SAN ANTONIO
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Art and Medicine
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VOLUME 70 NO. 7
San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS.
Art and Medicine
The Art of Examination: Medical School and Art Museum Partnerships By Bonnie Pitman ...............................................14
The Art of Healing By Allison Hays Lane .........................................18
University Health System: 100 Years of Service to the Community By Don Finley .....................................................21
EDITORIAL CORRESPONDENCE: Bexar County Medical Society 4334 N Loop 1604 W, Ste. 200 San Antonio, TX 78249 Email: editor@bcms.org
Art Therapy is a Mental Health Profession By Melissa Dilworth, LPC-AT-S, ATR-BC ............22
Recreation Therapists Incorporate Art in Patient Intervention By Cristal (Cris) Bleich, MSRLS, CTRS/BH ........23
MAGAZINE ADDRESS CHANGES: Call (210) 301-4391 or Email: membership@bcms.org
Mine is to Choose the Color of the Rainbow to Slide Down. What is Yours? By Rajam Ramamurthy, MD ........................................................................................26
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The Merging of Art and Science By Kathleen Waller Stewart, MD ...........................24
A Poem for the Ages By Fred H. Olin, MD ..................................................................30 Using Art to Heal Physician Burnout By Ruth Berggren, MD, MACP ......................32
BCMS President’s Message ...........................................................................................................8 BCMS News.............................................................................................................................................10 BCMS Legislative News ..........................................................................................................................11 BCMS Alliance.........................................................................................................................................12 Legal Ease: This Doctor is Horrible. Stay Away! By George F. “Rick” Evans, Jr., .................................34 Business: New Depreciation Rules By Bennett Allison, CPA, CFP .........................................................36 BCMS Circle of Friends Directory............................................................................................................38 In the Driver’s Seat...................................................................................................................................42 Auto Review: 2017 Jaguar F-Pace SUV By Steve Schutz, MD ..............................................................44
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BCMS BOARD OF DIRECTORS ELECTED OFFICERS Leah Jacobson, MD, President Adam V. Ratner, MD, Vice President Sheldon Gross, MD, President-elect Jayesh B. Shah, MD, Immediate Past President Gerald Q. Greenfield Jr., MD, PA, Secretary John Robert Holcomb, MD, Treasurer
DIRECTORS Rajaram Bala, MD, Member Lori Boies, PhD, BCMS Alliance President Josie Ann Cigarroa, MD, Member Kristi G. Clark, MD, Member George F. "Rick" Evans Jr., General Counsel Vincent Paul Fonseca, MD, Member Michael Joseph Guirl, MD, Member John W. Hinchey, MD, Member Col. Bradley A. Lloyd, MD, Military Rep. Rodolfo Molina, MD, Board of Mediations Chair John Joseph Nava, MD, Member Gerardo Ortega, MD, Member Robyn Phillips-Madson, DO, MPH, Medical School Representative James E. Remkus, MD, Board of Censors Chair Ronald Rodriguez, MD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative David M. Siegel, MD, JD, Member Bernard T. Swift, Jr., DO, MPH, Member
CEO/EXECUTIVE DIRECTOR Stephen C. Fitzer
CHIEF OPERATING OFFICER Melody Newsom Alice Sutton, Controller Mike W. Thomas, Director of Communications August Trevino, Development Director Brissa Vela, Membership Director
COMMUNICATIONS/ PUBLICATIONS COMMITTEE Rajam S. Ramamurthy, MD, Chair Kenneth C.Y. Yu, MD, Vice Chair Carmen Garza, MD, Community Member Kristi Kosub, MD, Member Lauren Michael, Medical Student Sara Noble, Medical Student Fred H. Olin, MD, Member Jaime Pankowsky, MD, Member Alan Preston, Community Member Adam Ratner, MD, Member David Schultz, Community Member J.J. Waller Jr., MD, Member Jane Yoon, Medical Student
6 San Antonio Medicine • July 2017
PRESIDENT’S MESSAGE
My First Attempt at Creative Writing as a Physician By Leah Jacobson, MD, 2017 BCMS President
As I became president of the Medical Society, one of the tasks I found most daunting was writing these articles. I, in no way, consider myself a writer. It can be difficult choosing a topic, and then there is the challenge of composing it. I was fortunate enough to participate in an abbreviated writing workshop in March at the Medical Society. The publications committee graciously included the BCMS executive committee in their monthly meeting. The workshop was conducted by two amazing Fourth Year medical students from UT-Health. It was entitled "6:55," and it was both enlightening and empowering. This type of workshop was described in more detail in the March edition of San Antonio Medicine. During the workshop, we first discussed the process of reflection and were given examples. We were given five minutes to write 6word stories. We then were given fifteen minutes to write at least one 55- word story. After that we shared and discussed our work. UT-Health has incorporated this program into the medical school curriculum for students, residents and faculty. Below, I share with you a few of my "6" word stories and "55" word stories from that workshop, as well as some that I have done since then.
Theme- physician burnout 6 word stories: "Early mornings, long days, late nights." "Little sleep, no lunch, much work." "Charts, charts, charts. Meetings, meetings, meetings." "Day "off"— try to catch up." "Long days. No time to play."
55 word stories: "I am up before dawn — ready to go save the world again. To the hospital I go to see newborn babies — they are so full of life. The laughs and cries of my patients gets me through the day. Then the burden of the charts begins to wear on me late into the night." "I am fortunate to have a day "off." The "to do" list is longer than the hours in the day. How do I begin to tackle this? Thoughtfully, I go down the list, checking off each completed task — receiving great 8 San Antonio Medicine • July 2017
satisfaction when the list gets shorter. Discouraged when I cannot complete it all that day." The Publications committee is working to plan a Writers' Workshop for Physicians this Fall. I highly encourage anyone interested to participate. Although I was a reluctant participant at the "6:55" workshop in March, I found it very worthwhile. If writing is not "your thing," there has to be something creative that you are passionate about. It could be photography, painting or drawing, playing and/or composing music, gardening, baking/cooking — just to name a few. Whatever it is, it is important to carve time out of your busy schedule and "just do it!" I think you will find that you are a happier and more productive individual if you do. Sincerely, Leah Jacobson, MD
BCMS NEWS
IN MEMORIAM:
Charles R. "Chuck" Bauer, MD By Melody Newsom, Chief Operating Officer Bexar County Medical Society
It is with a sad heart that we inform you that Charles R. “Chuck” Bauer, MD passed away Sunday, June 4, 2017. Dr. Bauer was loved and admired for all his service to the United States, Texas and to San Antonio. Dr. Bauer graduated from Marquette University School of Medicine in 1958 and completed a rotating internship at St. Mary's Hospital. He entered the US Air Force and spent 3 years as a flight surgeon at Tinker AFB, Oklahoma. From 1962-1967 he completed four years of general surgery residency and an additional year in Plastic and Reconstructive Surgery and Thoracic and Cardiovascular Surgery at the University of Florida, Gainesville, Florida. From 1967-1970 he was stationed at Tachikawa Air Base, Japan caring for Vietnam war casualties. Dr. Bauer was Commander, 659th Air Transportable Hospital, USAF Hospital Luke, and USAF Kessler Medical Center (Brig. General position). He retired in 1982 as a Colonel with Chief Physician and Chief Flight Surgeon ratings and was awarded the Legion of Merit with 2 oak leaf clusters. After being out of uniform for 22 years Colonel Bauer was one of the first physicians recruited into the Texas Medical Brigade (then known as the Texas Medical Rangers) during the initial organization of the Brigade. During his tenure in the Medical Brigade, Colonel Dr. Bauer held almost every important position appropriate for a physician. He responded as the Chief Medical Officer to Hurricanes Katrina, Rita, Dean, Dolly, Ike, and Gustav. Upon retirement from the Air Force, Dr. Bauer joined the faculty at the University of Texas Health Science Center San Antonio as a general and trauma surgeon and as the Assistant Dean for Ambulatory and Emergency Services. He was instrumental in the founding of the Division of Trauma and Emergency Surgery, the Division of Emergency Medicine. He is a founding member of the Department of Emergency Medicine. Doctor Bauer served until his death as an Adjunct Professor of Emergency Medicine. He was board certified in general surgery, emergency medicine and medical management. The American College of Physician Executives recognized him as a Certified Physician Executive (CPE). He continued clinical practice in emergency medicine and trauma surgery resuscitation at University Hospital.
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Dr. Bauer was interested in Disaster Response and Preparedness after arriving in San Antonio. He was the founding Chair of the Southwest Texas Regional Advisory Council (STRAC) and which he continued as the Chair Emeritus. He chaired the Bexar County Medical Society Emergency and Disaster Preparedness Committee from 1985–2006. He was nationally recognized for his contributions to medical preparedness and training for disasters by FEMA and by the Medial Reserve Corps Program of the US Department of Health and Humans Services. Dr. Bauer developed the South Texas Poison Center located at the UT Health Science Center and was instrumental in the establishment of the Texas Poison Center Network. He retired as a Colonel from the Texas State Guard, and served as the Commander of the Alamo Group, Texas Medical Rangers. Dr. Bauer was recognized by the San Antonio Business Journal with a Life Time Achievement Award for his community and medical services to San Antonio and Texas and has also received the 2009 Governor’s Lonestar Achievement Award. He completed numerous courses and taught on the subjects of HazMat, Biological, Chemical, Nuclear and Radiation, Disaster Response, and Hospital Emergency Incident Command. He had been the course director for close to 100 Advanced Trauma Life Support Courses and also taught Advanced Cardiac Life Support, Pediatric Life Support, Advanced HazMat Life Support and Advanced Pediatric Life Support. Dr. Charles R. Bauer dedicated his life to medicine, to serving the citizens of the United States of America and the State of Texas. There is no one that had done more for our community with such grace and humility. He has a heart of gold and was earlier this year awarded the Bexar County Medical Society’s highest honor, the Golden Aesculapius Award. He will be truly missed!
BCMS LEGISLATIVE NEWS
85TH LEGISLATIVE SESSION ADJOURNS SINE DIE By Mary E. Nava, MBA, Chief Government Affairs Officer and Lobbyist On May 29 (Memorial Day), the 85th Legislative Session came to a close. While medicine issues saw a number of wins and also the demise of some bad bills, a special session was looming on the horizon targeting the state agencies under Sunset, including the Texas Medical Board. Gov. Greg Abbott as anticipated, has called the Legislature back to work and a special session is set to begin July 18. At the time of this writing, several bills have already been signed into law by Gov. Abbott and others were on his desk awaiting action. Signed legislation includes: Billing Mediation - Senate Bill 507 by Sen. Kelly Hancock (R-North Richland Hills) and Rep. John Frullo (R-Lubbock) which expands the billing mediation process to all physicians and others providing out-of-network services at certain in-network facilities; also expands mediation to out-of-network situations for emergency care. Step Therapy - Senate Bill 680 by Sen. Hancock empowers physicians to override health plans’ step therapy protocols. Telemedicine - Senate Bill 1107 by Sen. Charles Schwertner, MD (R-Georgetown), establishes a statutory definition for telemedicine and clarifies that the standard of care for a traditional, in-person medical setting also applies to telemedicine services. In the House, Rep. Four Price (R-Amarillo) added language making it clearer that telemedicine is not a distinct service, but a tool physicians can use. Health plans are prohibited from excluding telemedicine from coverage just because the care isn’t provided in person. CPRIT - Senate Bill 224 by Sen. Kirk Watson (D-Austin) extends the sunset date of the cancer research organization from 2021 to 2023, and also adds two years to its eligibility to allocate funds, to 2022.
Please stay tuned to this column for a complete legislative wrapup covering the 85th Session. For local discussion on these and other legislative advocacy topics, consider joining the BCMS Legislative and Socioeconomics Committee by contacting Mary Nava at mary.nava@bcms.org. visit us at www.bcms.org
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BCMS ALLIANCE
SAVE THE DATE FOR THE BCMSA CENTENNIAL CELEBRATION AND SCHOLARSHIP FUNDRAISER! By Lori Boies, President 2017 Bexar County Society Alliance
The Bexar County Medical Society Alliance is excited to celebrate its 100th anniversary in October 2017! Our centennial marks 100 years of giving back to our community and providing strength and support to the medical family. Every year the BCMS Alliance, in conjunction with the BCMS Foundation, provides generous scholarship monies to exemplary students in Bexar County. To celebrate 100 years, please join us for our Centennial Celebration Allied Health Scholarship Fundraiser, which will help fund scholarships for students preparing for careers in an allied health field. This party for a cause will take place on Oct. 21, 2017 at 6 p.m. at Neiman Marcus La Cantera. Our “birth-
day party” will be complete with food, champagne, a mixologist, live music, an overall good time, and of course, dessert! Through community sponsors, including our Presenting Sponsor CHRISTUS Santa Rosa Health System, and ticket sales, we are planning for a very profitable event that will fund our ability to give thousands of dollars of scholarships to well-deserving allied health students in Bexar County. If you would like to join the list of community sponsors for our event, please do not hesitate to contact us! Please save the date on October 21st to join us for our centennial celebration! All the best, Lori Boies bcmsalliance@bcms-alliance.org
The BCMS Foundation and BCMS Alliance presented scholarships to eight graduating seniors on May 23 during a banquet at the Quarry Golf Club. (Front row) Emily Garcia, Amaly Saed, Lindsey Gutierrez, Bailey Jordan, Lidia Rangel, Karla Estrada, Shanoa Fowler, Kasandra Silva. (Back row) Steve Fitzer, BCMS CEO; Dr. Jesse Moss Jr.; Dr. Leah Jacobson, BCMS President; Dr. Dianna Burns-Banks; Jennifer Lewis, BCMS Alliance; Dr. David Henkes; Dr. Neal Gray; Dr. Gabriel Ortiz; and Dr. John Hinchey. Find us on the web: www.facebook.com/BCMSAlliance.org/ • www.bcmsalliance.org
12 San Antonio Medicine • July 2017
ART AND MEDICINE
The Art of Examination: Medical School and Art Museum Partnerships By Bonnie Pitman
Throughout the country, medical schools have added courses to help medical students, interns, residents and fellows look at works of art and in turn relate that to their own professional practices. These innovative programs bring medical students into direct contact with works of art and develop observation, interpretative, empathic and collaborative skills to enhance their clinical diagnosis and practices. The art museum and medical school partnerships at leading institutions in the U.S. and abroad improve and advocate these programs and demonstrate they are a bridge between the arts and sciences. A beautiful young girl rides gracefully on the back of a bull swimming out to sea. She is surrounded by a glistening blue sky with floating putti and garlands on one side and by an ominous eagle and dark clouds on the other. In the rough dark waters at Europa’s feet mermen, nymphs and sea creatures support her. The painting “Abduction of Europa” in the collection of The Dallas Museum of Art is an excellent introduction of compositional elements and diverse interpretations of its narrative. 14 San Antonio Medicine • July 2017
Thirty first- and second-year medical students from UT Southwestern Medical School gather in the European Gallery at The Dallas Museum of Art to look at the “Abduction of Europa” by Jean Baptiste Marie Pierre, created in 1750. A series of deep looking exercises follow as the students look closely at the painting for 90 seconds in silence. Then the students are asked to turn away from the painting and record everything that they remember seeing in their journals. We invite students to return to looking at the painting and discuss its compositional and narrative elements and share what they have written in their journals. What part of the painting first caught
ART AND MEDICINE your attention? Discuss the narrative story as it relates to the painting – some students know that it is a story from Ovid’s Metamorphoses in which the god Zeus assumes the form of a bull to seduce the mortal woman, Europa. What happened before and after this moment? Look closely and take the poses of figures in the painting. Then the class is asked to turn their backs once more to the “Abduction of Europa” and identify the figures who are looking directly at them. Only three out of the 30 students get the answer correctly, and this has occurred every year for three years. After 45 minutes of looking and discussing the painting, students are surprised that they did not observe closely enough to answer this question. We then compared this experience to making a physical examination, looking at a patient with a diagnosis in mind yet missing key details that could make a difference in the diagnosis. The point is made! We think we see and remember but we need to learn how to observe more closely and provide evidence of our observations whether it is looking at a patient or a work of art.
Introduction to Medical School and Art Museum Partnerships Observation, visual inspection with interpretation and verbal communication of one’s findings are essential skills in medical practice. These skills can be learned utilizing master works of art to teach medical students “visual literacy,” which is the ability to reason pathophysiology from careful, unbiased observation. Looking carefully at art involves analyzing the entire work before making judgments or interpretations. These approaches to analyzing works of art have led to embracing a more humanistic understanding of health and well-being; part of a movement towards improving new physicians’ clinical training. Medical students, residents, physicians and nurses who engage in looking at works of art from different periods in history and different cultures have been studied by many medical schools and the results of these studies document a dramatic increase in observation, understanding, analysis, problem solving and collaborative communication. Over the years, there has been an expansion of both the number and types of programs and partnerships. In 1999, Dr. Irwin Braverman, Yale School of Medicine, and Linda Friedlaender, Senior Curator of Education at Yale Center for British Art, collaborated on the first program to enhance observational skills of first-year medical students. Additionally, they conducted a controlled study, published three years later in the Journal of the American Medical Association, as part of Dr. Jacqueline Dolev’s medical school thesis, which showed that museum intervention did indeed enhance students’ observational skills. Their work inspired other medical schools to develop partnerships with art museums and they have
trained several museums and medical schools. Over the years several medical schools decided to create courses of six-to-10 sessions with durations of one-to-two hours that include actively teaching by both medical professionals and art museum educators. The expansion of the number of courses, seminars and workshops has been a core component of the growth of this field of medical humanities largely because the museum and the medical school create programs that meet their shared goals and support the continuation of these unique partnerships. In 2011, the Harvard Art Museum presented “Cultivating Humanism: A Symposium on Medicine and the Arts,” organized by Ray Williams, Former Director of Education at the Harvard Art Museum and currently Director of Academic Affairs at Blanton Museum of Art at the University of Texas at Austin. This daylong, interactive CME event cultivated personal reflection and renewal and helped physicians and museum educators further investigate the social and cultural facets of wellness, illness and death through works of art. This is another aspect of the importance of medical education programs that involve dentists, nurses, physician assistants, physical therapists and other healthcare professionals. The Art of Examination: Art Museums and Medical School Partnerships Forum was a landmark gathering that brought together more than 135 leading professionals in the medical education and museum education fields at a two-day convening in June 2016, organized and funded by The Edith O'Donnell Institute of Art History, The University of Texas at Dallas and held at the Museum of Modern Art in New York City. The Art of Examination Forum was the largest gathering of professionals dedicated to this work and the first time that many of these professionals had an opportunity to exchange information and ideas about these programs. Ten recommendations developed by the Forum are included at the end of the Report on the Forum. The presentations and knowledgeable voices of both museum and medical school professionals with long-standing partnerships provided a sound overview of the fields’ best practices, goals, history, approaches to teaching, terminology, evaluation, challenges and future direction. Information on research and evaluation studies was also shared. The scope, length and format of the workshops and courses varied. The Art of Examination: Art Museums and Medical School Partnerships Forum developed a list of over 70 programs that attests to and endorses the value of arts and humanities-based education in medical education. There is an excellent body of literature, primarily published in medical journals, that addresses the pedagogy of these programs and evaluation of their impact on students. Additionally, the Report from the Art of Examination Forum and other resources are available. These resources can be found on The Edith O’Donnell Insticontinued on page 16
visit us at www.bcms.org
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ART AND MEDICINE continued from page 15
tute of Art History, Art and www.utdallas.edu/arthistory/medicine.
Medicine
website
at
The Power of Art Can looking at an Etruscan sarcophagus, a portrait by American painter John Singleton Copley, or an abstract painting by Franz Kline change the way medical students see and develop their empathy their patients? Can reflection, meditation and creative writing on works of art enhance understanding and observation skills, and develop an understanding of cultural difference and compassion for their patients? Observation, visual inspection, with interpretation and verbal communication of one’s findings are essential skills in medical practice. Through the active practice of looking and communication through art; engaging in collaborative meaning-making; exploring connections between art-viewing and the physical exam; learning and reflecting metacognitively on their own looking process; the medical students learn about clinical diagnosis in a variety of situation, settings and disciplines. The following descriptions of classes and programs provide examples of partnerships and pedagogy that engage medical schools and art museums in these initiatives. The Edith O’ Donnell Institute of Art History, The University of Texas at has developed a resource of the Programs and encourages new submissions biannually. Please 16 San Antonio Medicine • July 2017
see: https://www.utdallas.edu/arthistory/medicine/#resources. The following summaries have been drawn from the program descriptions that the medical schools and museums have provided. The UT Health Science Center, Center for Medical Ethics and Humanities and the McNay Art Museum, San Antonio, TX offers Art Rounds, an interactive, inter professional course that takes UT San Antonio Medical students to the McNay Art Museum to learn physical observation skills. Using artwork as patients, students will learn how to observe details and how to interpret images based on available evidence. Taught jointly by UTHSCSA faculty and McNay Art Museum educators, students will view, observe, interpret, and give case reports on works of art. Studies demonstrate that these skills translate to improved patient physical observation skills. The two-hour classes are offered with 4-5 sessions at the McNay Museum and 3-4 lectures at UTHSC. The Sessions at the McNay focus on observing physical qualities of objects; communicating effectively with peers about observations; recognizing and discussing ambiguity in interpretations; and applying observation skills with works of art to observing and treating patients. Favorite features of the class include: 1) Art Patient — pairs of students are assigned an art patient (work of art in the McNay Collection) to visit each time they come to the museum. 2) Differential Diagnosis — students create a differential diagnosis based on portraits in the McNay collection. 3)Creative Response — Inspired by their art patient (a work of art
ART AND MEDICINE
in the McNay Collection), students create a response. Creative writing, photography, collage, sculpture, painting, and cooking are just a few of the wide-ranging responses exhibited. For the past four years, the course included medical and nursing students only. 2015, Art Rounds expanded to students in the Health Professions School including Occupational Therapy, Respiratory Therapy, and Physical Therapy. The course is led by UT Health Science Center, Center for Medical Ethics and Humanities, Adam V. Ratner, MD, the Stewart & Marianne Reuter Endowed Professor of Medical Humanities; and Kate Carey, Director of Education, the McNayArt Museum. Additional Medical School partners include: UT Nursing School Clarice Golightly-Jenkins, PhD, RN, MSN, CNS and Assistant Professor, Department of Health Restoration & Care Systems Management. The University of Texas Southwestern Medical School, The University of Texas at Dallas and the Dallas Museum of Art, Dallas, TX teaches a course : The Art of Examination, a preclinical elective focusing on developing skills for clinical diagnosis through looking at works of art. Through experiences with artwork, students in the course improve visual literacy skills, which is the ability to observe, analyze, interpret, and make meaning from information presented in the form of an image and relates to both examining patients as well as artworks. The course uses the power of art to promote the analysis and communication necessary in addressing ambiguity in the physical exam and patient interaction. The class includes thirty first- and second-year medical students from UT Southwestern Medical School. The course meets primarily at The Dallas Museum of Art, with classes also occurring at the Nasher Sculpture Center, The Crow Museum of Asian Art, and the UT Southwestern Clements Hospital and private collector’s homes. Topics include artists with disease, empathy, color theory and cultural influences, with their implications for medical practice. Participants cultivate habits of close observation, inspection, and cognitive reflections to shape his or her early medical career. Students learn to synthesize observations and one’s own knowledge and experiences as well as an awareness of the collaborative thinking process of the group, a skill vital to successful clinical practice. The class engages students in discussions, drawing and writing exercises, lectures, and interactive experiences that foster communication. The course consists of eight two-hour sessions; each session includes both classroom-based introductions on methods and questioning strategies for close observation of art followed by gallery activities during which students discussed assigned works of art in small. The faculty includes University of Texas Southwestern Medical School, Dr. Heather Wickless, M.D., M.P.H., Assistant Professor; Bonnie Pitman, Distinguished Scholar in Residence, The Edith O’Donnell Institute of Art History at The University of Texas at Dallas;
Amanda Blake, Interim Director of Education at The Dallas Museum of Art, and Courtney Crothers, Art Curator at the University of Texas Southwestern Medical School.
Summary With the rapid growth and great interest in the development of new courses and curricula involving art museums and medical schools, there is a need to exchange information and to create a network of colleagues in both the art museum and medical professions. These connections will expedite mutual learning, which can then be shared with medical students. The 2016 Art of Examination Forum offered a platform for medical and museum educators to learn new skills and discuss program and partnership strengths, weaknesses and challenges, the value of research and evaluation, and the impact on the medical and museum professions. Forum participants and those who could not attend strongly encouraged future convenings to share information and research and to develop faculty skills. A plan is developing with Harvard Medical Schools and Boston museums to present one in 2018. Some colleagues supported forming a new professional society and setting standards with the mission of integrating the art of medicine with other creative arts on a national and international scale. Others advocated the advancement of the field through existing medical and museum professional associations. The interest and advocacy are pushing the field forward at an exciting time for medical and art museum education. Bonnie Pitman is the Distinguished Scholar in Residence, The Edith O’Donnell Institute of Art History, at The University of Texas at Dallas.
The Edith O’Donnell Institute of Art History, at the University of Texas at Dallas launched the Art and Medicine website in the Fall of 2016 and updated in the Spring of 2017. The link to the website on Art and Medicine at The Edith O’Donnell Institute of Art History: www.utdallas.edu/arthistory/medicine/ Under the Partnership Resources tab there is a Bibliography, a listing of all the partnership programs that we had information on, and sample Syllabi. All of these materials can be downloaded as PDFs. If you would like to add additional information please send an email to Bonnie Pitman, Distinguished Scholar in Residence at UTD, BPitman@utdallas.edu and we will send you a form to complete. The website is updated everybi-annually. Under the FORUM tab are links to the REPORT on the June 2016 Art of Examination: Art Museum and Medical School Partnerships Forum, which includes a summary of finding and future actions, roster of participants as well as all the powerpoints and video recordings from the plenary session.
visit us at www.bcms.org
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ART AND MEDICINE
The Art of Healing By Allison Hays Lane, Archivist & Art Program Manager, University Health System
“Variety of form and brilliancy of color in the object presented to patients are an actual means of recovery.” – Florence Nightingale
For generations, the arts have been regarded as a crucial part of our human experience and a critical part of the development of a civilized world. They play a role in education, cultural awareness and reflections of our society. Communities around the world value music, writing and visual arts, which serve as a gauge of a cohesive, progressive society. A society that values what art draws us into — unexpected beauty, the questioning of life’s challenging aspects — is a society that possesses empathy and compassion, and embraces diversity. Over the last 60 years, a growing awareness of art’s value in the healing process has become a vital and essential aspect for the understanding of healing and the human condition. The integration of art into recovery is now seen as a therapeutic platform that enables the healing process to provide a foundation of hope and positive distraction, for finding new meaning and calming fears. The Latin origin of the word curator is “curare,” which means to take care of objects in an archive, museum or library. A more creative and modern interpretation, however, could apply to the process of caring for patients and their families in a hospital or clinical setting. Art in healing can take many forms — a terminal cancer patient creating art until the last moments; premature babies in a NICU calmed by the sound of a live harpist or flutist; and patients receiving chemotherapy over long hours, surrounded by music and artwork, and using that time to color or record their thoughts in a journal. All of these reflect the multi-faceted paradigm which is art in healing. Artist and painter David Blancas was a pediatric patient at University Hospital in 1977, having a tumor removed from his neck at
age five. Forty years later, Blancas has returned to create artwork and designs for a new pediatric pre- and post-operative area in our new Sky Tower. These areas use artful tropical jungle animals to provide an uplifting and positive distraction from the surgical procedures at hand. The artwork also plays a role in wayfinding by directing the patient to the “elephant” or “hippo” room. It is interesting to see the transformation of a healing setting through art, and the artist’s direct connection to the patient experience. More than a decade ago, Bexar County Commissioners Court, the Bexar County Hospital District Board of Managers, University Health System staff and civic leaders began their own journey into the art of healing as they envisioned the expansion and renovation of University Hospital and the historic Robert B. Green Campus in downtown San Antonio. The $899 million Capital Improvement Program included a $7.2 million design enhancement and public art component. A team began researching how other parts of the country incorporated evidence-based design using color, forms and natural light in a healthcare setting. We toured Harborview Medical Center in Seattle; Dell Children's Medical Center of Central Texas in Austin; Indiana University Health Methodist Hospital in Indianapolis; and Harvard Brigham and Women's/Children's Hospital in Boston. Exceptional national models like the Mayo Clinic and Cleveland Clinic also were profiled to gain a broad, across-the-board perspective of how to successfully inject art as an integral facet of a healthcare environment. LEED architectural design, xeriscape landscaping, aromatherapy with herbal plants, and infusing light and colors in public spaces all contribute to the overall philosophy. These contribute to patients feeling less continued on page 20
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anxious, using less medication and spending less time in the hospital. It may even boost the immune system. It also leads to greater staff retention. As University Health System developed its own unique program over three and half years, a number of public presentations were held in San Antonio and Austin to increase public awareness. Administrators, nurses, doctors, volunteers and public art city officials provided guidance and direction to help establish the guidelines for selecting artworks for future floors and clinics. Currently, the program has over 2,000 art-related objects throughout all levels of our hospital and clinical facilities. This vision and commitment to excellence and education enabled University Health System to establish Salud Arte: Art of Healing in 2010. This integrated program has three distinct phases for the implementation of the artwork. First is design enhancement, or artwork integrated into the construction of the building and augmenting elements already designed. Second is public art in sitespecific areas of the building and campus, where the placement of an art piece creates a signature element and assists with wayfinding. Finally, art procurement is the use of framed two-dimensional items as well as small sculpture and glass. As University Health System celebrates its 100-year legacy of compassionate service to the community, art serves as a gateway to a broader audience of patients and family members who might never have been exposed to art in the workplace, a place of healing or public setting. Just as a library offers expanded knowledge in literature, a setting with elements of art and creative design can provide positive distraction and inspiration. Some evidence even suggests it can lower medical costs through shorter hospital stays and less medication. Our art program is not a static list of objects, but a fluid and organic process that seeks to grow and adapt with the population we serve. The art program offers a tool for branding and marketing, letting the community know that we are unique in our approach to patient care and services. At our infusion and blood donor centers, art was incorporated based on personal input from staff members. Newly expanded pediatric programs sought to create clinical areas that provide a healing and welcoming experience for children from toddlers to teenagers, along with their families. University Health System also continues to develop art and humanities partnerships with citywide and regional groups. We joined with the Witte Museum to create a health awareness campaign for children (the H-E-B Body Adventure — powered by University Health System), and developed a poetry and creative writing program for our staff with Gemini INK. Other partners include SAY SI, Sea World, Cambridge Elementary School, McNay Art Museum, YOSA, Bibliotech and the San Antonio Public Library. 20 San Antonio Medicine • July 2017
An art program can increase mobility as patient and caregiver travels the floors to look at artworks. It can enhance mood, encourage relaxation and improve communication through art therapy. It reduces anxiety and stress, encourages self-expression, promotes selfesteem and helps some people work through traumatic experiences. Caregivers and family members who spend long periods of time alongside patients can also benefit from the chance to create, to view the art work or take advantage of programs aimed at relaxation and meditation. Our long-term goal is to develop all of these aspects into a cohesive, umbrella-style program that will continue to address the everchanging needs of our patients with compassion and creativity. We aspire to the development of a multi-faceted arts program that will stimulate healing, creativity and hopefulness, complementing our outstanding medical services and facilities. At the deepest level, the creative process and the healing process arise from a single source. When you are an artist, you are a healer; a wordless trust of the same mystery is the foundation of your work and its integrity.” - Rachel Naomi Remen, M.D.
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University Health System 100 years of service to the community By Don Finley, director of external communications, University Health System The opening of the Robert B. Green Memorial Hospital a century ago drew a crowd of some 5,000 people who were curious to see what the newspapers called one of “the most modern and best-equipped institutions in the south.” They had reason for a bit of civic pride. The Robert B. Green, named for a crusading county judge and state senator, was built with public funds — the city and county each contributing half of the $250,000 it cost to build. When it was discovered there weren’t enough funds to properly furnish and equip the new hospital, Alexander Joske, owner of Joskes Department Store, stepped forward and donated $15,000 The Robert B. Green Memorial Hospital sometime around 1939. to allow it to open on Feb. 2, 1917. The reason for that public and private investment was the recogCounty Hospital — known today as University Hospital. The mednition that San Antonio — the largest city in Texas at the time, and ical school and new hospital were both completed in 1968, affirming growing larger with an influx of troops massing for the start of World University Health System's role in teaching future generations of War I and refugees fleeing the Mexican Revolution — very much healthcare professionals. needed a hospital that would care for all who needed it, regardless University Health System today includes more than two dozen of their ability to pay. primary care, specialty, preventive and school-based health centers This year, University Health System is celebrating the centennial throughout the community, including the Robert B. Green Campus anniversary of its beginnings and taking stock of its history. You — a multi-specialty outpatient center that includes a new, six-story can read more about that history online at www.universityhealthclinical pavilion alongside the original historic building. system.com/100birthday. University Hospital still serves as the primary teaching facility for The years that followed that promising start were rocky. Funding UT Health San Antonio. In 2014, the million-square-foot Sky Tower was uncertain — not surprising for a hospital that cared for the poor, was completed, providing one of the most beautiful and technologparticularly one whose early years included the Great Depression. ically advanced clinical facilities for children and adults anywhere. Many of the Green’s programs were forced to close for a time. Both the clinical pavilion and Sky Tower were made possible with Finally, in 1955, Bexar County voters overwhelmingly approved the approval by Bexar County Commissioners of a bond sale to fund creation of the Bexar County Hospital District and a property tax the $899 million Capital Improvement Project that would position to fund it, making it one of the first hospital districts in Texas. Bexar University Health System for the challenges of the decades ahead. County Commissioners approved its budget and appointed its And as University Health System looks ahead to the next 100 Board of Managers. years, we remain committed to healing, advancing knowledge and After years of communitywide efforts to bring a medical school discovery, and promoting the good health of the community. And to San Antonio, the school was finally approved by state lawmakers above all, we strive to be compassionate professionals, fostering a with the stipulation that a new, state-of-the-art teaching hospital be culture of excellence and treating all who enter our doors with kindbuilt nearby. In 1965, construction began on the $15 million Bexar ness and respect. visit us at www.bcms.org
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A CREATIVE APPROACH: THE USE OF ART IN THE TREAMENT OF CHILDREN WITH MENTAL ILLNESS Virtually all children are natural artists from a young age, when they first experiment with finger paint or crayons. In the treatment of children with mental illness, this inherent interest in creativity yields extraordinary therapeutic value. Art facilitates the most vital aspects of therapy — communication, self-expression, insight — in an activity that most children find enjoyable and easily immerse themselves in. Whether a child is treated by an art therapist or art is used as part of the therapeutic process, art has a unique capacity to deliver effective psychological treatment in a way that overcomes some of the challenges of working with young patients while aligning with their abilities and interests.
Art Therapy is a Mental Health Profession By Melissa Dilworth, LPC-AT-S, ATR-BC Outpatient Therapist, Clarity Child Guidance Center Art Therapy is a mental health profession. Art Therapists utilize knowledge in mental health counseling with advanced training in artistic processes to assist clients with developmental, cognitive, and mental health well being. In the state of Texas, Art Therapists are licensed by the Texas State Board of Examiners of Professional Counselors. LPC-AT is the licensing credential. National credentialing of Art Therapists is overseen by the Art Therapy Credentialing Board. As a licensed Art Therapist working at Clarity’s outpatient clinic, I have the opportunity to utilize two art therapy approaches with clients: Art As Therapy and Analysis of Artwork. Art materials and art directives are prescribed to help address therapy goals. For many children, emotional regulation is a primary treatment goal, so working with a loose media such as paint may be prescribed. The client must utilize organizational skills, problem solving strategies, and physical control to manage such a task. Others struggle with limited insight and may benefit from projective interventions where they draw out a scenario and literally see and assess the image itself in an objective manner. Artwork is a projection of an individuals’ true self. Many individuals, especially children, have great difficulty articulating what they are feeling. Through the creative process, an individual is able to communicate symbolically. Art Therapists encourage clients to title their artwork, to speak about the image, or discuss the process of making the piece, to help facilitate an understanding of their emotional self. 22 San Antonio Medicine • July 2017
Art helps children overcome both the limitations of verbal expression and the challenges of talking about difficult subjects, according to Karl Koch, PhD, Psychologist, Clinical Director - Outpatient, Clarity CGC. “Art facilitates expression of the inner self because it is less likely to elicit psychological defensiveness associated with direct questioning about a A "Picasso" self-portrait from an art project in Therapeutic Recreation (TR). difficult emotional topic,” Koch said. “Art also facilitates motivation for treatment because it's inherently fun for children.” Because there are only a few licensed Art Therapists in San Antonio, Clarity is fortunate that many of the therapists at Clarity use therapeutic art interventions to help children and their families. As a team, Clarity strives to serve our community through quality and effective treatments. Art is communication. Art brings forth insight. Art promotes organization. Art is medicine.
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Recreation Therapists Incorporate Art in Patient Intervention By Cristal (Cris) Bleich, MSRLS, CTRS/BH Director of Therapeutic Recreation, Clarity Child Guidance Center Recreation therapy, also known as therapeutic recreation, is a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illness and/or disabling conditions, as a means to psychological and physical health, recovery and well being. A Certified Therapeutic Recreation Specialist (CTRS) is a professional who possesses a nationally recognized certification and has continually met the national standards to provide this type of therapy. Recreation therapists are certified by the National Council for Therapeutic Recreation Certification. The unique feature of therapeutic recreation that makes it different from other therapies is the use of recreational modalities in the designed intervention strategies. Through the use of recreation therapy, patients are exposed to a variety of interventions which include Reality-Oriented Physical Experiential Services (ROPES), a form of therapy focusing on action-oriented experiences; sports; sensory interventions; music; horticulture; group initiatives and art. Art is a key intervention used by CTRSs to help guide a patient toward health and happiness. Clarity’s therapeutic recreation department employs nine CTRSs. Using art throughout Clarity’s therapeutic recreation program helps children cope with their symptoms, stress, anxiety, depression, and other mental and emotional problems. Art provides patients opportunities to relax, to feel a sense of accomplishment, to discover
Staff and patients create the San Antonio skyline with thumbprints in a TR art project.
pride, and to develop a meaningful life-long hobby. CTRS uses art to encourage creative thinking, expression, and let patients come up with their own unique solutions. “Through art therapy and recreation therapy, children learn to discover themselves and discover coping skills they would have never been exposed to otherwise,” said Soad Michelsen, MD, Child & Adolescent Psychiatrist, Senior Medical Director, Clarity CGC. “Children learn a form of communication where it is safe to express their positive and negative feelings.” The therapeutic recreation team at Clarity displays patient-created art throughout the facility in order to foster their sense of accomplishment. Through this exposure to art and other recreational modalities, patients gain knowledge and skills to use as positive coping skills upon discharge.
In addition to tapping into the natural interests of children, art is also beneficial in that it is easily delivered in a variety of settings, including outpatient facilities, hospitals, classrooms and correctional facilities. Whether used in treatment by an art therapist or as one component of a multi-faceted therapeutic program, few modalities offer the depth and breadth of therapeutic benefits for children as art.
ABOUT CLARITY CHILD GUIDANCE CENTER Clarity Child Guidance Center (CGC) is the only not-for-profit organization in South Texas providing crisis assessment, inpatient, outpatient and day treatment mental health care to children ages 3-17. Clarity CGC offers the region's largest concentration of child and adolescent psychiatrists, with its onsite affiliation with Southwest Psychiatric Physicians. In addition, the center serves as a teaching hospital for The UT Health San Antonio and Baylor College of Medicine. Clarity CGC’s treatment network includes an eight-acre campus in the South Texas Medical Center with a 66-bed hospital and six-bed Crisis Assessment Center, as well as a Clarity Child Guidance Clinic located on the West Side of San Antonio. Clarity CGC is also committed to removing the stigma often associated with mental illness and has created the One in Five Minds campaign to raise awareness and educate the community, parents, professionals, and leaders about mental illness. Learn more and take the pledge at www.1in5minds.org. Clarity CGC is a United Way agency and serves children in need, regardless of their family’s ability to pay.
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The Merging of Art and Science Face to Face: The Craniofacial Program Portrait Project By Kathleen Waller Stewart, MD “Face to Face: The Craniofacial Program Portrait Project” is a unique partnership between the Craniofacial Program at the Children’s Hospital of Philadelphia (CHOP), the Edwin and Fannie Gray Center for Human Appearance at The University of Pennsylvania School of Medicine, and Studio Incamminati, an art school in Philadelphia dedicated to the techniques and principles of humanist realism. Through this program, the first of its kind in the United States, professional artists paint highly personalized portraits of children and adolescents with craniofacial conditions with the goal of enhancing the lives of all involved.
The Inception “Face to Face” was the joint brainchild of two remarkably accomplished men who happen to be close friends. Linton A. Whitaker, founder of the Craniofacial Program at CHOP, had a vision that went beyond repairing cleft lips and palates, which was the pinnacle of craniofacial plastic surgery when he began practicing his craft. Dr. Whitaker has developed one the worlds most recognized Craniofacial Plastic Surgery programs whose mission deals with a multitude of rare and complex craniofacial anomalies that challenge children and adolescents. Nelson Shanks (1937-2015) was an internationally-renowned artist celebrated for his exquisite ability to portray the human condition through his innovated approach to color as seen in his figurative works and portraiture. In partnership with his wife, Leona Shanks, Studio Incamminati, School for Contemporary Realist Art, was founded in 2002 in Philadelphia. Nelson Shanks’ commissions include a vast array of world leaders, including Pope John Paul XXIII, President Bill Clinton, the five female Supreme Court justices and, 24 San Antonio Medicine • July 2017
Princess Diana, to name a few. Dr. Whitaker and Mr. Shanks shared a love of aesthetics and beauty, a natural communion between a plastic surgeon and painter of the human form. Their conversations on this topic gave birth to the “Face to Face” venture, which was launched in 2013. The foundational concept was for artists affiliated with Studio Incamminati to paint the portraits of individual children and adolescents with craniofacial anomalies. Staff psychologists from the Edwin and Fannie Gray Center for Human Appearance followed these children along with their families closely during the process to assess the impact that this project had on psychosocial functioning and sense of well-being. The ultimate results of this endeavor have exceeded all expectations.
The Logistics The Craniofacial Program at CHOP recognizes that the complicated surgical approach to caring for these children is only a portion of a larger battle. The psychosocial hurdles facing each young patient are myriad and complex. Every child must deal with issues related to disturbed body image and subsequent poor self-esteem. In order to create a multispecialty, holistic and comprehensive program focusing on these challenges, the physician surgeons at CHOP work closely with the Edwin and Fannie Gray Center for Human Appearance at University of Pennsylvania. Not only is physical disfigurement considered a paramount issue for these children, but there are a multitude of other medical issues that surround speech, eating, hearing, and breathing. The psychological well being of each child is addressed concomitant with the physical. The array of craniofacial conditions encoun-
ART AND MEDICINE tered is vast and includes rare genetic disorders such as Treacher Collins Syndrome, Alpert Syndrome, Pfeiffer Syndrome, Moebius Syndrome, and so many others. Fourteen young patients have participated thus far in the “Face to Face” program. The children were paired with a professional artist affiliated with Studio Incamminati. Each portrait, painted in oil, was completed over multiple sittings (as many as 20). The children’s parents, and sometime their siblings, accompanied the sitters to each visit. The many hours that the artists, children, and their families spent together aided in developing strong trusting relationships, a necessary ingredient in capturing a intimate portrait.
The Results The children, their families, and the artists agreed at the outset to undergo in-depth interviews about their experiences both prior to and after the individual portraits were completed. Evaluations of these multiple interviews clearly demonstrate the very positive impact that the “Face to Face” portrait program had, not only on the patients, but the families and the artists as well. Without exception, these children experienced superior overall psychosocial functioning. The most notable impact was observed in the arena of improved self-image, which created an enhanced sense of empowerment in each child.
The role of a portrait painter is not only to create a like image of their sitter on the canvas, but to capture that person’s depth of character and the nuances of their psyche that combine to portray the specific uniqueness of the individual. The artists uniformly found the experience both moving and personally enriching.
Conclusion In today’s society, physical appearance affects our daily lives in countless ways. In particular, much of an individual is revealed and communicated by the human face. At the outset, these children with craniofacial anomalies cared for by the multispecialty team at the Craniofacial Program at CHOP did not view themselves as “portrait worthy.” Partly through the process of having their portraits painted by the professional artists affiliated with Studio Incamminati, these children have come to believe that the world can view them as people of value. This merging of art and science has resulted in a healing role in the lives of these remarkably strong and resilient patients. Please visit www.studioincamminati.org and click on "In the Community" to read more and to watch a short video further describing this program with interview of the children, their families, the physicians and artists.
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Students of Arathi School who have studied for 5-6 years to earn their ankle bells which is about the midpoint of their training in Bharathanatyam, a classical dance form.
Mine is to choose the Color of the Rainbow to Slide Down
What is Yours? By Rajam Ramamurthy, MD Simply saying I dance, would be an understatement of my life, the past 35 years. I learned, I taught, I created and stretched, I ached and cried, I exalted at the shear movement of my body. Can I share with you, who is thumbing this magazine, perhaps with your feet up on a desk, sixth cup of coffee in one hand and a waiting room full of patients, the exaltation and recharge that dance provided me and the women who shared the journey with me? It happened one evening at a social gathering. We were four young physicians in our 30s, each with a daughter around 5 or 6 years. The conversation drifted towards dance, specifically ‘Bharathanatyam,’ one of the ancient dance forms of India. All of us loved to dance and all of us grew up in India at a time when dance was denied to us. India had just attained independence. Waking up as though from a long slumber were the arts. Dance and music, sacred arts, practiced by a community of ‘Deva Dasi,’ literally meaning the one in love with god, was the only skill the women in this community possessed. Gone was the status as royal entertainers along with the Maharaja’s and their kingdoms as the British Raj’s voluptuous appetite dug into every spear of Indian life. The Devadasi’s slowly deteriorated into a community of courtesans. This was so long ago, but the stigma that it left on dance made it taboo for families to allow their daughters to even learn the art. I for one was born with bells around my ankles, so my mother would say, and remember dancing from age 4 all the 26 San Antonio Medicine • July 2017
way through medical school. I would quietly go into a room and be trying out movements I saw in movies. When I arrived in Chicago in 1967 for my pediatrics training and later a fellowship in neonatology, there was no time for anything except being in the hospital by 7:30 a.m. and working till you finished all your work. An intern had no day off. Life really gathered speed with romance, marriage and the arrival of two precious bundles as I danced around them all my waking and few disrupted sleeping hours. In 1975, I heard of a dance teacher who had started a ‘Bharathanatyam’ school in Chicago, one of the first in the country. How irresponsible to leave the children and go to dance. Little did I know that I should have carved that one hour for myself? Then again, I got swept away in the move to San Antonio, Texas. This is where the stars configured favorably. In 1981, five women, four physicians and a computer programmer, started the first Indian dance school in San Antonio. Our daughters and us studied this ancient art from a teacher from Dallas who came once a month and instructed. We the mothers held a class every Friday and to this day this tradition continues. Any dance is a total body exercise, more so Bharathanatyam which is precise and demands movement of every part of the body including your eyes. When our teacher retired, we mothers continued to teach. The youngest age at which we enroll a student is 5 years.
ART AND MEDICINE There is no upper limit. My pediatric training, particularly in child development, helped me to understand the motor skills of these little children. Some of the observations regarding attention, recollection and group dynamics was helpful to me in my practice as a neonatologist and in the premature infant development clinic. The stress of the neonatal Intensive care unit melted away as I turned on the dance music in the car. Every Friday, I eagerly prepared for class. I made it a point to dance with the students. At home, instead of the tread mill, I practice dance steps. Yoga for dancers is a practice very popular in India. We incorporated the yoga concept as part of the dance training. This has been very invigorating. As I age I find the yoga movements are the ones that help me to be flexible and strong. When I teach dance my total concentration is on dance, the outside world does not exist. This to me is mindfulness meditation. To get a shy 5-year-old to come on the floor to make that first stamping beat with the foot is as exalting as lifting 30 pounds of weight. To stand in the half sitting position, which is the hall mark stance in Bharathanatyam, strains every leg and trunk muscle. The most delightful part is what is called ‘Abhinaya’ or the portrayal of emotions. If I can teach an American born young girl the emotion of ‘Shringara’— romantic love where the girl casts her eyes down with
a little smile trying to escape her lips and she actually does it and creates the mood I would have accomplished a great victory as a teacher. As I am teaching the physical strenuous aspects of the dance and the subtle nuances of depicting emotions, constant fireworks are going on in my brain and I am in a state of super alertness. I come out of the dance studio thoroughly drenched in the exuberance of movement, my mind equally nourished by concentration and creation. I am ready for another call night eagerly waiting to see my tiny babies whose mere movement of one skinny leg wants me to dance with excitement. My wish for every physician is involvement in an activity that is their moment of meditation. “Sometimes it is important to work for that pot of gold. But other times it is essential to take time off and to make sure that your most important decision in the day simply consists of choosing which color to slide down on the rainbow.” — Douglas Pagels, “These are the Gifts I would like to give you.” Rajam Ramamurthy, MD Professor Emeritus, Department of Pediatrics UT Health
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A Poem for the Ages By Fred H. Olin, MD
Below is an Eponymic Epic I wrote during my first semester of medical school here in San Antonio back in late 1969. It was published in a short-lived student newspaper called “The Organ for the Artificial Dissemination of Information.” The paper lasted about 3 years, before it was suppressed by Dr. Truman Blocker, the “Temporary Institutional Head.” Dr. Blocker took Dean Carter Pannill’s place when he and the original chair of the Department of Medicine were fired by the University of Texas Board of Regents during the summer of 1972. Anyway, here it is:
60 Minutes Ago or An Auerbach The Anatomy Department came right out and said “Things should not be called by men’s names, (live or dead.) Accordingly, henceforth, and this is no whim, We’ll not be using even one eponym.” So they taught their courses in late ‘69 And for two or three minutes it all went just fine. The teachers spoke out in voices loud and clear, And here’s what they said for all students to hear: “The canal of Schlemm The cells of Schwann The foramen of Monro, Old Muller’s muscle, Hassall’s corpuscle Tetralogy of Fallot. “Fontana’s eye spaces, Bell’s palsy cases, Meissner, Nissl, Ruffini; Thebesian veins, Cajal silver stains, Cooper, Cowper, Pacini.
“The disks of Merkel, The cave of Meckel, Foramina of Luschka-Magendie. Apparatus of Golgi, Tubules of Malpighi, Horner, Henson and Henle.
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“Sphincter of Oddi, Pacchionian body, Pouches of Morison-Douglas. Tubus Fallopius, Tubus Eustachius, Circles of Douglas and Willis. “Howship’s lacunae, (and those of Morgagni,) Rathke, Camper, Purkinje. Gland of Bartholin, Arcus Riolan, And the duct of Santorini. “There are more than these forty, (Like the Organ of Corti) That you med students can truly depend on. Brunner and Harder, Ampulla of Vater, To say nothing of Achilles’ tendon.” This conveys the idea I’m trying to give, Of anatomist’s innate compunction. For without the use of these historical names They’d never be able to function. Fred H. Olin, MD, is a semi-retired orthopaedic surgeon who was born before WWII, but not long enough for him to be able to remember much about it.
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Using Art to Heal Physician Burnout By Ruth Berggren, MD, MACP From the beginning of time, human expression through music, literature and visual art forms has provided respite from the harsh realities of life. As healers, we’d do well to remember the words of our fellow physician Albert Schweitzer, the Nobel Peace Laureate, musician-theologian, who noted: “Joy, sorrow, tears, lamentation, laughter — to all these music gives voice, but in such a way that we are transported from the world of unrest to a world of peace, and see reality in a new way, as if we were sitting by a mountain lake and contemplating hills and woods and clouds in the tranquil and fathomless water.” Despite magnificent advances in the technology of medical science, we’ve found neither pills nor procedures to soothe the souls of the suffering as powerfully as music, poetry, literature and the visual arts. As statistics on physician burnout accrue, with controversies swirling about the shrinking pies of physician time and health care resources, it is still the case that the arts and medical humanities can transport us “from the world of unrest to a world of peace.” Students and faculty at the Center for Medical Humanities & Ethics at UT Health San Antonio believe that by studying, creating, sharing and surrounding ourselves with art forms (all of which are narrative storytelling in some way), we find not just those much-sought moments of transcendence: we become better healers, find community through shared values, and answers to professional burnout. In 2008, during my first year as center director, a medical student proposed to start a literary and arts journal by and for her peers. She proposed the journal’s title be Connective Tissue: a metaphor describing how the expression of our humanity can bind us together as a community, analogous to the manner in which connective tissue binds organs together into one body. Approaching Connective Tissue’s 10th anniversary, I am struck by its sustained growth and diversity: Our current issue brought submissions from nursing, dental, medical and PA students as well as from faculty, staff and even patients. There is no shortage of talent in our ranks. From photographers to poets, painters and writers of prose, everyone has a story to tell, and everyone has a need to tell their story. Connective Tissue entries illustrate not only the pathos of human suffering from disease, discrimination and injustice, but also the beauty to be discovered in quiet contemplation, the hard-won joys of transformation as learners discover their professional identities. 32 San Antonio Medicine • July 2017
Healer’s Touch is a statue by artisan carvers of the Shona Tribe in Zimbabwe. A much smaller version of this artwork was adopted by the Daisy Foundation in 1999 as Daisy Awards for Extraordinary Nurses to honor the superhuman work nurses do for patients and their families every day. University Hospital is a participating hospital in the program. Photo of statue by Mark Greenberg.
Connective Tissue features many examples of visual arts, and over time, a uniquely UT Health San Antonio genre has emerged from work by two of our recent graduates. You have been reading the genre on the pages of this magazine in recent months. Chris Yan and Sara Noble concocted “Project 6-55,” a writing workshop customized for busy clinicians who frequently believe that they are too busy or untalented for reflective writing. The workshop facilitates reflection on the meaning of our work as healers by pairing two previously described “flash-fiction” genres: the six word story (said to have originated with Ernest Hemingway during a bar-room wager), and the 55-word story (origins obscure but appearing in medical literature by the turn of this century). After a brief introduction, participants are given paper, pencil and a prompt, such as “think about a moment during your work week, when you were in the presence of a patient and you experienced …moral distress.” The workshop leader may substitute other words evocative of emotion, doubt, strife
ART AND MEDICINE or transformation, in other words, prompts that elicit our human response to the privilege and challenges of caring for our fellows in moments of great joy, pain, loss or distress. These are moments we experience every day. Rarely do we process them. They accumulate in ways that weigh us down. A six-word story costs so little effort to write. And yet, it can lighten the existential load we bear when we share the story with peers. In the Project 6-55 workshop, participants are timed: they have to write as many six word stories as they can come up with in exactly five minutes. Next, participants select the most evocative set of six words, and are given exactly 15 minutes to expand the story to 55 words. For the timid, those who regard a blank piece of paper with as much dread as if it were a 14,000-foot peak to be conquered, a digestible prescription is offered. Sig: take 10 words per line, times 5 lines on your paper, and 1 more line with just 5 words. Disp: # 55 words. Writers are coached to focus on clarity and simplicity of expression. They learn to dispense with adjectives and hue to the core of what they most desire to communicate. As a workshop leader, I relish the intensity in the room as a chorus of pencils fervently scratches sheets of paper, punctuated by frantic erasing under pressure of the stopwatch. There is something magical about the 15 minute time constraint. It relieves anxiety about a potentially limitless amorphous task (after all, one can only bear to probe the meaning of one’s existence by knowing the scrutiny will end very soon), and it forces one to shed all frills, layers of ego and self-indulgence in the interest of getting the gist across with a powerful economy of words. What emerges is something crystallized and pure. The writer often does not realize what is bubbling up from their subconscious through their choice and juxtaposition of words. Only by sharing the expression with peers does insight emerge through discussion and feedback. Every 6-55 workshop I’ve attended has elicited some form of wonder, frequently accompanied by laughter or tears, as healers recognize and affirm one another for the humanity in their responses to role of healer. So, too, the other disciplines within medical humanities pull from us expressions of our humane-ness, enhancing our cognitive empathy, which is nothing more complicated than our capacity to imagine the experience of the Other. At the Center for Medical Humanities & Ethics, we offer elective courses in four areas: Community Service Learning, Global Health, Literature and Art, Ethics and Professionalism. These four seemingly disparate areas are linked together in their common purpose, offering a means through which to teach ethics and professionalism while nurturing empathy and humanitarian values. One cannot accompany a patient through a fraught ethical dilemma without understanding the full context of their illness as well as their prognosis and medical options. The information you need to help make correct therapeutic decisions must come from context, which is to say, the story the patient
has to tell. But one can only get that context by eliciting the story and listening in a way that leads to insight, and mutual trust. One must understand how your physician perspective differs from that of your patient. One must understand how patients perceive and understand their disease in order to be credible enough to coach them back to health. Patients perceive a lack of empathy in their computer-screen fixated physicians and become dissatisfied with care, more likely to sue and less likely to adhere to treatment regimens. Hemoglobin A1cs and LDLs don’t reach their goal, and the doctor lashes out with “medical non-compliance” in the problem list. The literature is rife with studies proving that patients value a doctor who cares about them. Medical humanities courses teach all this in an experiential manner; all involve learning through reflection and active doing of some kind; all are designed to nurture empathy and to see reality through another’s perspective. How, you may ask, do medical humanities courses relate to the mission of medical education? Is there value and relevance to health care for this kind of teaching? The answers to these questions are tough to find and impossible to quantify, but I refer to narrative evaluations of courses like our “Art Rounds” elective for medical and nursing students at the McNay Art Museum, or “Patient Notes,” exploring music and medicine, or “Medicine through Literature” where students read physician-writers like Abraham Verghese, Anton Chekov and Victoria Sweet, as well as works by blind poets and exMarines. All our courses, from “Foundations in Global Health” to “Poverty, Health and Disease,” elicit student responses that suggest transformation, the introduction of new ways of seeing the Other, of understanding the role of the physician in the world, and the value to the world of being a compassionate physician. A decade of student narratives and letters from former graduates consistently attest that experiential learning in the medical humanities is truly “preparing tomorrow’s healers to ACT, with compassion and justice.” For physicians well into their careers and battling burnout, student attestations remind us of the joy in connecting. Connecting to humanity through the arts and to our core healing purpose through the stories of our patients — this is the ultimate answer to burnout. Dr. Ruth Berggren directs the Center for Medical Humanities & Ethics at UT Health San Antonio. In this role, she teaches ethics and professionalism while nurturing empathy and humanitarian values. Dr. Berggren is the Marvin Forland, M.D., Distinguished Professor in Medical Ethics, and she holds the James J. Young Chair for Excellence in Medical Education. Dr. Berggren is board-certified in both internal medicine and infectious diseases with significant experience and particular interest in clinical AIDS and viral hepatitis research, as well as in implementing HIV care in resource-poor settings. visit us at www.bcms.org
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LEGAL EASE
“This Doctor is horrible. Stay away.” By George F. “Rick” Evans, Jr. Evans, Rowe and Holbrook
What do I mean by “This Doctor is Horrible. Stay away?” I’m referring to the power of social media and the negative postings your patients (or at least some of them) are digitally sending through cyberspace for the world to see. There are countless social media sites by which people can vent their displeasure towards anybody, whether it be an auto body repair shop or you. And your other patients read them when they turn to the Google machine to check you out. So, what can you do about them? The law strongly, strongly favors freedom of speech but, that said, there are legal remedies available to you when a person goes beyond expressing his opinion but instead slanders or libels you. It’s one thing for a person to say he thought his doctor was callous, shorttempered or overpriced. Those are legally protected expressions of opinion. It’s another thing altogether for a person to say his doctor fraudulently billed him or sexually abused him. While expressions of personal opinion are legally protected, statements that are allegedly factual in nature are not. It’s sort of like saying “the food at this restaurant tastes terrible” versus “the food at this restaurant is contaminated with E. Coli.” The former is opinion whereas the latter is a statement of fact. 34 San Antonio Medicine • July 2017
If somebody posts something about you that is just their opinion, you’re out of luck insofar as the courthouse is concerned. If their posting is an untrue statement of fact, you have legal remedies available to you. Most postings, however, aren’t libelous so this article addresses what steps you can do when either you don’t have a case or, even if you do, you don’t want to go to the hassle of hiring a lawyer to pursue it for you. Here are the steps most lawyers and public relations companies agree upon. Don’t Fire Back: It’s a mistake to roast the person with a “you’re so freakin’ wrong you idiot that you have no clue what you’re saying.” Instead, (take a big gulp, or two, of Tequila, if necessary) and say this instead: “I appreciate and thank you for taking the time to share your feelings. There are some unmentioned facts in your post that may explain matters, but what’s important to me is that your concerns are acknowledged, appreciated and steps taken to “fix things.” So, please contact my office at your convenience so we can do what’s necessary to make sure your concerns are addressed. Again, thanks for your post. It’s important to me.” Don’t be defensive or combative even though your heart is screaming to the contrary.
LEGAL EASE
Respond Quickly: Don’t spend days or weeks stewing over it. It’s important that your reply be made as rapidly as possible. Prompt responses suggest spontaneity and honesty. The longer it takes, the more it looks like a measured, politically-correct and perhaps insincere reply. Be Brief: This paragraph is sure to get me in serious trouble, but I’m old enough now that I’m hoping you’ll forgive me for my dated sense of humor. A law professor once told me that, in drafting legal briefs to the court, they should be like a Scotsman’s kilt; long enough to cover the subject but short enough to keep it interesting (true story, it was in my property class in 1975 by perhaps the smarted profs I ever met). Anyway, the point is don’t be like a lawyer who gets paid by the minute. Keep it short, precise and limited to no more than a few sentences. Remember Shakespeare’s line in Hamlet “The lady doth protest too much, methinks.” Too much of a reply screams defensiveness. Consider making an offer: By that I mean reaching out to the patient and offering something that addresses the issue. In most circumstances, you can look good by saying “I’d like to offer a private appointment where we can sit down one on one and discuss each of your concerns so I can make sure they’re recognized and handled.”
Look, I know all appointments are private anyway, but this just makes it seem extra special. Remember, the object here is also to make people who read this stuff think you’re a good guy and not the malevolent creature the person suggests. Take the discussion off line: Your posts should make it clear that you’re asking the disgruntled person to communicate with you and your office directly. Notice how the suggested replies outlined above require that the person deal with you privately rather than continuing the discussion in a public forum. You want to steer unhappy people into venting privately rather than to a national, regional or local audience. Listen and be honest: You need to objectively assess what others are saying about you. Don’t blow it off. You really need to investigate it. God forbid, but there may actually be a germ of truth to some of those negative comments, and, if there’s enough of them, that “germ of truth” is now septicemia. If your practice has got a problem, own it and fix it. Drop your defensive shields and use it as a marketing opportunity by which you correct your blind spots so you evolve into a better and more profitable practice. Nobody likes negative commentary, but it isn’t going away anytime soon. Follow these steps and you’ll keep the impact to a minimum.
visit us at www.bcms.org
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BUSINESS
NEW DEPRECIATION RULES: Write-offs everywhere you look By Bennett Allison, CPA, CFP
Starting in 2016, the IRS changed the rules for the capitalization and depreciation of fixed assets with the introduction of Notice 2015-82. For many businesses, this change both simplifies record keeping and provides the opportunity to accelerate income tax deductions. Notice 2015-82 provides for a $2,500 de minimus safe harbor election. This election allows taxpayers to expense asset purchases up to $2,500 per item, per invoice starting January 1, 2016. For example, a doctor’s office spends $60,000 for the purchase of thirty new computers for all of its employees. At $2,000 each, the purchases fall under the $2,500 de minimus per item, per invoice limit. Accordingly, this purchase does not get considered for capitalization and depreciation purposes and instead $60,000 is taken immediately as a deductible expense. There are two caveats to keep in mind when applying the de minimus safe harbor. First, the $2,500 safe harbor must be applied for both internal book financial statement reporting and for external tax reporting. Second, the taxpayer must have a capitalization policy in place for the $2,500 expensing. The new rule is significant in that small to medium sized businesses will find in most situations that they can immediately writeoff almost all asset purchases when combining it with existing provisions such as the Sec. 179 deduction and 50% bonus depreciation. For 2016 and 2017 (assuming no law changes affect 2017), most medical practices should be able to write off assets purchases on the $2,500 per item, per invoice basis, then expense items such as furniture, machinery, and equipment up to $500,000 in total each year, and finally take 50% bonus depreciation on original use items (i.e. not used items) such as furniture, machinery, equipment, and certain leasehold improvements. The application of these rules are applied in the following example: ABC Physicians purchased and placed into service the following asset in 2016: 100 chairs at a cost of $600 each, 10 work stations at a cost of $1,500 each, 10 exam tables at a cost of $4,500 each, and 1 new MRI machine costing $475,000.
36 San Antonio Medicine • July 2017
The tax result under the new safe harbor rules for 2016 is as follows: • $60,000 expense for the chairs • $15,000 expense for the work stations • The exam tables will have to be capitalized, but all $45,000 can be taken as a current year expense under Sec. 179 up to $500,000 • The MRI machine will have to be capitalized. $455,000 can be taken as a current year expense under Sec. 179 to reach a total of $500,000. Of the remaining $20,000 ($475,000 - $455,000), $10,000 can be taken as an immediate deduction under 50% bonus depreciation. The remaining $10,000 is depreciated over 5 years. In the scenario above, $595,000 of assets are purchased with a resulting current year write-off of $587,000 (an extremely favorable tax result). Medical practices should definitely look at whether they are taking advantage of the new $2,500 expensing rules under Notice 2015-82. This will involve both adopting a capitalization policy and then informing office personnel about the new expensing rules to ensure they are properly applied. Between this new rule and existing depreciation provisions such as Sec. 179 expensing and 50% bonus depreciation, the opportunity to purchase assets and get an immediate tax write-off is better than ever. Bennett Allison, CPA, CFP™ is a shareholder at Sol Schwartz & Associates, P.C. (cba@ssacpa.com). He has over 21 years public accounting experience serving individuals, corporations, S-corporations, partnerships, trusts, estates, and non-profit organizations. In addition, Bennett works with a high concentration of physician practices and high net worth individuals. Contact Bennett at (210) 384-8000 Ext. 138.
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Please support our sponsors with your patronage; our sponsors support us.
ACCOUNTING FIRMS RSM US LLP (HH Silver Sponsor) RSM US is one of Texas’ largest, locally owned CPA firms, providing sophisticated accounting, audit, tax and business consulting services. Vicky Martin, CPA 210-828-6281 vicky.martin@rsmus.com www.rsmus.com “Offering service more than expected — on every engagement.” Sol Schwartz & Associates P.C. (HH Silver Sponsor) We specialize in areas that are most critical to a company’s fiscal well-being in today’s competitive markets. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”
ACO/IPA
IntegraNet Health (HHHH 10K Platinum Sponsor) IntegraNet Health is an Independent Physician Association that helps physicians achieve higher reimbursements from insurance companies whereby some of our higher performing physicians are able to achieve up to 200% of Medicare FFS. Executive Director Alan Preston, MHA, Sc.D. 1-832-705-5674 Apreston@IntegrNetHealth.com www.integraNetHealth.com
ASSET MANAGEMENT
Intercontinental Wealth Advisors LLC. (HHH Gold Sponsor) Your money’s worth is in the things it can do for you, things that are as unique and personal as your heart and mind. We craft customized solutions to meet in-
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vestment challenges and help achieve financial objectives. Vice President Jaime Chavez, RFC® 210-271-7947 ext. 109 jchavez@intercontl.com Wealth Manager David K. Alvarez, CFP® 210-271-7947 ext. 119 dalvarez@intercontl.com Vice President John Hennessy, ChFC® 210-271-7947 ext. 112 jhennessy@intercontl.com www.intercontl.com “Advice, Planning and Execution that goes beyond portfolio management”
ATTORNEYS
Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice. Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions”
Strasburger & Price, LLP (HHH Gold Sponsor) Strasburger counsels physician groups, individual doctors, hospitals, and other healthcare providers on a variety of concerns, including business transactions, regulatory compliance, entity formation, reimbursement, employment, estate planning, tax, and litigation. Carrie Douglas 210.250.6017 carrie.douglas@strasburger.com Cynthia Grimes 210.250.6003 cynthia.grimes@strasburger.com Marty Roos
210.250.6161 marty.roos@strasburger.com www.strasburger.com “Your Prescription for the Common & Not-So Common Legal Ailment”
BANKING
Amegy Bank of Texas (HHH Gold Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett 210- 343-4556 jeanne.bennett@amegybank.com Karen Leckie 210-343-4558 karen.leckie@amegybank.com www.amegybank.com “Community banking partnership”
BB&T (HHH Gold Sponsor) Checking, savings, investments, insurance — BB&T offers banking services to help you reach your financial goals and plan for a sound financial future. Stephanie Dick Vice President- Commercial Banking 210-247-2979 sdick@bbandt.com Ben Pressentin 210-762-3175 bpressentin@bbandt.com www.bbt.com
BBVA Compass (HHH Gold Sponsor) Our healthcare financial team provides customized solutions for you, your business and employees. Commercial Relationship Manager — Zaida Saliba 210-370-6012 Zaida.Saliba@BBVACompass.com Global Wealth Management Mary Mahlie 210-370-6029 mary.mahlie@bbvacompass.com Medical Branch Manager
Vicki Watkins 210-592-5755 vicki.watkins@bbva.com Business Banking Officer Jamie Gutierrez 210-284-2815 jamie.gutierrez@bbva.com www.bbvacompass.com “Working for a better future”
Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Ken Herring 210-283-4026 kherring@broadwaybank.com www.broadwaybank.com “We’re here for good.”
Ozona Bank (HHH Gold Sponsor) Ozona National Bank is a full-service commercial bank specializing in commercial real estate, construction (owner and non-owner occupied), business lines of credit and equipment loans. Lydia Gonzales 210-319-3501 lydiag@ozonabank.com www.ozonabank.com
The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Brandi Vitier 210-807-5581 brandi.vitier@ thebankofsa.com www.thebankofsa.com
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY SSFCU (HHH Gold Sponsor) Founded in 1956, Security Service provides medical professionals with exceptional service and competitive rates on a line of mortgage products including one-time close construction, unimproved lot/land, jumbo, and specialized adjustable-rate mortgage loans. Commercial Services Luis Rosales 210-476-4426 lrosales@ssfcu.org Investment Services John Dallahan 210-476-4410 jdallahan@ssfcu.org Mortgage Services Glynis Miller 210-476-4833 gmiller@ssfcu.org Firstmark Credit Union (HH Silver Sponsor) Address your office needs: Upgrading your equipment or technology? Expanding your office space? We offer loans to meet your business or personal needs. Competitive rates, favorable terms and local decisions. Gregg Thorne SVP Lending 210-308-7819 greggt@firstmarkcu.org www.firstmarkcu.org Frost (HH Silver Sponsor) As one of the largest Texas-based banks, Frost has helped Texans with their financial needs since 1868, offering award-winning customer service and a range of banking, investment and insurance services to individuals and businesses. Lewis Thorne 210-220-6513 lthorne@frostbank.com www.frostbank.com “Frost@Work provides your employees with free personalized banking services.” RBFCU (HH Silver Sponsor) 210-945-3800 nallen@rbfcu.org www.rbfcu.org
CONTRACTORS/BUILDERS /COMMERCIAL
Cambridge Contracting (HHH Gold Sponsor) We are a full service general contracting company that specializes in commercial finishouts and
ground up construction. Rusty Hastings Rusty@cambridgesa.com 210-337-3900 www.cambridgesa.com
Huffman Developments (HHH Gold Sponsor) Premier medical and professional office condominium developer. Our model allows you to own your own office space as opposed to leasing. Steve Huffman 210-979-2500 shuffman@huffmandev.com Lauren Spalten 210-667-6988 lspalten@huffmandev.com www.huffmandev.com
FINANCIAL SERVICES
Northwestern Mutual Wealth Management (HHHH 10K Platinum Sponsor) Our mission is to help you enjoy a lifetime of financial security with greater certainty and clarity. Our outcomebased planning approach involves defining your objectives, creating a plan to maximize potential and inspiring action towards your goals. Fee-based financial plans offered at discount for BCMS members. Eric Kala CFP®, AEP®, CLU®, ChFC® Wealth Management Advisor | Estate & Business Planning Advisor 210.446.5755 eric.kala@nm.com www.erickala.com “Inspiring Action, Maximizing Potential”
Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Jeffrey Allison 210-268-1530 jallison@ aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”
e3 Wealth, LLC (HHH Gold Sponsor) Over $550 million in assets under management, e3 Wealth delivers truly customized solutions to individuals and businesses while placing heavy emphasis on risk minimization, tax diversification, proper utilization and protection for each client's unique financial purpose. Managing Partner Joseph Quartucci, ChFC® 512-268-9220 jquartucci@e3wealth.com Senior Partner Terry Taylor 512-268-9220 ttaylor@e3wealth.com Senior Partner Jennifer Taylor 512-268-9220 jtaylor@e3wealth.com www.e3wealth.com
Intercontinental Wealth Advisors LLC. (HHH Gold Sponsor) Your money’s worth is in the things it can do for you, things that are as unique and personal as your heart and mind. We craft customized solutions to meet investment challenges and help achieve financial objectives. Vice President Jaime Chavez, RFC® 210-271-7947 ext. 109 jchavez@intercontl.com Wealth Manager David K. Alvarez, CFP® 210-271-7947 ext. 119 dalvarez@intercontl.com Vice President John Hennessy, ChFC® 210-271-7947 ext. 112 jhennessy@intercontl.com www.intercontl.com “Advice, Planning and Execution that goes beyond portfolio management” First Command Financial Services (HH Silver Sponsor) Nigel Davies 210-824-9894 njdavies@firstcommand.com www.firstcommand.com
GRADUATE PROGRAMS Trinity University (HH Silver Sponsor) The Executive Master’s Program in Healthcare Administration is ranked in the Top 10 programs nationally. A
part-time, hybrid-learning program designed for physicians and healthcare managers to pursue a graduate degree while continuing to work full-time. Amer Kaissi, Ph.D. Professor and Executive Program Director 210-999-8132 amer.kaissi@trinity.edu https://new.trinity.edu/academics/departments/health-careadministration
HEALTHCARE REAL ESTATE SAN ANTONIO COMMERCIAL ADVISORS (HH Silver Sponsor) Jon Wiegand advises healthcare professionals on their real estate decisions. These include investment sales- acquisitions and dispositions, tenant representation, leasing, sale leasebacks, site selection and development projects Jon Wiegand 210-585-4911 jwiegand@sacadvisors.com www.sacadvisors.com “Call today for a free real estate analysis, valued at $5,000”
HOME HEALTH SERVICES Abbie Health Care Inc. (HH Silver Sponsor) Our goal at Abbie health care inc. is to promote independence, healing and comfort through quality, competent and compassionate care provided by skilled nurses, therapists, medical social worker and home health aides at home. Sr. Clinical Account Executive Gloria Duke, RN 210-273-7482 Gloria@abbiehealthcare.com "New Way of Thinking, Caring & Living"
HOSPITALS/ HEALTHCARE SERVICES
Southwest General Hospital (HHH Gold Sponsor) Southwest General is a full-service hospital, accredited by DNV, serving San Antonio for over 30 years. Quality awards include accredited centers in: Chest Pain, Primary Stroke, Wound Care, and Bariatric Surgery. Director of Business Development Barbara Urrabazo 210.921.3521 Burrabazo@Iasishealthcare.com
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BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY continued from page 39 Community Relations Liaison Sonia Imperial 210-364-7536 www.swgeneralhospital.com “Quality healthcare with you in mind.”
Warm Springs Medical Center Thousand Oaks Westover Hills (HHH Gold Sponsor) Our mission is to serve people with disabilities by providing compassionate, expert care during the rehabilitation process, and support recovery through education and research. Central referral line 210-592-5350 “Joint Commission COE.” Methodist Healthcare System (HH Silver Sponsor) Palmire Arellano 210-575-0172 palmira.arellano@mhshealth.com http://sahealth.com Select Rehabilitation of San Antonio (HH Silver Sponsor) We provide specialized rehabilitation programs and services for individuals with medical, physical and functional challenges. Miranda Peck 210-482-3000 Jana Raschbaum 210-478-6633 JRaschbaum@selectmedical.com mipeck@selectmedical.com http://sanantonio-rehab.com “The highest degree of excellence in medical rehabilitation.”
Kristie Arocha 210-255-0013 karocha@swbc.com SWBC Mortgage www.swbc.com Mortgages, investments, personal and commercial insurance, benefits, PEO, ad valorem tax services
TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need. Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org John Isgitt 512-370-1776 www.tmait.org “We offer BCMS members a free insurance portfolio review.”
Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com
INSURANCE
INSURANCE/MEDICAL MALPRACTICE
SWBC (HHHH 10K Platinum Sponsor) SWBC is a financial services company offering a wide range of insurance, mortgage, PEO, Ad Valorem and investment services. We focus dedicated attention on our clients to ensure their lasting satisfaction and long-term relationships. VP Community Relations Deborah Gray Marino 210-525-1241 DMarino@swbc.com Wealth Advisor Gil Castillo, CRPC® 210-321-7258 Gcastillo@swbc.com Mortgage
Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) Texas Medical Liability Trust is a not-for-profit health care liability claim trust providing malpractice insurance products to the physicians of Texas. Currently, we protect more than 18,000 physicians in all specialties who practice in all areas of the state. TMLT is a recommended partner of the Bexar County Medical Society and is endorsed by the Texas Medical Association, the Texas Academy of Family Physicians, and the Dallas, Harris, Tarrant and Travis county medical societies.
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Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society
mkeeney@proassurance.com 800.282.6242 www.proassurance.com
The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”
Henry Schein Medical (HHHH 10K Platinum Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 percent to 50 percent.”
The Doctors Company (HH Silver Sponsor) The Doctors Company is fiercely committed to defending, protecting, and rewarding the practice of good medicine. With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer. Learn more at www.thedoctors.com. Susan Speed Senior Account Executive (512) 275-1874 Susan.speed@thedoctors.com Marcy Nicholson Director, Business Development (512) 275-1845 mnicholson@thedoctors.com “With 78,000 members, we are the nation’s largest physician-owned medical malpractice insurer”
MedPro Group (HH Silver Sponsor) Medical Protective is the nation's oldest and only AAA-rated provider of healthcare malpractice insurance. Kirsten Baze 512-375-3972 Kirsten.Baze@medpro.com www.medpro.com ProAssurance (HH Silver Sponsor) Group (rated A+ (Superior) by A.M. Best) helps you protect your important identity and navigate today’s medical environment with greater ease—that’s only fair. Keith Askew Market Manager kaskew@proassurance.com Mark Keeney Director, Sales
MEDICAL SUPPLIES AND EQUIPMENT
MERCHANT CARD/CHECK PROCESSING Firstdata/Telecheck (HH Silver Sponsor) We stand at the center of the fastpaced payments ecosystem, collaborating to deliver nextgeneration technology and help our clients grow their businesses. Sandra Torres-Lynum SR. Business Consultant 25 years of dedicated service 210-387-8505 Sandra.TorresLynum@FirstData.com ‘The true leader in the payments processing industry’
OFFICE EQUIPMENT/ TECHNOLOGIES
Dahill (HHH Gold Sponsor) Dahill offers comprehensive document workflow solutions to help healthcare providers apply, manage and use technology that simplifies caregiver workloads. The results: Improved access to patient data, tighter regulatory compliance, operational efficiencies, reduced administrative costs and better health outcomes. Major Account Executive Wayne Parker 210-326-8054 WParker@dahill.com Major Account Executive
BCMS CIRCLE OF FRIENDS SERVICES DIRECTORY Bradley Shill 210-332-4911 BShill@dahill.com Add footer: www.dahill.com “Work Smarter”
PAYROLL SERVICES
SWBC (HHHH 10K Platinum Sponsor) Our clients gain a team of employment experts providing solutions in all areas of human capital – Payroll, HR, Compliance, Performance Management, Workers’ Compensation, Risk Management and Employee Benefits. Kristine Edge Sales Manager 830-980-1207 Kedge@swbc.com Working together to help our clients achieve their business objectives.
PROFESSIONAL ORGANIZATIONS The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, non-profit, R&D, healthcare delivery, professional services and more! President Kevin Barber 210-308-7907 (Direct) kbarber@bdo.com Program Coordinator Valerie Rogler 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”
SENIOR LIVING Legacy at Forest Ridge (HH Silver Sponsor) Legacy at Forest Ridge provides residents with top-tier care while maintaining their privacy and independence, in a luxurious resortquality environment. Shane Brown Executive Director 210-305-5713 hello@legacyatforestridge.com www.LegacyAtForestRidge.com “Assisted living like you’ve never seen before.”
STAFFING SERVICES
Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Brody Whitley, Branch Director 210-301-4362 bwhitley@ favoritestaffing.com www.favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”
To join the Circle of Friends program or for more information, call 210-301-4366 or email August.Trevino@bcms.org Visit www.bcms.org
One of Your Valuable Benefits
One of the benefits of being a member of the Bexar County Medical Society is the Circle of Friends (COF) program. Using your COF program offers a great way for you to save money on services and products that your practice uses every day. It’s like an Angie’s List for doctors. The Circle of Friends have vendors that range from accounting and banking to insurance and medical supplies… A-to-Z! Please note, all Circle of Friends sponsors pledge superior service and special discounts for Bexar County Medical Society members like yourselves. Just as important is the fact that their financial donations help keep the cost of your dues down and fund many of the society’s important programs and events. It’s a win-win scenario! Please Support our Sponsors with your Patronage — Our Sponsors Support Us! A complete directory of vendors and services can be found at http://www.bcms.org/busdir/index.html On the BCMS app. visit us at www.bcms.org
41
RECOMMENDED AUTO DEALERS AUTO PROGRAM
• • • •
We will locate the vehicle at the best price, right down to the color and equipment. We will put you in touch with exactly the right person at the dealership to handle your transaction. We will arrange for a test drive at your home or office. We make the buying process easy! When you go to the dealership, speak only with the representative indicated by BCMS.
Ancira Chevrolet 6111 Bandera Road San Antonio, TX
Batchelor Cadillac 11001 IH 10 W at Huebner San Antonio, TX
Jude Fowler 210-681-4900
Esther Luna 210-690-0700
GUNN AUTO GROUP
GUNN AUTO GROUP
GUNN AUTO GROUP
GUNN Honda 14610 IH 10 W San Antonio, TX
GUNN Infiniti 12150 IH 10 W San Antonio, TX
GUNN Acura 11911 IH 10 W San Antonio, TX
GUNN Nissan 750 NE Loop 410 San Antonio, TX 78209
Bill Boyd 210-859-2719
Pete DeNeergard 210-680-3371
Hugo Rodriguez and Rick Tejada 210-824-1272
Coby Allen 210-625-4988
Abe Novy 210-496-0806
Alamo City Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216
Cavender Audi 15447 IH 10 W San Antonio, TX 78249
Cavender Toyota 5730 NW Loop 410 San Antonio, TX
Northside Ford 12300 San Pedro San Antonio, TX
David Espinoza 210-912-5087
Sean Fortier 210-681-3399
Gary Holdgraf 210-862-9769
Wayne Alderman 210-525-9800
Ancira Chrysler 10807 IH 10 West San Antonio, TX 78230
Ancira Nissan 10835 IH 10 West San Antonio, TX 78230
Jarrod Ashley 210-558-1500
Jason Thompson 210-558-5000
GUNN AUTO GROUP
GUNN AUTO GROUP
GUNN Chevrolet GMC Buick 16550 IH 35 N Selma, TX 78154
Ancira Buick, GMC San Antonio, TX Jude Fowler 210-681-4900
Ingram Park Nissan 7000 NW Loop 410 San Antonio, TX Alan Henderson 210-681-6300 KAHLIG AUTO GROUP
Ingram Park Auto Center Dodge 7000 NW Loop 410 San Antonio, TX
Ingram Park Auto Center Mazda 7000 NW Loop 410 San Antonio, TX
Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX
Mercedes Benz of Boerne 31445 IH 10 W Boerne, TX
North Park Subaru 9807 San Pedro San Antonio, TX 78216
Daniel Jex 210-684-6610
Frank Lira 210-381-7532
Richard Wood 210-366-9600
John Wang 830-981-6000
Mark Castello 210-308-0200
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
North Park Subaru at Dominion 21415 IH 10 W San Antonio, TX 78257
North Park Toyota 10703 SW Loop 410 San Antonio, TX 78211
North Park Mazda 9333 San Pedro San Antonio, TX 78216
North Park Lexus 611 Lockhill Selma San Antonio, TX
North Park Lexus at Dominion 21531 IH 10 W San Antonio, TX
Stephen Markham 877-356-0476
Justin Boone 210-635-5000
Scott Brothers 210-253-3300
Jose Contreras 210-308-8900
Justin Blake 888-341-2182
KAHLIG AUTO GROUP
KAHLIG AUTO GROUP
North Park Lincoln 9207 San Pedro San Antonio, TX
North Park VW at Dominion 21315 IH 10 W San Antonio, TX 78257
Land Rover of San Antonio 13660 IH-10 West (@UTSA Blvd.) San Antonio, TX
Porsche Center 9455 IH-10 West San Antonio, TX
James Cole 800-611-0176
Ed Noriega 210-561-4900
Matt Hokenson 210-764-6945
Sandy Small 210-341-8841
AUTO PROGRAM
Call Phil Hornbeak 210-301-4367 or email phil.hornbeak@bcms.org
THANK YOU
to the large group practices with 100% MEMBERSHIP in BCMS and TMA
ABCD Pediatrics, PA
Renal Associates of San Antonio, PA
Clinical Pathology Associates
San Antonio Gastroenterology Associates, PA
Dermatology Associates of San Antonio, PA
San Antonio Infectious Diseases Consultants
Diabetes & Glandular Disease Clinic, PA
San Antonio Kidney Disease Center
ENT Clinics of San Antonio, PA
San Antonio Pediatric Surgery Associates, PA
Gastroenterology Consultants of San Antonio
Sound Physicians
General Surgical Associates
South Alamo Medical Group
Greater San Antonio Emergency Physicians, PA
South Texas Radiology Group, PA
Institute for Women's Health
Tejas Anesthesia, PA
Lone Star OB-GYN Associates, PA
Texas Partners in Acute Care
M & S Radiology Associates, PA
The San Antonio Orthopaedic Group
MacGregor Medical Center San Antonio
Urology San Antonio, PA
MEDNAX
WellMed Medical Management Inc.
Peripheral Vascular Associates, PA Contact BCMS today to join the 100% Membership Program!
*100% member practice participation as of June 20, 2017.
visit us at www.bcms.org
43
AUTO REVIEW
2017 Jaguar F-Pace SUV By Steve Schutz, MD
Many years ago, William Lyons, the vi-
Pace SUV, as the start button pulses red in a
trate vividly how much SUVs and crossovers
sionary leader who founded Jaguar, famously
heartbeat-ish blink-blink, pause, blink-
are surging and "regular" cars are dying. In
opined, "The car is the closest thing we will
blink, pause. It's a visual gimmick, of course,
2000, Porsche sold 22,410 cars in the U.S.
ever create to something that is alive." All
but it sends a message — as does the rotary
compared with 43,728 Jaguars, but in 2015,
these decades later I'd add the drone, Ama-
shift knob that rises from the center console
thanks to the Cayenne and Macan SUVs,
zon's Alexa, and any number of robots to the
after you start the car — that Jaguar is dif-
the story was reversed with Porsche selling a
list of life-like human creations — I would
ferent from Lexus/Mercedes/Audi etc. It's
remarkable 51,756 cars and SUVs compared
insert the adjective "annoying" to them, btw
more alive. Umm, OK.
with Jaguar's 14,466 cars. (For the record,
— but Sir William had a point. Our auto-
The fact that we're discussing a Jaguar
thanks to the new XE sedan and F-Pace,
mobiles are helpers and maybe even friends
SUV at all means that England's best known
Jaguar sales totaled 31,243 in 2016 and
to all of us, and it seems appropriate to pause
luxury automaker is less different from the
promise to be much more in 2017.)
to appreciate that warm connection to our
above mentioned competitors than it was
Not surprisingly, the F-Pace is very good
cars as we head inexorably toward a future
because Jaguar used to boast that they would
looking — it’s a Jaguar, after all. Integrating
dystopia where we're no longer allowed to
always build only cars, not SUVs, minivans,
a bigger facsimile of the front end from the
drive ourselves but instead must rely on
or crossovers.
XJ, XF, and XE sedans with a standard SUV
shared malodorous and autonomous pods to
While I applauded that vow when it was
profile, very fetching curves in its bodywork,
made 15 or so years ago, it was not a wise
and many elegant styling details, the F-Pace
Anyway, Jaguar obviously remembered
one. I've published these figures before, but
can’t help but catch your eye. It’s understated
Mr. Lyons' words as they developed the F-
they're worth repeating because they illus-
but gorgeous, like seeing Jessica Alba in jeans
ferry us from place to place. Ugh.
44 San Antonio Medicine • July 2017
AUTO REVIEW
and a t-shirt but no makeup at Starbucks.
which will be the F-Pace’s main competitor
— buyers are after, which is a car-like driv-
Inside, the F-Pace is a lot like its XF and
along with the ubiquitous Audi Q5. There’s
ing experience coupled with heightened bad
XJ siblings. The familiar rotary shift knob is
no third row of seats in the F-Pace, but
weather performance, I’d say the F-Pace
there along with the usual buttons and sur-
there’s plenty of room for you, two adult
nailed it.
faces. I’m not completely comfortable with
passengers, and all of your gear (behind the
I’ll bet William Lyons never imagined
the rotary shift knob in Range Rovers, but I
rear seats). Just remember that, while there
Jaguar would sell an SUV, but still, I think
like it in Jaguars, and it seems at home in the
are three seats and seatbelts in back, you
he’d approve of the F-Pace. It’s as “alive” as
F-Pace.
should stick with just two passengers in row
any Jaguar sedan, and it adds the utility that
two if you want everybody to be happy.
today’s luxury buyers demand. Take that,
The materials and ergonomics are nice, as you’d expect in a vehicle at this price point.
Since the F-Pace is built on the XF/XJ
Thankfully, Jaguar’s tech, like its cousin
platform, you’d expect it to drive like a tall
Land Rover’s, has improved. The central
car rather than a short SUV, and it does.
If you’re in the market for this kind of ve-
touch screen is much more intuitive with
That’s obviously a good thing if you value
hicle, call Phil Hornbeak at 210-301-4367.
menus that help rather than delay your find-
driving dynamics, as I do. I drove Jaguar’s
ing what you want, and managing the audio,
first and only SUV on open highways, twisty
Steve Schutz, MD, is a
climate control, and navigation systems is
back roads, and in town, and it behaved
board-certified gastroenterolo-
much easier than it used to be. This is 2017,
more like a station wagon than an SUV in
gist who lived in San Antonio
so I still needed to go back to my iPhone a
all circumstances. Given that, I wouldn’t
in the 1990s when he was sta-
couple of times. But I didn’t just give up,
trust the F-Pace on the Rubicon Trail or any
tioned here in the U.S. Air
which I guess is progress.
other off road, “paradises,” but for what ac-
Force. He has been writing auto reviews for
tual F-Pace — and Porsche Macan/Audi Q5
San Antonio Medicine since 1995.
The cabin is more spacious than a Macan,
Porsche.
visit us at www.bcms.org
45
46 San Antonio Medicine • July 2017