LouisviLLe Medicine - Greater Louisville Medical Society

Transcription

Louisville
GREATER LOUISVILLE MEDICAL SOCIETY
Medicine
VOL. 61 NO. 4 SEPTEMBER 2013
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GLMS Board of Governors
Russell A. Williams, MD, board chair
James Patrick Murphy, MD, MMM, president
Bruce A. Scott, MD, president-elect and AMA delegate
Heather L. Harmon, MD, vice president
Robert H. Couch, MD, treasurer
Robert A. Zaring, MD, MMM, secretary and AMA
alternate delegate
Rosemary Ouseph, MD, at-large
Tracy L. Ragland, MD, at-large
Jeffrey L. Reynolds, MD, at-large
Neal J. Richmond, MD, at-large
John L. Roberts, MD, at-large
Wayne B. Tuckson, MD, at-large
Fred A. Williams Jr., MD, KMA president-elect
Randy Schrodt Jr., MD, KMA 5th district trustee
David R. Watkins, MD, KMA 5th district
alternate trustee
K. Thomas Reichard, MD, GLMS Foundation president
Stephen S. Kirzinger, MD, Medical Society Professional Services president
Toni M. Ganzel, MD, MBA, dean,
U of L School of Medicine
LaQuandra S. Nesbitt, MD, MPH, director,
Louisville Metro Department of Public
Health & Wellness
Karyn Hascal, The Healing Place president
Ilene Bosscher, GLMS Alliance president
Louisville Medicine Editorial Board
Editor: Mary G. Barry, MD
Elizabeth A. Amin, MD
Waqar C. Aziz, MD
Deborah Ann Ballard, MD, MPH
R. Caleb Buege, MD
Arun K. Gadre, MD
Stanley A. Gall, MD
Larry P. Griffin, MD
Kenneth C. Henderson, MD
Jonathan E. Hodes, MD, MS
Martin Huecker, MD
Teresita Bacani-Oropilla, MD
Tracy L. Ragland, MD
M. Saleem Seyal, MD
Dave Langdon, Louisville Metro Department
of Public Health & Wellness
Russell A. Williams, MD, board chair
James Patrick Murphy, MD, MMM, president
Bruce A. Scott, MD, president-elect
Lelan K. Woodmansee, CAE, executive director
Bert Guinn, MBA, CAE, chief communications officer
Ellen R. Hale, communications associate
Kate Allen, communications designer
Louisville
Medicine
Vol. 61 No. 4 SEPTEMBER 2013
Greater Louisville Medical Society
feature articles departments
9
In Remembrance
Joseph E. Sadtler, MD
Morton L. Kasdan, MD, FACS
5
From the President
Taking Care of Business
James Patrick Murphy, MD, MMM
13
History of Louisville
National Medical
College and the Red
Cross Hospital: African
American Medicine in
Louisville, Kentucky –
1872 to 1976
Part 5
Morris M. Weiss, MD, FACC,
FAHA, FACP
7
Alliance News
Ilene Bosscher, MA, MDiv,
LMFT, LPCC
11
Reflections
Rest in Peace
25
Physicians in Print
16
My Mentor
Ben Rogers
27
We Welcome You
18
Rounds
David A. Casey, MD
35
Doctors’ Lounge
I’m Getting a Complex
Mary G. Barry, MD
20
White Coat Ceremony
Congratulations
James Patrick Murphy, MD,
MMM
Dean’s Remarks
Toni M. Ganzel, MD, MBA
Advertising
Cheri K. McGuire, director of marketing
736.6336, [email protected]
It Would Only Take a Monkey
Ronald L. Levin, MD, FACOG
Ensuring Excellence Through
Medical Mentorship
Beau M. Bailey, MD
Student Remarks
Lee Richardson
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Louisville Medicine is published monthly by the
Greater Louisville Medical Society, 101 W. Chestnut St.
Louisville, Ky. 40202 (502) 589-2001, Fax 581-9022,
www.glms.org.
24
A Day in the Life of a
Doctor
Kevin Kwan
Articles to be submitted for publication in LM must
be received on electronic file on the first day of the
month, two months preceding publication.
Opinions expressed herein are those of individual
contributors and do not necessarily reflect the position
of the Greater Louisville Medical Society. LM reminds
readers this is not a peer reviewed scientific journal.
LM reserves the right to make the final decision on
all content and advertisements.
Circulation: 4,000
On the cover: GLMS President James Patrick
Murphy, MD, MMM speaking to new medical
students at the White Coat Ceremony, July 28, 2013
GLMS Mission
Promote the science, art and profession of medicine; Protect the integrity of the
patient-physician relationship; Advocate for the health and well-being of the
community; Unite physicians regardless of practice setting toSeptember
achieve these2013
ends.
3
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From the
President
JAMES Patrick Murphy, MD, MMM
GLMS President
[email protected]
Taking Care of Business
N
o margin, no mission: on my first day
of class at the USC Marshall School
of Business I learned this tenet. In
other words, when there is no profit and the
electric bill is not paid, the lights will go off no margin, no mission.
This concept was not foreign to me. In 1998,
upon finally saving enough money to lease a
modest office, I discovered my receptionist
was regularly failing to collect co-payments
from patients she empathetically felt were
strapped for cash. After I “motivated” her by
asking how long she would work without pay
when we ran out of money, she quit. Thankfully my empathetic wife stepped in to collect
the co-pays. Our lights stayed on. I kept seeing
patients.
Health care expenditures in the U.S. are now
about 18 percent of the GDP, or close to $3
trillion. Physicians rightly expect a slice of that
pie - to pay the rent, the receptionist, and the
electric bill - with something left over as profit.
Profit - the difference between revenue and
expenses - is how most businesses define success. Generally, in our health care system the
revenue for each case is set by a third party
payer - e.g. the Medicare allowed rate of reimbursement. Thus, it would seem that the best
formula for our success is to treat as many
patients as possible at minimal cost - maximizing profit.
But should the practice of medicine gauge
success by the profit margin?
According to Michael Porter and Mark
Kramer, a narrow focus on profit in any business leads to the neglect of broader influences
that determine long-term success. In “Creating Shared Value” (Harvard Business Review,
January 2011 http://bit.ly/kRqE3T), they concluded that shared value - “the next major
transformation of business thinking” - occurs
as economic benefit becomes intertwined with
social benefit. In other words, doing good for
your fellow man is also good for your business.
In keeping with this theme, management guru
Dave Logan has advised that the first step in
making a business profitable is:
any thought of how this action will benefit
our business. It is our golden rule: care for
others, regardless. But remember that caring
for others means taking care of business too.
Find a group of people important to your
business who need help, and commit to helping them, without any thought about how this
action will benefit your business.
Hold steadfast to our golden rule, not the
rule of gold. Make a bold statement to the
world. Start that non-profit you have been
contemplating. Help organize that medical
mission. Join that board. Show up and vote
for that resolution. Run for that political office.
Complete the training for that business degree.
Attend that meeting in the executive suite.
http://cbsn.ws/14ANPPW
Physicians do this intuitively. It is why we
started down this tortuous path. It’s why we
gave up our youth to endless lectures, textbooks, labs, insomnia, and stress, risked our
health, and stole from our family life. We
went into debt, endured ridicule on morning
rounds, and exposed our careers to legal ruin
– all so we could commit to helping the people
important to our profession, our patients.
But there are too many entrepreneurial
sharks swimming around for us to ignore the
business side of health care. Can one give a
dollar value to the cry of a newborn, the tears
of a cancer survivor, the renewed pulse of a
resuscitated heart? Of course not, but to be
successful also means that you have a place
to come to work the next day.
So learn the business of medicine. When
you delegate decisions to companies who serve
shareholders first, then you allow economic
forces undue control of your ability to practice medicine. Physicians have an obligation
to lead in the health care industry, and the
industry will benefit by our leadership.
Shakespeare wrote, “To thine own self be
true.” For physicians this translates as: be true
to how you - as an individual - define success.
Fortunately, our individual definitions of success overlap enough to allow physician solidarity and leadership in our health care system.
No margin, no mission: the “mission” part
comes natural for us - finding people who need
us and committing to helping them without
(No mission, no need for margin.)
Be the next major transformation of business thinking. L
M
Note: Dr. Murphy, board-certified in Anesthesiology, Pain Medicine and Addiction Medicine,
is the president and medical director of Murphy
Pain Center. He is an assistant clinical professor
at the University of Louisville School of Medicine and serves on the board of the International
Association of Pain and Chemical Dependency.
Let’s Connect
Email me at [email protected].
Follow me on Twitter
@jamespmurphymd.
Connect with me on LinkedIn.
Sign up for, visit and comment on
the new GLMS blog (instructions at
www.glms.org).
Download the GLMS mobile app
(instructions at www.glms.org).
Or just give me a call. My number
is in the GLMS “mug book” and the
new mobile app.
September 2013
5
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LOUISVILLE | LA GRANGE | EASTPOINT
CRESTWOOD | MEDICAL ASSOCIATES
Alliance News
Ilene Bosscher, MA, MDiv, LMFT, LPCC
GLMSA President
[email protected]
Teeing off our year!
B
rian Briscoe, MD, who is chair of
our Men in the Alliance (MIA)
Committee, current GLMS President
Pat Murphy, MD, and I have been planning
the GLMS Alliance’s involvement in the third
annual GLMS Foundation Scholarship Golf
Tournament on September 23 at Hurstbourne
Country Club, which raises funds for medical
student scholarships. Come play, come
cheer or come for cocktails and dinner!
For more information about this event,
visit www.oldmedicalschool.org or contact
[email protected]. The MIA
Committee, including Rick Tobe, Robert
Hilgers, MD, and C. Dean Furman, is also
looking into a skeet shooting/winery event
in November and joining the KMA Alliance
for a bourbon tasting/distillery tour at the
AMA Alliance Southern States Leadership
Conference here in Louisville March 21-22,
2014. The MIA gang is also exploring a poker
club, a breakfast gathering and a men’s health
and wellness event.
Don’t miss the GLMS Alliance’s opening
cocktail party on September 21 at the home
of Dominique and Robert Hendren, MD,
in Goshen from 4-8 p.m. To RSVP, contact
Dominique at dominiquehendren@gmail.
com. We will hold a silent auction to benefit
the GLMS Foundation’s medical scholarship
fund and our sponsorship of a hole at the golf
event in honor of our Men in the Alliance.
The cocktail party will be a casual event with
great food, drinks and time to gather with all
members of the GLMSA medical community.
Plan to have a great time! There will be signup sheets for volunteering at our events for
the coming year, and we will announce the
slate of this year’s events as well. Additionally,
we plan to welcome our new members, hand
out our GLMSA Roster and kick off our year
of honoring our current life members. Our
first honoree is GLMSA Past President and
current GLMSA Board Member Barbara Cox.
Cheers to you, Barbara! You have blessed so
many of us, from medical student spouses
just beginning their journey through life as a
physician’s spouse to your fellow life members
and the community at large. We appreciate
your dedication and service to the medical
community of Louisville.
The GLMS Alliance serves our community
by hosting such events as preparing meals for
Gilda’s Club members. We love our Book Club
and hope you will join us. The first book is The
Cat’s Table by Michael Ondaatje on September
12 at 10:30 a.m. at Heine Brothers’ Coffee on
Chenoweth Lane. Contact Carol Lambert at
[email protected] for more information. Our
Technology Coffees will begin with a focus
on Facebook, so email me at imcbosscher@
aol.com. Dominique Hendren is the chair of
the Health and Wellness Committee; contact
her at [email protected] if you
are interested in joining that group.
GLMS Alliance
Upcoming Events
Sept. 8-10 - KMA Alliance Annual Meeting
Sept. 12 - Book Club
Sept. 21 - Cocktail Party
Sept. 23 - GLMS Foundation Scholarship
Golf Tournament
Oct. 18-19 - KMAA Meeting
The KMA Alliance Annual Meeting is at
the Hyatt Regency in Louisville on September
8-10. To register or see the details for the
meeting, visit www.kyma.org or call the KMA
at 502-426-6200. GLMSA Past President
Rhonda Rhodes will be installed as the new
KMAA president during a luncheon in her
honor at 610 Magnolia on September 9 from
12:45-2 p.m., with a silent auction to follow.
That evening, there will be a dinner at 7 p.m.
for the newly installed KMA and KMAA
presidents in the Hyatt Regency Ballroom.
Let’s support Rhonda at these great events
in her life!
The GLMSA Membership Committee
rewrote the dues statement and sent out
membership invitations to all current and
former members of GLMSA and, for the
first time ever, to all male spouses of active
GLMS physician members. We invite them
all to be an important part of the future of
the GLMSA! Membership costs $25 and
is a great way to keep yourself connected
to the Louisville medical community. For
GLMSA membership information, go to
www.glms.org and click on GLMS Alliance
under the Membership tab.
Save the date for the fall KMA Alliance
meeting on October 18-19 in Owensboro,
in conjunction with (serendipitously) the
Owensboro Bourbon and Apple Festival. See
you there! LM
Note: Contact Ilene Bosscher at
[email protected] or 502-552-7319.
To contact new men’s group, email
[email protected]
(top to bottom, left to right) Kim Moser, Adele Murphy,
Rhonda Rhodes, Ruth Ryan, and Ilene Bosscher;
Millicent Evans and Barbara Cox; Nancy Swikert,
Ilene Bosscher, Rhonda Rhodes, and Kim Moser; Ilene
Bosscher, Brian Briscoe, and Pat Murphy
September 2013
7
In Remembrance
Joseph E. Sadtler, MD (1936-2013)
J
oe Sadtler was the youngest of four
children of Clarence Henry and Mary
Frances Sadtler. He attended Holy
Spirit elementary school and graduated
from St. Xavier High School in 1954. He
spent a year traveling in the United States
trying different jobs including working in
the oil fields in Tulsa, Oklahoma. He told
his children that he discovered that year
what he did not want to do for the rest of
his life.
physician. We shared many wonderful
patients. His Family Practice patients loved
him, as the care and treatment he gave was
the highest standard.
Joe returned to Louisville and enrolled
in Bellarmine College. He married his
sweetheart, Nancy Donnelly, in 1957 and
graduated with honors in 1959. Joe and
Nancy had four children: Joe, Jr.; Liz; John;
and Jeffery.
- Morton L. Kasdan, MD, FACS
I visited Joe before he died and, aware of
the prognosis, he was cheerful and upbeat.
I have lost a great friend, the children a
loving and devoted father and our medical
community an example of what every
physician should be. LM
Joe finished the University of Louisville
Medical School in 1963, and entered
the United States Air Force (USAF) as a
general medical officer at Homestead Air
Force Base. He returned to Louisville in
1967 to begin a very successful private
practice.
I had the privilege of calling Joe one of
my closest friends in college and medical
school. When I returned to Louisville
after my USAF tour Joe helped me get my
practice started and was a loyal referring
September 2013
9
REFLECTIONS
Rest in Peace
I
t had been a long day. Having attended the fifth funeral of
friends in the last six weeks, it was time to reflect on my own
thoughts and emotions, and those of the bereaved whom I
had attempted to console. It was clear that being members of, or
close to, the healing professions did not offer any privileges. Two
were physicians, one the son of one, and one the wife of another.
Death did not respect age either. At 37, one was in the prime of life,
the other, in his nineties, had fulfilled his personal, spiritual and
professional life. The others were in between. Random was the rule.
under lock and key, or resting peacefully and permanently. Some
others have the custom of congregating for a more cheerful wake,
with adequate toasts for the dearly departed before and after the
rites. Visitations, too, can be sedate, with respectful people falling
in line to condole with the bereaved family. On the other hand,
they can be a loving crush of family, including little children, and
friends. Some friends, after long absences from each other, find here
an opportunity to reunite with the family of the bereaved and each
other, and express their love and their grief together.
Funerals can be the most private or the most revealing in the
summary of any person’s life. One’s stature and accomplishments
are enumerated, scrutinized, lionized and put to public view. One’s
lovable qualities are enhanced, expanded on. Likewise, indelicately
for some, intimate details better left unknown or unsaid come to
light. Fortunately, like light passing through a prism, we dwell on
the whole effect, and end up with a beautiful interplay of the pure
colors that ensue.
The essence of getting together at funerals is sharing. We share
in the memories, happy and sad. We try to fix them in our minds
and hearts, cleanse them of pains, forgive the hurts that are part of
loving and living, and enshrine them in their own tidy jewel boxes,
to reopen pro re nata (as needed) depending on our needs. This is
a process, this enshrining of memories, a long and gentle one for
many, or alternately a tumultuous one for some. Eventually the tide
of emotions ebbs to a quiet rhythm, while the memories live on. Is
that perhaps why people think and say that “Time heals all wounds?”
In a melting pot of peoples from many nations such as we have
in the USA, each culture has different customs and traditions in
the ways of honoring the demise of their loved ones. Some can be
imported, some cannot. In the East, one would not be surprised to
see professional mourners singing the highlights of the life of their
lost one behind the casket on the way to the cemetery, nor would
one be startled to have a band or piped music announce that the
funeral procession is passing through. By no means can that happen
with traffic on Bardstown Road!
Lastly, if one believes in an Eternal Love that encompasses all,
funerals are reminders that this is the time to go back to that Source,
in peace. LM
Note: Dr. Oropilla is a retired psychiatrist.
Relatives who had travelled long distances from foreign lands to
attend the burial of a loved one here were dismayed and saddened we
did not sit with our dead until he was buried, and had left him forlorn
at night in a funeral home instead. These attitudes may be unseemly
to others, but not to them. Nine-day prayers and gatherings are still
practiced to this day among some of us, but with our loved one safely
September 2013
11
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4293_KY_LouisvilleMed_Sep2013.indd 1
7/22/13 2:50 PM
Vital Signs
The GLMS Publication for Patients
Subscriptions to Vital
Signs are available
as a benefit to all
active and associate
members at no cost.
To receive Vital Signs at your practice contact
Membership Coordinator Jennifer Howard
at [email protected]
or 502-736-6362.
12
LOUISVILLE MEDICINE
James Patrick Murphy, MD
Experience
Small enough to be like family,
large enough to exceed expectations
Conditions Treated
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Work Injuries
Back Injury
Neck Injury
Headaches
Sports Injury
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Cancer Pain
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(812) 284-HELP | (812) 284-4357
www.murphypaincenter.com
History of Louisville National
Medical College and the
Red Cross Hospital: African
American Medicine in Louisville,
Kentucky – 1872 to 1976
Part 5
Morris M. Weiss, MD, FACC, FAHA, FACP
Note: Red Cross Hospital was founded in 1896. This series concludes with the hospital’s final years.
I
n 1954, Waverly Johnson was appointed the new administrator
of Red Cross Hospital. Johnson worked diligently for years
until the hospital closed, battling diminished income and the
desegregation of most of Louisville’s hospitals in the late 1950s and
1960s. African American patients could now be admitted to what
were formerly “all-white” hospitals.
The Red Cross Hospital was fully accredited in 1957, primarily
through the work of Waverly Johnson. In 1959, the last fundraising
brochure was produced, titled “Our Last Appeal.”
It was during the late 1960s that a final attempt was made to
salvage the Red Cross Hospital. By 1970, on the western edge of
Germantown, the Red Cross Hospital sat almost forgotten. The
census had gradually waned but peaked in March 1970 at the time
of a near-walkout of employees at Louisville General Hospital. In
1970, Medicare was paying the hospital bills of the elderly. This had
been a boon to the Red Cross Hospital, but the Medicare patients
had to stay after the government coverage expired, and Waverly
Johnson stated, “We cannot afford this service.”
In an attempt to change its image, the Red Cross Hospital became
the Community Hospital in 1974 and there was debate whether
to move the hospital to another medical facility, either on Eastern
Parkway, western Louisville or the old Norton’s infirmary (Third
and Oak streets). This was considered by William E. Summers
III, chairman of the hospital board at that time, and Dr. C. Milton
Young III, the hospital’s medical director. A series of community
meetings with ministers was held, but no final plan could be agreed
upon. Within a year, the last patient was admitted. Following this,
there was steady decline until the hospital admitted its last patient
on September 18, 1975, with official bankruptcy in 1976.
Red Cross Hospital (Community Hospital) closed after 77 years of
existence. The demise is recorded in a story in The Courier-Journal.
The building lay vacant and was slowly vandalized of its copper pipes
and was the refuge of vagrant street people in times of inclement
weather. On June 11, 1980, the Volunteers of America converted the
Community Hospital to a flourishing rehabilitation center.
Throughout the 77-year period, Red Cross Hospital was Louisville’s
African Americans’ most prized public institution. The support came
from countless church contributions, baking contests, picnics and
other small social events that raised funds for the hospital. The
eventual integration of Louisville’s African American physicians into
the Jefferson County Medical Society, along with the desegregation
of local hospitals, brought about the demise of Red Cross Hospital.
A few comments are in order concerning the death of the hospital.
Reading the extant records in the Ekstrom Collection is a sorrowful
task.
I found a handwritten letter from Henry R. Heyburn, the hospital
attorney, in which he addresses the financial crisis. Heyburn alludes
to the fact that if it doesn’t “show improvement,” it will have to close
its doors: “You need to pep up psychologically.” Hospital costs needed
to be reduced. He asks, “What is the moral, financial and other value
of Red Cross Hospital in the Louisville Negro community?” He wants
to know if such exists and “Can we tap into this? If the answer is ‘yes,’
we should organize a broad-based community action committee.
The white members of the board cannot make this judgment.” This
is one of the most trenchant letters I have ever read by a man capable
of expressing his thoughts on paper. The letter was penned at home
while he recovered from an illness.
In the archives is the scrapbook compiled by Houston Baker,
principal of Central High School. Baker headed several fundraising
drives in the 1940s and early 1950s. His wife apparently saved the
clippings but cut the dates off most of the articles. The microfilm
holds the mother lode of information about Red Cross Hospital
during this period of attempted revival and a series of photographs
of doctors, nurses, board members and hospital scenes. It begins
with an article about an effort to find $50,000 from February 12 to
March 5, 1945. It lists companies and individuals from which they
were attempting to get help. There also are similar articles in the
Louisville Defender. This drive reached its quota.
There are photographs in the Defender of Drs. J.B. Bell and John
Walls, the hospital and the women’s committee to raise money. The
September 2013
13
final amount was $53,029.62 (goal: $50,000). The tape also includes
a 1945 article honoring three female trustees of Red Cross Hospital:
Mrs. Scott, Mrs. Whedbee and Mrs. Matthews – all widows of
founding physicians. The article was written by Hortense Young,
the wife of Dr. C. Milton Young Jr., and mother of Dr. C. Milton
Young III, who recently retired from practice.
white communities. He worked with his wife, Murray (a teacher at
Central High School), on many civil rights causes.
Dr. Maurice F. Rabb
Dr. Maurice F. Rabb (Fig.
2), anesthesiologist at Red
Cross Hospital, was born in
Columbus, Mississippi, and
was “stimulated” by Dr. T.B.
James, the family physician.
He encouraged this young
man to go into the medical
profession.
Another series of articles (unfortunately, all undated) is from
1951, when Red Cross Hospital was attempting to raise $300,000
to update the building and the interior. This was accomplished and
the new building was started in 1950 and completed in 1951. Many
prominent Louisville citizens and doctors contributed.
The last gasp of the hospital occurred in 1975. A lone folder
in the archives at the University of Louisville contains a list of
corporations from which Community Hospital requested financial
support. These 22 corporations included the Ford Motor Company,
the Kentucky Colonels, Gov. Julian Carroll’s office, the Department
of Human Resources, the Bureau of Social Security, the Louisville
Urban League, the General Electric employee community fund,
the J. Graham Brown Foundation, the B.F. Goodrich employees’
charity fund, Brown-Forman, Brown & Williamson, Celanese,
DuPont, Durkee, International Harvester, National Distillers, P.
Lorillard, Schenley Distributors, LG&E, Frito-Lay, L&N Railroad,
the Louisville Water Company and South Central Bell. I found no
replies – and soon after, bankruptcy proceedings were initiated and
finalized in 1976.
Appendix VI
Brief Biographies of a Few Physicians
Who Played Prominent Roles in the Red
Cross Hospital
Dr. John Walls
Dr. Rabb attended Union
Academy in Columbus, but
had to walk across town to
get there, even though his
family lived next door to a
white junior high school. Union Academy had only 10 years of
class work and, in 1919, his father sent him to Tuskegee to finish
his high school studies at Fisk University. He graduated six years
later from Fisk with a high school and a college diploma. From Fisk,
Dr. Rabb was admitted to Meharry Medical College in Nashville,
Tennessee, graduating with an MD in 1929. This was followed by an
internship at Kansas City General Hospital – an all-black hospital.
After finishing his internship, he moved to Shelbyville, Kentucky,
and practiced there from 1930 to 1946.
In 1946, he moved to Louisville and practiced with Dr. C. Milton
Young Jr. Through the help of Charles Tachau, Dr. Rabb obtained
a residency in anesthesia at Louisville General Hospital. He was
the first African American to have such a position. Other staff
appointments included St. Joseph Infirmary, Jewish Hospital and
the Veterans Administration Hospital.
Through the years, Dr. Rabb was very active in the NAACP and was
on the National Board for a number of years. Joseph Alexander, the
first African American medical student at the University of Louisville
School of Medicine, was recruited by Dr. Rabb.
In 1954, his son, Maurice Rabb Jr., and the author of this paper
entered as freshmen at the University of Louisville School of
Medicine.
In the following decades, Dr. Rabb was active in the housing
desegregation movement.
Dr. Jesse B. Bell
Dr. John Walls (Fig. 1) improved health conditions and aided the
civil rights movement more than any physician in the 20th century.
A graduate of Meharry Medical College, he arrived in Louisville in
1918 and started a “well baby clinic” for indigents and recruited his
fellow physicians to help out on a rotating basis. Dr. Walls was not
flamboyant, but very effective in both the African American and
14
LOUISVILLE MEDICINE
Dr. Jesse B. Bell (Fig. 3) was born on April 20, 1904, in Tallulah,
Louisiana, a very small agrarian town noted for its sawmill activities.
He attended school in Tallulah until the seventh grade. The school
year was three months for black students (December, January and
February). In 1918, his parents sent him to Alcorn College, which
had a preparatory school. He finished high school in 1924 and,
from Alcorn, transferred to Morehouse College in Atlanta, Georgia.
After three years, he entered Meharry Medical College in Nashville,
Tennessee, graduating in 1931. After one year of rotating internships
and successful passage of
the state medical board
examination, he began
his practice in Frankfort,
Kentucky, in June 1932.
The Bells later moved to
Louisville, and he worked
for the Health Department
in Louisville for 11 years as a
full-time resident at Waverly
Hills Sanitarium. Dr. Bell
entered private practice in
1946 and continued until his
retirement in 1977. In 1941,
Dr. Hugh Leavell was Dr. Bell’s superior at the Health Department.
There were few facilities for the practice of medicine for black
physicians, and he chose Dr. Bell to help enhance the Red Cross
Hospital, already 40 years old. This effort was very successful. With
the aid of Dr. Leavell and other prominent figures in Louisville,
money was raised to bring the Red Cross Hospital up to state and
national credentialing standards. Dr. Bell was influential in obtaining
Waverly B. Johnson as administrator of Red Cross Hospital and,
under Johnson, the hospital flourished.
Dr. Bell was active in community and medical affairs. He died
at age 96. His papers can be found at the Filson Historical Society
in Louisville.
The following is a list of some of his major activities:
• Louisville Lung Association
• Louisville Memorial Hospital Board of Governors
• Kentucky Commission of Higher Education
• Health Board in Louisville
• Kentucky Health Service Advisory Council
• Kentucky Heart Association
• Mammoth Life and Accident Insurance Company (Louisville)
Dr. C. Milton Young Jr. and Dr. C.
Milton Young III
Dr. C. Milton Young Jr. was one of Louisville’s medical pioneers.
He interned at Homer G. Phillips Hospital in St. Louis, Missouri,
before settling in Louisville to establish his general medical practice
in 1928. In 1936, he was appointed physician to the Louisville
Municipal College, the African American branch of the University
of Louisville, and later became director of Central Louisville Health
Center. He subsequently spent a year at the University of Minnesota
and graduated with a master’s degree in public health. He was an
assistant health director of the city of Louisville in the late 1930s and
early 1940s. He was active in the American Medical Association,
Jefferson County Medical Society and Falls City Medical Society,
which he served as president. He was chief of the Red Cross Hospital
and was on active staff at Jewish Hospital at the end of his career.
He retired from active practice in 1978.
recent retirement.
Dr. John A.C. Lattimore
Dr. John A.C. Lattimore was influential in the establishment of the
Red Cross Hospital at the end of the 19th and early 20th centuries.
He was born in Laundale, North Carolina, and was a buggy boy for
Dr. Bullock of Greensboro, North Carolina. Dr. Bullock recognized
his intelligence and suggested he study medicine. He entered Bennett
College in Greensboro, graduating in 1897, and enrolled in Meharry
Medical College in Nashville, Tennessee.
He arrived in Louisville to begin his practice and was always
willing to lend a helping hand to any enterprise that meant progress
for his race. Dr. Lattimore aided every movement aimed at advancing
African American culture and was an active member of many
civic and fraternal organizations, including the National Medical
Association, the National Negro Business League, Louisville NAACP
and Urban League, and he was a devout member of the AME
Church. Dr. Lattimore developed a lucrative private practice, but
always took care of the poor.
Drs. J.M. Hammonds, A.C. McIntyre
and W.H. Pickett
Drs. J.M. Hammonds, A.C. McIntyre and W.H. Pickett were early
African American physicians in Kentucky who worked with Dr.
Henry Fitzbutler in establishing Louisville National Medical College.
Their exact roles are unknown, other than helping with the education
of the medical students. Biographical data is not available concerning
these men.
References
For additional readings, a list of pertinent monographs pertinent
to this series:
The Fascinating Story of Black Kentuckians: The Heritage and
Traditions. Researched, compiled and edited by Allison Dunnigan.
Associated Publishers Inc., a division of the Association for the Study
of African-American Life and History Inc. Washington, D.C., 1982.
Marian B. Lucas and George C. Wright: A History of Blacks in
Kentucky.
Lawrence H. Williams: Black Higher Education in Kentucky,
1879-1930.
History of Blacks in Kentucky, Volume 1: From Slavery to
Segregation, 1760-1891, Marian B. Lucas. Volume II: In Pursuit
of Equality, 1890-1980, George C. Wright. Kentucky Historical
Society 1992.
James Summerville, “Educating Black Doctors: A History of
Meharry Medical College,” University, Alabama: University of
Alabama Press, 1983. LM
Note: Dr. Weiss practices Cardiovascular Diseases with Medical Center
Cardiologists. He is a member of the Innominate Society, Louisville’s
medical history society.
His son, Dr. C. Milton Young III, was a successful physician in
Rheumatology and Arthritis who practiced in Louisville until his
September 2013
15
My Mentor
Ben Rogers
O
ne could
almost say
I hated her
for a time, the woman who proved to be
my greatest medical
mentor. She did the
unthinkable in the
eyes of a younger me,
perhaps overstepping a few boundaries in
the process, and, in the end, taught me as
valuable a lesson about health care as anyone has since.
case volume and had hired a few more aides.
I spent more time hanging out in operating
rooms than putting away stock. I lingered
a little longer at dinner, chatting with the
techs and nurses instead of leaving early to
help clean the room they were coming out
of just as I was finishing my meal. To put
it honestly, I became more concerned with
what my job could offer me than with what
I could offer the hospital.
At the beginning of my sophomore year
of college, I transferred from the pharmacy
of my local hospital up to the Surgery Department. I had known I wanted to be a
physician from a young age, and being a
surgical aide provided the perfect opportunity to explore a potential future career
while earning a little spending money in
the process. My job description was simple:
clean beds, get sheets and equipment ready
for the procedures, transport a few patients
when needed and generally be a help to the
department. It was about as good as it gets
for an aspiring surgeon.
Often the hardest things to hear from
another’s mouth are those things that you
already know but don’t want to admit. It isn’t
necessary to relay the exact conversation I
had with Linda, another aide, that fall afternoon of my junior year. It was short if not
sweet and can be summed up simply: she
told me, in no uncertain terms, that I wasn’t
doing my job as well as I could and that I
needed to fix it. I responded like many hurt
young men might; I stopped talking to her.
It was summer when I started, and I was
eager to impress. I worked happily, never
complaining about having to do “grunt”
work; truthfully, I enjoyed it most of the
time. The long days, nice weather and absence of responsibilities made it easy to
enjoy working hard and staying late. There
were only four of us at the time as well,
which made putting suction canisters together and pushing laparoscopic equipment
through the halls feel important, as if the
work wouldn’t get done if I weren’t there
to see to it.
A year passed, taking my zeal with it; it
left stress at school in its place. As time had
gone on, I began to see my work as meaningless. The department was increasing its
16
LOUISVILLE MEDICINE
I’m sure everyone noticed, though no one
ever said anything to me about it. Almost
no one said anything.
Luckily, my foolhardiness led me to decide that I would work harder than her for a
while to prove to myself that she was wrong.
But Linda was everywhere. She somehow
put away the department’s stock, supplied
the female locker rooms, kept every supply
room immaculate and cleaned every room
I ever did. Still, we never spoke. For months
we worked in silence, side by side, for hours
at a time. When she left each night and the
work was done, I allowed myself to observe
surgeries. I’m not sure how long it took,
but at some point I looked around and saw
Linda in everything. Suction never ran out.
There were always plenty of the warm blankets that the patients loved so much. Nurses
could count on equipment and supplies to
be in the exact spot they always were. Clean
sheets and scrubs and pillow covers were
always available.
Linda did more than force me to realize how much I was capable of doing or
how to go about handling difficult issues in
the future. She was a constant demonstration of what a great caregiver was. Patient
care became more for me than the things
I dreamed of doing one day – removing
diseased organs or bypassing arteries – it
became putting a warm blanket on a cold
body or smiling at a scared patient and reassuring them as I wheeled them into an
operating room. Patient care meant that I
put equipment outside a room before the
nurse knew she needed it so that the patient could spend five minutes less under
anesthesia. Treatment could be something
the patient never even knew had happened;
it became something in the here and now,
simpler, tangible, easy.
I’m not ashamed to say that I needed
those lessons often during my first three
years of medical school. Remembering
that late nights studying, even if no one
was around to see, might someday make a
difference in the lives of others was a great
motivator. In truth, throughout medical
school it is hard to feel like you are contributing to patient care as much as you wish
you could. So remembering that caring for
a patient meant never wishing I could do
more advanced things but rather doing the
best at what things were available to me
became the paradigm that helped me most.
I can’t remember when or how, but Linda
and I began talking to each other again. By
the time I graduated, she became my friend
as much as my mentor. She started her 35th
year at the hospital this year with little sign
of slowing, but if she ever does retire she
will be very heavily recruited. LM
Note: Ben Rogers is a fourth-year medical
student at the University of Louisville.
STROKE
Norton Neuroscience
Institute Stroke
Symposium
An update for all health care providers
S
troke is the fourth leading cause of death in the
United States, and Kentuckians’ stroke mortality rates
are higher than the national average.
The science of stroke and management of stroke
patients are rapidly evolving fields. It is imperative for
health care professionals caring for stroke patients to be
aware of the most effective and current therapies. Don’t
miss this opportunity to hear about the latest trends and
topics in stroke care.
Stroke Update: The Full Spectrum of
Care for Health Care Providers
Friday, Sept. 27, 2013
7 a.m. to 5 p.m.
Muhammad Ali Center
144 N. Sixth St. • Louisville, Ky.
Continuing education credits available. To register,
call (502) 629-1234 and mention promo code
“GLMS Stroke.”
September 2013
17
Rounds
David A. Casey, MD
I
put my key into the
lock of the back door
of the rec room. This
way is double locked. I
walk through the empty
room, unused on this
early Sunday morning
and open the back door
to the unit itself. I cannot come this way without being reminded of
hundreds of previous passages into this space.
Mostly pleasant thoughts, but not all. There is
a certain somberness to this place. People come
here, typically, because they have no alternatives.
Most improve, but many struggle on with anguished lives, only to return in time. The need
to keep the doors locked is second nature, but
there was a time when this troubled me much
more than it does now. It is simply an unhappy
necessity.
Things have changed since I first walked onto
this unit – we called it a ward then – more than
30 years ago. Nowadays patients usually come
and go in days instead of weeks or sometimes
months, as in the past. The patients, on average,
are more ill, changing the climate of interaction
among patients and staff. The nurses call this
“acuity.” Concepts of care, medications, documentation, patient types, all have evolved far
from my first experiences. Prescription drug
abuse, overlapping with chronic pain, depression, and social chaos seems to be the epidemic
of today. But the essence of my task today has
not changed at all. I am here for rounds. I have
20 or so patients to see on the psychiatric unit
and an as-yet-unknown number of consultations on the medical floors. I no longer work
on this unit during the regular workweek. My
colleagues and I have responsibility for covering
weekends and holidays, share and share alike. I
will take report from the charge nurse, discuss
cases with the resident, write in charts, review
labs, make phone calls, give orders. I will be
here most of the day. I don’t mind the work
and, in fact, frequently find it quite fascinating.
However, I increasingly dislike devoting what
would otherwise be a free weekend day to the
task. Of course, the biggest change is in myself.
I’m older, more experienced, but perhaps a bit
fatigued. I’m also a lot more philosophical about
my work. I no longer believe there is an answer to
every question or a treatment for every problem.
I’m more inclined to offer care and less sanguine
about the likelihood of cure. I think more and
more in terms of people rather than diseases. The
patients I am here to see all carry diagnoses that
denote them as belonging to some distinct and
separate category of illness. Diagnosis is about
grouping people into these categories. They are
18
LOUISVILLE MEDICINE
bipolars, or depressives, or borderlines, not to
mention heart patients or diabetics (which an
amazing number in fact are). Now I am more
interested in what makes each person distinct
and individual. Two schizophrenics may have
some similar symptoms yet be as different from
one another as any other people. I am constantly
reminded of how little I know about these patients as individual people, despite my long experience with their disorders.
I am a geriatric psychiatrist, a somewhat rare
breed of doctor. I love working with older people,
the more so as the gap between my age and theirs
is rapidly closing. My comfort level is a bit less on
weekend rounds, as there are patients of many
ages all grouped together in a limited space. This
seems a poor way to manage them. Although
they are all psychiatric patients, their needs are
quite divergent. I led several quite successful
geropsychiatric programs for many years, but
the finances of health care make such units difficult to sustain and the programs were closed.
Ironically, these geropsych patients haven’t gone
anywhere and neither have the costs of caring for
them. They are still hospitalized, but their costs
are obscured by spreading them among various
medical and adult psych units where the deficits
are diluted. In the meantime, the quality of their
care is diluted as well. Occasionally I feel the
need to rail against this. This has done me no
good, and now I am more likely to accept and
live with the world as it actually is. These changes
and others have left me working primarily with
outpatients, other than the occasional vacation
coverage and weekend rounds on the general
adult unit – such as today.
I walk through the unit and note certain patients I have seen before. Some of them represent
recognizable types. Paranoid patients huddle in
the corner, manics come up in my face. However,
every weekend there are a few patients who are
going to be especially difficult. There are certain
repetitive themes: Do we need a medical consultation? Can we get one on the weekend? How do
we deal with a patient’s demand for hydrocodone
or alprazolam? Today there is a particularly vexing question, a twist on a problem I have dealt
with before. An elderly man has been admitted
with early dementia, depression and agitation.
He probably has had psychotic symptoms as
well. His physical health is precarious, so much
so that some of the nurses want him moved to
a medical unit. His wife has been suffering for
years with Alzheimer’s disease, for which he
was the caregiver. Now we are informed that
his wife has died. In their religious tradition, the
funeral is to be held at once. His son has called
the unit asking for his father to have a pass from
the hospital for this purpose. He wants me to
be the one to inform his father of his wife’s death. The charge nurse
tells me that the patient is calm at this moment but received a “prn”
of medication for agitation through the night and slept only a few
hours. I interview the patient and, with trepidation, tell him the sad
news. He calmly tells me he has been thinking of killing his wife and
himself. He seems relieved. Later I get a call from his daughter. She
vehemently disagrees with her brother and does not think her father
can handle the funeral, and the family cannot handle him. I get the
impression that this is a new chapter in a very long book of family
conflict. I vacillate until the final possible moment. I call the son and
tell him I don’t think a pass is a good idea. I expect that he will be
angry or even threaten legal action. He doesn’t. He is not happy but
accepts the decision.
Note: Dr. Casey is associate professor and vice chair of the Department of Psychiatry and Behavioral Sciences at the University of
Louisville School of Medicine. He is also senior vice chair and head
of clinical services. He practices Geriatric Psychiatry with UofL
Physicians-Psychiatry.
BAPTIST HEALTH
WELCOMES
© 2013 Baptist Health
There is so much about medicine I did not learn about in medical school and so much that turned out to be wrong or incomplete.
My training was thorough but certainly did not confer upon me the
wisdom to make such decisions. Nevertheless, they must be made
each day, and it is the doctor’s duty to do so. These are the problems
that occupy my mind, especially when I drop in just for a day or two,
as on weekend rounds. These are the challenges of medical practice,
the decisions about people’s lives that are within the scope of our
work but have no scientific solutions. These are value judgments.
But whose values? Mine? The patient’s? Their family’s? I take a deep
breath and go on to the next room. LM
JONATHAN HODES,
MD, MS, FACS.
CENTER FOR ADVANCED NEUROSURGERY
Dr. Hodes uses holistic approaches and minimally invasive
techniques to treat brain and spine diseases. He was
The physicians of Kentuckiana Ear, Nose & Throat, PSC
are pleased to announce and welcome a new associate.
Sean M. Miller, M.D.
Burton Cohen, M.D.
Bruce Scott, M.D.
Sammy Sohi, M.D.
Kenneth Silk, M.D.
Mark Severtson, M.D.
Thomas Higgins, Jr., M.D.
Dr. Miller is a Louisville native returning home to practice medicine. He
attended Saint Xavier High School, and completed his medical education at the
University of Louisville and subsequently pursued his residency training in
Otolaryngology-Head and Neck Surgery through the Saint Louis University School
of Medicine.
Dr. Miller’s practice interests include the entire spectrum of ear, nose and throat
disorders in both pediatric and adult patients.
He is married to Dr. Natalie Beaven Miller, an allergist/immunologist. They
are delighted to be returning to their home state with their first child, a daughter
named Cecilia.
the first U.S. neurosurgeon to complete a formal neurointerventional radiology fellowship and has additional
training in radiosurgery, minimally-invasive spine surgery,
and endoscopic brain surgery. To refer a patient to Dr.
Hodes, call (502) 896-1313.
Baptist Health Center for Advanced Neurosurgery
3900 Kresge Way, Suite 41
Louisville, KY 40207
(502) 896-1313
BaptistMedicalAssociates.com
Dr. Miller will be practicing at the following locations:
Springs Medical Center
6420 Dutchmans Pkwy, #380
Jewish Outpatient Care Center
225 Abraham Flexner Way, #401
Springhill Commons
1405 Spring Street
Jeffersonville, IN 47130
502-894-8441
New Referrals Accepted at all Locations
September 2013
19
White Coat Ceremony
On July 28, 2013, the University of Louisville welcomed the Class of 2017 medical students. As an annual
contribution to each new generation of emerging physicians, the Greater Louisville Medical Society purchases the
students’ first white coats and provides them with a free 5x7 professional portrait. GLMS President James Patrick
Murphy, MD, MMM, congratulated the students at this year’s event and in honor of the occasion wrote a moving
poem entitled “A White Coat.” The poem along with the accompanying speeches from Dr. Murphy, Dean Toni M.
Ganzel, MD, and second-year student Lee Richardson are hereby presented. Thank you to all members for your
ongoing support of our bright and enthusiastic medical students.
Congratulations
“I
’m looking for someone to share in an adventure.”
Fans of the author J.R.R. Tolkien will recognize this as the
challenge Gandalf the wizard made to the hobbit, Bilbo Baggins.
This is, among other things, an adventure.
I am honored to be here on behalf of your medical society - The Greater
Louisville Medical Society - to congratulate you on this milestone. At close
to 4,000 members, we are one of the largest local medical societies in the
country. Our mission is to: promote medicine as art and science, advocate
for the wellness of our community, and protect the patient-physician
relationship.
Today is a big day for you and for us. Today is a milestone along the road
that will lead to your joining our ranks. Today you are not only putting
on your white coats, but you are also becoming members of the Greater
Louisville Medical Society. To help you stay connected you will have access
20
LOUISVILLE MEDICINE
James Patrick Murphy, MD, MMM
to our mobile app, where you can get alerts, educational materials, and access
information about your new GLMS colleagues. As sponsors of the White
Coat Ceremony, your medical society colleagues are honored to provide:
your first white coat, your medical society pin, membership in the Greater
Louisville Medical Society and professional photographic portrait of you
in your new white coat. We are your colleagues, here to support you, and
we welcome you.
The Greater Louisville Medical Society has strong ties to the University
of Louisville. Most of our members either graduated from the university
or did post-graduate training there. I am proud to call myself a graduate
of the University of Louisville Medical School Class of 1985.
Back when I was in your shoes, we did not have a white coat ceremony.
Back then they wouldn’t let us wear a white coat until third year, much less
actually touch a living patient. I wish we could have had a ceremony like
this. That is why I invited my own family to come today. This is a special day
for you and for your family and friends who have supported you. To these
special people in your life, I also offer my congratulations and my gratitude.
Gratitude, yes, because you have chosen a path that is not easy and does
not compensate you materially for the years spent, the sacrifices, the risks
- financial, physical, emotional. But it is indeed an adventure.
of the hospital cafeterias. In my third year of medical school Dean Ganzel
was my attending on rotation through Otolaryngology. On the last day
she, so graciously, took her four medical students to lunch. We ate lunch
at the Kentucky Center for the Arts in our white coats. The coat meant
something. It said something to the world.
As I look out upon you I see a discovery. I see a cure. I see lives saved
from disaster. I see longer, better, meaningful lives. I see a suicide prevented.
I see a critically ill baby saved. I see an aneurysm removed. I see a heart
murmur discovered. I see a cancer detected because you followed up on
the red blood cells you saw in the urinalysis report.
I have worn many white coats since them - short, long, in between - but
whenever I put on the coat it still has meaning. It speaks. So I wondered
what the message would be if instead of me, my white coat could say a few
words. Well, my white coat and I discussed it and now, on behalf of my
white coat, I offer this: (See poem below)
I also see heartache, depression, fractured lives, and failures. It is all part
of the path you have chosen to follow. You may not know all the reasons
why you are sitting here today. I don’t think I knew. But every day, from
this day forward you will be finding answers.
Dean Ganzel, colleagues, friends and families, Mom, I thank you for this
day. And to the Class of 2017, I congratulate you and welcome you. For
those who hear this calling there is no greater professional honor than to
wear that white coat and hear the words, “That’s my doctor.”
The white coat itself is significant. I remember the day I finally got mine.
We walked around the medical complex and even went to eat lunch in one
Looking out at you, it is clear that I have found someone to share in an
adventure. LM
a white coat
by James Patrick Murphy, MD, MMM
a white coat
a white coat
a white coat
a white coat
I symbolize
in my presence
answer alarm
ability
the goals you hope
comfort, care and
with answers that
tailored with
to realize
convalescence
first do no harm
humility
a white coat
a white coat
a white coat
a white coat
my color’s pure
wear this fashion
hear the calling
a solemn oath
to show your values
only if
wear me when
a way of life
will endure
you share my passion
you lift the falling
or maybe both
a white coat
a white coat
a white coat
a white coat
I will glisten
for my profession
my fabric must
I’m going to
if you can try
put patients first
be nothing but
forever be
to mostly listen
make no concession
a weave of trust
a part of you
James Patrick Murphy, MD, MMM (left) and Toni M. Ganzel, MD, MBA (right) speaking at the White Coat Ceremony
September 2013
21
Dean’s RemarksToni M. Ganzel, MD, MBA
W
hat a great day! I join my colleagues on the platform in welcoming the Class of 2017 to the School of Medicine and the
University of Louisville, our teaching hospitals, our physician
community and our beloved profession of medicine.
Congratulations on all your accomplishments and success, but as you
well know, you haven’t done it alone – your parents, spouses, significant
others have been a big part of those accomplishments and that success.
Today’s White Coat celebration is for them as well. And parents, while we
expect our students to be humble and not boastful – please be clear that
does NOT apply to you! You may brag about your son or daughter whenever you want, wherever you want and to whomever you want – friends,
acquaintances, co-workers at the water cooler, total strangers in the line at
Kroger’s. I never understood that as a student, but now that I’m a parent,
I totally get it. Go for it, I’m with you.
Class of 2017, we are so glad you have chosen to be part of our School
of Medicine family. We chose you very carefully because we believe that
each and every one of you will make a great doctor.
Why? First, you have the right intellect – we’ve scrutinized your transcripts and your grade points and MCAT, so we’ve determined you’re
highly competent.
Second, you have the right motivation. We’ve looked at your personal
statement, your shadowing experiences, questioned you during the interview
and we’ve determined that you’re deeply committed.
Competence and commitment are important and predict success in
medical school but they are not enough to make you a great doctor. In
order to be a great doctor, it’s that third key question the admissions committee wants answered, “Are you compassionate?” Because medicine is
about the patient and patients don’t care how much you know until they
know how much you care.
Why does that matter? Because there’s power in compassion for your
patient’s well being and for your own well being. The importance of compassion in patient care may just seem obvious, but it’s also supported by
data and as a research university, we love data. As context, there is a curious phenomenon in clinical research called the placebo effect. For those
of you who are not familiar with this, a placebo is basically a sugar pill or
an inert substance that doesn’t do anything, so it can be used to test the
effectiveness of a real drug.
A fascinating study just published from Harvard Medical School illustrates this. A group of patients with symptomatic irritable bowel disease were
randomized to receive a placebo or a placebo plus intentional compassion:
time talking about their family, their concerns, warmth, a touch. All were
asked to return in 3 weeks. The placebo plus compassion group reported
significantly greater improvement in overall symptoms and quality of life
than the placebo alone. The placebo was the same in both groups, and it
was fake. The compassion was real and it was powerful. The results of this
study suggest that maybe we can make patients feel better just through our
compassion - not cure their appendicitis, or rid them of their brain tumor,
but make them feel better overall.
We chose you because you somehow conveyed you are compassionate
individuals. We want to take you from being compassionate individuals
to compassionate physicians. So we’ll talk about it, teach it, assess it, and
recognize and reward it because our challenge, and yours, is to nurture
that compassion so you don’t lose it when you’re tired or frustrated or the
patient is particularly difficult.
22
LOUISVILLE MEDICINE
Now, compassion is not only good for your patients, it’s also good for you.
Numerous studies have shown that physicians who have a self-awareness
of compassion and intentionally practice compassionate care have greater
job satisfaction, are less likely to experience depression or anxiety and
less likely to burn out. Compassion is also important to us as a school. We
want to be a compassionate school, not only for our patients but also for
our students and our faculty and staff. I call this everyday compassion and
I see a steady stream of everyday compassion towards our students and I
hope that’s reassuring to you students and to your parents that you will be
cared about and supported, because medical school is not an easy journey.
We also see everyday examples of compassion demonstrated by our
students. They show their compassion through their community service,
their free clinics, their international medical mission trips and they show
everyday compassion towards one another in their peer advocacy and
support groups.
I even had the privilege of personally experiencing that student everyday compassion a few years ago. We’d just had a devastating house fire; we
got out safely, our dogs got out safely and for that we felt very blessed but
almost nothing was salvageable. And let me tell you, for an avid shopper
like myself, losing all my clothes, my shoes and my purses was problematic!
Everyone was so kind in reaching out, but the students were exceptionally
sweet - they texted and called, and sent notes. And they took up a collection
and got me a very generous gift card! I was so touched but at the same time
embarrassed. For heaven’s sake, these were students – they didn’t have jobs,
they didn’t have money…but they took up a collection…for me. I felt like
I should return because they needed it more than I did. But then, I didn’t
want to seem rude or ungrateful…so instead I used it to buy two really
cute pairs of shoes and a coordinating purse. Hey, a girl’s gotta do what a
girl’s gotta do. I did confess to them in my thank you note that I didn’t use
the gift card for anything practical but several of them said, “Oh don’t be
sorry, you used it just the way we hoped you would.”
Do you know who else values compassion? Our city. Our mayor, Greg
Fischer has outlined three things that our community needs to grow and
thrive: become a city of life-long learners; become a healthier city and
become an even more compassionate city. In November 2011 the Metro
Council approved the Charter of Compassion and we became the second
largest city to join the compassionate city movement. This involves galvanizing groups across all faiths and organizations around compassion to make
a greater difference in our community. In 2012 Louisville was selected to
receive the International Compassionate City Award (beating out Seattle).
As an example, tens of thousands of Louisville volunteers came together
for community service in the Give-a-day week this spring. It’s great to be
part of a city that is committed to compassion and we are now in discussions with the mayor’s office to explore ways we can partner together in
this initiative to have an even more powerful impact.
I want to close by bringing us back to the patient and tell you one of my
favorite stories about compassion shown by one of our graduates, who was
a second year resident at the time. One of my faculty colleagues in Internal
Medicine shared this with me. The internal medicine team was rounding on
an unfortunate patient with advanced cancer who had complex treatment
and a complicated hospital course, no financial means. And at one point,
she said to the team “I’m just a burden.” The resident looked at her, paused
and said from the heart, “You’re not a burden. This is what we do.” That
was compassion – and it’s what we do – as physicians, as a school, as a city.
There’s such power in compassion for the well being of all. Treasure it,
nurture it and hold on to it and never let it go. LM
Student RemarksLee Richardson
S
o First-Years, imagine this situation in the not too distant future:
you’re standing in the OR after sleeping overnight in Kosair
Children’s Hospital. It’s early, and you’re exhausted from a busy night.
Nevertheless, you’re elated you got to scrub in on your first ever surgery,
which happens to be an open-heart repair. The team has been at work for
just over an hour, and the surgeon barely notices your presence until one
of the nurses asks you to… cough cough scoot out of the way from the
table and to not to disturb anything in the sterile environment. Taking a
moment away from the operation, the surgeon looks up and says “Ohhh a
medical student. What year are you?” Thrilled that your presence is finally
acknowledged, you puff out your chest and reply -- probably a little too
excited -- “I’m about to finish my First-Year!” The surgeon, nodding his
head, continues with the delicate operation. But don’t fret, because after
a few moments, he looks back up, prepared to do some teaching. Excited
to learn about the different approaches that are utilized for this operation,
or maybe even the statistical outcome analysis of patients undergoing
this surgery, you tune in attentively, eager to absorb all the knowledge the
attending has to offer. Clearing his throat, the surgeon begins to talk: “OK,
a First-Year. So you know the heart is a very important organ.” You lean
forward, nodding your head in affirmation of the importance of the heart.
The doctor pauses, possibly for suspense you believe, before he continues:
“It is an organ absolutely essential to human life. Also, it’s hollow, and is
divided into four distinct chambers...”
That person I just told you about happened to be a new medical student
last year. A First-Year. Just like you. And I tell you this story, partly because
it’s funny, but it also provides a window into the new life you’re about to start:
the life of a newly minted, white-coat donning first-year medical student.
There were so many things that I loved about last year, but one part that
really stood out were the early and abundant opportunities to spend time
in the hospitals and clinics under the guidance of attending physicians,
residents, and even a few upper level medical students. During second
semester, you’ll have the chance (or maybe more aptly put, you’ll be
incentivized via curricular requirements) to spend a few hours shadowing
and observing clinicians in a specialty of your choice, be it neonatology,
plastic surgery, or family medicine. Maybe you’ll get an OR lecture on
the ever majestic and vital 4 chambered heart, or you’ll help a First-Year
resident clear cyst after cyst after cyst in the ER.
But trust me, you’ll learn wayyy more than you expect. You guys begin
dissecting in a week. A WEEK! Before you know it, you’ll be exposed to all
sorts of new terms and concepts, but even with this plethora of information
no one person can be expected to know everything, and that’s where
having dependable classmates comes in. Even though our lecturers and
the attendings provide us with expert knowledge, the most helpful ways to
compartmentalize vital info, I really think, come thanks to the work ethic
of my class. From sharing amazing study guides, or powerpoint reviews,
textbooks online and so on, it’s really unbelievable to look back upon how
many resources we’ve shared with each other over the past year. Facebook
has proven to be a vital tool, both for study guides and panda sneeze videos,
and your listserv email will inevitably provide you with helpful internet
links and unintentional reply-all’s to embarrassing emails. Technology
really does bring us closer, so I encourage you over the next year to use
the connections you have as a class to help each other out.
Now, the thing is, you can’t always get away with telling attendings “Oh,
I’m just a First-Year,” because yes eventually you’ll move on to the next year.
One of the best ways to learn is to ask questions… encourage the new FirstYears not to be afraid to ask questions; be it during gross lab, a lunchtime
lecture, or even to physicians about shadowing. I would plan on sharing
stories about suturing in the ER after I asked one of the doctors to teach
me. Since then I’ve done a number of lac repairs myself under resident
supervision, something I wouldn’t have been able to do if I hadn’t asked
the attending to teach me how to do it. This past summer I rotated through
a hospital in Ecuador, a first-time trip planned with two other students in
my class, that we got to go on simply because we said we were interested
in going there. We’ve got an amazing supporting group of clinicians and
administrators, and I’ve been stunned at how many cool things I’ve been
able to do as a medical student that I couldn’t do as an undergrad. A lot
of good opportunities came from not being afraid to put myself out there
and simply ask somebody to let me to do things.
Soon you all will be taking your first steps to becoming someone’s doctor
and be sure to remember and thank those who helped you get where you
are. Even though I’ve joked about belittling First-Year students, know that
you have an unprecedented amount of respect now that you are a First-Year
medical student. Trust me, more than one of you will be asked to check the
burr on someone’s foot right before Thanksgiving dinner thanks to your
newfound knowledge as a medical student. But that’s exciting! I know
without the help of some of my undergrad mentors and family support, I
wouldn’t be in Med School. New mentors are going to arise in school too,
so I would just advise the new class to be grateful for the culture of teaching
that exists here, that permeates the entire campus from the PhD lecturers
to your MD attendings. In addition, we have to be cognizant that our
ultimate teachers are the patients (or especially in the case of First-Years,
the individuals that donated their bodies for Gross Lab dissections) that
have allowed us to learn from them in order to care for future patients.
And I think if you’re grateful for these, because you’ve got a challenging,
lengthy, but beautiful journey ahead of you. Best of Luck Class of 2017,
and don’t get too concerned.
Finally, I’d like to finish by always be grateful for the opportunity you’ve
been given to go into medicine. LM
So really if you don’t learn anything else by the end of this year, hopefully
you’ve taken advantage of my insider info that the heart has 4 chambers...
September 2013
23
A Day in the life of
a doctor
Kevin Kwan
E
ver since I was a little kid, I have
been fascinated with the field of human health and medicine. My family
didn’t have cable television, so after school I
always ended up watching rerun TV shows
like Grey’s Anatomy, Bones, and Scrubs.
Even though these shows were not for little
children, they seemed to always catch my
interest. Unlike most kids growing up I did
not mind going to see the pediatrician and
I enjoyed watching and asking questions
about what they do.
me how to take a patient’s blood pressure,
check the pulse, and test the reflexes. Out
of all the activities that I had the chance
to do, my favorite was testing a patient’s
reflexes because I was finally able to answer
a childhood question as to why the doctors
always thumped my knee. The answer was
to determine if there was something wrong
with your nerves or if you had a back or
nerve injury. Up until then I did not know
that slow reflexes could indicate a disease
of some sort being present.
an independent practice, I assumed that it
would consist of one doctor and maybe a
few nurses going around checking on patients. However I was surprised to learn that
the office was very similar to what a normal
hospital office would look like, with multiple
staff walking around, testing samples in the
laboratory, drawing blood samples from patients, etc. I had expected the experience to
be like a pediatric office where only the doctor and two nurses usually walked around
from patient to patient. Thus my idea of being a doctor began to
form, and now having finished my freshman
year at UK, I am increasingly curious about
the daily lives and duties of doctors. So,
thanks to the help of Representative Larry
Clark and the Greater Louisville Medical
Society, I was blessed with the chance to see
exactly what a day in the life of a doctor is
like, and to get answers for the many questions that I have. So far I have only shadowed six doctors, Dr. Mary Barry, Dr. Henry
Sadlo, Dr. Tracy Ragland, Dr. Russ Williams,
Dr. Julio Melo and Dr. James Patrick Murphy, and through each of these shadowing
experiences, I have gained a much clearer
view into the true routine of being a doctor.
During my shadowing experience with
Dr. Sadlo, I was exposed to the magic of
cardiology and obtained a great deal of
knowledge about the heart that I did not
know before. I was able to see images of
the fluid moving through the chambers of
a person’s heart, which I found very fascinating. Also from these images, I was able
to learn about the hole in the septum of
the heart that is present during the time of
birth. If the hole does not close up, heart
problems will develop later on in life. The
hole failing to seal up could cause multiple
heart problems such as mixing of oxygenated and deoxygenated blood. Shadowing
Dr. Sadlo really inspired me to to learn more
and more about the human heart.
This experience exposed me to the benefits from working at both a hospital-owned
and an independent practice. I learned that
people with independent practices have
more control over what they do. They are
also able to refer patients to doctors from all
different hospitals, and not be involved in
potential trouble for doing so, like hospitalemployed physicians.
From Dr. Barry’s shadowing experience
I learned more of what was to be expected
in medical school, and about the responsibilities and characteristics of a successful
physician. During my time with her she
not only lectured me but she also gave me
a hands -on experience with medicine
that I would never in a million years have
thought I would be able to do without having previous medical experience. She taught
24
LOUISVILLE MEDICINE
Lastly, with Dr. Ragland in her Med-Peds
office, I not only had the chance to see what
it was like to be a part of a doctor-owned
practice, but I was also able to learn about
current political issues facing doctors today.
We discussed current practice issues, such as
the nurse practitioners’ interest in removing
the collaborative MD/APRN agreement.
Before, when I heard about a place being
Out of all the shadowing experiences I
have had so far, one patient experience really
stood out to me and increased my interest
in medical school. The patient was a lady
in her early 40s, I would say. She came into
Dr. Barry’s office with a sleeping problem
stemming from her heart beating at an accelerated pace at night. This patient really
caught my interest because I have been especially fascinated with the functions of the
heart since my sixth grade science class. I
was amazed at how fast Dr. Barry was able
to relate the problem to a nerve that was in
between the esophagus and the heart called
the vagus nerve, that I never knew existed
until that experience.
After seeing the patient, Dr. Barry tasked
Physicians in Print
Bays HE, Toth PP, Kris-Etherton PM, Abate N, Aronne LJ, Brown WV,
Gonzalez-Campoy JM, Jones SR, Kumar R, La Forge R, Samuel VT.
Obesity, adiposity, and dyslipidemia: A consensus statement from the
National Lipid Association. J Clin Lipidol. 2013 Jul-Aug;7(4):304-83.
PubMed PMID: 23890517.
Bhatt G, Li XF, Jain A, Sharma VR, Pan J, Rai A, Rai SN, Civelek AC.
The normal variant (18)F FDG uptake in the lower thoracic spinal cord
segments in cancer patients without CNS malignancy. Am J Nucl Med
Mol Imaging. 2013 Jul 10;3(4):317-25. PubMed PMID: 3901357.
Burnett NP, Dunki-Jacobs EM, Callender GG, Anderson RJ, Scoggins
CR, McMasters KM, Martin RC. Evaluation of Alpha-fetoprotein Staging System for Hepatocellular Carcinoma in Noncirrhotic Patients. Am
Surg. 2013 Jul;79(7):716-22. PubMed PMID: 23816006.
Calobrace MB. Reply: simultaneous augmentation/mastopexy: a
retrospective 5-year review of 332 consecutive cases. Plast Reconstr
Surg. 2013 Aug;132(2):311e-2e. PubMed PMID: 3897360.
Costich JF, Fallat ME, Scaggs CM, Bartlett R. Pilot statewide study of
pediatric emergency department alignment with national guidelines.
Pediatr Emerg Care. 2013 Jul;29(7):806-7. PubMed PMID: 23823258.
Dunki-Jacobs EM, Callender GG, McMasters KM. Current management of melanoma. Curr Probl Surg. 2013 Aug;50(8):351-82. PubMed
PMID: 23849560.
El-Kersh K, Rawasia WF, Chaddha U, Guardiola J. Rarity revisited:
cryptococcal peritonitis. BMJ Case Rep. 2013 Jul 10;2013. PubMed
PMID: 23845672.
Galandiuk S. Surgical behaviour. Br J Surg. 2013 Jun;100 Suppl 6:345. PubMed PMID: 23804054.
Haninger DM, Davis TA, Parker JR, Slone SP, Parker JC Jr.
me with researching about this nerve and
answering the question about how this
nerve can affect the pace the heart beats.
I learned that the vagus nerve does more
than just affect the heart; it also regulates
muscle movement necessary to keep a person breathing and chemical levels in the digestive system. Also, I found out that vagus
nerve impulses plus the response to them
can change a person’s heart rate, which was
the problem the patient was experiencing
at night, preventing her from sleeping. This
event increased my interest in pursuing a
career in the field of cardiology.
In addition to having an inspirational
patient experience, with shadowing each
doctor I found one similarity that was an
enormous surprise to me. Besides knowing their patient’s medical history, they also
Intravascular large B-cell lymphoma presenting as acute
hemorrhagic cerebral infarct with delirium. Ann Clin Lab Sci. 2013
Summer;43(3):305-10. PubMed PMID: 23884226.
Hillard B, El-Baz AS, Sears L, Tasman A, Sokhadze EM. Neurofeedback Training Aimed to Improve Focused Attention and Alertness
in Children With ADHD: A Study of Relative Power of EEG Rhythms
Using Custom-Made Software Application. Clin EEG Neurosci. 2013
Jul;44(3):193-202. PubMed PMID: 23820311.
Kelishadi SS, Elston JB, Rao AJ, Tutela JP, Mizuguchi NN. Posterior
wedgeresection: a more aesthetic labiaplasty. Aesthet Surg J. 2013
Aug 1;33(6):847-53. PubMed PMID: 23812954.
Li Y, Gobin AM, Dryden GW, Kang X, Xiao D, Li SP, Zhang G, Martin
RC. Infrared light-absorbing gold/gold sulfide nanoparticles induce
cell death in esophageal adenocarcinoma. Int J Nanomedicine.
2013;8:2153-61. PubMed PMID: 23818775.
Soucy KG, Koenig SC, Giridharan GA, Sobieski MA, Slaughter MS. Rotary pumps and diminished pulsatility: do we need a pulse? ASAIO J.
2013 Jul-Aug;59(4):355-66. PubMed PMID: 23820272.
Trivedi JR, Sobieski MA, Schwartz S, Williams ML, Slaughter MS.
Novel thrombosis risk index as predictor of left ventricular assist
device thrombosis. ASAIO J. 2013 Jul-Aug;59(4):380-3. PubMed PMID:
23820276. LM
NOTE: GLMS members’ names appear in boldface type. Most of the
references have been obtained through the use of a MEDLINE computer search which is provided by Norton Healthcare Medical Library.
If you have a recent reference that did not appear and would like to
have it published in our next issue, please send it to Ellen Hale by fax
(502-736-6339) or email ([email protected]).
were knowledgeable about their patients
themselves. Before these shadowing experiences, I thought doctors just knew about
medical history. After shadowing, my view
on the relationships between doctors and
patients has changed. I was amazed at how
well the doctors communicated with each
of the patients, and how much they knew
about each one of them, even though their
patients only saw them a few times or less
in the year. I observed that by learning more
about a patient, a doctor could create a sense
of safety for a patient to open up, allowing
for a better diagnosis of a patient’s problem.
By knowing more about a patient, a doctor
can build up a secure level of trust with a
patient that makes them more comfortable
and able to talk openly. This also shows that
a doctor truly does care about the safety and
wellbeing of a patient, and does not just see
them as a liability on paper, which is what I
had initially believed.
In conclusion, I would just like to thank
Representative Larry Clark and the Greater
Louisville Medical Society for giving me this
wonderful and awe-inspiring opportunity to
shadow and have a firsthand look at all the
possibilities the physician’s life has to offer.
I now know I want to pursue a career as a
physician. I hope to one day be as respected
and as well-loved a physician as each of the
doctors I have had the gracious opportunity
of shadowing. LM
Note: Kevin Kwan is in his second year at
the University of Kentucky majoring in
biochemistry. Kevin recently completed a
summer internship with the GLMS Editorial Board.
September 2013
25
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Professional
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Common Pain Conditions We Treat
Common Pain Treatments We Offer
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120 Executive Park - Louisville, KY 40207
Phone: (502) 855-7200
Fax:
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WE WELCOME YOU
GLMS
would like to welcome and congratulate the following physicians who have been elected by
Judicial Council as provisional members. During the next 30 days, GLMS members have the
right to submit written comments pertinent to these new members. All comments received will be forwarded to
Judicial Council for review. Provisional membership shall last for a period of two years or until the member’s first
hospital reappointment. Provisional members shall become full members upon completion of this time period
and favorable review by Judicial Council. LM
Candidates Elected to Provisional Active Membership
Ander, Tracy Michelle (32099)
3900 Kresge Way Ste 56 40207
502-895-7265
Neurology
Ohio U 09
Ayyoubi, Tayyeb (20976)
Baiza Hanifi
530 S Jackson St 40202
502-852-5617
Anatomic & Clinical Pathology 04
Blood Bank Transfusion Md 08
Hematopathology 09
Kabul Medical Institute/Dean 86
Bert, Robert James (31684)
Phyllis Dodds Bert
530 S Jackson St CCB-C07
40202
502-852-7259
Diagnostic Radiology 97
Neuroradiology 99,10
U of Illinois 91
Blackburn, Ethan W (31640)
Tristan D. Blackburn
315 E Broadway Ste 195 40202
Hand Surgery
U of Louisville 07
Blackburn, Tristan (31641)
Ethan Blackburn
3991 Dutchmans Ln Ste 300
40207
502-899-6061
Internal Medicine 10
Rheumatology 12
U of Louisville 07
Cavanah, Stephen F.W. (31375)
Gail L. Cavanah
2355 Poplar Level Rd Ste 301
40217
502-636-0406
Endocrinology 91,02
U of Louisville 83
Cheng, Allen (32153)
201 Abraham Flexner Way Ste
1200 40202
502-583-8383
General Surgery 11
Texas A&M U 01
Christie, Kari Beth (32104)
Brian Christie
530 S Jackson St Rm C2A01
40202
852-5851
Anesthesiology
U of Kentucky 08
Church, An Ly (32103)
5129 Dixie Hwy Ste 100 40216
502-447-8786
U of Minnesota 06
Crafton, Ronald Lee (4218)
1025 New Moody Ln 40031
502-222-3347
Emergency Medicine 97,07
U of Louisville 92
Deveaux, Peter Gerard (17036)
Lynn C. Deveaux
401 E Chestnut St Unit 710 40202
502-583-8303
Colon & Rectal Surgery 06
General Surgery 01,11
Chicago Medical School 94
Dixit, Bhargab (31485)
Prerana Dixit
3900 Dutchmans Lane Ste 7B
40207
502-896-4711
Internal Medicine 98,09
Gastroenterology 02,12
R.G. Kar Medical College 88
Dougherty, Dana Lynn
(31847)
6400 Dutchmans Pkwy Ste 300
40205
502-894-2444
Family Practice 03
Saint Louis U 00
Fraig, Mostafa M (21466)
Lamia M. Elsayed
502-852-5617
Cytopathology 99
Pathology 98
Cairo U 90
(continued on page 29)
September 2013
27
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Goldberg, Steven Edward
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Najla Aswad
309 11th St 41008
502-732-4378
Admin. Family Practice 94,01
Emergency Medicine 08
Jefferson Medical Col 88
Gondi, Sreedevi (32187)
3900 Kresge Way Ste 60 40207
502-893-7710
Cardiovascular Diseases
U of Louisville 04
Gopalraj, Rangaraj K (20188)
401 E Chestnut St Ste 170 40202
502-588-4271
Geriatrics 10
Family Practice 09
Hospice and Palliative Medicine 12
Kilpauk Med College 99
Gravari, Evangelia (21467)
Dimitrios Lordanoglou
571 S Floyd St Ste 342 40202
502-852-8470
Pediatrics 08
Neonatal-Perinatal Medicine 12
Aristotle U 97
Grubb, Kendra J (32132)
201 Abraham Flexner Way
Ste 1200 40202
502-583-8383
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U of Southern California 05
Hall, Kelli G (2563)
Carl E. Hall, Jr
250 E Liberty St Ste 801 40202
502-585-2799
Family Medicine
U of Florida 87
Hamad, Reem (2123)
Ammar Almasalkhi, MD
6041 Timber Ridge Dr 40059
502-228-2225
Internal Medicine 96,06
Damascus U School of
Medicine 87
Hicks, David L (31082)
Jessica
1850 Bluegrass Ave 40215
502-361-6617
Anesthesiology
U of Kentucky 08
Houser, Molly (30564)
Joshua Andrews
601 S Floyd St Ste 700 40202
502-629-7181
Obstetrics and Gynecology 10
East Tennessee State U 04
Johnson, Kandis (31697)
201 Abraham Flexner Way
Ste 1200 40202
502-583-8383
Anesthesiology
Indiana U 08
Kenney, Nicholas A (32154)
Lorrie Kenney
1023 New Moody Ln Ste 102
40031
502-222-0598
U of Louisville 07
Lain, Kristine Lynee (21314)
Christopher M. Lain
601 S Floyd St Ste 700 40202
502-629-7181
Obstetrics and Gynecology 02,
04, 11
Maternal/Fetal Medicine 04, 11
U of Chicago 94
Lua-Canby, Arlyn (2324)
720 Hospital Dr Ste 1 40065
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Cebu Inst of Medicine 79
Maher, Thomas R (19917)
Allison Valiquett Maher
587-4404
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Indiana U 02
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(20975)
Behnam Vatankhah
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U of Shahid Beheshti 98
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Susan
401 E Chestnut St Unit 310 40202
502-584-8563
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U of Louisville 01
September 2013
29
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Michael Murrell
315 E Broadway Ste 565 40202
502-629-8630
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401 E Chestnut St Unit 710
40202
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U of Louisville 07
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John S. Flickinger
5129 Dixie Hwy Ste 100 40216
502-447-8786
Universidad Del Valle 96
Perez, Cesar (32164)
502-562-4370
U of Panama 03
Perrenoud, Jeannine (21507)
329 Floyd Dr 41008
732-1877
Kansas City U 01
Pope, II Thomas Monroe
(1324)
Melisa M. Pope, MD
502-222-5388
Emergency Medicine 94,04
University of Kentucky 89
Schneider, John Matthew
(30978)
Kathryn
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U of Louisville 08
Shah, Disha Uttam (32121)
Siddharth Shah, MD
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P O Box 34748 40232
502-473-2132
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Deanna Todd Tzanetos
9113 Leesgate Rd 40222
502-426-1621
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Pranay Aryal
501 S Floyd St 40202
502-852-8616
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502-852-6395
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China Medical U 98
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LOUISVILLE MEDICINE
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I’M GETTING A COMPLEX
Mary G. Barry, MD
I
Louisville Medicine Editor
[email protected]
think about genes a lot. It’s required, when
you do what we do. But as my patients age
and one of my partners says the word “retirement” out loud, I worry about gene pools
more. I see the same traits, the same ailments,
and the same slow mimicking of body habitus
in family groups I take care of. The patients I
first met in their 20s are now hitting 50 and up,
and turning rapidly into their elders, whom I
first met at 40 to 80. I have watched that generation grow old (or not make it there) and I
strive to keep the younger ones on track to be
100. Therefore I am reminded, many times a
day, of the influence of gene pools. But what’s
different about practice in 2013 is man’s ability
to use genes: to attack them, to target them, to
mass-survey for them, to manipulate them, to
hunt them. Never mind about the NSA. We
can volunteer to be our own Big Brother, and
enter our names, and with them our genomes,
into online gene banks.
Recently a young and healthy woman, adopted with no known kin, brought me her
genetic risk assessment from the 23andMe
site, which was founded in part by Sergey
Brin, a co-founder of Google, whose mother
has Parkinson’s Disease. One sends in a saliva
sample and presto-chango (in fact because
of the blood, sweat, and tears of many many
researchers on the Human Genome project
over the years) six weeks later one receives
a breakdown of one’s estimated risk of all
kinds of things. 23andMe started out in late
2007 charging $1,000 a test, and now, after a
venture-capital infusion in 2012, only $99.
The company wants to increase its sample
size from 200,000 to a million by making it
cheaper.
Your assessment gets a star if risk is based
on multiple large, peer-reviewed studies. “We
use them to develop quantitative estimates
and explanations of what they mean for you.”
Starred in the list of “Carrier Status” are Cystic
Fibrosis, for example, a sadly common disease,
but also Factor XI Deficiency, an incredibly
rare disorder. Reading that list makes me
shudder in remembrance of med school Biochem exams. Over 120 items are listed in the
“Disease Risk” category, including gallstones
and celiac disease (starred) and endometriosis
and Essential Tremor (not starred). One can
test oneself for drug response, for instance
Coumadin and Plavix sensitivity, and for various traits, including “Biological Aging ” - is
one’s DNA too wrinkled? Getting a paunch?
Interestingly, you can see how many degrees
of genetic separation there are between you
and the Neanderthals (there are times your
spouse might think, “hardly any,” so this could
come in handy).
However, 23andMe also “provides confidential customer datasets to and partnering with”
various foundations for research into genetic
associations with named disorders. This is the
part that gives me the willies. I know they can
track me by my iPhone, my license plate and
my credit card – but am I prepared to have
them study my very genes?
Parts of my genes, and yours, are very old.
Dr. Carlos Bustamante et al of the Stanford
University School of Medicine have now
tracked down an ancient Y chromosome
(whose donor lived between 120,000 to
150,000 years ago) and found equally ancient
Mitochondrial DNA (passed down the female
side only) from roughly the same period. His
team compared Ys (passed only from father
to son of course) from 69 men in nine world
regions, using “high-throughput sequencing” to ID about 10 million nucleotides in
each. David Poznik, lead author, said that
they found through mutation-rate estimates
“a single variant that shows how three ancient
lineages came together about 48,000 years ago,
plus or minus a couple hundred years – the
accuracy is exquisite.”
Just a quick stroll through “news for genes”
reveals all kinds of major advances. Dr. Carlos
Moraes, PhD, and team at the University of
Miami have created a way to delete mutant
mitochondrial DNA. They made a nuclease,
called a TALEN (sounds like a Navy weapons
system) which cleaves off the bad sequences,
while restoring the energy-producing capacity
of the mitochondrial machinery. Dr. Jeremey
McRae of New Zealand has isolated genes
that control our sensitivity to the smell of
Limburger cheese. Dr. Steven Cole of UCLA
has found genetic correlates to happiness. His
team studied how people who endorse “having
a deep sense of meaning and purpose in life”
compare to people searching for “unmitigated
self-gratification.” (He lives in LA – you gotta
write what you know.) Though both groups
said they were really happy, the do-gooders’
genomes showed much lower levels of inflammation and much stronger expression of
antiviral genes. The hedonists were the exact
opposite, way inflamed with weak antiviral
responses. Said Dr. Cole, “Apparently the human genome is much more sensitive to different ways of achieving happiness than are
conscious minds.”
Finally, Dr. Nitesh V. Chawla, professor of
computer science at Notre Dame, has patented
an EMR–driven Collaborative Assessment and
Recommendation Engine (CARE) for personalized disease risk predictions and wellbeing.
Speak Your Mind The views
expressed in Doctors’ Lounge or any
other article in this publication are not
those of the Greater Louisville Medical
Society or Louisville Medicine. If you
would like to respond to an article in
this issue, please submit an article or
letter to the editor. Contributions may
be sent to [email protected] or may be
submitted online at www.glms.org.
The GLMS Editorial Board reserves the
right to choose what will be published.
September 2013
33
Doctors’ Lounge
(continued from page 33)
It uses “Big Data science” to filter records to
find similarities among patients. “It can be
used to explore broader disease histories, suggest previously unconsidered concerns, and
facilitate discussion about early testing and
prevention, and wellness strategies.”
Hmm – eerily familiar to what I do all
day; apparently I am now being replaced by
a computer program who will spit out a long
list of probabilities “individualized” for each
patient. I assume adding your 23andMe profile
will generate another list, and then you crossreference. And to whom will the list-toting
patient appeal for guidance? Will that person
have to prove they are boatloads of genes away
from the Neanderthal, or just look smart?
The incredible complexity of malignant
genetic mutations is mind-boggling; even if
we learn how to delete one or two sequences,
will that help the person whose cancer has
50 kinds of mutations in just one gene? Even
more unimaginable is the infinitely rich genetic diversity of the living parts of our planet
Earth, a place so beautiful, with skies above so
filled with galaxies, that I long ago decided I
believed in Creation (billions and billions of
eons ago, I add, not 6,000 years as our friends
the Young-Earth Creationists maintain). Evolution and war and wind and disaster have
changed much of what once lived on this
Earth, including our innermost blueprints.
So I can relate to the urge to find out about
those blueprints (itself a word so outdated it
will soon be lost).
I perfectly understood my young adopted
woman, who very reasonably and sensibly
sought to add some order to what in life she
might be afraid of, and what in life she could
do more to prevent. As it is, with other patients
who have no known family history, I explain
that we can assume the worst-case scenario
at will, or not. What we do each time is an
individual discussion. Having experts hunt
around our 21,000 gene stock might clarify,
or just add a new source of fear and worry. I
am not sure I want to know more about my
genes, but feel comforted that my knee genes
feel old because they well, are, 48,000 years
to be exact. But I am intrigued by how much
Viking might be in me. To survive medical
practice today, we all would do well to amp
up our Viking traits.LM
Note: Dr. Barry practices Internal Medicine
with Norton Community Medical AssociatesBarret. She is a clinical associate professor
at the University of Louisville School of
Medicine, Department of Medicine.
Notable comments from
GLMS Doctors’ Lounge Blog
Dr. Katherine Abbott responding online to the GLMS Doctors’ Lounge blog post “How to Stop Worrying:”
As a pediatrician, for my patients to have proper medical treatment, I need their ADD parents to be able to have access to their
own medications too. Since the “pill mill” bill went into effect, I have had more and more parents coming to talk to me, frantic
because their primary care MD suddenly is refusing to treat them for Adult ADD because their Ekasper report “looks bad” …
especially if they are on another controlled substance for a different condition. They are being made to feel like criminals instead
of people with a valid medical diagnosis!
While I understand the need to cut abuse of controlled substances, I find it odd that nothing is being said about insurance
companies like Coventry, Wellpoint, and even the Humana plan utilized by state workers, who are preventing doctors who want
to prescribe Vyvanse (the prodrug form of amphetamine that has very low diversion potential) from doing so without “trying”
the patient on the short acting form first! If the legislators are so eager to minimize the amount of abusable prescriptions being
written, then something needs to be done about this issue too.
In a followup email, Dr Abbott continued:
It is one thing to check E Kasper reports, but they are supposed to PROTECT the patients who aren’t doctor-shopping and to
reassure the prescriber that the medication is not being abused or diverted. Instead it’s causing many doctors to worry so much
about being labeled “over-prescribers” that they are forgetting their actual job of caring for the patient – which includes writing
prescriptions for documented medical conditions. LM
Join the conversation
The GLMS Doctors' Lounge is a blog accessible only to members at http://glmsdoctorslounge.org. It's
designed to be a place for physicians and medical students to connect with each other and discuss what's on
their minds. All GLMS members are invited to follow the blog, submit original posts or make comments on
existing posts.
How to Get Started
Email [email protected] to request access to the blog. GLMS staff will send you an email invitation to use in
signing up.
34
LOUISVILLE MEDICINE
Doctors’ Lounge
It Would Only Take a Monkey
Ronald L. Levin, MD, FACOG
I
sit at a desk in a clinic where my job is to
supervise residents and medical students.
After performing this duty for many years
and hearing stories from friends regarding
their experiences with various private physicians, I have come to a sad and frightening
conclusion, that in the not too distant future
the job of an office/clinic physician could be
performed by a decently trained monkey. Not
so you say! Well, let me explain the not so crazy theory based on
much that I have observed of medicine circa 2013.
The monkey only has to sit in front of a specially programmed
computer and learn to hit five buttons – just five large buttons!
Button 1. The patient has been seen by a screening nurse/assistant
who fills out a history form on the computer and enters the chief
complaint, the sex, height, weight, pulse and blood pressure then
alerts the monkey. The monkey then hits button number one which
records all this data and then Button number 2.
It is a rare patient with abdominal pain that we see that can go
through the ER without either an ultrasound or CT scan. To paraphrase the World War II expression, “Damn the physical exam,
full speed ahead.”
In this age of the hand held I-machine, it seems as if the physician-patient relationship – that time-honored bond, is no longer
needed. The warm hand and personal rapport are rapidly becoming
a thing of the past, only to be written about by old doctors, trained
in the day of the importance of hands on care and humanistic
medicine. LM
Note: Dr. Levin is a Clinical Professor at the University of Louisville
School of Medicine, Department of Obstetrics & Gynecology &
Women’s Health. He is a retired gynecologist.
Button 2. The monkey hits this button which orders a CT scan,
MRI and Ultra sound and the data from these tests are then entered
into the computer by a radiology technician.
Button 3. The monkey then hits this button and the patient is
sent to the laboratory where blood is drawn for a complete blood
panel and urinalysis. This data is also automatically entered into
the computer.
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monkey to push Button 4 and the computer compiles and analyzes
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A light flashes the conclusion of the computerized diagnosis which
alerts the monkey to push the last button.
Button 5. The fifth and last button is pushed which reveals the
therapy for the computer generated diagnosis and a nearby printer
prints out prescriptions and directions as needed. The prescriptions
are signed by the computer, gathered up by the nurse along with the
bill and handed to the patient who is shown to the exit by an aide.
The monkey happily eats his/her rewarded banana and is ready for
the next patient. The monkey is not at all worried about malpractice
and all the time and energy and money spent in training young human physicians how to perform a good history and physical. The
monkey certainly does not worry about costs of unnecessary tests or
unneeded radiation exposure. Unfortunately too few humans worry
about these problems either. More and more offices and clinics are
now controlled by “electronic records” where it seems the doctor
spends more time facing the computer screen than he/she spends
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Doctors’ Lounge
Ensuring Excellence Through
Medical Mentorship
Beau M. Bailey, MD
I
started competing nationally
in men’s gymnastics at the age of
4. My coach, Chris
Leech, was a very intimidating man with
unachievable expectations, or so it often
seemed to me. His knowledge of the sport
was only surpassed by his attention to detail
and somewhat short temper. I was often
frustrated as a kid by his unrelenting corrections and the need for multiple repetitions
until a skill or routine was performed to his
standard. While I found success achieving
my goals later in my gymnastics career, I was
not a naturally gifted gymnast and had to
work very hard to overcome my shortcomings to succeed. I am fortunate to have had
an exceptional mentor who demanded so
much from me. His guidance and direction
were invaluable in the development of the
skills and foundation I needed to excel. I
have found the principles I learned from
Chris apply in many aspects of my life and
have been particularly helpful as I try to
get the most out of my residency training.
There has been a significant amount of
change in the approach to medical student
and resident training, particularly in the
last 10 years. These changes include implementation of work hour restrictions, new
accreditation systems and new framework
for resident evaluation, just to name a few.
Many more changes are on the horizon
with the goals of improving patient care,
patient safety, resident competence and
trainee preparation for additional patient
care responsibilities.
With the progress that has been seen
as a result of new training approaches,
debate still exists over the significance of
these changes and how they will affect the
training experience of medical students and
residents. A common theme in the debate
is the concern about the preparedness and
clinical capabilities of physician trainees. In
2011, Antiel et al surveyed residency directors to determine perceived implications of
duty hour changes on trainees as it relates
to the Accreditation Council for Graduate
Medical Education core competencies. The
vast majority of program directors believed
these changes would decrease both coordination of patient care and residents’ overall
educational experience, as well as trainees’
medical knowledge and interpersonal and
communication skills.¹ Resident physicians
appear to have a similar concern as noted by
Drolet et al in a national survey of residents
in 2012. Nearly half of resident trainees
perceived a decreased quality of resident
education and greater than 50 percent felt
less prepared for more senior resident roles.²
As new work hour restrictions are implemented, medical education is revamped
and the scope of residency training changes,
the ultimate goal remains the same. I quote
the GLMS mission statement: “To promote
the science, art and profession of medicine;
protect the integrity of the patient-physician
relationship; advocate for the health and
well-being of the community; and unite
physicians regardless of practice setting to
achieve these ends.”³
With the goal of training competent physicians and ensuring exceptional patient
care, the question of the quality and comprehensiveness of physician training is important and must continue to be addressed.
I suggest that one of the key components of
effective training is mentorship. Tools to improve medical knowledge are easily accessible with advancements in technology. The
majority of trainees have handheld devices
that allow nearly instant access to medical
information that helps facilitate assessment,
diagnosis and management of disease. Most
medical training programs have nearly unlimited access to evidence-based journals,
medical databases and online textbooks that
include exhaustive summaries of disease
pathophysiology, diagnosis and treatment.
Medical knowledge is even formatted into
pocket-sized references to be utilized in real
time to facilitate patient care.
While access to evidence-based practice
is at our fingertips, the true art of medicine
lies in critical thinking, objective evaluation
and the application of medical knowledge to
the process of patient care. The value of an
experienced clinician imparting wisdom obtained through time and repetition cannot
be overstated. The medical mentor ensures
high performance of each individual and
fosters teamwork among multidisciplinary
teams. They provide a calm, focused perspective in the face of the unknown and
under arduous circumstances. They scrutinize the evaluation and management of the
patient and provide guidance to facilitate exceptional patient care. Just as great coaches
lead their teams to excel, mentorship is the
key to facilitating resident development and
the acquisition of skills necessary to provide
excellent patient care.
Wingard et al described the impact
mentorship can have on physicians early
in training through their structured mentor
program for junior faculty at the University
of California, San Diego. Under this program, junior faculty were enrolled in a seven-month program including curriculumbased series of professional development
courses, career planning and individualized
academic performance counseling through
formal faculty mentoring relationships. The
results of surveyed junior faculty after the
completion of the mentor program were
significant for more confidence in their academic roles, professional development, skills
in education, research and administrative
responsibilities.4 Similar conclusions were
drawn by Sabunjak et al in a large systematic
review of literature assessing the effects of
mentoring in medical schools, residency
and fellowship programs. From review of
September 2013
37
Doctors’ Lounge
39 studies assessing the effects of mentoring, they concluded that “mentorship was
reported to have an important influence
on personal development, career guidance,
career choice, and research productivity.”5
As I think of the most influential aspects
of my training to this point, I reflect on the
impact of my personal mentors. The first
great teacher I had the opportunity to work
with was Dr. William Beninati, an intensivist at LDS Hospital in Salt Lake City, Utah.
Dr. Beninati helped me understand how
to effectively manage a critically ill patient.
He was particularly adept at simplifying
difficult critical care concepts and facilitating the student’s understanding of the
pathophysiology of disease and how that
guides patient management. He patiently
taught me the correct approach to invasive
procedures and helped me gain confidence
in my ability to use these skills in patient
care. Dr. Beninati was very influential in my
career choice and my desire to be a physician who facilitates excellent patient care.
Over the course of two years of residency,
I have had many excellent attending physicians that have helped me develop skills and
knowledge that have dramatically advanced
my development as a physician. Dr. Andrew
DeFilippis taught me to use subtle physical
exam findings in the assessment and management of cardiology patients, in particular
the assessment of jugular venous distention
in evaluation of volume status. Dr. Bryan
Moffett has been an example of how to utilize primary literature and expert guidelines
in patient care and helped me develop an
appreciation of lifelong learning and daily
study to improve clinical capabilities. My
outpatient clinic mentor, Dr. Madison Ryle,
has shown me the importance of listening
to the concerns of patients and caring for
their well-being as well as their satisfaction.
Dr. Ryle is outstanding at communicating
with his patients and building a relationship of trust that facilitates patient care. Dr.
Michael Ruppe has shown me a true love
for his profession and finding satisfaction in
his work. Dr. Charlene Mitchell has taught
me responsible utilization of the health care
system and has helped foster my desire to
be active in research. I have learned self38
LOUISVILLE MEDICINE
less dedication to responsibility from my
program director, Dr. Christopher Sweeney.
These are just a few examples of the many
great mentors I have encountered during
my training at the University of Louisville,
who selflessly devote their effort to ensuring exceptional education of their medical
residents.
I will be forever grateful to Chris Leech
for making me get back on the pommel
horse time and time again. Despite my
complaints at the time, I’m thankful for
the tedious repetition of very basic skills
that provided the foundation to progress to
elite level elements with time. I have come
to appreciate the countless hours of strength
training programs that subsequently became essential to my progress as a gymnast.
I now recognize that a quality coach gets the
most out of each individual, then shapes
those individuals into a winning team. The
best coaches inspire their athletes to overcome their shortcomings and build on their
strengths. They have unique insight into the
subtle details of their discipline that, when
integrated with refined skills, leads their
trainees to excel.
I also look back on my mentors who have
helped shape my abilities as a resident physician with the same admiration that I have
for Chris Leech. I appreciate their sacrifice
and commitment to student and resident
training. I’m grateful for their example and
appreciate their devotion to ensuring excellent patient care. Their abilities inspire me to
continue to learn and improve and develop
into the type of physician I would want caring for my own family members one day.
Unfortunately, the continuous additional
constraints on time and increased responsibility of practitioners are making mentorship more and more difficult. There is a need
to evaluate further the impact of mentorship
in residency training, through more robust
research to support its efficacy and ensure
that it is promoted as an integral part of
physician training. With all the recent and
anticipated changes in graduate medical
education, mentorship remains the key to
learning the art of medicine and integrating
the knowledge available to ensure exceptional patient care.
References
1. Antiel RM, Thompson SM, Hafferty
FW, et al. Duty Hour Recommendations and Implications for Meeting the
ACGME Core Competencies: Views
of Residency Directors. Mayo Clinic
Proceedings, 2011;185-91.
2. Drolet BC, Christopher DA, Fischer
SA. Residents’ Response to Duty-Hour
Regulations-A Follow-up National Survey. N Engl J Med, 2012. DOI: 10.1056/
NEJMp1202848.
3. Mission Statement of Greater Louis-
ville Medical Society. Retrieved from
Greater Louisville Medical Society site:
www.glms.org.
4. Wingard DL, Garman KA, Reznik
V. Facilitating Faculty Success: Outcomes and Cost Benefit of the UCSD
National Center of Leadership in
Academic Medicine. Acad Med,
2004:79(10supple);s9-11.
5. Sambunjak D, Straus SE, Marusic A.
Mentoring in Academic Medicine A
Systematic Review. JAMA, 2006. Sep
6;296(9):1103-15. LM
Note: Dr. Bailey is a resident in Internal
Medicine and Pediatrics at the University
of Louisville School of Medicine.
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LouisviLLe Medicine - Greater Louisville Medical Society

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