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TMA Report

The development of TMA policy

by Gary Floyd, MD, TMA President

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

Over the past year, the Texas Medical Association has had to weigh in on one sensitive topic after another—from issues impacting the patient-physician relationship to how physicians practice medicine and the prevention of further cuts in the Medicare program.

Often, after TMA publishes its stance in the association’s daily newsletter, Texas Medicine Today, we receive inquiries from members on how TMA came up with that position since no one surveyed them individually or asked for their opinion. This has made me realize many of our members don’t understand who runs TMA or the process TMA uses to develop its policy, which drives the association’s communications and advocacy.

The association is governed by a 500-member House of Delegates, the legislative and policymaking body. The House is made up of elected county medical society delegates (one delegate per 100 members or fraction thereof) and the following ex officio members: members of the Board of Trustees; 15 councilors; Texas delegates and alternate delegates to the American Medical Association; members of the Council on Legislation and chairs of the other councils; delegates from the Young Physician Section, International Medical Graduate Section, Resident and Fellow Section, Women Physician Section, LGBTQ Section, and Medical Student Section; and delegates of selected specialty societies.

The House of Delegates meets every year at an annual session held during TexMed in the spring. In 2023, TexMed will be in Fort Worth on May 19–20.

The best way to get your idea adopted as TMA policy is to begin at the grassroots level.

1 Present your idea or change to an existing policy at your county medical society meeting. Ideas and actions also are developed by association boards, councils, committees, and sections. You can work with these groups to develop a policy recommendation.

2 If the county society, section, or other entity agrees, it can submit your idea as a report or resolution to be considered at the next meeting of the House of Delegates. Instructions for writing a resolution are at http://www.texmed.org/Resolution.

3 Every report and resolution is assigned to a reference committee that vets it further through open hearings at which any TMA member can testify. The reference committees then send their recommendations on each report and resolution to the house. If you would like to serve on a reference committee, let our House of Delegates speakers know by filling out the form at tma.tips/refcom.

4 If your idea is adopted by the house, it is incorporated into the TMA Policy Compendium (www.texmed.org/Policy). If it has nationwide appeal, it may also be forwarded to AMA for action.

As TMA president, I am obliged to represent our TMA policies. As you can imagine, we have members on both sides of several very sensitive issues. Some members would like TMA to issue an immediate, strong opinion favoring their stance. However, by working with our legislators, we have learned that calm, measured, commonsense approaches are far better received than knee-jerk responses. Therefore, in our responses we tend to emphasize areas of commonality for our members, like protecting the sanctity and privacy of our patient-physician relationships and creating a safe environment for our physicians to exercise their best medical judgment in providing the appropriate standard of care for all their patients.

Please reach out to your county medical society and learn more about TMA’s policymaking process. We want to hear from you!

It’s Not Okay

President’s Paragraph

by Shanna Combs, MD, TCMS President

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

On June 23, 2022, the Tarrant County medical community lost an amazing physician, who died by suicide. He was a remarkable person whose work touched so many lives—he was always willing to help others. He is greatly missed by all who knew him.

Unfortunately, physician suicide has become an all-too-common occurrence in the United States.

• Approximately 300–400 physicians die by suicide each year in the U.S.

• Among male physicians, the suicide rate is 1.41 times higher than the general male population.

• Among female physicians, it is even more pronounced at 2.27 times higher than the general female population.¹

As terrible as this sounds, there is hope. Physicians who are proactive about their mental health are able to take better care of their patients as well as have more resilience in the face of stress. However, this is not so easy to accomplish.

There is already a stigma associated with mental health, and it is made even worse for physicians due to the concern of needing to report a diagnosis to our medical boards, licensing organizations, as well as to credentialing offices in the hospitals and health systems we work in. We as physicians also have difficulty taking care of ourselves in general, let alone when it comes to mental health, as we are the healers and must be perfect.

The truth is, being a physician is hard. We train for many years to be able to do the work that we do. We often share our war stories about medical school and residency, but when it comes to the deeper struggles we have, we tend to keep those to ourselves. We push them down and hide behind a smile (or a mask) and continue to pretend that everything is okay.

But it’s not okay.

We as a profession need to start taking care of ourselves and looking out for our colleagues. It is okay to tell someone when you are struggling and to seek out help when you need it. A psychiatrist friend puts it best—“Everyone needs a therapist. I have one.” At some point we all learned the physiology of the human body, and of the brain specifically. Sometimes that brain needs a little extra help from chemistry, and that is okay as well. If you have a thyroid problem, you do not put up a fight about taking a thyroid pill. The same goes when our brain chemistry needs a little help. We also need to reach out to one another, to check in and see if our colleagues are really doing okay and if they need any help or support. It’s okay to not be okay, but we need to recognize this and seek out the help we so desperately need, and to help our colleagues obtain the help that they need.

We also need to work from an advocacy standpoint so that physicians can seek the help that they need without the fear of needing to report their illness. All other aspects of medicine and healthcare are taken care of in a private manner between a physician and a patient. Why should mental health be any different? Until this changes, no number of wellness programs, resilience building, etc., will be able to fix the problem.

I encourage everyone to seek help when needed and to reach out to our colleagues, partners, and friends. We have worked tirelessly to get to the point we can practice medicine, and those around you want you to stay here.

References
¹John Matheson, “Physician Suicide.” American College of Emergency Physicians. Accessed August 3, 2022.

https://www.acep.org/life-as-a-physician/wellness/wellness/wellness-week-articles/physician-suicide/#:~:text=Each%20year%20in%20the%20U.S.,times%20more%20often%20than%20females

Mental Health Resources

National Suicide Prevention Lifeline
1-800-273-TALK (8255)
Available 24/7

Crisis Text Line
Text TALK to 741-741
Available 24/7

Physician Support Line
1 (888) 409-0141
Open seven days a week,
7:00am – 12:00am CST
Psychiatrists helping their U.S. physician colleagues and medical students navigate the many intersections of our personal and professional lives. Free and confidential. No appointment necessary.

Emotional PPE Project
emotionalppe.org
The Project connects healthcare workers in need with licensed mental health professionals who can help.

My First Practice Experience

by Robert Bunata, MD

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

The first time I saw and treated patients in a private practice setting, other than moonlighting in an ER or at the Cook County jail, was in 1968 when my dad, a general practitioner, had a heart attack as he entered Oak Park Hospital to make rounds on a freezing January day. He checked himself into the ER, ordered an EKG, and later called me from the ICU to ask if I could cover his office appointments once or twice a week. My mother, who knew all of his patients, called and rescheduled appointments for the evenings when I was free from my third-year orthopedic resident responsibilities.

I dressed in a suit and tie, removed the blood stains from my shoes, and carefully combed my hair. Not the usual resident attire; I had to look dignified to fulfill this responsibility. The first night, elderly Mrs. Novak came for her office visit with a simple request for cough syrup, adding a weak, pitiful “cough, cough.” I wrote a script which she promptly handed back, “No, no. that’s not the right one,” she admonished. “The one with the silver label, the one your dad gives me. I think the name is, oh, I don’t remember. I wrote it down so there’d be no mistake.” Knowing exactly what she was seeking, she handed me the note. I looked up the medicine’s name in the PDR (an old-fashioned, remarkably thick and heavy red book with Bible thin pages listing every known medicine in three separate indexes in a way only Sherlock or an egghead could understand). Carefully perusing the ingredients, I saw: 15% alcohol. Over the next few weeks, I got several more requests for medicinal nightcaps.

The second evening a patient reported, “I’ve got my usual sinus infection again, and I need the treatment your dad does. It’s the only thing that works.” I nodded knowingly and said, “Just a minute while I get some extra supplies.” My dad shared this office, a converted residential apartment, with a friend who was a dentist. My dad’s part was the dining room and kitchen, while Ed drilled teeth in the bedroom and made crowns in a closet. They were like two peas in a pod. I stepped into Ed’s closet and, despite my dad still being in the ICU and after much hesitation, called the Oak Park Hospital where a dedicated nun answered, “Okay, I can let you talk to him this time, but we can’t make a habit of it.” Hah, little did she know.

I got carefully worded instructions as to what “the treatment” was. After wrapping a generous wad of cotton on an applicator, I soaked it in epinephrine and then in cocaine (standard office formulary at that time). Next was the hard part, a part my dad had extensively practiced but I had never conceived of doing. I put on the doctor’s head mirror, the kind you used to see doctors wear in cigarette commercials, and sat facing the patient, who was in a chair in front of a bare lightbulb. I tried to look professional and adept at peeking through the hole in the center of the mirror while focusing on the patient’s nose, but I blinded him with the concentrated glare. Since my retina-burned patient squeezed his eyes shut and couldn’t see my incompetence, I felt comfortable peeking around the mirror’s edge. I jammed and twirled the cotton swab quickly into one nostril, then the other, pausing to wipe away the tears, his and mine. Seeing no blood, I surmised I hadn’t done much damage. After a burst of sneezing and snorting, the patient said, “Thanks, doc, that’s a whole lot better already,” as he blew more stuff out than I cared to look at.

My dad’s carefully worded instructions included, “I usually charge ten dollars, but his wife recently fractured her ankle, and they have more medical bills than they can afford. So charge him three dollars total.” The instructions didn’t end there. “I know what you’re thinking so listen, I decided long ago that for my peace of mind I would maintain my independence. I choose to run my business as I see fit, believing that if I take care of my patients, they will take care of me. They’re our neighbors, not cash registers.”

Okay, lesson received. But the execution turned out to be the tricky part. He came ready to pay more, so he handed me a twenty-dollar bill. Oh goodness, the change must be seventeen. I, too, had come prepared: five- and ten-dollar bills together in my right side suitcoat pocket, and a roll of ones on the left. Being a bank teller couldn’t be that hard—after all, I went to medical school. I took his twenty with my left hand and reached into my right suitcoat pocket for the carefully divided packet of larger bills. I set the twenty on the desk so I could select one five and one ten from the bundle, and put the rest back in the right pocket, while retrieving the one-dollar bills from the left pocket. Holding the fifteen dollars pinched between my little finger and palm, I tried to count two singles, but when they stuck together, I dropped the whole wad of ones on the floor. Scrambling like a pigeon chasing crumbs was ultimately undignified regardless of how impeccably I was dressed.

Then came Mrs. Smith. Mrs. Smith’s young daughter had a skin condition (my worst subject was dermatology, which in my mind is akin to sorcery), and Mrs. Smith wanted the cream my dad had prescribed last time. Once again, I had no idea what she was talking about. I searched and searched for Mrs. Smith’s record and found nothing on her, her husband, or their daughter. In fact, there was only one Smith in the entire file; it was a most uncommon name in that neighborhood. I gave up and called the same dedicated nun, who reluctantly turned the phone over to my dad. “Where is Mrs. Smith’s chart? She wants the cream for her daughter’s rash,” I asked. My dad chuckled, then said, “Look on the chart labeled ‘Prochaska.’ Lillian Prochaska is Lorain Smith’s mother, and all the family’s records are on one chart.” Even Mrs. Smith’s husband and daughter? It almost blew my mind. I recovered the Prochaska family “chart,” three five by eight index cards stapled together, a system from the 1930s when he built his private practice. Definitely not an EMR. It took two seconds to find the magic formula. Not only was the problem solved, but I gained a deeper understanding of the nature of my dad’s private practice.

Twelve years later, my parents went to the Art Institute on a Sunday in January. When they came home my dad shoveled the drive free of snow so he could make rounds the next day, but the next morning he didn’t wake up. Dr. Bobby Wroten waited in the All Saints doctors’ lounge until I finished my case, then told me my dad had died. I took the last plane that landed that afternoon before O’Hare was closed due to a gigantic snowstorm, and then caught the last cab home. Three days later O’Hare had just reopened, and outside the funeral home across the street from my dad’s office, the plowed snow was piled six feet high on the sides of every street, including down the middle of busy Cermak Avenue; the sidewalks were barely passable, and it was 26 degrees. Once upon a time, an acquaintance had insisted that the number of people who came to a funeral depended on the weather. The line of people who came to bid my dad farewell filled the funeral home and stretched outside more than a block long. The viewing lasted past closing, well into the night.

That was my first experience with my dad’s “family practice” and medicine in the sixties.

The Last Word – Life Lessons

by Hujefa Vora, MD, Publications Committee Chair

From the Achieves: This Last Word was originally published in the September 2017 issue of the Tarrant County Physician and has been edited for clarity. You can read find the full reprint along with the rest of the content from the July/August 2022 publication here.

He was an amazing businessman. His acumen, combined with an ability to take the required risks, helped him to build an automobile repair empire. His smile was infectious. With it, he instilled a fierce sense of loyalty in his employees and business partners. And his words. His Texan twang was musical and fierce. He could cut a deal in seconds with a “Howdy Y’all” and then a “Sign here . . .” That’s how he won the heart of his high school sweetheart. He danced with her from the prom, where he was the King, all the way to the white-washed wedding chapel. They had four children, each one more beloved than the previous, each with that same smile. When he first came to me, I could see what they all loved in him. Despite always being short on time, I would spend the extra few minutes just to laugh at his latest story. I would adjust his blood pressure medication. Somewhere along the way, I added a statin. He did not smoke, and he had no family history. He was doing well, and so that’s why the stroke came so unexpectedly. Four years ago, the conditions changed. The stroke took the entire right side of his body. He couldn’t walk. He couldn’t use his right hand and arm. He was immediately wheelchair-bound. That was not the worst of it, though. The worst was when we found out that he had lost his voice.

The stroke hit his speech centers. He developed an expressive aphasia. He could understand everything that was said, but he could no longer utter a word. The damage to Broca’s area was irreparable. His physicians concurred with this assessment. Perhaps we thought his life was over, or at least the life he had built. His wife’s love for him was stronger than that, though. It was stronger than the assault on his brain and body. She kept him in his business. She kept him in the game. She would take him to physical therapy to strengthen his resolve. She took him to speech therapy and learned his language. She brought back his smile.

She took him to work every day. She was his voice in the meetings. He would smile and grunt, and his empire did not crumble. Physically, he was weak, but as a partnership, she and her husband held strong. I remained amazed by all of this whenever I saw them in clinic. Here was a strong man brought to his knees by a stroke that should have ended him, but instead, he flourished. He flourished because he had a partner that stood by his side always. Even as we did not, she understood his every unintelligible utterance, his body language, and above all else, his smile.

I am given the honor of seeing them periodically in the office. He has had a hospitalization here and there, and she remains his constant companion. She is his advocate. She is his voice. Despite everything we think we know about medical science, she has proven that he is unbreakable.

I often wonder about the intricacies of their relationship. I wonder at his wife’s ability to understand him. Most of all, I marvel at their resilience. Despite overwhelmingly insurmountable odds, they have survived.

Most of all, I marvel at their resilience. Despite overwhelmingly insurmountable odds, they have survived.

There are so many life lessons I have learned from my patients over the years. I want to bring only one of these to all of you. Together, we are stronger. Despite any of our individual weaknesses, we can always give a voice to one another. This becomes especially true in our partnerships and relationships outside of our practices. I am a dinosaur on an island. I am a solo internist. How do I ensure that my voice is heard? I can promise you that the people in Austin and Washington think they know what it is I need and I want. They think they know what we are saying. They think that they can fix medicine. Meanwhile, we think that they are listening to us. We believe that our intelligence and our charisma will carry the day. This is in fact our greatest strength and our greatest weakness. We know we have the answers on how to fix healthcare. I know this to be a fact. My fellow physicians, I have heard all of you loud and clear over the past several months. I have had amazing conversations. I have gained so much insight into my own difficulties in medical practice, and I have come to a better understanding of so many of the difficulties many of you face in your day to day. Some of these discussions have led to even deeper insights . . . But there is the rub. How will we get to action? Action requires us to understand our greatest weakness. We help others all day long, and even though we think we have all of the answers, we are unable to really express them. We too have a form of Broca’s aphasia. I would assert that we need a partnership to make absolutely certain our voice is heard. I believe the partner that binds us all together is the Tarrant County Medical Society, in conjunction with the Texas Medical Association. Many of you have expressed your inability to completely agree with this. We don’t always agree with our partners 100 percent of the time. (Don’t tell my wife this!) Moreover, we need a partner and an advocate that speaks our language and understands us.

Maybe I’m just preaching to the choir. In the end, we will all need to continue to work together, not individually . . . We must come together and make sure that our voice is heard loud and clear . . . They will hear us. Kumbaya. My name is Hujefa Vora, and this is our Last Word.

Medicine on the Road

by Sebastian Meza, OMS-I

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

Texas is suffering a healthcare crisis from a lack of practicing physicians. This fact is even graver in rural communities, where the nearest hospital might be a couple of hours away. It is time that we take medical care closer to these vulnerable patients, and that is where mobile healthcare clinics can offer an efficient solution.

As a first-year medical student at the Texas College of Osteopathic medicine, I was fortunate enough to serve with the Pediatric Mobile Clinic at the Health Science Center. To picture this mobile clinic, you must imagine a bus or RV that has been transformed into a fully functional pediatric clinic. It might seem like there would not be much space in the mobile unit, but it is fully equipped to perform many medical services. The unit carries out vaccination drives, full screen wellness check-ups, sports physicals, and much more. It is a small glimpse into the future of medicine.

Looking back at my very first day serving as a student doctor, I did not know the extent of what the pediatric mobile clinic could do. My first patient came in and presented with learning difficulties, café au lait spots, and some vision problems. It was an enormous surprise to find myself examining a possible case of neurofibromatosis, a rare disease that we had covered just a few days prior. I left that day thinking about how this child would not have been able to receive care or be referred to a specialist if the Pediatric Mobile Clinic had not shown up at his school. I felt grateful and fortunate to have been there to serve the children of our Fort Worth community.

It was not until I had a chance to serve in this mobile unit that I realized that this concept was a great solution for Texas’ rural communities. Mobile clinics bring medical services to areas that are hours away from major cities with large medical centers. These clinics are easily adaptable and can be transformed to house many different kinds of practices. They operate much like a regular clinic; patients can look up when the mobile clinic will be near them and then schedule appointments online. Primary care practices can take full advantage of transforming and adapting the mobile units to serve a specific patient population.

For example, mobile clinics can directly help many underserved communities by being closer to patients, which saves time and transportation costs that can often be barriers to seeking treatment. Mobile health clinics do require an initial capital expense for institutions and hospitals. However, they bring in enough revenue to cover their own costs, they draw patients into the sphere of the base clinic or the hospital, and they help keep our community healthier.

I did not expect to feel so strongly about the concept of mobile healthcare clinics when I first set foot onto that crowded bus, but it is impossible not to recognize how efficient it is to have mobile clinics at our major schools and hospital institutions, as well as in rural communities. These mobile clinics should be part of our vision for the future of healthcare. It is time to advocate for more mobile clinics on our Fort Worth roads!

Behavioral Health to Combat Physician Burnout

By Sofia Olsson, MS-I, and Anand Singh, MS-I

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

Burnout is not a new term for physicians. In fact, prior to the pandemic, an online survey conducted by the American Medical Association in January 2020 found that there was an overall physician burnout rate of 46 percent.¹ Unfortunately, the pandemic has exacerbated burnout for physicians due to a multitude of unprecedented factors. Burnout can be defined by three main symptoms: exhaustion, depersonalization, and lack of efficacy.² Physicians may exhibit harmful behaviors as coping methods in response to burnout, so it is important to acknowledge behavioral health as it addresses how individuals’ daily habits and actions impact their mental and physical health. As two medical students, we founded Behaviors Supporting Mental Health (BSMH) to raise awareness surrounding behavioral health for all individuals. For our current campaign, we are focusing on physicians’ response to burnout. Through BSMH, we hope to provide resources for physicians to address their behavioral health and reduce or prevent burnout.

Continuous refinement of our daily habits, actions, and behaviors leads to better
mental and physical health.

First, though, we want to acknowledge the prevalence of burnout and what factors are contributing to this phenomenon. According to research conducted by the Agency for Healthcare Research and Quality, the cause of physician burnout is multifactorial.³ The study found that some of the main causes of physician burnout are tied to physicians having to balance family responsibilities, work under time pressure, deal with a chaotic work environment, have a low control of pace, and implement electronic health records.³ Unfortunately, physician burnout has been linked to consequences such as lower quality of patient satisfaction and care, physician alcohol and drug abuse, and even physician suicide.² Therefore, addressing physician burnout and combatting unhealthy behaviors are critical for physicians themselves as well as for the patients they serve.

The activities physicians partake in can impact their risk for burnout, so assessment of one’s behavioral health is important regardless of current mental health. Several coping strategies, such as making an action plan, taking a time out, or having discussions with colleagues, have been correlated with a lower frequency of emotional exhaustion in physicians.⁴ On the other hand, keeping stress to oneself has been associated with a greater frequency of emotional exhaustion.⁴ After making note of behaviors and identifying their purpose, one can decide whether these actions should be eliminated, continued, or supplemented.⁵ Changing behaviors, however, is easier said than done. Since useful coping skills are not “one size fits all,” BSMH aims to provide resources that help physicians build a toolkit of ways to improve their behavioral health. For example, the app Provider Resilience, designed by the Defense Health Agency, functions as a method to keep physicians motivated and hold them accountable in their behavioral health.⁶ The QR code shown is a link to the BSMH website (https://tinyurl.com/bsmhproject), which includes further resources tailored to prevent or relieve burnout in physicians. Our contact information can also be found here for anyone with questions or a desire to collaborate.

Continuous refinement of our daily habits, actions, and behaviors leads to better mental and physical health. Regardless of the extent of a physician’s burnout, addressing behavioral health is always a necessity. Intentional actions impact one’s identity as a physician and any other role they have outside the clinic. Transitioning one’s behavioral health from passive to intentional can improve one’s ability to balance familial responsibilities, work under pressure, and deal with a chaotic work environment.² This puts physicians in control of their behaviors and decreases their risk for substance abuse and suicide while improving the quality of patient care.^7,8 Meaningful reflection and continuous behavioral health improvement creates a healthier mindset that allows physicians to better care for their patients and themselves.

References

1. Berg S. Physician burnout: Which medical specialties feel the most stress. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-which-medical-specialties-feel-most-stress. Published January 21, 2020. Accessed May 18, 2022.

2. Drummond D. Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Fam Pract Manag. 2015;22(5):42-47.

3. Physician Burnout. Content last reviewed July 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html

4. Lemaire JB, Wallace JE. Not all coping strategies are created equal: a mixed methods study exploring physicians’ self reported coping strategies. BMC Health Serv Res. 2010;10:208. Published 2010 Jul 14. doi:10.1186/1472-6963-10-208

5. Hem, Marit Helene, et al. “The Significance of Ethics Reflection Groups in Mental Health Care: A FOCUS Group Study among Health Care Professionals.” BMC Medical Ethics, vol. 19, no. 1, 2018, https://doi.org/10.1186/s12910-018-0297-y. 

6. Provider Resilience. Version 2.0.1. National Center for Telehealth & Technology. 2021.

7. Harvey, Samuel B, et al. “Mental Illness and Suicide among Physicians.” The Lancet, vol. 398, no. 10303, 2021, pp. 920–930., https://doi.org/10.1016/s0140-6736(21)01596-8. 

8. Panagioti M, Geraghty K, Johnson J, et al. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Intern Med. 2018;178(10):1317–1331. doi:10.1001/jamainternmed.2018.3713

CALL FOR MUSICAL PHYSICIANS: Join Fort Worth’s First Medical Orchestra

by Allison Howard

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

Physicians, dust off your instruments—Fort Worth’s first medical orchestra is looking for healthcare workers who have a dual passion for music and medicine.

The group, which is being organized by retired physical therapist and flautist Susan Fain, is expected to begin rehearsing this fall. While the details are still being ironed out, Susan says that everything is falling into place.

“We are collaborating and negotiating for a space, conductors, and music,” she says. “And it looks really good.”

Susan, who holds doctoral degrees in both physical therapy and flute performance, was first inspired about 10 years ago when she heard the Doctors Orchestral Society of New York. She soon discovered there were over 30 such orchestras throughout the U.S., and she saw it as the perfect opportunity to marry her passions.

“In medicine you’re helping people, and in music, you really are helping people,” she says. “You’re helping yourself, learning to create, and all of that discipline is across both professions.”

She believes this could be a step toward work-life balance for those who love sharing music with others but have set their instruments aside due to lack of opportunity. Now, she is ready to create that opportunity, and she is thrilled to do so in a city that is rife with a passion for the arts.

Susan, whose career was divided between practicing physical therapy, pursuing music, and raising her five children, has played flute in both civic and professional orchestras. And her experience organizing events and groups is extensive, ranging from planning classical concerts to putting together a small orchestra (where she served as the conductor!). Now, retired from physical therapy and ready to devote herself fully to her love of music, she is thrilled to start this next endeavor.

“I want to be like Esther – ‘You might have been born for such a time as this,’” Susan says. “To bring the two halves of my life together and make them both count.”

It seems she isn’t the only one that feels that way. As the word spreads there has been a lot of interest; so far, 10 instrumentalists have committed to the orchestra, and more have expressed a desire to get involved.

Ultimately, Susan’s goal is to form a full orchestra that will perform a handful of concerts each year to raise support for local charities. She believes it will enrich the community and be a chance to cut through much of the noise created by the constant challenges in the practice of medicine.

“Performing is like creating an oasis for the audience,” she says. “This is a moment where you can forget the outside world, and all the things going on in society that we struggle with, and we can sit for a moment and just stop and reflect on truth and beauty. That, to me, is what it’s all about.”

For more information about the Fort Worth Medical Orchestra, contact Susan Fain at sdfain1@gmail.co m or 405-830-2107.

President’s Paragraph

July 1st

by Shanna Combs, TCMS President

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

As I write this, we are amidst graduation season for kindergarten, high school, college, and medical school; it is a time to celebrate the culmination of one of many of life’s journeys. By the time you read this, it will be another magical time of year that all medical professionals know . . . July 1. The time of year when medical students are starting their journey into medical school, or starting their clerkships and entering the clinical learning environment. It is also the time when newly minted doctors put on their crisp, long white coats and try out what it sounds like to say, “Hi, I’m Doctor So-and-so.” It is the time of year when the cycle of medical education continues to turn, and for those of us in practice, it is a time to reflect on our own journey in medicine. Below are some words of wisdom I have for the next generation of physicians.

First year medical students

Welcome to the profession! You have started the journey into the best career you can ever have. The path ahead will not be easy, and there will be many highs and lows. Always keep in mind the reason you chose medicine and enjoy the ride.

Clerkship students

You finally made it . . . you are out of the classroom and getting to do what you wanted to do when you started medical school – learn how to take care of patients. The hours will be long, and your brain will hurt from all the new knowledge, but you are finally starting the work that you signed up for. The best piece of advice I have is the same thing I was told at the beginning of my clerkship year: “You are paying for the privilege to be here . . . get your money’s worth.” There will be no other time in your career where the whole world of medicine is open to you.

Decisions you make are no longer about a, b, c, or d choices; there is now a human life attached to your decisions. There is a whole lot of grey in medicine and not every patient “reads the book.” Keep an open mind and learn as much as you can.

Residents

You are now a doctor . . . listen to the nurses. They can teach you many things and help you in times when you do not know what you are doing, or they can make your life a living hell.

You, too, were a medical student once and were taught by a resident who took you under their wing – or were dismissed by a resident who forgot where they came from. What type of resident do you want your medical student to see you as?

You now have the privilege to sign orders, write prescriptions, and perform procedures. All of this has an impact on a human life. Never forget that.

Attendings

The doctor who is not willing to say “I don’t know” or “I need help” is the most dangerous doctor out there. When another doctor asks for help, realize that they have reached the end of their knowledge base and are asking for your expertise.

It is called the practice of medicine, not perfection. You may have completed medical school, residency, and possibly even fellowship, but there is always something more to learn. When you do this, it is no longer just for your own education or to pass the test, but so you can provide the best care for your patients. They are the reason we do what we do.

Happy July 1 everyone!

Medicine Has No Borders

by Aiyana Ponce, OMS-I

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

As a high schooler attending a medical magnet school, my first patient interaction came early, but the lesson I learned that day has influenced the type of physician I hope to become. Nervously, I greeted my first patient, Laura, and informed her that I would be assisting the nurse that day. I helped with her bath and brushed her hair with care, just as I brushed my own mother’s hair when she was hospitalized. Laura was blind and her tracheostomy tube prevented her from speaking, but despite that initial disconnected feeling, I was told, “The goal should be to take care of the patient as if she were your own family member.” That goal was to serve with compassion and empathy. These words have remained with me each time I have interacted with a patient. I took lessons such as this one with me after graduating and made it my mission to maximize my impact on others while serving my community.

Over spring break this year, I participated in a medical mission trip to Guatemala with 35 of my peers. Over the course of five days, we traveled by air, sea, and land to visit Santa Maria de Jesus, Magdalena Milpas Atlas, Monterrico, and San Juan, where we saw over 600 patients. Upon arrival at the pop-up clinic locations that were normally schools or church community rooms, there was often an impressively long line that formed before doors opened. Patients waited hours to be seen each day, and that was a humbling sight.

As a first-generation American raised in the U.S.-Mexico border region and a native Spanish speaker, I served as a link between patients, physicians, and medical students. My responsibilities were to initially take patient’s vital signs and blood glucose readings and then discuss their medical history and chief complaints so I could give the information to the attending physicians volunteering with us. Other days, I had the opportunity to work with a student partner and conduct full patient interviews. We would present our differential diagnoses to one of the attending physicians and work alongside the patient to create the best plan of care. On one of these days, I noticed that a patient came in particular distress. Upon my initial analysis, I noticed that he had what I call “working hands.” Large, dry, and calloused, they resembled the hands of my construction laborer father. As soon as I introduced myself by saying, “Buenos días, mi nombre es Aiyana,” his demeanor changed entirely. One moment he was shyly nodding and following the motions, and the next he looked up, seemingly comforted by familiar words. He, like many others, opened up and provided critical information necessary for his recovery. This change in demeanor occurred patient after patient, and I began realizing how incredible it was to contribute to the enhancement of patient care that would otherwise be limited by communication barriers. I am proud of my work as a translator, but I learned that there is far more that goes into quality of care than a shared language. Though some physicians and students were limited by language, I witnessed spectacular uses of eye contact, hand motions, diagrams, and body language – all of which portrayed a genuine desire to connect with and educate patients. Everyone seemed to have an impeccable awareness of their patients’ needs and feelings, despite their differences.

As soon as I introduced myself by saying, “Buenos días, mi nombre es Aiyana,” his demeanor changed entirely. One moment he was shyly nodding and following the motions, and the next he looked up, seemingly comforted by familiar words.

It is a privilege to be entrusted to care for the life of another human being and I do not plan on taking such a responsibility lightly. It is important to acknowledge that one does not need to travel to faraway lands to serve those in need, as many underserved individuals are likely residing minutes away from us right now. In the future, I will continue to participate in mission trips abroad in addition to serving the local community, wherever I go!

Choices

The Last Word

By Hujefa Vora, MD, TCMS Publications Committee Chair

Last month, I wrote about choices. We all seem to encounter hundreds, if not thousands, of choices every day. And who really knows how the slightest choice affects the next set of choices that present themselves before us. Our choices at times can appear meaningless to us. As I prepare for my day, I choose my scrubs from my closet. Unconsciously, I make the decision to wear the blue ones. I decide to just grab a granola bar for breakfast as a matter of convenience on my way out the door rather than to sit down with my wife at the dining table for the coffee and omelet and communion I am truly craving. On my way to work, I decide to stop and fill up some gas, though my truck still has a quarter tank. The floor nurse messages me that my patient’s family has decided to try and meet with me around lunchtime today rather than meet me for my morning rounds. I let her know that I am not sure that this will work, as there are likely to be another few hundred choices that I have to make before I get there. I will try. That seems to be all I can do in any given situation. At any rate, I decide to go by and see the patient first this morning. This will give me a moment of clarity without the interference that sometimes follows families into a room. I make the choice to turn left rather than right—I will start my day in the ICU and make my way back to the orthopedic facility later. I know that I will make it to all of the patients before the end of my day. My choices thus far have been mundane rather than the life and death decisions which we are glorified with when others speak of our profession.

The choices I made that morning were not anything but ordinary. And yet, as we find sometimes, they guided me exactly to the place where I was needed most.

As I arrive at the hospital, the cafeteria’s coffee machine calls my name. The granola bar wasn’t quite enough. I chose a decaf vanilla latte. Now the coffee machine is not that place, but it is certainly the place I needed most. Caffeine would make it better, but that goes without saying. My coffee and I meander onto the unit. The nurses are busy at their bedsides, assessing the patients at the start of their morning. As I walk toward the central nurses’ station, I note the rhythms of the telemetry monitors. Muffled underneath is the low hum of air flowing through endotracheal tubes. The aroma of the coffee hides the scent of hand sanitizer and bleach. Just the granola bar was a poor choice, but the choice of coffee from the cafeteria more than compensates for that. It is all entrancing, calming, and yet chaotic. The ICU has its own music. Occasionally, the better choice of words is controlled chaos. My moment is broken by a flourish from the room 20 feet in front of me. The rhythm is broken as a woman flies out of the room, hurtles towards me, and demands her nurse. For a moment, I hesitate. I then realize that the blue scrubs I chose this morning happen to be the same blues worn by our ICU nurses. I follow her into the room. The patient is bucking the ventilator. In his bed, he is strapped down, but from the spasms in his shoulders and neck, his arms look like they will try and pry loose. I hit the Code button on the hospital bed. The ICU machine is awakened by a cacophony of deafening alarm bells. Three nurses barrel into the room with a crash cart. A few simple, unplanned choices have guided me to this moment.

“The choices I made this morning were not anything but ordinary. And yet, as we find sometimes, they guided me exactly to the place where I was needed most.”

There were no decisions this morning prior to this moment that required my four years of college, four years of medical school, or three years of residency. And yet, they were a doctor’s decisions and choices. The next few choices were those of a seasoned physician with more than 20 years of working in hospitals and ICUs.

I don’t have any history, as this is not the room of the patient I have yet to visit this morning. All I have is the information the nurses start barraging me with. The patient is seizing, so IV benzodiazepines are administered. Another choice. The patient starts to calm, spasming muscles relaxing. Calm washes over the scene for a moment. Everyone, including the patient, pauses to breathe. The momentary silence is broken by the sobbing of the patient’s wife, I presume. She asks if the doctor has been called. Without skipping a beat, I reassure her that the intensivist is on his way. The wife stutters out a prayer, then thanks me for my actions. My choice in that moment is not to correct her, but rather affirm to her that we will take good care of her husband until the intensivist arrives. I remain in the room for several more minutes until the intensivist comes in to relieve me. He assesses the situation, thanks me for intervening while he was indisposed with another patient situation, and then allows me to walk back out of the room. As I leave, he pokes his head out of the glass door and shoves a cup into my hand. “Don’t forget your coffee.”

Every choice we make in our days is governed by several principles. I am about to speak in generalities, a choice I am making in this moment. We are physicians. Our lives revolve around this choice. Being a physician is not just a job, not simply some way to make money, but rather a life choice, because being a physician is not my job, but it is my Life. We are called upon, above all else, to do no harm—our choice is to take this oath and live by it. No matter the moment, the situation, the patient comes first, above all else. We apply our knowledge, our skills, and our hearts to every patient individually, understanding that it is our oath and the choices that have followed thereafter that define our most noble profession at its core. As a physician, it should always be my choices, and my patients’ choices, which guide me to those moments and through those moments when I am needed most. One might say that I am pro-choice. I choose to agree. My name is Hujefa Vora, and I choose the word “choice” as this, The Last Word.