you can read to your child in your belly or read to your newborn,” Jivraj said. “Because just exposing them to the vocabulary and to the words it helps create those processes in their brains so when they are exposed to it later on, they are not completely confused about it.”

Both books “Connor and His Composting Adventures” and “Ella and Her Vaccine Soldiers” are available in the Amazon Store as a download or paperback version. They are also available to download on Kindle.

Join Walk with a Doc on March 12

Join our local chapter of Walk with a Doc on Saturday, March 12, for a fun morning walking, talking about health, and meeting people in our community. You can find information about the spring dates here.

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

TCU Medical Student and TMA/TCMS Member Anand Singh Elected to AMA Student Board

By Prescotte Stokes III

Read the original article here.

The American Medical Association-Medical Student Section (AMA-MSS) Region 3 executive board recently elected Anand Singh, a first-year medical student at TCU School of Medicine to serve as the Co-Advocacy Chair.

The AMA-MSS Region 3 includes medical schools in Arkansas, Kansas, Louisiana, Mississippi, Oklahoma and Texas.

“My job is to learn about what different health care policies are being passed in these different states,” Singh said. “And spread that news and raise awareness among medical students because as we all know these policies impact everyone from students to physicians and patients.”

Singh will oversee the Region 3 advocacy committee and lead advocacy initiatives to engage region chapters.

He will also work with the Advocacy Subcommittee of the Committee on Legislation and Advocacy (COLA) to help our region engage with events like National Advocacy Week (NAW) and the Medical Student Advocacy Conference (MAC). He will also support the Membership Chair and Secretary in reaching out to local chapters to highlight advocacy endeavors and provide advocacy updates in AMA-MSS Region 3 monthly newsletters.

“Policy writing is very niche and not every physician has to do that but the way this connects with the medical school is how they teach us to be an advocate for your patients,” Singh said. “And growing that idea on a larger scale its advocating for your population. Not only talking to physicians you’re talking to legislative members, congress members and kind of impact a larger audience that’s a really great opportunity as future physicians.”

The Medical Student Section (MSS) aims to be a voice for medical students’ across the AMA to help improve medical education and advocating for the future of medicine.

Navigating Blindly

Kristian Falcon, OMS-III

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

“Si se puede!” (Yes, you can). . .

. . . is what I have been told throughout my life by my parents and by my entire familia. Being the first ever in my family to go into the medical field is a commonality that many Hispanic students share. My father emigrated from Mexico at the age of 18 and had to delay attending university to first learn English. My mother immigrated here at the age of 26, after already holding a teaching license and an equivalent master’s degree in Mexico. She had to redo her education after first learning English to regain her teaching license in the U.S.

Learning English at the same time as my mother was no easy feat. She taught me my vowels and how to read while we taught her proper syntax and English grammar. When it came time to apply to college, how was I supposed to ask my parents to revise my application essays since when growing up, I was the one who edited and revised their emails and text messages?

When I began college, my father asked me, “What are you going to do with a degree in biology?” to which I responded, “Be a scientist.” He wasn’t asking because he didn’t believe in me; he was asking because he truly didn’t know what I could do with such a degree, and to be 100 percent honest, I didn’t either. Becoming a doctor was not a thought I had before; I fell into this path through getting involved with my passion to serve others and my interest in science. Once I realized that I pictured my future self as being a physician, my family grew concerned about the difficult path I would face. They suggested alternative careers, knowing that no one from our family had ever gone down this path before and that many who try, fail.

Maybe I was naïve and didn’t do the proper research on what a career as a physician entailed, but without any guidance, I faced only my short-term goals, one at a time. What I didn’t realize was that becoming a doctor involved much more than just meeting specific checkboxes. It required immense dedication, time, and sacrifice.

At times, I questioned if I even belonged in medical school. During my application process I was told, “You only interviewed there because you’re Hispanic and speak Spanish,” or “You’re lucky you’re underrepresented in medicine; you’ll get accepted anywhere.” I was continually discredited of my merits and accomplishments because of my ethnicity, even though I had years of volunteering, research, and experiences in the medical field as an EMT, and had not only a bachelor’s but also a master’s degree. Upon entering medical school there were less than 20 Hispanic medical students in my class of 220. Hispanic students make up only 15 percent of the student population of all the health professional colleges combined in the health science center I attend, while in Texas, the Hispanic population comprises roughly 40 percent of the state’s population.

Lacking representation and not having mentors who had faced similar paths, I struggled to fit in and find my place. While many of my colleagues had family and friends that were doctors, I grew up not knowing a single person in this field besides my own doctor. I faced obstacles because I had to find resources on my own to help me accomplish my goals. Every medical experience, preceptorship, or shadowing opportunity was one I went out and found on my own; I didn’t have the luxury of growing up with those opportunities around me. I carved my own path.

Within the first month of my third year, I was reminded of the importance of having Hispanic representation in the medical field. I attended to many patients who were Hispanic and spoke only Spanish. While medical translators are vital and do an amazing job of communicating adequately with a patient when there is a language barrier, being able to communicate directly and relate to a patient forms a bond unlike another. Conversations with a translator can sometimes be procedural and very formal; being able to communicate freely in one’s own language allows for a more human interaction and a better understanding between a provider and a patient.

It is the moment when I see a patient become more animated and more comfortable that I remember why I chose this career and that I bring more representation to this field. I remember why I chose to be the first in my family to carve this path, and why I choose to be involved in leadership and advocacy so that many others like me can take this path a little less blindly. While I still have over a year left until I graduate and become a physician, my message to those who seek this path is, “Si se puede!”