Public Health – Tarrant County Physician Online

Physician Suicide: Addressing the Crisis

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the September/October 2026 issue of Tarrant County Physician.

It’s time to break the silence on physician suicide. This may be an exceedingly difficult topic for many of you; perhaps you have experience with losing a colleague or a loved one to suicide. Some of you may even have your own struggles. Unfortunately, physicians still have one of the highest suicide rates of any profession, with 300 to 400 physicians a year dying by suicide in the US.^3,7 Here are some staggering facts: one in six physicians has thought about or attempted suicide.⁴ Physicians in total die by suicide at twice the rate of the general population.^2,11 Suicide is the leading cause of death among male residents and the second leading cause of death among female residents.³ Medical students are three times more likely to die by suicide than their peers of the same age.^3,7 Our residents are suffering. Our students are suffering. And we are suffering.

“Physician, heal thyself” is a biblical proverb that is often taken out of context. It does not mean we should treat our own illnesses. Rather, it reminds us that physicians, too, must care for our mental and physical health by getting support from those who have the knowledge and training to help us. Too often, physicians continue caring for others while ignoring or delaying care for themselves—whether for something as minor as a cold or as serious as heart disease or suicidal thoughts. Even today, society often assumes physicians do not get sick or struggle with mental illness. Many of us were trained to believe that acknowledging illness could be seen as weakness, so we press on without seeking care, even as we expect our patients to do otherwise. Physicians who seek help may also fear consequences with licensure, credentialing, or patient trust.^3,7,13 Our self-reliance and perfectionism can make asking for help even harder. And although we are trained to recognize risk factors in our patients, we may miss them in ourselves or our colleagues. This potential blind spot is especially concerning because physicians share many of the same suicide risk factors as the general population, including mental health disorders, impaired relationships, and self-criticism.^1,5,7

Burnout from high workloads, time pressures, moral distress, and relationship discord is a real issue for physicians. There are additional institutional and regulatory pressures as well, often associated with administrative burden and an increased sense that autonomy is being lost.^3,6,7 Decreased efficiency and errors may also occur.^4,6 There is a perceived lack of psychological safety for physicians. Let’s face it, our cultural norms discourage vulnerability and seeking help for ourselves.^7,9,13 Yet the relationships we hold, the identities we carry, and the quiet pressures we internalize all play a role in suicide risk. So how can we help? I have a couple of ideas.

Last year at Burnett School of Medicine at TCU, several faculty, staff, and medical students had a fantastic session with the program manager for the Jordan Elizabeth Harris Foundation. She told the story of the foundation’s young namesake, Jordan Harris, who died by suicide shortly before graduating from college. Her parents created this foundation to help prevent others from experiencing the loss of a loved one dying by suicide. Not only was this educational, but it was also a training session on how to respond in these situations. Anyone can help prevent suicide. Just observing a physician, or anyone for that matter, in distress, and reaching out, can save a life. This training program is called QPR, which stands for Question, Persuade, and Refer. Like CPR, any person can be trained to effectively provide QPR—they do not have to be a healthcare professional. The American Hospital Association developed an entire guidebook that looked not only at data regarding healthcare worker suicide but also data about effective prevention strategies that hospitals could implement.12

Thursday, September 17, is National Physician Suicide Awareness Day (#NPSADay). This is now an annual opportunity to break the silence and raise awareness of mental health issues and suicide in physicians. A partnership between The Physicians Foundation, All In: Wellbeing First for Healthcare, and the Dr. Lorna Breen Foundation was formed to address physician suicide with a particular campaign called Vital Signs. This campaign is designed to train organizations, clinics, and even individuals in suicide prevention. In this campaign, Vital Signs refers to warning signs of impending physician decompensation or suicide. This partnership recommends a variety of prevention measures including recognizing warning signs, encouraging mental health reflection, sharing suicide prevention resources, checking in with physicians who do not appear to be doing well, removing intrusive mental health questions to licensure and hospital privilege applications, and creating a culture of well-being in organizations. They also have toolkits and even training slides for organizations to use (for free).^12,13,14

And let’s not forget our own TCMS wellness program, which I mentioned in my first President’s Paragraph. Our Tarrant County Medical Society Physician Wellness Program facilitates confidential, non-reportable help with coaching sessions and four complimentary counseling visits for members OR spouses, including couples counseling. The website is listed with the mental health resources I have shared below; it is sponsored by Tarrant County Academy of Medicine.

We entered this profession to heal—to listen to comfort, to save lives. Yet somewhere along the way, many of us learned to silence our own pain. We learned to wear resilience like armor, to treat vulnerability as weakness, and to fear that asking for help might cost us our careers. But silence has a cost. And too often, that cost is a life. Breaking the silence is not just an act of courage—it is an act of care. It is how we honor those we have lost, protect those still struggling, and reshape the culture of medicine into one that heals its healers. The question is no longer whether we should speak up. It is how we create spaces where speaking up is safe, supported, and sustained.

“The journey of a thousand miles begins with a single step.”
– Lao Tzu

References:

H. Makhija, J. E. Davidson, K. C. Lee, A. Barnes, A. Choflet, and S. Zisook, “National Incidence of Physician Suicide and Associated Features,” JAMA Psychiatry 82, no. 5 (2025): 451–458, https://doi.org/10.1001/jamapsychiatry.2024.4816.
D. Duarte, M. M. El-Hagrassy, T. C. E. Couto, W. Gurgel, F. Fregni, and H. Correa, “Male and Female Physician Suicidality: A Systematic Review and Meta-analysis,” JAMA Psychiatry 77, no. 6 (2020): 587–597, https://doi.org/10.1001/jamapsychiatry.2020.0011.
H. H. McClafferty, D. K. Hubbard, D. Foradori, et al., “Physician Health and Wellness,” Pediatrics 150, no. 5 (2022): e2022059665, https://doi.org/10.1542/peds.2022-059665.
Jon McKenna, “Medscape Physicians and Suicide Report 2025: ‘A Lot More Still Needs to Be Done,’” Medscape, February 21, 2025.
K. J. Gold, T. L. Schwenk, and A. Sen, “Physician Suicide in the United States: Updated Estimates from the National Violent Death Reporting System,” Psychology, Health & Medicine 27, no. 7 (2022): 1563–1575, https://doi.org/10.1080/13548506.2021.1903053.
Constance Guille and Srijan Sen, “Burnout, Depression, and Diminished Well-Being among Physicians,” New England Journal of Medicine 391 (2024): 1519–1527, https://doi.org/10.1056/NEJMra2302878.
S. B. Harvey, R. M. Epstein, N. Glozier, K. Petrie, J. Strudwick, A. Gayed, K. Dean, and M. Henderson, “Mental Illness and Suicide among Physicians,” The Lancet 398, no. 10303 (2021): 920–930, https://doi.org/10.1016/S0140-6736(21)01596-8.
US Preventive Services Task Force, “Screening for Depression and Suicide Risk in Adults: US Preventive Services Task Force Recommendation Statement,” JAMA 329, no. 23 (2023): 2057–2067, https://doi.org/10.1001/jama.2023.9297.
M. A. Oquendo and A. Porras-Segovia, “Barriers for the Research, Prevention, and Treatment of Suicidal Behavior,” Current Topics in Behavioral Neurosciences 46 (2020): 25–40, https://doi.org/10.1007/7854_2020_159.
S. K. Doupnik, B. Rudd, T. Schmutte, et al., “Association of Suicide Prevention Interventions with Subsequent Suicide Attempts, Linkage to Follow-up Care, and Depression Symptoms for Acute Care Settings: A Systematic Review and Meta-analysis,” JAMA Psychiatry 77, no. 10 (2020): 1021–1030, https://doi.org/10.1001/jamapsychiatry.2020.1586.
C. Zimmermann, S. Strohmaier, H. Herkner, N. Niederkrotenthaler, and E. Schernhammer, “Suicide Rates among Physicians Compared with the General Population in Studies from 20 Countries: Gender-Stratified Systematic Review and Meta-analysis,” BMJ 386 (2024): e078964, https://doi.org/10.1136/bmj-2023-078964.
American Hospital Association, “Suicide Prevention in the Health Care Workforce,” accessed August 10, 2026, https://www.aha.org/suicideprevention/health-care-workforce.
American Medical Association, “Preventing Physician Suicide,” updated August 7, 2025, https://www.ama-assn.org/practice-management/physician-health/preventing-physician-suicide.
The Physicians Foundation, “Campaign: Vital Signs,” accessed August 10, 2026, https://physiciansfoundation.org/research/campaign-vital-signs/.

Public Health Infrastructure at Work: Lessons from Ebola, New World Screwworm, Cyclospora, and the 2026 World Cup

Public Health Notes

By Kenton K. Murthy, DO, MS, MPH, AAHIVS
TCPH Assistant Director & Deputy Local Health Authority

This article was originally published in the September/October 2026 issue of Tarrant County Physician.

As physicians, we spend much of our careers focused on the patient in front of us. Public health often focuses on the patient we never see: the illness that was prevented, the outbreak that was contained, or the emergency that never materialized. When the system works as intended, its greatest successes can look like nothing happened.

The summer of 2026 has provided four very different reminders of why that infrastructure matters: a rapidly expanding Ebola outbreak in Central Africa, the return of New World screwworm to Texas, a large rise in cyclosporiasis associated in part with iceberg lettuce, and the successful completion of the largest FIFA World Cup in history. Each event required a different response, but all depended on the same foundation: timely clinical recognition, laboratory capacity, surveillance, clear communication, and coordination across jurisdictions and disciplines.

Ebola: A Global Threat Requiring Local Readiness
The current Ebola outbreak is caused by Bundibugyo virus, one of the Orthoebolaviruses that can cause severe hemorrhagic disease. As of August, the Democratic Republic of the Congo had reported over 4,000 confirmed cases and 1,916 deaths. The outbreak had become the largest Ebola outbreak recorded in the country. Uganda declared the end of its locally transmitted outbreak on July 28 after 42 days without a new locally acquired case, although ongoing transmission in the DRC leaves neighboring countries at risk for reintroduction._¹

For physicians in the United States, the immediate risk remains low. No cases associated with this outbreak have been confirmed here. CDC describes the overall risk to the American public and travelers as low and the likelihood of spread to the United States as very low.² Low risk does not eliminate the need for readiness. Early Ebola symptoms, including fever, fatigue, headache, myalgias, vomiting, and diarrhea, overlap with much more common illnesses. Recognition begins with a careful travel and exposure history, particularly during the 21 days before symptom onset.

If a patient has compatible symptoms and a relevant exposure, the first steps are to isolate the patient, implement appropriate infection-prevention precautions, notify the facility’s infection-prevention team, and contact the local or state health department to coordinate assessment and testing.³ That early call protects the patient, clinical staff, laboratory personnel, and the broader community. Local health departments, state agencies, and international partners have different responsibilities, but the value lies in how those responsibilities connect. In the affected areas, conflict, population displacement, limited diagnostic access, shortages of protective equipment, and infections among health workers have made control substantially more difficult. The biology of the virus is only one part of the outbreak; the strength of the surrounding system helps determine what happens next.

New World Screwworm: One Health in Real Time
Closer to home, New World screwworm is no longer only a threat approaching the southern border; it has been confirmed in Texas. The first US animal detection in the current outbreak was confirmed in a calf in Zavala County on June 3. By early August, the Texas Animal Health Commission reported confirmed animal cases on 35 premises in 15 counties.⁴

New World screwworm may sound primarily like an agricultural concern, but it is also a health issue with implications for veterinary medicine, wildlife, human health, and the Texas economy. The larvae of Cochliomyia hominivorax feed on living rather than necrotic tissue. Its reemergence reminds us that protecting health sometimes requires veterinary medicine, agriculture, wildlife management, laboratories, emergency management, and human public health to operate as a system.

There have been no reports of locally acquired human infestation in the United States, and CDC characterizes the current risk to people as very low.⁵ Clinicians should nevertheless recognize the presentation: a rapidly worsening, painful, foul-smelling wound; bloody drainage; visible larvae; or the sensation of movement in a wound or body opening. Treatment requires removal and safe disposal of all visible larvae and eggs, repeat examination of the lesion, wound care, and treatment of secondary infection when present. Suspected human cases should be reported immediately, and intact larvae should be preserved for identification rather than discarded.⁶

The Texas response demonstrates collaboration beyond traditional health departments. USDA, the Texas Animal Health Commission, Texas Parks and Wildlife, CDC, DSHS, local health authorities, veterinarians, producers, and laboratories all have distinct roles. Surveillance, animal-movement controls, wound inspections, public education, and release of sterile male flies are being used together. The sterile insect technique helped eradicate indigenous New World screwworm from the United States in 1966. Its renewed use is a reminder that public health tools can be biological, regulatory, clinical, and operational at the same time.⁴

Cyclospora and Iceberg Lettuce: The Value of Routine Reporting
The 2026 rise in cyclosporiasis illustrates the importance of routine disease surveillance and foodborne outbreak investigation. From May 1 through August 3, CDC reported 10,468 laboratory-confirmed, domestically acquired cases in 47 states, including 517 hospitalizations and, unfortunately, two deaths. CDC was also reviewing tens of thousands of additional illnesses that were not yet laboratory confirmed or required further investigation.⁷

One major subset of these illnesses was linked epidemiologically to iceberg lettuce sourced from central Mexico. Taylor Farms de Mexico recalled affected iceberg lettuce on July 17. Although Texas was not among the 15 outbreak case states listed at that time, recalled products had been distributed through Texas retail and food-service channels.⁸

For clinicians, cyclosporiasis should be considered in patients with prolonged or relapsing watery diarrhea, fatigue, anorexia, weight loss, bloating, and cramping, particularly when symptoms begin about a week after a produce or restaurant exposure. Testing may need to be requested specifically because routine stool examinations and some gastrointestinal panels do not automatically include Cyclospora. Trimethoprim-sulfamethoxazole is the treatment of choice; for immunocompetent adults, CDC lists one double-strength tablet twice daily for seven to 10 days.⁹ Every appropriately ordered test and timely report adds one piece to a much larger puzzle. Epidemiologists, laboratorians, environmental health specialists, regulatory agencies, clinicians, and industry partners then work together to compare exposures, identify clusters, trace products, and prevent additional illness. Clinical medicine and public health are not separate systems; they are complementary parts of the same healthcare continuum.

The World Cup: Preparedness That Stayed in the Background
Perhaps the most overlooked public health success is the event that concludes without a public health emergency. The 2026 FIFA World Cup brought 48 national teams and millions of visitors to 16 host cities across the United States, Canada, and Mexico over 39 days.¹⁰ Despite signs across Tarrant County stating “We Are Dallas,” Arlington actually hosted nine matches and welcomed hundreds of thousands of visitors, and local agencies monitored communicable disease, food safety, heat, air quality, medical surge, and other routine and event-related risks.¹¹

The work began well before the first whistle blew. Locally, healthcare systems, public health, emergency management, EMS, fire, law enforcement, laboratories, airport authorities, and municipal and regional partners established communication pathways and response plans. Nationally, CDC participated in a federal coordination structure; held regular calls with public health officials from all US host sites; deployed epidemiology, laboratory, informatics, and preparedness personnel; and created a shared dashboard for disease trends, heat, and air quality. Twenty port health stations maintained around-the-clock protocols at US ports of entry.¹⁰

At the close of the tournament, available public reporting indicated that no major tournament-associated public health emergency had occurred.10 That does not mean there were no public health concerns to monitor—it means those concerns did not become a defining incident. Risks were anticipated, information was shared, and agencies knew how to reach one another when a signal required attention. An uneventful outcome is often the product of very eventful preparation.

What Public Health Infrastructure Actually Means
Public health infrastructure is not simply a building, a department, or an organizational chart. It is the workforce that answers a report after hours; the laboratory that can identify an uncommon pathogen; the data system that connects cases across counties and states; the epidemiologist who conducts a detailed interview; the infection preventionist who protects a clinical team; the veterinarian who recognizes an unusual wound; the regulatory authority that can remove a contaminated product; and the communication network that provides accurate guidance without unnecessary alarm.

The same sequence appears repeatedly. A clinician or veterinarian recognizes something unusual. A laboratory provides confirmation. Local public health investigates the patient and immediate exposures. State partners identify broader patterns. Federal and international agencies compare signals across jurisdictions. Regulatory, animal health, emergency management, and healthcare partners then act within their respective authorities. No single organization can perform the entire chain, and delays at any handoff can allow a manageable event to become more difficult.

This is not an argument for alarm or for applying the same response to every signal. Good public health is calibrated. It distinguishes common illness from low-probability, high-consequence disease; confirms findings before drawing conclusions; communicates what is known and unknown; and adjusts the response as evidence changes. Strong infrastructure makes that proportional response possible.

The Physician’s Role
For practicing physicians, participation in this system is straightforward but essential:

Ask about travel and exposure when a patient’s syndrome or timing is unusual, particularly for acute febrile illness after travel to an outbreak area.
Order the test that matches the clinical concern, including a specific request for Cyclospora when prolonged or relapsing watery diarrhea warrants it.
Report early. A call to infection prevention or the local health department is not a declaration that a diagnosis is confirmed—it is the beginning of a coordinated risk assessment.

Beyond these examples, vaccination, antimicrobial stewardship, thoughtful diagnostic testing, and routine communicable disease reporting all strengthen the systems our patients depend on. Every clinician contributes to the larger public health enterprise, often without realizing it.

Public health is most visible during a crisis, but it is most effective before a crisis fully develops. Ebola, New World screwworm, cyclosporiasis, and the World Cup have very different challenges, yet they share a common lesson: timely information, defined roles, trusted partners, and coordinated action can protect both individual patients and entire communities. The strongest systems are built through relationships among clinicians, hospitals, laboratories, local health departments, state agencies, federal partners, and international organizations long before an emergency occurs. When those elements are in place, nothing happening may be the most meaningful outcome of all.

References:

World Health Organization, “Ebola Disease Caused by Bundibugyo Virus—Democratic Republic of the Congo,” Disease Outbreak News, August 1, 2026, https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON614. W World Health Organization
Centers for Disease Control and Prevention, “Ebola Outbreak: Current Situation,” July 22, 2026, https://www.cdc.gov/ebola/situation-summary/about-current-outbreak.html.
Centers for Disease Control and Prevention, “Screening and Evaluating an Ill Person for Viral Hemorrhagic Fevers,” updated August 3, 2026, https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/diagnosis-testing/index.html. C CDC
Texas Animal Health Commission, “New World Screwworms,” accessed September 2, 2026, https://www.tahc.texas.gov/emergency/nws.html.
Centers for Disease Control and Prevention, “New World Screwworm Outbreak,” updated August 11, 2026, https://www.cdc.gov/new-world-screwworm/situation-summary/index.html.
Centers for Disease Control and Prevention, “Clinical Overview of New World Screwworm,” February 24, 2026, https://www.cdc.gov/new-world-screwworm/hcp/clinical-overview/index.html. C CDC
Centers for Disease Control and Prevention, “Surveillance of Cyclosporiasis,” updated August 11, 2026, https://www.cdc.gov/cyclosporiasis/php/surveillance/index.html. C CDC
US Food and Drug Administration, “Investigation of 15-State Outbreak of Cyclospora Illnesses: Iceberg Lettuce (July 2026),” July 2026, https://www.fda.gov/food/outbreaks-foodborne-illness/investigation-15-state-outbreak-cyclospora-illnesses-iceberg-lettuce-july-2026. ” “OUR WORLD”+1
Centers for Disease Control and Prevention, “Clinical Overview of Cyclosporiasis,” February 29, 2024, https://www.cdc.gov/cyclosporiasis/hcp/clinical-overview/index.html. C CDC
Centers for Disease Control and Prevention, “Statement on CDC Public Health Readiness & Response for the FIFA World Cup 2026™,” July 19, 2026, https://www.cdc.gov/media/releases/2026/statement-on-cdc-public-health-readiness-response-for-the-fifa-world-cup-2026.html. C CDC
City of Arlington, “City of Arlington Prepares for FIFA World Cup 2026™,” February 20, 2026, https://www.arlingtontx.gov/News-Articles/2026/February/City-of-Arlington-Prepares-for-FIFA-World-Cup-2026%E2%84%A2.

Project Access Tarrant County: Spring Highlights

Project Access

By Kathryn Keaton

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

April: Through its Salud en Tus Manos health literacy initiative, Project Access Tarrant County partnered with three other community organizations to present a financial literacy class for uninsured adults. Made possible through BEACON (Building Economic Access, Community, Opportunity & Network) funding from North Texas Community Foundation, the class focused on practical skills such as budgeting, managing debt, building credit, and making informed financial decisions. By strengthening financial literacy, participants are better equipped to reduce financial stress and improve their ability to access and maintain healthcare.

May: Project Access Tarrant County hosted a well-woman event in the Tarrant County Medical Society parking lot in partnership with the Texas Health Community Hope Wellness for Life Mobile Unit. During the event, 15 uninsured women received well-woman and/or mammogram services. Students from TCOM’s Underserved Women’s Health Initiative also provided hands-on instruction on breast self-awareness and distributed educational materials on menopause, helping patients better understand preventive care and recognize changes that should be discussed with a healthcare provider.

June: Salud en Tus Manos continued to grow with the launch of Food as Medicine, a new four-part series developed in partnership with TCU. Designed for patients living with diabetes or hypertension, each session combined nutrition education with hands-on cooking instruction in TCU’s culinary classroom. Participants learned how everyday food choices can support chronic disease management while preparing healthier versions of familiar meals. The series empowers patients with practical, culturally relevant strategies they can confidently incorporate into their daily lives.

Upcoming: Project Access Tarrant County is preparing for its inaugural golf tournament on September 28, a new fundraising event supporting specialty and surgical care for uninsured adults in Tarrant County. Teams and sponsorship opportunities are still available, and we look forward to launching what we hope will become a long-standing tradition in support of our mission. To sign up, visit the Tarrant County Academy of Medicine website or email Kathryn at kkeaton@tcms.org!

May and June’s events were supported by Texas Health Resources as part of a Texas Health Community Impact grant award. The contents are those of the author and do not necessarily represent the official views of Texas Health.

Your Attention, Please! A Commentary on the Delayed Diagnosis of ADHD in Female Patients

TCOM Student Article

By Cassandra Miller, OMS-II

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

Are you prone to losing things? Are you frequently absentminded or easily distracted? These tendencies may seem like the byproducts of a busy lifestyle or personality traits. However, they may also reflect an underlying condition such as an undiagnosed neurodevelopmental disorder like Attention-Deficit/Hyperactivity Disorder (ADHD). Historically, ADHD has been regarded as a predominantly male disorder, leading to gender-based bias in diagnostic criteria and clinical recognition.^1,2 As a result, many female patients remain undiagnosed during childhood. Recent literature suggests that the increasing rate of ADHD diagnoses in women later in life may be linked to differences in symptom presentation, the development of compensatory masking behaviors that obscure clinical detection, and symptom overlap between various psychiatric conditions.^3,4 Addressing diagnostic gaps is of paramount importance to improving early identification of ADHD in female patients and optimizing long-term treatment outcomes.

Despite increasing awareness of ADHD’s prevalence, it remains underrecognized in younger females. Original ADHD diagnostic criteria were derived from studies of hyperactive boys and placed emphasis on behaviors such as impulsivity.¹ As a result, patients with primarily inattentive symptoms are less likely to be diagnosed in childhood. This disparity in diagnosis contributes to the pattern of women being diagnosed in adulthood, as they tend to exhibit primarily inattentive symptoms such as difficulties with time management, overall task completion, and frequent mistakes during routine activities.³

Another contributor to the delayed diagnosis of ADHD in women is the phenomenon of masking. Masking is defined as “a key component of social camouflaging and refers to the concealment of neurodivergent traits and the adoption of alternate social personas.”^5,6 Although more heavily studied in the context of Autism Spectrum Disorder, masking can have positive social effects in overcoming societal stigma associated with ADHD.6 However, this method of meeting external expectations can prove challenging for clinicians as key symptoms may be obscured. Additionally, masking can be exhausting for patients and, over time, lead to poor self-esteem and burnout.^5,6 This, coupled with a disproportionate rate of psychiatric comorbidity in women, represents another factor in ADHD misdiagnosis.

Moreover, women with ADHD are more likely to be diagnosed with a mood or anxiety disorder prior to receiving an ADHD diagnosis.⁷ The overlap in symptoms across these psychiatric conditions can lead clinicians to attribute symptoms such as impaired concentration, restlessness, and emotional dysregulation to mood disorders rather than a neurodevelopmental disorder.7 As a result of delayed diagnosis, ineffective and potentially unnecessary treatments may ensue.

Delayed diagnosis has also been attributed to sociocultural and hormonal factors.³ Regardless, the consequences of delayed diagnosis are substantial. Women with a late ADHD diagnosis report higher levels of academic underachievement, interpersonal difficulties, and feelings of shame.⁶ Clinical education to reduce diagnostic bias and refinement of screening tools is vital to bridging this gender-based gap and reducing the long-term burden of untreated ADHD in young women.

References:

Stephen P. Hinshaw, Phuc T. Nguyen, Sinclaire M. O’Grady, and Emily A. Rosenthal, “Annual Research Review: Attention-Deficit/Hyperactivity Disorder in Girls and Women: Underrepresentation, Longitudinal Processes, and Key Directions,” Journal of Child Psychology and Psychiatry 63, no. 4 (2022): 484–496, https://doi.org/10.1111/jcpp.13480.
Patricia O. Quinn and Manisha Madhoo, “ADHD in Women and Girls: Uncovering This Hidden Diagnosis,” Primary Care Companion for CNS Disorders 16, no. 3 (2014), https://pubmed.ncbi.nlm.nih.gov/25317366/.
Susan Young et al., “Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/Hyperactivity Disorder in Girls and Women,” BMC Psychiatry 20, no. 1 (2020): 404, https://pubmed.ncbi.nlm.nih.gov/32787804/.
Joanna C. Agnew-Blais, “Hidden in Plain Sight: Delayed ADHD Diagnosis in Girls and Women,” Journal of Child Psychology and Psychiatry 65, no. 9 (2024): 1018–1020, https://pubmed.ncbi.nlm.nih.gov/38798101/.
Patricia Wurth et al., “Masking in Adults with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Systematic Review,” Frontiers in Psychiatry 16 (2025), https://doi.org/10.3389/fpsyt.2025.1668780.
Emily Holden and Helen Kobayashi-Wood, “The Adverse Life Experiences of Women with Undiagnosed Attention-Deficit/Hyperactivity Disorder: A Qualitative Study,” Scientific Reports 15 (2025), https://doi.org/10.1038/s41598-025-04782-y.
Darby E. Attoe and Emma A. Climie, “Miss. Diagnosis: A Systematic Review of ADHD in Adult Women,” Journal of Attention Disorders 27, no. 7 (2023): 645–657, https://doi.org/10.1177/10870547231161533.

AI Analyzes Data, but Whole-Person Care Still Matters

Feature Article

By Nelumdini Samaranayake, PhD, Assistant Professor
Department of Medical Education and Health Systems Science at Texas College of Osteopathic Medicine, UNT Health Fort Worth

Sponsored by Robert Bunata, MD

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

Artificial Intelligence (AI) is no longer something discussed only as the future of medicine; it is already part of everyday healthcare practice. From documentation and ambient scribing to decision-support tools, AI is increasingly integrated into the workflows physicians use each day. In many ways, these technologies are improving efficiency, reducing administrative burden, and helping clinicians manage growing amounts of clinical information. This article reflects the rapidly changing developments and evidence available as of May 2026.

As this technology continues to evolve in healthcare, an important question emerges: how will AI—and how should AI—influence the way clinicians think and make decisions? AI excels at identifying problems, processing vast amounts of data, detecting differences that might otherwise go unnoticed, and offering insights faster than any human could.

Cardiologist and author Eric Topol notes in Deep Medicine that, as technology becomes more capable of handling technical tasks, it may create more space for human-centered care in healthcare.¹ While AI has the potential to support broader clinical insight and decision-making, human interpretation and communication, along with the ability to understand a patient’s real-life circumstances, cannot be fully replaced by technology.

What AI Does Not Fully Capture
What AI often struggles to capture is the bigger picture surrounding the patient.
Although newer AI systems are increasingly capable of analyzing conversational, behavioral, and contextual information, the challenge has shifted from simply processing data to meaningfully understanding the broader context of an individual’s life and circumstances. AI may detect patterns in speech, documentation, and other data sources, but it does not experience a patient’s circumstances firsthand. Family concerns, cultural influences, financial realities, and unspoken worries often require human interpretation and meaningful conversation to fully understand. These factors can be difficult to measure, and even when represented in data, they may not always be recognized within the context of an individual patient’s life.

As AI becomes more integrated into care, there is a growing risk of overly narrow clinical thinking, where complex human conditions are interpreted primarily through structured data. A patient can gradually become a set of variables rather than a person with a story. While this may improve efficiency, it can narrow clinical reasoning in ways that are not immediately obvious.

When Data Does Not Tell the Whole Story
This becomes particularly relevant in educational discussions when considering a patient with poorly controlled diabetes. An AI tool may appropriately highlight lab values and suggest adjustments to the treatment plan. From a data standpoint, that recommendation makes sense. However, even when social, cultural, and environmental factors are available, understanding how they influence a patient’s daily life can be more complex. Access to food, cultural dietary practices, health literacy, transportation barriers, financial constraints, and social support may affect whether a recommendation is realistic, acceptable, or sustainable for an individual patient. While AI may increasingly incorporate such information into its analyses, determining how these factors shape a patient’s choices and circumstances often requires human judgment, conversation, and shared decision-making. Without that broader understanding, even the most evidence-informed recommendation may not work effectively in practice. This is where thoughtful integration becomes important. AI should be viewed as a tool. Although powerful, it remains a tool. It is not the decision-maker, and it does not carry responsibility or accountability. Those responsibilities remain with clinicians. The concern is not the presence of AI itself, but how increasing reliance on these tools may skew clinical reasoning over time.

Trust in AI is not only a technical challenge but also a legal one. Recent healthcare AI discussions published in JAMA have highlighted that regulatory and accountability frameworks are still evolving, leaving important questions unanswered regarding accountability, oversight, and liability when AI-supported tools contribute to errors or patient harm. As AI becomes increasingly integrated into healthcare decision-making, establishing clear standards for accountability will be essential for maintaining public trust.²

The Responsibility Still Belongs to Us
We are already seeing AI embedded in documentation workflows, particularly through the use of ambient scribing technologies. These tools can generate clinical notes, summarize encounters, and even suggest language for patient communication. They may reduce administrative burden and allow physicians to spend more time interacting directly with patients, which is a meaningful advancement. However, their use also requires careful clinical judgment and oversight. There have been situations in which AI-generated outputs were shared with patients without being fully reviewed or validated. In some cases, information that appeared to represent a diagnosis or clinical conclusion created confusion or unnecessary distress when it had not been carefully verified by the responsible physician. These moments are not failures of technology alone; they are reminders of how easily shortcuts can influence communication and clinical interpretation. They reinforce an important point: anything generated by AI must be reviewed, interpreted, and confirmed before it is shared with a patient. This includes not only the accuracy of the information itself, but whether it is appropriate for the situation and whether the patient has been adequately prepared.

Clear communication and informed patient consent are not optional steps; they are essential components of care. AI does not remove that responsibility; it reinforces it.

Why Clinical Judgment Matters More
As healthcare environments become increasingly influenced by AI, the role of the clinician becomes more important. AI should not come first in the clinical process. Instead, it should come after an initial, patient-centered assessment. First, we engage with the patient; we listen, observe, and begin to understand their story. Then we form an initial impression grounded in both data and human interaction. Afterward, AI may be used to expand or challenge that thinking. This sequence matters because it preserves clinical reasoning while allowing AI to serve as a cognitive support tool rather than a directive force. This approach helps keep clinical decision-making focused on the patient rather than solely on algorithmic output. Equally important is maintaining a mindset of critical evaluation.

AI systems are not perfect. They can generate highly confident responses that are incorrect, particularly when built on biased, incomplete, and non-representative data. They may produce outputs that appear highly credible but lack important context or accuracy. In those moments, the clinician must be willing to pause, question, and reassess. This is not about distrust, but responsibility. The presence of AI requires us to think more carefully, not less. It challenges us to ask better questions: Does this output align with what I am seeing? What might be missing? What does the patient’s situation reveal that the data does not? These are the questions that protect against over-reliance and preserve sound clinical judgment.

Looking Ahead
The role of AI in medicine goes beyond technology. It influences how clinicians think, how decisions are made, how information is presented, and how care is delivered. As AI continues to grow within healthcare, it brings both valuable opportunities and new responsibilities.

The benefits are promising. AI can assist clinicians in processing information, recognizing patterns within datasets, and highlighting details that may otherwise go unnoticed. When used thoughtfully, these tools can strengthen clinical assessment and support decision-making without replacing professional judgment. But the risk is less visible. If we are not careful, AI can narrow our thinking. Clinical attention can gradually shift toward structured data while real-life circumstances receive less consideration. Over time, this can influence how patients are understood and how decisions are made.
This issue is not rooted solely in AI. In many ways, the outcome depends on how thoughtfully these tools are incorporated into clinical care. It also creates an opportunity to shape how future clinicians think about AI—not as a shortcut or an answer engine, but as a tool that requires interpretation, reflection, and responsibility. We can guide this use of AI to strengthen clinical reasoning rather than weaken it. AI may assist with information analysis, but medicine continues to rely on human interpretation, empathy, and trust. Medicine is not defined by competing with machines in processing data. That is not where our value lies. It is in the human qualities that machines cannot replace. We understand nuance. We interpret context. We recognize emotion. We build trust. We see the patient not as a set of data points, but as a person with a life, a story, and circumstances that matter.

AI may assist in clinical decision-making, but accountability, interpretation, and patient care remain human responsibilities. While AI can analyze data, clinicians are still responsible for seeing the whole person. AI is already a part of everyday medicine; now the question is how AI will shape the way we think, decide, and care.

References

Eric Topol, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again (New York: Basic Books, 2019).
Michelle M. Mello and I. Glenn Cohen, “Regulation of Health and Health Care Artificial Intelligence,” JAMA 333, no. 20 (2025): 1769–1770, https://jamanetwork.com/journals/jama/fullarticle/2831831.

Women’s Mental Health: The Barriers to Access

The President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

This May, I had the privilege of presenting at a workshop with psychiatric colleagues regarding women’s mental health at the annual meeting of the American Psychiatric Association. We had strong attendance and a robust discussion. But given all the questions from our audience members, it became evident to me that this is a topic deserving of additional outreach, and not just to fellow psychiatrists. However, I had a dilemma . . . a draft deadline and multiple PowerPoint slides with all the information. After a couple of hours of trying to gather everything into a cohesive article to present to you all here, I decided to seek the assistance of AI. I dumped everything I had into Copilot, gave it about four dozen or more prompts, and it coalesced all my work. I still had to edit extensively; who knew that Copilot was so fond of run-on sentences?! The following has been further edited by the people who help maintain the decorum of our Tarrant County Physician journal.

Women’s mental health is as much an access issue as a diagnostic one. Across clinical settings, it is common to see:

Depression

Anxiety

Trauma-related conditions

Perinatal Mental Health Challenges

Emotional strain associated with:
• Caregiving responsibilities
• Financial hardship
• Discrimination
• Chronic disease

Whether these concerns are recognized, disclosed, and treated is often shaped by social context, such as current physical environment and cultural and/or historical aspects of different communities. Insurance, transportation, childcare, translation services, stigma, community trust, and local behavioral health capacity all affect timely care. Women in underserved communities are at particular risk for late diagnosis and interrupted treatment because social determinants of health and health system barriers often converge. And national mental health workforce shortage areas remain widespread.¹

Underserved care is not found in a single setting but is a condition of limited access that can exist anywhere. A woman may live in a rural county with the closest psychiatrist being a long drive away. Another woman may live in an urban neighborhood with multiple hospitals yet still face long waits, unaffordable copays, language barriers, and fragmented referral pathways. In both settings, available services may not be truly usable. Women may present late, rely on urgent care, or disengage when treatment plans fail to account for barriers such as housing instability, caregiving demands, or work schedules. For physicians, treatment planning must address not only diagnosis and severity but also whether follow-up is realistic.

Rural and urban settings pose different challenges. In rural practice, barriers often include distance, limited specialist supply, service closures, privacy concerns, and broadband gaps that weaken telehealth. In urban settings, the problem is often system complexity: long wait times, fragmented care, uneven service distribution, insurance limitations, and cultural or linguistic mismatch between a patient and their physician. These differences require different responses. Rural physicians may depend more on collaborative care, telepsychiatry, and cross-system referral relationships, whereas urban physicians may focus on reducing handoff failures, improving navigation, and integrating behavioral health into primary care or women’s health clinics. Rural counties fare worse than non-rural counties on measures of clinical care and social determinants of health,² and shortage designations affect both rural and urban areas.¹

Perinatal mental health is critically important, but risks change across the lifespan. Anxiety, depression, trauma exposure, eating disorders, self-harm risk, intimate partner violence, caregiving stress, chronic illness, loneliness, grief, and cognitive concerns may present differently at each stage of life. In underserved communities, unstable housing, food insecurity, discrimination, limited preventive care, and delayed treatment can intensify symptoms and complicate care. A useful clinical framework goes beyond symptom checklists to assess safety, functioning, social stressors, and barriers to follow-up.
Routine screening is one of the strongest opportunities to improve women’s mental health care, but only when paired with a workflow that supports action. In women’s health, primary care, and perinatal settings, screening can identify depression, anxiety, trauma-related symptoms, and safety concerns before they escalate. A positive screen should trigger a risk assessment, a discussion of treatment options, a referral or warm handoff when indicated, and a plan for monitoring response and adherence. Routine screening for depression and anxiety is recommended in well-woman, pre-pregnancy, prenatal, and postpartum care. Standardized instruments and systems for timely assessment, treatment, and follow-up are also recommended.³

Care models should reflect practice realities rather than assume one solution fits all. In rural settings, telehealth can reduce travel burdens and extend specialty access, especially when supported by audio-only options and coordination with local primary care. In urban settings, access may improve more through shorter referral loops, stronger safety-net capacity, co-located behavioral health services, and language-concordant care. Telehealth is most effective when patients have the privacy, reliable connectivity, digital skills, and device access needed to use it. Underserved communities may also benefit from multiple telehealth formats, including phone-based care.⁴ At the same time, rural telehealth continues to face setting-specific implementation barriers.⁵

As you can see, addressing women’s mental health requires a layered, setting-specific approach. Trauma-informed, culturally responsive care is essential. In rural settings, physicians may need to offset workforce shortages and distance through collaborative care and telehealth-enabled consultation. In urban settings, the priority is often reducing fragmentation and improving access within systems that may appear resource-rich but remain difficult to navigate.
Ultimately, the central question is not simply whether a patient lives in a rural or urban area, but whether she can obtain timely, acceptable, and practical care. That requires early identification, realistic care planning, and systems that coordinate between screening, referral, and treatment. For physicians, the implication is straightforward: overcoming social barriers is part of the care plan, not peripheral to it.

“Healing takes time, and asking for help is a courageous step.” —Mariska Hargitay

References:

Health Resources and Services Administration, “Health Workforce Shortage Areas,” accessed June 30, 2026, https://data.hrsa.gov/topics/health-workforce/shortage-areas/dashboard.
W. B. Weeks et al., “Rural-Urban Disparities in Health Outcomes, Clinical Care, Health Behaviors, and Social Determinants of Health and an Action-Oriented, Dynamic Tool for Visualizing Them,” PLOS Global Public Health 3, no. 10 (2023): e0002420, https://doi.org/10.1371/journal.pgph.0002420.
American College of Obstetricians and Gynecologists, “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum,” Clinical Practice Guideline, June 2023, https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum.
U.S. Department of Health and Human Services, “Telehealth for Underserved Communities,” August 20, 2024, https://telehealth.hhs.gov/documents/Telehealth_for_Underserved_Communities_08-20-24.pdf.
Rural Health Information Hub, “Rural Telehealth Toolkit,” last modified June 8, 2023, https://www.ruralhealthinfo.org/toolkits/telehealth.
Centers for Disease Control and Prevention, “Social Determinants of Health,” last modified May 16, 2024, https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html.

Beyond the Desk: Where This Work Really Happens

Project Access Tarrant County

By Kathryn Keaton

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

Over the past month, much of our Project Access work did not take place at a desk.

It began at a conference hosted by Texas A&M Fort Worth where we presented alongside other professionals on the role of Medical-Legal Partnerships in addressing barriers to care. The conversation focused on collaboration and how healthcare, legal, and community-based organizations can work together more effectively to support patients navigating complex systems. PATC had the honor of presenting what we are doing to combat barriers in our session, “When Noncompliance Isn’t the Problem: Addressing SDOH in Indigent Populations.”

Presenting at the Medical-Legal Partnerships Conference

Later in the month, the setting looked very different.

At a church gym in Arlington, a group of participants gathered for “Financial Confidence Starts Here,” a new endeavor within our Salud en tus Manos initiative. Led by a certified financial coach, the session focused on practical, real-life strategies: managing expenses, prioritizing financial obligations, and navigating the challenges that arise when a health issue disrupts income or stability.

These two settings—a professional conference and a community-based classroom—may appear unrelated. In practice, they are closely connected.
It is easy to assume that nonprofit healthcare coordination happens primarily behind the scenes through referrals, scheduling, and documentation. Those components are essential, but they represent only part of the work required to ensure that patients not only access care but are prepared to successfully complete it.

Teaching the “Financial Confidence Starts Here” class

Increasingly, we are seeing that what happens outside of traditional clinical settings has a measurable impact on what happens within them.

At the conference, conversations were centered on systems and how partnerships can reduce barriers and improve access at a structural level. In the classroom, those same barriers were discussed from a different perspective: how they are experienced in daily life. Participants asked practical questions about managing bills, handling unexpected expenses, and making decisions when financial and health challenges intersect.

Together, these experiences reinforce a consistent reality: access alone is not enough.

Patients benefit from care when they are prepared to engage with it—when they understand how to communicate with their providers, how to manage the logistical and financial aspects of treatment, and how to navigate the systems surrounding their care. Building that level of readiness often happens outside the exam room.

For our volunteer physicians, this work matters.

Patients who arrive with greater confidence, clearer understanding, and fewer external barriers are better positioned for efficient, effective visits. Time can be spent on clinical decision-making rather than navigating preventable obstacles. The work happening in community and professional settings ultimately supports the care delivered in clinical ones.

With PATC patients at Salud en tus Manos

For our funders, this work is equally important.

Initiatives like Salud en tus Manos continue to evolve in response to what we are seeing in the community. Expanding into teaching financial literacy through “Financial Confidence Starts Here” reflects a growing recognition that financial stability is closely tied to health outcomes. When patients are equipped with practical tools and knowledge, the impact of donated care is strengthened—appointments are kept, treatment plans are completed, and outcomes are more sustainable.

At Project Access Tarrant County, we remain committed to both.
The coordination of specialty and surgical care is and will always be central to our mission. At the same time, our work increasingly includes engagement in spaces that extend beyond traditional healthcare settings, whether through professional collaboration or direct community education.
Much of our work does happen behind the scenes.

But some of the most important work happens far beyond in conference rooms where ideas are shared, in classrooms where confidence is built, and in conversations that ensure when a patient finally sits in front of a physician, they are ready to fully engage in their care.

And that is where this work truly happens.

Advancing the Future of HIV Care in Our Community

Public Health Notes

By Kenton K. Murthy, DO, MS, MPH, AAHIVS
TCPH Assistant Director & Deputy Local Health Authority

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

The Preventive Medicine Clinic (PMC), the oldest Ryan White HIV clinic in Tarrant County, has served the community continuously since its founding in 1991. In 2026, Tarrant County Public Health marks a significant milestone—35 years of delivering comprehensive HIV care, prevention, and patient support through this foundational program. In recognition of this milestone, PMC is undergoing a strategic transformation aimed at expanding access, enhancing quality, and delivering care in a more cost-effective and sustainable manner.

This evolution calls for a new identity—one that reflects not only where we have been, but where we are going. Today, we introduce Thrive Health. People living with HIV are no longer simply surviving; with the right care and treatment, they are thriving, and our new identity is meant to reflect this new era of care.

But we are not simply a rebrand; we are also entering a new phase focused on integration, innovation, and system-wide collaboration to address a persistent challenge: HIV incidence remains steady, and in some populations, is increasing. This moment calls not only for recognition of past success but for decisive action moving forward.

The Ryan White System of Care in Tarrant County
The modern HIV care system in the United States is built in large part on the foundation of the Ryan White HIV/AIDS Program, administered by Health Resources and Services Administration, an agency of the US Department of Health and Human Services. First established in 1990, the program was named after Ryan White, a young hemophilia patient who became a national advocate for HIV awareness after facing significant stigma and discrimination.

This program was designed to address a critical gap by ensuring access to HIV care for individuals who were uninsured or underinsured during a time when treatment options were limited and outcomes were poor. Over time, it evolved into a comprehensive system of care that supports medical treatment, medications, and essential support services.

Today, the Ryan White HIV/AIDS Program represents a multi-billion-dollar federal investment, with annual national funding of approximately $2.6 billion, supporting care for more than half of all people living with HIV in the United States. It has been widely recognized for achieving some of the highest viral suppression rates of any federally funded healthcare program.

In Tarrant County, Ryan White funding supports a coordinated network of clinics, including Thrive Health and other regional partners, delivering comprehensive care that includes HIV primary medical services; antiretroviral therapy management; rapid-start treatment for newly diagnosed patients; PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) services; case management; mental health and substance use care; oral health; pharmacy support; laboratory monitoring; and assistance addressing housing and transportation. Through this integrated model, HIV has been transformed into a manageable chronic condition, with significant improvements in life expectancy and reductions in transmission.

Local Epidemiology: A Growing HIV Burden in Tarrant County
Unfortunately, in Tarrant County, as in other parts of the United States, the burden of HIV continues to grow. In 2022, it was estimated that approximately 6,715 individuals were living with HIV in Tarrant County. By 2026, that number has risen to an estimated range of 7,500 to 8,000 individuals.
This increase is multifactorial and reflects a number of factors:

Ongoing HIV transmission

Improved survival due to effective antiretroviral therapy
Population growth within Tarrant County
The downstream effects of the COVID-19 pandemic, which disrupted routine healthcare delivery, reduced access to HIV testing and prevention services, and contributed to delays in diagnosis and linkage to care

Collectively, these factors highlight the persistent gaps in prevention and access that must continue to be addressed by healthcare and public health experts.

Why Continued HIV Screening Matters
Despite advances in treatment, HIV remains a significant public health concern. Routine screening is critical because early diagnosis allows for immediate initiation of therapy, leading to improved individual outcomes and reduced transmission through viral suppression. At the same time, a substantial number of individuals remain undiagnosed or are diagnosed late in the course of disease.

Tarrant County Public Health’s Disease Surveillance, Outreach, and Prevention (DSOP) team plays a central role in HIV and STD control efforts. Their work includes conducting field-based testing and outreach in high-risk populations, performing partner services and contact tracing, and leading comprehensive contact investigations for newly diagnosed HIV and syphilis cases. In addition, DSOP facilitates linkage to care for newly diagnosed individuals and actively works to re-engage patients who have fallen out of care, while collaborating closely with clinicians and epidemiologists to monitor trends and improve outcomes.

In addition, for several years, a key success in Tarrant County has been the implementation of opt-out HIV screening at JPS Emergency Department. This innovative program has led to the identification of numerous new HIV cases and has improved linkage to care at Ryan White outpatient clinics.
Building on this success, Tarrant County Public Health, in collaboration with the Tarrant County HIV Administrative Agency and key physician leadership from JPS, is actively working with other local hospitals to expand opt-out HIV screening across emergency departments throughout the region, with the goal of standardizing testing practices and improving early detection across multiple healthcare systems. These initiatives, if successful, could improve early detection of HIV and treatment of people living with HIV, thus helping to stop the spread of this disease.

Thrive Health: A Transformational Model for Integrated, Cost-Effective, High-Value Care
The transition from PMC to Thrive Health represents a deliberate transformation aligned with Tarrant County Public Health’s broader effort to become a more efficient, high-performing public health system. The previous clinic identities no longer fully reflected the scope or impact of services being delivered, and the 35-year anniversary provides an appropriate moment to evolve into a more unified and forward-looking model.

This transformation is driven by a focus on improving operational efficiency, returning to a physician-centric model of care, and optimizing the use of existing staff to increase patient throughput and enhance care delivery. At its core, the redesign is aligned with the Triple Aim of Healthcare—improving quality, expanding access, and reducing costs.

From a quality perspective, Thrive Health is expanding preventive services, including increasing vaccination rates—particularly among HIV PrEP patients—and incorporating routine Pap smears for eligible women in the STD clinic who have not been screened within recommended intervals. From an access standpoint, the move toward a team-based care model is expected to increase patient volume and reduce barriers to care.

In parallel, several targeted care initiatives are being implemented. A Rapid Restart Program is being developed to identify patients who have been out of care for six months or longer, with coordinated efforts from front desk staff, patient navigators, and case managers to reconnect these individuals to care and to overcome barriers. For appropriate patients, providers will review prior records, order necessary labs, and facilitate expedited re-initiation of antiretroviral therapy, including the use of home-based care teams when appropriate.

Alongside expanded vaccination efforts, preventive care is being strengthened through the integration of cervical cancer screening. Thrive Health is initially focusing on high-risk populations such as patients on PrEP before scaling to broader clinic populations. Together, these initiatives represent a shift toward a more proactive, population health-driven model of care.

Launching the Tarrant County HIV Care Collaborative
While Thrive Health celebrates 35 years of service in Tarrant County, we recognize that this work cannot be done alone. Our success and longevity is built on strong partnerships with fellow Ryan White HIV providers, including JPS Healing Wings, CAN Community Health, and AIDS Healthcare Foundation.

To further strengthen these collaborations, Tarrant County Public Health is launching the Tarrant County Ryan White HIV Care Collaborative—a first-of-its-kind initiative bringing together Ryan White providers across the region. This collaborative will serve as a platform for regular discussions on local HIV trends, ongoing education in prevention and treatment, and enhanced coordination of care across systems. A central priority will be improving linkage-to-care efforts through closer integration with DSOP and epidemiology teams.

Together, this unified approach represents a critical step toward reducing HIV transmission and improving health outcomes across Tarrant County.

Looking Forward
Thrive Health’s legacy demonstrates that coordinated HIV care works. However, continued innovation, collaboration, and system redesign are essential to meet the evolving needs of our population.

The future of HIV care in Tarrant County will be found in collaborations that deliver high-value, patient-centered care that allow individuals to lead healthy, fulfilling lives. By working together, we can move closer to ending the HIV epidemic—one patient, one system, and one collaboration at a time—because when we work together, we thrive.

Beating the Stigma: The Challenges in Treating Substance Use Disorders

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

By the time you all read this article, I hope you will have had a chance to listen to some of Tarrant County Medical Minute’s many interesting podcast episodes. I recently had the privilege of being invited as a guest on the podcast (you can find my episode here), which TCMS launched in 2025. It was fun, and I also found it to be an opportunity to continue to highlight mental health and advocacy. As I’ve mentioned before, mental health is marginalized and stigmatized but so essential to overall health. I appreciated the opportunity to talk about this on the podcast, fulfilling one of my promises to speak openly about mental health issues.

So, today we are going to talk about an even more stigmatized mental health issue—substance use disorders. They are far more common than many of us realize. According to the Substance Abuse and Mental Health Services Administration in their National Survey on Drug Use and Health in 2023–24, nearly 48 million Americans age 12 and older, or about one in six people, meet criteria for a substance use disorder in any given year.¹

Texas mirrors this national statistic. Alcohol use disorder accounts for the largest proportion, followed by drug use disorders involving marijuana, stimulants, opioids and more. State‑level estimates from the National Survey on Drug Use and Health indicate that roughly one out of seven Texans meets criteria for a substance use disorder each year.² While this is slightly lower than the national average, it still represents millions of people across our state whose health, relationships, and economic stability are affected. In a state as large and diverse as Texas, the collective impact of these conditions is substantial: it affects healthcare utilization, workforce participation, public safety, and even community well-being.

For physicians, this data shows what is already evident in clinical practice. Substance use disorders frequently coexist with chronic medical conditions, complicating diagnoses and treatments while increasing the risk of poor health outcomes. For legislators and policymakers, the numbers highlight the scope of the issue and the importance of continuous investment in prevention, early identification, evidence‑based treatment, and long‑term recovery support. And for the general public, the message is both sobering and illuminating: substance use disorders are common, treatable medical conditions, not moral failures or character flaws.

Substance use disorders do not exist in isolation. National data consistently demonstrates high rates of co‑occurring mental illness as well.¹ This overlap reinforces the need for integrated approaches to care that address the whole person rather than fragmented systems that separate “mental health” from “substance use.” The stigma surrounding substance use disorders mirrors the stigma that has historically marginalized mental health conditions—just as depression and anxiety were once dismissed as weaknesses rather than illnesses, substance use disorders continue to be judged rather than treated.

Stigma remains one of the most powerful barriers to care. It delays seeking help, discourages honest conversations between patients and physicians, and shapes policies that emphasize punishment over treatment. When individuals fear judgment, they are less likely to disclose substance use concerns, less likely to engage in treatment, and less likely to experience recovery. This is true no matter what walk of life you stem from, no matter what profession you are in. Reducing stigma is thus a clinical, ethical, and public health imperative.

Texas‑specific health data further illustrates the downstream effects of untreated substance use disorders, including alcohol‑related hospitalizations, drug‑related overdoses, and preventable deaths.² Even when prevalence rates are slightly lower than national averages, the absolute number of affected individuals places significant strain on healthcare systems and communities. These outcomes are not inevitable; evidence‑based prevention strategies, timely access to treatment, and sustained recovery supports have been shown to reduce morbidity, mortality, and costs.³ The key is that these initiatives have to be adequately funded and broadly accessible.

It is essential to treat substance use disorders as seriously and compassionately as other chronic illnesses. This includes speaking openly about prevalence, acknowledging the role of stigma, and advocating for systems of care that are based on scientific evidence rather than outdated assumptions. If one in six Americans—and one in seven Texans—are affected, then nearly every family, workplace, and community has a stake in how we respond. As physicians, policy advocates, and community leaders, we have both the opportunity and the responsibility to lead with data, compassion, and transparency. By reframing substance use disorders as the common, treatable health conditions they are, we can achieve these goals of reducing stigma, improving access to care, and improving the health and well-being of the populations we serve.

For physicians, the message should be clear: substance use disorders are common and addressing them as part of routine medical care should be best practice. Screening and brief, non-judgmental conversations about substance use should be normalized in our clinical settings. How we ask and how we respond do matter. Framing substance use disorders as treatable medical conditions like the evidence shows will increase patient disclosures, increase their engagement in treatment, and ultimately lead to their trust in us. We must lead the shift from judgment to treatment by insisting that substance use disorders are met with evidenced based care, equitable insurance coverage, and our compassion—not silence or shame.

“We, as a culture, have not fully acknowledged how much help is needed. The only real shame is on us for not being willing to speak openly. For continuing to deny that mental health is related to our overall health. We need to start talking, and we need to start now.”
– OPRAH WINFREY

References:

Blaire Bryant, Naomi Freel, and Emily Steckler, “SAMHSA Releases New 2024 Data on Rates of Mental Illness and Substance Use Disorder in the US,” National Association of Counties, July 28, 2025, https://www.naco.org/news/samhsa-releases-new-2024-data-rates-mental-illness-and-substance-use-disorder-us.
“Substance Use Disorder Statistics,” Drug Policy Facts, accessed May 4, 2026, https://www.drugpolicyfacts.org/node/4476.
Johanna Bellon et al., “Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US,” JAMA Network Open 5, no. 12 (2022): e2244644, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799220.
Substance Abuse and Mental Health Services Administration, “National Survey on Drug Use and Health (NSDUH): 2023 National Releases,” SAMHSA, accessed April 1, 2026, https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2023.
Substance Abuse and Mental Health Services Administration, “State Estimates of Mental Health and Substance Use,” accessed April 1, 2026, https://nsduhweb.rti.org/respweb/estimates.html.
Li-Tzy Wu, He Zhu, and Udi E. Ghitza, “Multicomorbidity of Chronic Diseases and Substance Use Disorders and Their Association with Hospitalization: Results from Electronic Health Records Data,” Drug and Alcohol Dependence 192 (2018): 316–23, https://doi.org/10.1016/j.drugalcdep.2018.08.013.
Lauren R. Ray et al., “Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis,” JAMA Network Open 3, no. 6 (2020): e208279, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358.

Understanding Before Access: Why PATC Is Measuring Health Literacy More Intentionally

Project Access Tarrant County

By Kathryn Keaton

This article was originally published in the March/April 2026 issue of Tarrant County Physician.

At Project Access Tarrant County, we have always believed that the “access” in our name involves more than seeing a specialist—it also includes comprehension. A growing body of research confirms what community health organizations have long observed: Health literacy is directly tied to healthcare utilization, outcomes, and cost.

Health literacy, as defined by Healthy People 2030, is “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”¹ PATC is uniquely positioned to help our patients improve health literacy not just for their PATC service, but also for their future lifetime of healthcare.

A 2025 systematic review found that limited health literacy is consistently associated with higher healthcare costs, increased hospitalizations, and greater emergency department use—all areas PATC aims to reduce in Tarrant County.² Literacy is not a secondary social factor; it is a healthcare variable. Health literacy influences how patients navigate outpatient, inpatient, emergency, and digital health systems (even more so in immigrant populations)—and PATC is changing how we approach this issue in our patient base.

Moving Beyond “High School or Not”
Historically, many healthcare systems—including safety-net organizations—have captured each patient’s education level in broad terms. Emerging research shows that education level alone does not reliably predict a patient’s ability to understand medical terminology, consent forms, referral instructions, or post-procedure care plans. Studies have demonstrated that even patient-facing surgical materials are frequently written above recommended reading levels.

A decade ago, the AMA and National Institute of Health recommended that medical materials be written at an eighth grade or below reading level,³ but today, most experts agree that material should be written at a sixth grade or below reading level.⁴

When written information assumes advanced comprehension, patients are placed at risk of misunderstanding critical instructions. Just last year, a PATC patient almost canceled her vital surgery because she mistakenly thought she was instructed to stop her diabetes medication for a full week leading up to her surgery. She had enough health literacy to question those instructions, but not enough confidence to question their accuracy.

To respond more intentionally, PATC is refining how we capture and evaluate education and health literacy across our patient population.

What We’re Changing

Narrowing our educational ranges
Rather than broad categories, we now collect more targeted education data. This allows us to examine patterns in referral completion, adherence, and communication preferences.
Identifying whether education occurred inside or outside the United States
Educational systems vary widely across countries. A high school diploma earned abroad may reflect a different exposure to English-language healthcare terminology or system navigation. Recent national research examining health literacy by Hispanic ethnicity reinforces this nuance.⁵
Implementing SAHL evaluations for each adult patient

PATC is incorporating the Short Assessment of Health Literacy (SAHL), a validated screening tool created in 2010 by Health Services Research that directly measures a patient’s ability to recognize and understand common medical terms.

Unlike education level, SAHL evaluates functional comprehension—an essential factor in specialty care navigation. The tool is curated in both English and Spanish, with other languages available.⁶

Why Literacy Directly Impacts Care
Health literacy affects:

Medication adherence
Chronic disease management
Completion of specialty referrals
Understanding of pre-procedure instructions
Post-surgical recovery compliance

Systematic reviews across multiple countries show that lower health literacy is associated with delayed care, increased acute utilization, and poorer chronic disease management—even in universal healthcare systems, insurance coverage alone does not eliminate access barriers.⁷

For uninsured patients navigating specialty referrals—often involving multiple providers, consent forms, preparation instructions, and follow-up plans—comprehension is foundational. When literacy gaps are not identified, missed appointments may be labeled as “noncompliance.” In reality, they may reflect confusion, fear, or uncertainty.

Connecting Data to Our Broader Health Literacy Efforts
Importantly, PATC’s shift is not just about collecting more data. It strengthens and informs our broader health literacy initiatives, including:

Simplifying written instructions
Evaluating readability of patient-facing materials
Reinforcing clear text-based communications (CareMessage)
Informing topics for future Salud en Tus Manos curriculum
Literacy is not just a patient issue—it is a system design issue. By measuring literacy more intentionally, PATC can ensure that communication strategies match patient needs.

Access Requires Understanding
Healthcare systems are becoming increasingly complex and digital. Artificial intelligence tools, online portals, and automated communications can enhance access—but only if patients can understand and use them effectively.

Access to care is not complete when an appointment is scheduled. It is complete when a patient understands what that appointment means—and what to do next.

By refining how we measure education and incorporating validated literacy screening, PATC is strengthening the foundation of specialty care coordination—because access begins with understanding.

References:

Office of Disease Prevention and Health Promotion, “Health Literacy in Healthy People 2030,” Healthy People 2030, U.S. Department of Health and Human Services, accessed March 12, 2026, https://odphp.health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030.
Francesca Tusoni et al., “What Is the Impact of Health Literacy on Healthcare Costs? A Systematic Review and Evidence Synthesis,” BMJ Open 15, no. 12 (2025): e108816, https://bmjopen.bmj.com/content/15/12/e108816.
Patrick J. L. Fitzgerald et al., “Readability of Patient Education Materials on the American Association for Surgery of Trauma Website,” Journal of Surgical Research (2014), https://pmc.ncbi.nlm.nih.gov/articles/PMC4139691/.
Cheryl A. Tucker, “Promoting Personal Health Literacy Through Readability, Understandability, and Actionability of Online Patient Education Materials,” Journal of the American Heart Association 13, no. 8 (2024): e033916, https://www.ahajournals.org/doi/10.1161/JAHA.124.033916.
Athena K. Ramos et al., “Health Literacy by Hispanic Ethnicity and its Association with Healthcare Experiences, Self-rated Health, and Quality of Life,” Journal of Immigrant and Minority Health (2026), https://doi.org/10.1007/s10903-026-01848-5.
Shoou-Yih Daniel Lee et al., “Short Assessment of Health Literacy—Spanish and English,” Health Services Research 45, no. 4 (2010): 1105–1120, https://doi.org/10.1111/j.1475-6773.2010.01119.x.
R Schönegger, C Von Reibnitz, and Hans-Peter Wiesinger, “Health Literacy and Healthcare Utilisation in Universal Healthcare Systems: A Systematic Review,” European Journal of Public Health 35, no. 4 (October 2025), https://doi.org/10.1093/eurpub/ckaf161.1476.