MD-Update Issue 139

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #139 WWW.MD-UPDATE.COM

Infectious Enthusiasm VOLUME 12 • #2 • April 2022

Infectious disease specialist Mark Burns, MD, loves his job, and it shows

ALSO IN THIS ISSUE ELISEO COLON, MD, CHI SAINT JOSEPH HEALTH, PULMONARY & CRITICAL CARE NATHAN LIU, MD, UofL PHYSICIANS, GASTROENTEROLOGY BENJAMIN NELTNER, MD, CHI SAINT JOSEPH HEALTH, INTERNAL MEDICINE

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2022

Editorial Calendar

ISSUE #140 (June) WOMEN’S & CHILDREN’S HEALTH

OB-GYN, Women’s Cardiology, Oncology, Urology, Pediatrics, Radiology, Travel Medicine

ISSUE #141 (September) MUSCULOSKELETAL HEALTH

Orthopedics, Sports Medicine, Plastic Surgery, Physical Medicine & Rehabilitation, PT/OT

ISSUE #142 (October) CANCER CARE

Oncology, Plastic Surgery, Hematology, Radiation, Radiology

ISSUE #143 (December) IT’S ALL IN YOUR HEAD

Neurology, Neuroscience, Ophthalmology, Pain Medicine, ENT, Psychiatry, Mental Health Editorial topics and dates are subject to change

To participate, please contact Gil Dunn, Publisher • GDUNN@MD-UPDATE.COM • 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com

LETTER FROM THE EDITOR/PUBLISHER MD-UPDATE MD-Update.com Volume 12, Number 2

Welcome to the Internal Systems issue of MD-Update Back in February when I spoke with Dr. Mark Burns, chief of UofL Infectious Disease, he told me that he was busy prior to the pandemic doing research, treating his continuity patients with HIV and various other infections, and making hospital rounds. He quickly became a public-facing spokesperson talking about infectious disease, vaccination and protection.

Dr. Burns had an early childhood encounter with a doctor who treated him for possible infection from a dog bite. I invite you to meet Dr. Mark Burns in our cover story on page 12.

Tort Reform and Noneconomic Damage “Caps” As I write this on April 11, 2022, the Kentucky legislature will be voting on two bills this week.

SB 142 and HB 455. Each bill seeks to amend the KY Constitution and effectively put “caps” on noneconomic damages from death and injuries. On page 7, our legal columnist, Joshua Owens, Esq., gives us an excellent summary of the two bills and their impact, saying, “Caps have been successful at curtailing medical malpractice litigation in the states that have implemented them and average medical malpractice insurance premiums have typically dropped.”

I believe Governor Beshear will veto the bills as unconstitutional, but his veto will be overridden by the Republican super majority. Tort reform is needed to address multiple problems within the healthcare industry in Kentucky. It’s way past time for kicking this can down the road.

Physician Retirement Advice I’m very pleased to have my friend Dr. Robert Granacher share his insights into the topic of non-financial retirement for physicians on page 10. “Retire to something, not from medicine,” Dr. Granacher says. I know he is open to hearing from you on the subject if you want to give him a call.

Coincidentally, I also heard last week from Dr. Jesse Wright, who just published his novel, A Stream to Follow, dealing with a soldier healing from PSTD in a WWII battlefield setting. More on that in our next issue.

Upcoming Issue and Topics Please take a look at the MD-Update editorial calendar on the preceeding page for your specialty.

Contact me because we want to hear from you. Every doctor I’ve spoken to over the last 15 years has an interesting story to tell. Let’s hear yours.

Until next time, all the best,

Gil Dunn Editor/Publisher MD-Update

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ISSUE #139

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CONTENTS

ISSUE #139

Infectious Enthusiasm 12 Infectious disease specialist Mark Burns, MD, loves his job, and it shows 4 6 7 8 10 12

HEADLINES ACCOUNTING LEGAL FINANCE OP/ED COVER STORY

SPECIAL SECTIONS: 16 GASTROENTEROLOGY 18 PULMONOLOGY 20 INTERNAL MEDICINE 22 COMPLEMENTARY CARE: HYPERTENSION

23 COMPLEMENTARY CARE: ORGAN DONATION 24 PUBLIC HEALTH 26 MENTAL WELLNESS 28 NEWS 30 EVENTS COVER PHOTOGRAPHY BY ALEXANDRA ROGERS

SPECIAL SECTIONS GASTROENTEROLOGY • PULMONOLOGY-CRITICAL CARE • INTERNAL MEDICINE/PRIMARY CARE

16 GASTROENTEROLOGY

18 PULMONOLOGYCRITICAL CARE

22 INTERNAL MEDICINE/ PRIMARY CARE ISSUE #139

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Headlines

Leading Cardiologist, Health Equity Expert Named Chair of UofL Department of Medicine Williams aims to expand healthcare access and advance provider wellness in Louisville

LOUISVILLE A nationally renowned cardiologist

and health equity expert has been selected to head the UofL Department of Medicine. Kim Williams Sr., MD, will serve as chair of the department beginning July 1.

As chair, Williams will lead the scientific, clinical, and educational programs of the UofL School of Medicine’s largest department, which includes more than 200 faculty and 150 staff in 10 divisions. He will also be responsible for the planning and guidance of clinical efforts within the UofL Health system as well as developing and implementing a vision for the department that integrates clinical, educational, and research missions, while fostering a culture of collaboration, equity, and inclusion.

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“We are excited that Dr. Williams will be joining our team,” said School of Medicine Dean Toni Ganzel. “He brings a wealth of expertise in cardiology and health equity. His academic background, clinical experience and leadership skills will be strong assets to the department, the institution, and our community. His work will enhance and augment our work with strategic partners in health equity.”

A Chicago native, Williams has over 40 years of experience as an educator, researcher, and clinician focused on advocacy for nutrition, national and international health care disparities, health care delivery, and advanced access to cardiac imaging. He currently is chief of the Division of Cardiology at Rush University and

PHOTO PROVIDED BY UOFL HEALTH

associate dean for faculty diversity, equity, and inclusion. He specializes in cardiology, cardio-nutrition, cardio-rheumatology, cardio-nephrology, preventive cardiology, and cardiovascular Kim Williams, Sr., MD radiology. A past president of the American College of Cardiology and the American Society of Nuclear Cardiology, he is former chairman of the board of directors of the Association of Black Cardiologists.

Williams is also the founder of the Urban Cardiology Initiative in Detroit, a program that works to reduce ethnic heart care disparities. Williams continues community-based efforts in Chicago at Rush, including leading the H.E.A.R.T. program (Helping Everyone Assess Risk Today), screening for heart disease and intervening with education, nutrition, and lifestyle changes.

Williams earned his medical degree from the University of Chicago Pritzker School of Medicine. He completed his internship and residency at Emory University Department of Medicine and a fellowship in cardiology at the University of Chicago.

“Building and leading Rush cardiology has been challenging and fulfilling, yet I was drawn to the UofL Department of Medicine by the leaders, the faculty and the fundamentals already in place, as well as the potential that I see for growth and impact in the areas of prevention and health equity,” Williams said. “We have leadership with vision, and we have some existing programs that will be enhanced – and some robust opportunities to develop – aiming to expand health care access in Louisville, maintain our high level of clinical quality and patient experience, deliver cost efficient care and keep provider wellness at the forefront.”

Headlines

Study Looks at How to Detect RSV in Adults Norton Infectious Diseases Institute enrolling patients LOUISVILLE Norton

Infectious Diseases Institute has been chosen to study how to effectively detect respiratory syncytial virus (RSV) in adults.

“For the most part, RSV attention has been focused on children,” said Julio A. Ramirez, MD, FACP, chief scientific officer, Norton Infectious Diseases Institute. “But some studies have suggested that up to 10% of adults with respiratory illness have RSV.” The study, funded by Pfizer, will look at some of the best ways to identify RSV in adults. The long-term goal is to determine which adults are most impacted. Patients ages 40 years and older who are experiencing respiratory symptoms and admitted to one of

Norton Healthcare’s four adult-service hospitals in Louisville are invited to participate in the study. Once enrolled, nasopharyngeal, saliva, sputum and blood samples will be collected.

RSV may also play a part in making underlying chronic health conditions worse, including cardiovascular, pulmonary, metabolic, and immune systems conditions.

“The majority of adults who get RSV have very minor symptoms,” said Ruth Carrico, PhD, DNP, APRN, FNP-C, CIC, FSHEA, FNAP, FAAN, director of research operations, Norton Infectious Diseases Institute. “But severe cases do occur in adults.”

Norton Infectious Diseases Institute was chosen for this study because of the team’s

experience in clinical research. The team began enrolling patients in December 2021 and has more than 300 patients participating to date.

The goal is to enroll up to 3,000 individuals over the course of the next two RSV seasons, which generally run November through April.

ABOUT THE RESEARCH TEAM Julio A. Ramirez, MD, FACP, is chief scientific officer for Norton Infectious Diseases Institute and professor of medicine at the University of Louisville School of Medicine.

Ruth Carrico, PhD, DNP, APRN, FNP-C, CIC, FSHEA, FNAP, FAAN, is director of research operations for Norton Infectious Diseases Institute. She is a family nurse practitioner and gratis faculty professor with the University of Louisville School Medicine Division of Infectious Diseases.

Volunteers of America Provides “Hope and Healing” by Registering Over 500 Organ Donors Innovative nonprofit partnership educates public and clients about addiction recovery and organ donation LOUISVILLE Leaders from Volunteers of America, Kentucky Organ Donors Affiliates (KODA), and Kentucky Circuit Court Clerks’ Trust For Life announced a groundbreaking milestone in their “Hope and Healing” partnership. The organizations teamed up in 2019 to create an innovative program to help increase organ donations in Kentucky and surrounding states. Under the partnership, Volunteers of America, one of the region’s largest providers of addiction recovery services, was the first nonprofit in the area to directly register individuals as organ donors.

The organization has now registered more than 500 program graduates as organ donors.

The partnership is crucial because Kentucky is increasing the renewal period for drivers’ licenses from four years to eight years, meaning that fewer Kentuckians will be asked each year

if they want to join the organ donor registry as they apply for or renew their drivers’ licenses.

More than 2 million Kentuckians are currently on the organ donor registry, but over 1,000 Kentuckians are in need of lifesaving transplants. In the United States, 20 people die waiting for an organ transplant each day because there are not enough registered donors.

“The most common reason we hear people saying ‘No’ to registering as a donor when they get their license is that they assume they can’t,” said Shelley Snyder, executive director of the Kentucky Circuit Clerks’ Trust For Life. “Many people assume they are too old or have too many medical issues. This is a myth. Everyone can register, and there are no limits. Each registered donor provides hope to those on the waiting list.”

Organs recovered from individuals who

have a history of alcohol and drug usage are safe, healthy, and acceptable for donation. This innovative partnership to increase donors across the state has also received attention from national organizations.

About Donate Life KY Kentucky Organ Donor Affiliates (KODA) is an organ procurement organization whose mission is to provide organ and tissues to those in need while maintaining respect for those who gave. The mission of Kentucky Circuit Clerks’ Trust For Life (TFL) is to educate and encourage Kentuckians to register as organ and tissue donors while obtaining a driver’s license and beyond. These organizations partner in education and outreach and use the combined, national Donate Life brand; learn more at www.donatelifeky.org.

ISSUE #139

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Accounting

Revenue Cycle Management (RCM) in Healthcare: Part 1

BY ADAM SHEWMAKER, FHFMA, HEALTHCARE CONSULTING DIRECTOR

Healthcare professionals strive to deliver exceptional service and outcomes to their patients throughout every facet of care. A significant point of friction for patients is cost – both the uncertainty of expense and lack of clarity in terms of understanding medical billing.

A patient-centered approach to billing can reduce that worry, improve overall patient experience, and shorten the revenue cycle of claims. Understanding the revenue cycle in healthcare is the first step toward creating a patient-centered, streamlined revenue system.

Revenue Cycle Management: What Is It? The healthcare revenue cycle encompasses all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.

Revenue cycle management (RCM) is how an organization manages finances and associated processes as they relate to the full scope of patient care.

Primary functions involved in RCM include: • Patient registration: Collecting patient demographics, including billing address and insurance eligibility • Insurance verification: Validating patient insurance • Medical transcription: Transcribing patient reports supplied by doctors and nurses • Medical coding: Applying universal medical codes to the diagnoses of and procedures performed upon the patient • Charge entry and billing: Applying a dollar amount to services provided and creating a claim • Claim submission: Determining amount of reimbursement the provider seeks from insurance and applying for that amount 6

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• Claim rejections: Instances where claims are rejected for payment by insurers • Payment and posting: Applying payments by insurers to the balance of the patient’s claim • Secondary claims submission: Submitting claims to additional insurers, such as Medicaid • Denial management: Determining cause of claim denial and assessing if the denial can be appealed • Medical appeals: Appealing a payment denial by an insurer • Patient collections: Determining amount owed by patient after insurance payments are applied and collecting payment • Refunds: Determining if any parties are owed refunds after the balance of payments has been received from all billable parties.

One of the biggest organizational roadblocks to executing these functions efficiently is poor interdepartmental communication. Having both the clinical and administrative sides of your organization unified in the process of RCM is vital to increasing revenue. When front-end and back-end administrative units communicate, there is far less duplication of effort and internal waste.

Advantages of Revenue Cycle Management With an efficient RCM system in place, your organization can accurately forecast revenue, identify points of friction within the billing process, and more readily identify instances of waste and fraud.

• Simplified Claims, Faster Payment When the revenue cycle is managed properly from start to finish, there are more opportunities to reduce patient stress from confusing claims and billing statements. Offering payment opportunities in-office at

time of appointment and via online portals linked to digital charts enables patients to use familiar, non-threatening interfaces to submit payment for copays and associated up-front costs.

• Better Organizational Outcomes Revenue is the engine that keeps the healthcare system running smoothly. The disruption seen in 2020 and beyond has impacted patients, providers, and stakeholders alike. Provider expenditures grew across the board, while sources of revenue were skewed greatly due to increased Federal COVID-19 spending (up 36.0% in 2020, compared to 5.9% growth in 2019) as well as reduced spending by consumers (down 3.7%) and insurers (down 1.2%). An efficient RCM system bolsters revenue streams and offers a degree of future-proofing.

Overview of the Revenue Cycle Process There are many opportunities for process improvement throughout the revenue cycle. By better understanding how these functions relate to each other, your RCM team can identify weak points and craft a strategy to eliminate them. We’ll discuss these opportunities in our next column in MD-Update, coming in June 2022.

Adam Shewmaker can be reached at 502.566.1054 or ashewmaker@ddafhealthcare.com.

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Legal

Is Kentucky Ready for Damage “Caps?”

BY JOSHUA J. OWEN

On February 3, 2022, Kentucky House Representative Josh Bray (R-71) and Kentucky Senator Ralph Alvarado (R-28) each introduced legislation (House Bill 455 and Senate Bill 142) to amend Section 54 of the Kentucky Constitution. Section 54 currently reads: “The General Assembly shall have no power to limit the amount to be recovered for injuries resulting in death, or for injuries to person or property.”

Limits on “Noneconomic” Damages The proposed legislation seeks to amend Section 54 to allow the General Assembly to 1) limit the recovery of noneconomic damages for injuries resulting in death; and 2) limit the recovery of noneconomic damages for injuries to person or property. In other words, the legislature would have the ability to place “caps” on damage awards. Furthermore, the legislation seeks to provide a uniform statute of limitations or statutes of repose, or both, for any civil action for injuries resulting in death or for injuries or property damage. If passed, Kentuckians will vote in November whether to approve the Amendment. This legislation is supported by the Kentucky Chamber of Commerce.

Noneconomic damages are damages for pain and suffering, mental anguish, inconvenience, loss of use, and diminished quality of life. Jury awards of noneconomic damages vary dramatically due to a variety of legal claims for damages. Economic damages, i.e., a loss of earning power, would not be “capped.”

Twenty-six States Have Similar “Caps” Since 2000, numerous states have passed ballot initiatives to amend their constitutions, and sixteen states have passed a “cap” on non-economic damages. At least twenty-six states “cap” non-economic damages in medical malpractice claims. The “caps” range from $250,000.00 to $2,350,000.00, with the median cap being $465,900.00.

This is the first time in several years that this legislation is being considered in both the Senate and House of Representatives. In 2004, a similar proposed constitutional amendment passed the Senate, but the House never considered the bill on the floor.

Higher Damages, Higher Costs?

The United States has the world’s costliest legal system as a share of its economy, according to the U.S. Chamber of Commerce Institute for Legal Reform’s 2018 Costs and Compensation of the U.S. Tort System Report.

It found that Kentucky ranked 42nd in tort costs per household with an average of $2,608, and currently ranks in the bottom ten states in the nation regarding its legal liability climate. Furthermore, per the Institute for Legal Reform, 89 percent of company executives and attorneys surveyed say a state’s legal environment impacts important decisions about where to locate or conduct business, which is a 14 percent increase from the same survey in 2015.

According to the Kentucky Chamber of Commerce, the rising costs associated with medical malpractice liability are taking a significant toll on the health care industry, resulting in increased costs for consumers and a continued inability to attract and retain enough physicians in all regions of Kentucky. The high price of liability insurance and the lack of reasonable tort limitations in Kentucky, including the lack of “caps,” are believed to have contributed to a shortage of medical professionals.

A 2021 analysis from the American Medical Association shows Kentucky leads the nation in increases in medical liability plan costs. In 2020, 29.6 percent of medical liability policies in Kentucky saw a cost increase of more than 10 percent, the most in the U.S. In all, 55.6% of these policies in Kentucky saw some increase in 2020, which was the second-most in the nation. Since Kentucky has no limits on jury verdicts, numerous awards running into the

millions of dollars, in part due to recovery of noneconomic damages, have occurred. While most medical malpractice cases resolve prior to trial, health care providers must preemptively budget for litigation costs, increasing health care costs for everyone. “Caps” have been successful at curtailing medical malpractice litigation in the states that have implemented them, and average malpractice insurance premiums have typically dropped.

Legislation Challenges If passed, this legislation would bring Kentucky in line with neighboring states like Ohio, Tennessee, Indiana, and West Virginia, although other regional states have had “caps” ruled unconstitutional by their state courts.

Even though neither bill affects a person’s right to sue for negligence, “caps” on damages have been a hot button issue. However, unlike in years past, Republicans, typically tort reform advocates, now hold veto proof majorities in both the Kentucky House and Senate.

If the proposed legislation were to pass, legal challenges are sure to follow. Some contend the proposed amendment to Section 54 of the Kentucky Constitution would be in conflict with the jural rights doctrine recognized by Kentucky Courts in Williams v. Wilson, 972 S.W.2d 260 (Ky. 1998). Opponents also argue it would violate the strict separation of powers in the Kentucky Constitution by infringing on the province of the judiciary.

Is Kentucky Legislature ready to cap economic damages? We will know by the end of the 2022 legislative session, which is set to end on April 14, 2022.

Joshua J. Owen is an insurance law and medical malpractice defense attorney with Sturgill, Turner, Barker & Moloney, PLLC. He can be reached at jowen@sturgillturner.com or 859.255.8581. This article is intended to be a summary of state or federal law and does not constitute legal advice.

ISSUE #139

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Finance

Four Common Financial Mistakes to Avoid

BY SCOTT NEAL

My high school basketball coach put up a poster in our locker room. In rather large bold print it read, “Learn from the mistakes of others; you aren’t going to live long enough to make them all yourself.” Made sense then.

Still does. In our financial practice, we get to witness some common mistakes in others’ thinking about money. In this issue, I want to address four of those and how to avoid them.

Starting Social Security Benefits at a Time That is Not Optimal for Your Circumstances.

This is perhaps the most egregious mistake we see. Its consequences can cost thousands of dollars, the decision generally cannot be

“Life’s biggest danger isn’t dying, it’s living.”

— Laurence Kotlikoff reversed, and the loss of benefit cannot be recouped. Stop to think about it for a minute: you can begin benefits at age 62. There is no increase in benefit if you postpone starting past age 70; therefore, you have 97 different months for starting benefits. If you are married, your spouse has the same options, making the possible combinations ginormous. His or her decision is independent of yours, but their decision should be integrated with yours

for maximum lifetime family benefit.

The Wharton School conducted a study several years ago that indicated that, for most people, the decision to begin taking Social Security benefits was based on how the question was framed. If I show you how long you must live to make delaying the start of benefits pay off, (i.e., I frame the question to address breakeven), you will likely start early and take less benefit, thus betting that you will die sooner, rather than later. If I frame the questions around potential longevity risk (i.e., outliving one’s resources), most people will usually start benefits later. Dr. Laurence Kotlikoff claims, “Life’s biggest danger isn’t dying, it’s living.”

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Finance

We address this question by carefully considering all the possible months between age 62 and 70 for both spouses and showing the impact on living standard after taxes. With some there are non-financial factors to consider, but this gets to the financial impact of the decision.

Failing to Prepare for the Tax Impact of Decisions.

We all make various decisions throughout the year. Many of those impact the tax bill either resulting in a refund and the government using our money without paying interest on it, or negatively, ending up with a tax surprise the following April. Hopefully, we have taught our clients that they should have us model each decision before it gets implemented. Once the transaction is complete, there is usually nothing more that can be done to change the outcome.

To deal effectively with this situation, we like to prepare an alternative scenario case study considering all the known facts (and making prudent estimates of the unknowns) for the rest of the year. Let’s say you are faced with the decision of selling a piece of rental property that you have owned and depreciated for several years. Selling the property would result in a significant capital gain.

Many advisors would simply estimate the impact by using this year’s capital gains tax rate without taking into consideration the

depreciation recapture rules or modeling the impact of a Section 1031 tax-free exchange.

Capital losses should also be considered that could be taken to offset the gains. This is just one example that a full-blown multi-year tax projection can address. This is easily done and can save a lot of frustration and expense when tax time rolls around next spring.

Investing Without a Clearly Defined Goal.

It is human nature to focus on the nearterm at the expense of considering the longterm. We want or need certain things now to feel good about a decision and our station in life. We often do that without considering the long-term. Investing is a long-term proposition, but too often, investors still don’t know exactly what that means, or even how to give a time dimension to goals. Furthermore, most investors and many financial advisors use a static return goal when a dynamic one would work better and would ultimately be more accurate. Given that more risk usually translates into greater expected return, we like to ask the question, how much return do you need to generate to meet your goals? And how much risk must you be willing and able to take to get your needed return? A good goal-setting session is needed to specify a specific, measurable, actionable, time bound, exciting, and relevant goal that is sufficiently outside your comfort zone.

Misunderstanding the Risk Your Advisor is Trying to Address.

When we ask investors what risk they are trying to minimize, they usually reply with some form of avoiding drawdown risk, i.e. the loss experienced when an investment goes down in value even for short periods.

Other risks are purchasing power risk and the risk of not accomplishing goals. If you were to ask investment professionals how they address risk, most would reply that they do it with diversification among asset classes and properly allocating assets on the efficient frontier. That’s a fancy way to describe avoiding volatility risk, which is very different from drawdown or other forms of risk. Indeed, mitigating the effects of volatility is important but not an end all, be all. The lack of agreement on what constitutes risk and how to address it can result in disillusionment, if not disappointment, with your portfolio. We have addressed the different kinds of risk in a previous article but suffice it to say that the most common mistake is to live with misaligned expectation regarding risk and then to be disappointed with the result.

Remember my coach’s admonition and avoid these very common mistakes made by so many.

Scott Neal is president of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. Send your questions and comments to scott@dsneal.com or call 1-800-344-9098.

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ISSUE #139

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Op/Ed

Non-Financial Retirement Planning for Physicians

BY ROBERT P. GRANACHER JR., MD, MBA

When the time comes to think about retirement, many physicians are reluctant to leave their careers behind. Unfortunately, a lot of very smart people do not know what to do with themselves when they retire. This article will not focus upon investments or retirement planning from a financial standpoint, but all physicians are encouraged early in their career to hire a full-time investment counselor who can guide them to developing a retirement fund for the time when they do retire.

Many physicians ease into retirement by finding part-time or volunteer work, while others exit their professions entirely with no significant planning. An interesting concept is determining the time when physicians retire.

The American Medical Association has kept statistics for quite some time, and their most recent data as of 20211 are noted below.

• 12% before age 60 • 29% between ages 60 and 65 • 31% between ages 65 and 70 • 13% between ages 71 and 74 • 14% after age 75 This author is in that latter segment, as he retired at age 79 in 2020 after serving more than 45 years as a behavioral neurologist and neuropsychiatrist in Lexington.

What is Non-Financial Retirement Planning?

It is the most overlooked part of retirement planning. Unfortunately, when most physicians think about retirement planning, they think of financials, investment portfolios, budgets, and five-year plans. In fact, when the pandemic hit in 2020, Google searches on financial planning were up 400%. Those same people were often surprised to learn that, as the saying goes, many folks spend more time planning a vacation than their retirement. It is wise for a physician to plan on living longer than he or she expects and plan how to spend his or her time. Retirement today can last up 10

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to 30 years. Some of us may live well into our 80s or 90s. That time can be as engaging and productive as any other period of our lives.

Many physicians practice into their 80s.

On the other hand, often physicians are surprised by the need for retirement due to poor health. Many are aware of the record-breaking growth of the Boomer population, with 10,000 turning age 65 every day. By 2050, estimates are that more people worldwide will be over the age of 60 than under the age of 10.

Growth of the 75-and-over population alone may reach 5 million in the next five years in the United States.

On the non-financial retirement planning side, physicians often give little thought to recreating the structure and friendships they lose from work, or to figure out how they will invest those 30 extra years. An empty calendar can drive once-active people to the television, the couch, and an unhealthy sedentary lifestyle with quickly reducing health function and increasing body weight.

In terms of non-financial planning for retirement, happiness can be planned! Below are five keys to a successful retirement transition: • Consider a second career. Many physicians say they want to continue working after retirement, but they just do not know how to do that, and they try to transition into retirement by gradually retiring.

• The overriding principle of happiness during retirement is to enjoy life. The best way to enjoy life is to do what one has done as a physician, except this time consider volunteering for a cause you care about. Retired physicians who actively volunteer are able to find areas to use their medical skills, and it helps them meet new, like-minded friends and to stay active and engaged in their retirement.

• How will you maintain your health? Both physical and mental wellbeing are essential to fully enjoy your next chapter of life.

• Sustain the relationships in your life that have meant the most to you. Your relationships may change, such as through divorce or death. As children and grandchildren move away, consider how retirement may affect your family relationships. Many physicians actually move to geographic areas where they can keep better contact with their children and grandchildren.

• What personal legacy will you build? What is the best way to invest your time, talents, and resources? Reaching retirement age gives us the chance to consider this important question. Creating and implementing a personal plan can help frame the answer for each of us. All of us can make an impact.

How Do Non-Financial Factors Affect Retirement Decisions?

Steven Sass is a research economist at the Center for Retirement Research at Boston College. In 2016, he published an article on just this subject.2 Physicians are no different than other fulltime non-physician workers in the United States in that those with greater wealth and higher incomes are more likely to retire early. Those less prepared are more likely to remain in the labor force. A recent study reported by Sass notes that “fair” or “poor” health increases the likelihood of retirement by 6.3%. This study thus supports the notion that non-financial job characteristics can have large effects on labor transitions. Not liking work accounts for less than 10% of the very important reasons that persons retire early, except for respondents at ages 68 to 70. Poor health accounts for less than 30%, except for respondents younger than 62 years or older than 70 years. Far more prevalent than these factors pushing workers out of the labor force, and physicians are no different here either, is a desire to do other things or to spend more time with family. This inclination is especially

Op/Ed

strong during the popular retirement ages of 62 to 67.

The studies reviewed in this research article provide little support for the notion that adverse job characteristics cause physicians to leave medicine. They instead identify the importance of non-financial rewards in keeping some workers in the labor force and pulling others, the majority, into retirement.

Again, the American Medical Association has carefully recorded retirement insights from doctors who have already retired. Amy Farouk, in 2018, published six key physician retirement insights associated with retirement.3 • Consider a gradual transition, which can help you “grow into retirement.” Many physicians find this the easiest way to get into retirement, and they suggest not to suddenly stop working. One physician negotiated with his group that allowed him to work 2½ days a week for the last five years in the office before retirement. He had no call or surgery. He noted it had been a very nice transition and fun.

• Retire to something, not from medicine.

Retired physicians underscored the importance of mapping out meaningful activities that will give the individual a sense of purpose in their retirement years. They found it to be critically important to have a continuing purpose for their life. They noted that one should have a plan, as golf or fishing will not fill every day. If at all possible, volunteer and give back to your community, and stay physically and mentally active. Spend time before retirement assessing personal life goals for this new

stage in life and develop a strategy to meet those goals. This is probably the greatest transition most of us will ever experience in our lives.

• Commit to enjoying your retirement, from new experiences to old friends. Cultivate several hobbies or non-medical areas of interest. Have a clear focus appropriate to your family, personality, and means. Clarify the things that would make you awaken with enthusiasm and pleasure, then plan on doing them. Value your family and friends.

They are essential for a fruitful retirement.

• Take care of your health. Do your best to maintain good health. Money will never buy happiness, and certainly not if your health is poor. As noted earlier in this article, plan your finances, and do so in conjunction with an advisor and your spouse or partner.

Use evidence-based advice for your financial planning, and avoid emotionally-based manipulations of your investments. Make sure you are comfortable with your financial plan, and get all your affairs in order (e.g., wills, advanced directives, powers of attorney, etc.), then enjoy the experience. Use a professional planner to advise.

• Prioritize your spending. Live within your means. Downsize if necessary. Bigger and better is not necessarily the best. Do not perform risky investing in order to increase income. Know that having many material things is not the key to happiness!

Summary: 1. Enlist the services of a certified financial planner (CFP) early in your career,

Empowering physicians to focus solely on the demands of their clinical practice

include your spouse or partner in all decisions.

2. Focus upon nonfinancial planning at least 5 years before planned retirement.

Include your spouse or partner in the planning. Ease into it if you feel the need.

3. Remember, relationships should be the core of your planning.

4. Retire to something, not from medicine.

5. Map out activities that give you a sense of purpose.

6. Cultivate non-medical areas of interest.

7. Do your best to pursue good health.

8. Live within your means.

Robert Granacher, MD, can be reached at 859.333.0068 or rgranacher@aol.com.

REFERENCES

1. https://www.ama-assn.org/practice-management/careerdevelopment/top-considerations-physicians-ahead-retirement.

Site accessed February 4, 2022 2. Sass, SA. How do non-financial factors affect retirement decisions? Center for Retirement Research at Boston College, February 2016.

3. Farouk, A. 2018. Six key physician retirement insights from doctors already there. https://www.ama-assn.org/pratice/ management/career/development/six-key-phsyician-retirementinsights-doctors-already-there. Site accessed February 3, 2022.

OTHER READING

1. Seegert, L. I want to retire, but I can’t quite say goodbye.

Medscape May 5,2020.

2. F arouk, A. Early retirement? 5 factors physicians should evaluate.

January 4, 2019. Practice-management/career-development/ early-retirement-5-factors-physicians-should-evaluate. Site accessed February 4, 2022.

3. Clark, Dorie. Planning your post-retirement career. HBR. org, April 28, 2016. Site accessed February 4, 2022.

4. Miller, R.N. Life after medicine: 3 keys to a fulfilling retirement. https://www.ama-assn.org/practice-management/careerdevelopment/life-medicine-3-keys-fulfilling-retirement. Sit accessed Feb 4, 2022.

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Cover Story

Infectious Enthusiasm

Infectious disease specialist Dr. Mark Burns loves his job, and it shows

BY JIM KELSEY LOUISVILLE Mark Burns, MD, FACP, has a

passion for infectious disease that could be called, well, contagious. It’s one that he shares for the betterment of his patients, community, and colleagues as assistant professor of medicine in the Division of Infectious Diseases at University of Louisville School of Medicine and in his practice with UofL Health.

“I got into medicine to help people,” says Burns. “My philosophy is simple. You treat everyone as though they were a member of your family or a loved one. Even though you may not have personal relationships with these people, there are others who do.”

Burns was with his mother and sister when he first thought about becoming a doctor.

A little boy of about 5 years old growing up in Louisville, Burns went with his sister and mom to a local laundromat. While his mother, a former nurse’s aide, did the laundry, Burns played outside with his sister, who is now an RN, also at UofL Health. They were

playing with a stray dog when Burns was bitten. His injuries weren’t serious, but the potential for infection led his mother to take him to the hospital.

“I remember looking around seeing a lot of people in the waiting room with all these different injuries, people who were actively bleeding,” Burns says. “When the doctor came out and took me back, I was just so impressed with the way he looked. He had the long white coat and appeared very confident in what he was doing. I was just so impressed.

After getting my shots and going through that experience, I told my mom, ‘That’s what I want to do when I grow up.’”

Like many little boys, that goal came and went as he got involved in sports, graduated from duPont Manual High School, and played junior varsity basketball at the University of Louisville. After two years at UofL, he transferred to The Ohio State University, where he earned a bachelor’s degree in respiratory therapy.

Burns then came back to Louisville, attending the University of Louisville School of

“My philosophy is simple. You treat everyone as though they were a member of your family or a loved one.” — Mark Burns, MD

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MD-UPDATE

PHOTOS BY MARK MAHAN

Medicine from 1984-88. He stayed at UofL for his residency in internal medicine. He did emergency medicine at the VA hospital until 2015, when he returned to UofL for a fellowship in infectious disease.

“I thought about a potential career in sports, but I never lost interest in medicine,” Burns says. “As time went on and reality set in, I realized probably the best path for me would be a path through some type of medical field. My goal when I went to Ohio State was to be a respiratory therapist only because I wasn’t totally confident that I could do the advanced classroom work. But I ended up doing really well there and made the dean’s list, and after gaining that confidence, I realized that maybe medical school was not such a foregone conclusion. The rest is history.”

Treating a Wide Patient Population Burns credits Julio Ramirez, MD, a former infectious disease specialist at UofL Health, who served as mentor to him. It was Ramirez who opened Burns’ eyes to the importance of infectious disease.

“After speaking with him, I felt I could probably make a greater impact in the field of infectious disease,” says Burns, who initially was interested in pulmonary critical care. “I realized that infectious disease encompasses a very large group of diverse patients. Every area of medicine deals with infection. I thought this way I could be involved in all different areas of medicine. I felt I could have the greatest impact that way.”

Now, Burns takes care of patients and teaches as well. His work includes consulting on new patients and rounding on established patients in the hospital. He does outpatient care in a bone and joint infection clinic and an HIV clinic.

Burns treats infectious disease of all types, including viral, bacterial, fungal, and parasitic infections. Most of his patients are over the

Born and raised in Louisville, Mark Burns, MD, FACP, has been active as a community speaker, spreading information and dispelling myths about the COVID-19 vaccines.

ISSUE #139

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age of 18 and present with what Burns calls “difficult to treat infections.” He says that, while anyone can have a severe infection, those most at risk are patients who are immunocompromised whether due to medication or diseases such as diabetes, kidney disease, HIV, or tuberculosis, to name a few. He says solid organ and stem cell transplant patients can also have dangerous infections.

“The body recognizes when something is foreign and can have certain reactions,” Burns says.

“These reactions are initiated and promulgated by the immune system. The goal is to keep these organs from rejecting by trying to suppress the immune system. It is a double-edged sword because it can suppress the immune system to the point where it can’t fight infection.

That’s where we come in. We find out what the problem is and the best way to approach the problem. We sometimes have people on medications ahead of time to avoid some of the more common problems that can occur.”

Comorbidities and COVID-19 People with comorbidities such as heart problems, obesity, chronic lung disease, and sickle cell anemia, to name a few, are also at higher risk of having infectious disease.

“When they have an infectious disease problem, it seems like it’s always worse,” Burns says. “COVID-19 is a perfect example of that.

They are at higher risk of being hospitalized or even dying versus someone who does not have those comorbidities. People who have lower socioeconomic status tend to have these comorbidities and, unfortunately, it puts them not only at higher risk getting an infectious disease, but having it more severely and, in the case of COVID-19, having a worse outcome.”

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MD-UPDATE

Like most of the world, Burns has been heavily impacted by the COVID-19 pandemic. He found himself frequently collaborating with other physicians treating those patients hit hardest by the virus.

“The primary danger comes when COVID19 affects the lungs,” Burns says. “Our colleagues in pulmonary critical care were dealing with the complications of that, and they relied upon our expertise to see if there was anything we could do to help facilitate treatment of the virus.”

A Spokesperson During a Pandemic One of the things Burns has done in addition to treating COVID-19 has been to educate the general public about the virus and, particularly, about vaccinations. He has been a frequent public speaker during the pandemic, spreading the word about vaccines and trying to clear up some of the fears and misconceptions.

“I’ve preached about the vaccines ever since they’ve come out and railed against the fact the people don’t want to be vaccinated because of the reasons that I hear,” Burns says.

“For whatever reason, when we talk about COVID-19 vaccine, it seems like it’s very difficult to get people to realize that this is a vaccine and it is here to help you. In general, people have been receptive. I found that people had questions and they just wanted their questions answered.”

While devastating, Burns finds the science of COVID-19 fascinating. He has seen other serious infectious disease outbreaks throughout his career, but none quite like COVID-19.

“COVID-19 opened up a new chapter

in infectious diseases,” says Burns, who was involved in the clinical trials for the Johnson & Johnson vaccine. “Coronaviruses in and of themselves are not new. Human coronaviruses were first discovered in the 1960s. Even the combination of human and animal coronaviruses is not new. SARS (severe acute respiratory syndrome) back in 2002 was probably the first one of these human/animal coronaviruses.

About 10 years after that we had the development of MERS (Middle East respiratory syndrome). COVID-19 is the first one to develop into a worldwide pandemic. The interesting thing about COVID-19 is how it progresses and re-infects different cells in the body.”

Infectious Disease is a Specialty Of course, other infectious diseases have not gone away. From HIV to hepatitis to parasitic and viral diseases, Burns sees them all. He collaborates with podiatrists to treat patients who have open wounds or diabetic foot ulcers that can lead to osteomyelitis. He works with orthopedic surgeons who may have a trauma patient with an open wound or broken bones that get infected.

“I urge physicians not to hesitate, but to rely on your infectious disease doctors,” he says. “We are specialists. We have been trained in this area and deal with this every day. Physicians are very knowledgeable, but the infectious disease specialist will know a bit more about a particular type of disease or infection.”

Burns likens infectious disease specialists to any expert in a field of study. Everyone needs to ask a specialist for help sometime.

As a physician and educator, Burns’ passion for what he does is indeed spreading.

Leading the charge against infectious diseases.

That’s the Power of U. At UofL Health, our innovative treatment, prevention and research of infectious diseases is making a world of difference. As global leaders in clinical trials and translational research, we offer patients state-of-the-art advances in care.

We are home to transformative discoveries. Our Clinical and Translational Research Support Center provides national and international institutions with all aspects of leading-edge research. In addition, we have been awarded contracts from National Institutes of Health (NIH) and Centers for Disease Control (CDC) to study patients with respiratory tract infections.

Our expertise covers a full spectrum of services: n

General Infectious Diseases

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Bone and Joint Infections

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HIV/AIDS

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Vaccine and International Travel Center

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Research

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Clinical and Translational Research Support Center (CTRSC)

With every referral, patients receive life-changing care.

So they can get well. And stay well. That’s the Power of U. Mark Burns, MD Infectious Diseases

THAT’S THE POWER OF U Visit UofLHealth.org Call 502-561-8844 to refer your patient today.

Nathan Liu, MD, and medical assistant Emily Billingsly

Bringing Pioneering Procedures to Kentucky

Gastroenterologists with UofL Health are leading the way with new tools and techniques for both common and complex conditions

BY DONNA ISON LOUISVILLE In the field of gastroenterology, innovations in endoscopy and minimally invasive surgery have led to much improved results and quality of life for patients. UofL Health is a vanguard of this medical movement. According to Nathan Liu, MD, “The University of Louisville is on the forefront of doing these advanced procedures. We are able to do things that nearby states are not doing at this time. We’re able to do procedures that we weren’t able to do in the past.”

Along with the ongoing treatment of more common conditions, such as GERD (gastric reflux), celiac disease, and irritable bowel syndrome, the gastroenterologists within UofL Health address the most complex conditions—using the latest therapeutic agents, endoscopic procedures, and surgical techniques to combat Crohn’s disease, gastroparesis, and the full range of gastrointestinal cancers (colorectal, esophageal, gastric, small bowel, pancreatic, and liver).

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MD-UPDATE

Liu is an interventional gastroenterologist and an assistant professor of medicine for UofL. Hailing from Athens, Georgia, Liu did his undergraduate studies in biology and chemistry at Emory University in Atlanta, then remained in Georgia to attend the Medical College of Georgia. Following that, Liu moved to Louisville, where he completed a residency in internal medicine and a three-year fellowship in gastroenterology. He then did an additional 18 months of training in advanced therapeutic endoscopy and a submucosal fellowship at the University of Florida in Gainesville.

His journey to becoming a physician began when his younger brother was diagnosed with Kawasaki’s disease as a child. Liu says, “It was my first real experience with medicine. And when the doctors were able to make a quick diagnosis for him and get him treated, it prevented irreversible damage to his heart and arteries.” Initially, Liu envisioned himself as a cardiothoracic pediatric surgeon. But during his first year of medical school, he was introduced to gastroenterology and has not looked PHOTOGRAPHY BY ALEXANDRA ROGERS

back. As for his brother, he continues to thrive and just graduated medical school last year.

Improved Techniques and Technologies In his role as an interventional gastroenterologist, Liu sees patients ranging from 16 years of age up to octogenarians. He states, “I perform EGD [esophagogastroduodenoscopy], colonoscopies and screening colonoscopies. I do endoscopic ultrasound, which helps to diagnose pancreatic cancer. I also do ERCP [endoscopic retrograde pancreatography], which allows us to remove stones in the bile duct.”

In addition, because of his expertise in complicated colon polyps, Liu often receives referrals from other surgeons and gastroenterologists for more extensive higher-risk polyps for removal. While at the University of Florida, Liu was trained in endoscopic submucosal dissection (ESD), developed in Japan, which allows him to perform minimally invasive surgery within the colon walls. If a polyp is growing into just a single layer of the colon on

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the inner side, with ESD, it can be removed in one piece to allow pathologists to stage it, determining whether it is a curative resection or will need radiation, chemo, and surgery.

The first advanced procedure incorporated into the gastroenterologist arsenal was ERCP. Along with camera visualization of lesions in the esophagus, stomach, and small bowel, with ERCP, Liu can place stents or remove stones in the bile ducts. Previously, this required open surgery. Liu acknowledges that ERCP is a highrisk procedure used only for therapeutic purposes on patients who absolutely need it. These patients often present with jaundice, abnormal liver tests, and intermittent right upper quadrant pain despite gallbladder removal.

Pre-oral endoscopic myotomy (POEM), also pioneered in Japan, is a revolutionary endoscopic therapy for achalasia, a swallowing disorder. Liu had the privilege of learning this procedure from his mentor, Peter Draganov, MD, who trained with the Japanese physicians who perfected the procedure.

“POEM is a new procedure that falls under this new field of what we call third-space endoscopy. It’s basically where we enter the natural GI wall with our endoscope where we can tunnel with our camera and perform therapeutic procedures,” Liu explains.

Previously, the only option was a laparoscopic Heller myotomy or a large balloon, which required an extremely healthy patient and often ruled out the older population. POEM is performed under general anesthesia and usually requires no more than an overnight hospital stay.

Achalasia is an incredibly challenging condition, with patients often suffering for 10 or even 20 years before being properly diagnosed and treated. According to Liu, “Before the POEM procedure, these patients are not able to eat or drink at all. They complain of chest pain regurgitation, have significant morbidity, and are afraid to go out to eat in public for fear of eating food and then having to run to the bathroom to throw it up. Sometimes these

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Gastroenterology

patients will have food that’s retained in their esophagus for even weeks. And then, after the procedure is over, they’re able to eat and drink normally.”

A third emerging area in the field is bariatric endoscopy, which involves endoscopic procedures to help combat obesity. Liu said, “We’re able to do endoscopic suturing, where we take our camera and suture within the GI tract to create a sleeve, basically sleeve gastroplasty.” UofL Health is in the early stages of incorporating bariatric endoscopy into its long list of procedures.

New Screening Guidelines Naturally, one cannot discuss the field of gastroenterology without discussing colon cancer. The American Cancer Society lists colon cancer as the third leading cause of cancer-related deaths in men and in women.

Statistically, one in 23 men and one in 25 women will be diagnosed within their lifetime. New recommendations dictate that individuals should begin scheduling colonoscopies at age 45.

“Colon cancer is one of those cancers that we can help prevent from forming. It often arises from polyps, and if it hasn’t invaded deep into the walls of the colon, we’re able to perform colonoscopy with snare removal and remove these polyps before they become cancer,” Liu states. “Early screening and doing colonoscopy early in patients when they first develop signs and symptoms is paramount.”

Several factors play into a person’s likelihood of developing colon cancer: age, obesity, smoking, high cholesterol, and a genetic component, such as familial adenomatous polyposis (FAP). Liu says, “It’s a really complex equation where genetics and environment are both involved, including age as well, too. So, it’s not as simple as one thing. And that’s why we do screening for everybody at age 45 and earlier with a family history or symptoms.”

In Conclusion As the field continues to move away from open surgery, Liu is looking forward to adopting new tools and new skills and offering his patients an even greater number of minimally invasive, safe, and effective procedures.

ISSUE #139

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Pulmonology

BiFocal: The Dual Preoccupations of the COVID Era Pulmonologist Long-haul COVID-19 is one of may challenges for pulmonologists

BY TIM CORKRAN LEXINGTON As a pulmonologist in the time of COVID-19, Eliseo Colon, MD, has had a busy two years. The practice leader at CHI Saint Joseph Medical Group – Pulmonary and Critical Care Medicine in Lexington now finds himself emerging from the pandemic with a new set of preoccupations and a return to his career-long focus. He must now address both the evolving field of long COVID and utilize new technologies for early intervention in sufferers of severe respiratory illness. This bifocal attention is demanding, but he finds hope and inspiration in it.

Colon, a native of Puerto Rico, was educated and trained in New York and joined CHI Saint Joseph Medical Group in 2011.

As a pulmonologist in central Kentucky, his patient population is skewed toward men over 50, and he has long been an advocate of early screening for high-risk patients. Normally, his practice receives referrals for patients from all over the eastern half of the Commonwealth, but during the worst of the pandemic, he spent over a year focusing on critical care.

Like so many medical professionals, this time on the front lines enlightens his return to pre-pandemic practices.

Long Covid: Diagnosing, Treating and Understanding Colon sees the positive trends away from COVID-19 related acute respiratory issues in his patient population on a daily basis and is now developing clarity of the dynamics of long COVID-19. The general consensus is that long COVID-19 is a suite of symptoms — fatigue, shortness of breath, physical 18

MD-UPDATE

weakness, cough, some cognitive issues — that are in evidence some 4-6 months after illness. While pulmonologists are gathering data about patients with persistent symptoms, diagnosing long COVID-19 is less of a concern than treating the symptoms.

Eliseo Colon, MD, practice leader at CHI Saint Joseph Medical Group – Pulmonary and Critical Care Medicine

Emerging primary concerns currently include pulmonary clotting and cardiac inflammation. Colon says that “COVID-19 has a higher incidence of pulmonary blot clotting,” which has required an increase in use of anticoagulants (blood thinners) to head off the threat of pulmonary embolism. Myocarditis, due to either the virus or the body’s own immune system, is regularly observed in long COVID-19 patients. Colon and his colleagues work together to identify these patients, and he says, “The treatment depends on how symptomatic they are.”

Like many respiratory illnesses, co-morbidities tend to exacerbate the symptoms of long COVID, says Colon.

DR. COLON PHOTO BY GIL DUNN

Endo-bronchial valves, approved by the FDA 3 years ago, are designed to reduce gas trapping and hyperinflation in patients with severe emphysema.

Getting Back to What He Does Best After 18 months in the depths of the pandemic, Colon and his fellow pulmonologists are beginning to be able to return their focus to the preventative measures and early detection services that they offer at CHI Saint Joseph Health. He remains a vocal advocate for low-dose CT scans for his high-risk patients, smokers and miners, in particular.

Outpatient services like lung cancer screening and the pulmonary rehabilitation program, which were of limited availability during the worst of the pandemic, are now back to pre-pandemic levels.

Utilization of valuable technologies is once again an important part of Colon’s practice.

Endo-bronchial valves, placed in people with severe COPD or emphysema, have continued to evolve in their usefulness. These small, oneway valves, first approved by the FDA three years ago, are designed to reduce gas trapping and hyperinflation in patients with severe emphysema. They can be as small as 4 mm across and can be removed as needed.

Colon is also excited about a computer guided navigational tool that aids in the detection of small peripheral nodules that are possible indicators of lung cancer. Electromagnetic navigational bronchoscopy provides access to the most distant regions of the lungs.

Colon explains, “After a CAT scan suggests a point of concern, this allows us to investigate

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more closely.” He says that the screen readout provides a pathway through the bronchi to the suspect nodule, which allows him to go in at that point and biopsy.

Finding these smallest lesions aids in early diagnosis of lung cancers.

Colon is adamant about smoking cessation and really values the bronchoscopy tool, but, more than anything, he wants his general practitioner colleagues to push their high-risk patients to seek opportunities for early detection. He says that “The survival rate of lung cancer patients is over 90% for people who go through early screening.”

With a personal medical phiElectromagnetic navigational bronchoscopy provides access to the losophy that “You have to take most distant regions of the lungs. “After a CAT scan suggests a point care of your mind and your body,” of concern, this allows us to reach and biopsy those peripheral Colon is glad to be back helping lesions.”- Eli Colon, MD

Pulmonology

patients avoid the worst outcomes of severe respiratory illness. He will continue to contribute to his field’s understanding of long COVID, but his primary focus will be utilizing the technology and treatment programs proven to aid early detection efforts.

CHI SAINT JOSEPH MEDICAL GROUP - PULMONOLOGY AND CRITICAL CARE MEDICINE Eli Colon, MD 1401 Harrodsburg Road Suite C 405 Lexington, KY 40504

859.276.4429

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Sturgill, Turner, Barker & Moloney, PLLC ♦ Lexington, Ky. ♦ 859.255.8581 ♦ STURGILLTURNER.LAW ISSUE #139

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Internal Medicine

Serving the Underserved Ben Neltner, MD, enjoys the challenges of being a general practitioner

and Lexington was in between our hometowns, so it worked out really well LEXINGTON If you spend for us,” says Neltner, who very much time talking became a first-time dad shop with Ben Neltner, in January when he and MD, the word “underCaitlyn welcomed a baby girl. served” is likely to come up.

Neltner has enjoyed the challengTo be sure, he sees a broad es of navigating his first few months cross-section of patients as part of full-time practice and all the newof his primary care practice in ness. For him, the key is building Lexington with CHI Saint. Joseph relationships.

Health Medical Group – Primary “A lot of times when you meet Care. But the tone in his voice the patients for the first time, changes — and the passion comes there can be mistrust and questhrough — when he discusses tioning,” he says. “But, when they helping the underserved. get to know you, it can be like Like the motto of the Hard helping a family member. With a Rock Café, “Love All, Serve All,” lot of the patients I’ve had, even he embodies the popular chain’s in the short time — nine months tagline daily.

— I’ve been here, there is already “What I love the most about a great relationship.” my job is fostering relationships So far, his job in primary care with patients and helping them includes seeing patients coming get to where they can trust me in for one of three primary things: and have somebody to believe wellness exams, chronic disease in,” he says. “It is a wide variety Ben Neltner, MD, joined CHI Saint Joseph Health Medical Group – Primary Care management, and acute visits. of patients from all kinds of back- as a general practitioner last July.

“The patients are coming to grounds; I have CEOs and people you for anything, and we have to who are homeless.” be flexible,” he says. “I love the wide scope of While Neltner didn’t intentionally seek out New City, New Job, New patients we see.” the underserved, circumstances during his Baby, New Challenges training lit a fire in the Northern Kentucky After graduating from Covington Catholic native that still burns bright. When he was in High School, Neltner attended the University Different Ways of high school, he volunteered at St. Elizabeth’s of Louisville for both undergraduate and “Seeing” Patients hospice center. During residency, he worked University of Louisville School of Medicine.

The rapid introduction and implementain a free clinic with mostly uninsured patients It was at UofL where he met his future tion of telemedicine over the past couple of and also helped staff a refugee clinic in wife Caitlyn, a budding pediatrician and years has altered the way doctors interact with Charlottesville, Virginia.

Winchester, Kentucky, native. patients. For Neltner, it is another new thing “Those experiences were absolutely invaluThe two did a couples match for residen- he takes in stride. able,” he says, “and it was great training cy in Charlottesville, Virginia, before being “Telehealth been wonderful for our practo work with those underserved popula- called back to their home state last summer: tice,” he says. “What I have found, especially tions. I have refugees in my patient group in Ben to work at CHI Saint Joseph Health and in my patients that are underserved, is they Lexington, so my experience really helped me Caitlyn to work at Commonwealth Pediatrics. don’t have dependable transportation and to understand what they face.”

“We wanted to move back to Kentucky, utilize loved ones to help them.”

BY PAT HENDERSON

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MD-UPDATE

“What I love the most about my job is fostering relationships with patients and helping them get to where they can trust me and have somebody to believe in.”

PHOTO BY GIL DUNN

SPECIAL SECTION

The role for those same loved ones — kids and especially grandkids — has shifted from chauffeur to computer consultant as they help get them online for telehealth visits. An obvious result is fewer cancelled appointments, but another benefit is allowing an extra set of ears to hear care instructions.

“With the geriatric population, I’ve had instances where getting a visual on their living room or their kitchen gives me an understanding of what their home situation is, and that’s been helpful,” Neltner says.

Telehealth also has been impactful for people with mental health issues. Neltner notes that patients with severe anxiety and depression, for instance, have a hard time getting out of the house and may skip an appointment.

“The other real strong argument that’s been used for years is people in rural areas that don’t have as good access to healthcare and specialists,” Neltner says. “Our preference is still for the in-office visit, but it is better than them not being seen.”

CHI SAINT JOSEPH MEDICAL GROUP - PRIMARY CARE Benjamin Neltner, MD 1401 Harrodsburg Road Suite B 160 Lexington, KY 40504

859.276.4486 Teamwork Really Does Make the Dream Work Neltner sees teamwork as a crucial part of everything he does. In his role as a general practitioner, his “teammates” come in two types: patients and coworkers.

“It is important to me to establish, from a patient’s very first visit, that this is a mutual

Internal Medicine

relationship,” he says. “I’m going to respect what they have to say and they are going to respect what I have to say, then we will come to decisions together.”

He cites having access to other professionals on the CHI Saint Joseph Health team, ranging from referral specialists and imaging schedulers to social workers and case managers to on-site pharmacists, as making it easier to provide more comprehensive care.

“I absolutely love my clinic,” says Neltner.

“We have a lot of resources here, and it takes a team to manage patients with multiple or complex medical issues.”

This can be especially beneficial for people who come to Lexington from rural communities, where such resources may not be available, and certainly aren’t found in one place.

And it is the sense of satisfaction from providing more holistic services to patients, and building relationships with them along the way, that helps Neltner stay on task with overserving the underserved.

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Complementary Care

Silent No More

Specialized hypertension program is now available in Central Kentucky

BY GIL DUNN LEXINGTON Individuals in Central and Eastern Kentucky with uncontrolled hypertension have a new ally in their struggle with “the silent killer.” Physicians with hypertensive patients have a new resource. Kristy Salley, APRN, CHC, with Lexington Cardiology, part of Baptist Health Medical Group, is now a certified hypertension clinician. She specializes in uncontrolled hypertension and is accepting patients through the Baptist Health referral system.

Salley is the first APRN in Kentucky to achieve certification in hypertension from the American Hypertension Specialist Certification Program. She has been a cardiology nurse practitioner for six years, having received her nursing degree and APRN certification at Eastern Kentucky University. On her own initiative she researched the steps necessary to pass the certification test.

“No one in the practice knew I was studying for this,” she says, “but when I received my official hypertension clinician certification, my colleagues were elated and very supportive.”

Lexington Cardiology and Salley began the specialized in-office hypertension program in May 2021. Obstacles with COVID-19 restrictions initially affected patient flow. Salley says that the practice used telehealth visits effectively and has seen a return of in-office visits as COVID-19 infection rates have declined.

Kristy Salley, APRN, CHC, with Lexington Cardiology, is a certified hypertension clinician.

of hypertension such as renal artery stenosis, hyperaldosteronism, or pheochromocytoma.

“With my certification, I provide expertise in the management of refractory hypertension with consideration of concomitant medical conditions. I follow and work closely with my patients to improve their blood pressure and overall health outcomes. I obtained my certification in hypertension so I could better serve our population of patients in Kentucky,” says Salley.

Individualized Patient Care The patient population that Salley believes she can help the most are patients with refractory hypertension who are on multiple anti-hypertensive medications with comorbidities such as coronary artery disease, diabetes mellitus, chronic kidney disease, obesity, and peripheral vascular disease. She says she often rules out patients for secondary causes 22

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PHOTO PROVIDED BY BAPTIST HEALTH LEXINGTON

Kentucky’s prevalence of hypertension is around ten percent higher than the national average. Uncontrolled hypertension can lead to serious complications such as heart attacks, strokes, and organ damage. Salley states that she saw the need for Kentuckians to have a skilled health care provider with additional training specific in hypertension. For this reason, she chose to pursue this avenue to help the community.

Salley recalls a specific example of her work.

“I had a patient with a long-standing history of hypertension with average blood pressure around 200 systolic. She was frustrated and felt defeated, thinking she just had to live with it. I worked with her, adjusted some of her medications that were causing other adverse reactions, and diagnosed her untreated sleep apnea that was also contributing to her elevated blood pressures. Her blood pressure is now consistently around 120 over 70, and she is thrilled.”

“Each case is so patient specific,” says Salley.

“My goal and personal philosophy are to provide safe, holistic, patient-centered care to the best of my abilities and to treat each patient with respect, dignity, and empathy,” says Salley.

Complementary Care

Organ Donation: Anyone Can Be a Lifesaver Organ and tissue donations have increased 75% in the last five years

BY MENISA MARSHALL LOUISVILLE As president and CEO of Kentucky Organ Donor Affiliates, Julie Bergin, BSN, FACHE wants you to remember two things: • Everyone has the potential to be an organ donor.

• Registering to be an organ donor saves lives.

“Nothing automatically excludes you from being a candidate for organ donation,” Bergin says.

Bergin’s passion for healthcare began at age 16 while working during school breaks at a hospital where her mother was a nurse. She joined KODA in 2003 as an organ recovery coordinator. After a brief return to ICU nursing and clinical education, she came back to KODA in 2011 as director of quality services. She was promoted to COO in 2014 and CEO in 2017.

Bergin’s heart connected solidly with KODA’s mission after a family member was a donor and a close friend became a recipient.

Many of KODA’s 100+ employees share similar connections.

KODA serves most of Kentucky and small areas of Indiana, Ohio, and West Virginia.

Its mission is to unite organs and tissues with those in need. They partner with Kentucky Circuit Clerks’ Trust For Life, who registers Kentucky residents as organ donors, and Kentucky Lions Eye Bank, which handles cornea donations and transplants.

KODA operates 365 days a year. Its 24/7 call center takes over 25,000 calls a year from hospitals, which are required to report all onsite deaths. Teams respond quickly to assess every situation and discuss potential donations with families.

Six organs — hearts, lungs, livers, kidneys, pancreas, and intestines — qualify for dona-

“Nothing automatically excludes you from being a candidate for organ donation.”

Julie Bergin, BSN, FACHE, president and CEO of Kentucky Organ Donor Affiliates

tion. They may come from recently deceased individuals or patients with no brain function, typically due to injury or cardiac death.

Donations that involve discontinuing ventilation often reflect a patient’s desires expressed through a living will or advance directive.

Tissue donations include skin, bones, tendons, and saphenous veins. These typically come from hospital patients who experience cardiac standstill. A carefully controlled process allows tissue donations up to 24 hours after heart standstill occurs.

“Quick action is critical,” Bergin says. “We sometimes have only a 2- to 4-hour window for recovery.”

Numbers Speak Loudly In 2021 KODA facilitiated 189 donations that changed the lives of 496 organ recipients. This marked a fifth consecutive annual increase in donations. Since 2017 organ donations have increased 75%, and tissue donations have increased 45%.

“We’re proud of achieving the most donations ever seen in Kentucky and hope to continue this trend,” Bergin says.

Historically, Kentucky’s small rural hospitals have transferred critical patients to trauma centers and other higher acuity facilities. With transfers limited by the pandemic, KODA has worked with smaller hospitals statewide to perform their first-ever in-house organ donations.

During the pandemic’s first 15 months KODA recovered no organs from COVIDpositive patients. Currently, COVID patients can donate organs. Bergin said abdominal organs — specifically kidneys and livers — can be transplanted without transmitting COVID. Approximately 60% of organ donors are male and 40% are female. Transplant recipients are all ages and come from all walks of life.

About 1,000 people are on Kentucky’s organ wait list. Nationwide more than 100,000 people are in need of a transplant.

While thousands of donor referrals are made annually, Bergin notes that only 1% of the population dies in a way that makes organ donation possible. This underscores the urgency of evaluating all potential donations.

Nationwide, kidneys are the most frequently donated organs, followed by livers and hearts. KODA facilitated 130 liver transplants and 60 heart transplants last year.

Lungs account for a relatively small percentage of transplants. KODA has seen a twoyear decline in lungs recovered for transplant although the need may grow due to COVID complications.

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Complementary Care

Pancreas transplants are also rare, since effective control measures are widely available for Type I diabetics. Pediatric patients are usually the only candidates for an intestines transplant.

In Kentucky 63% of the adult population are registered donors with one of country’s fastest growing registries.

KODA encourages everyone to document their wishes by signing up for the donor registry. This “act of love” spares loved ones the pain of making hard decisions in situations that may occur with little advance warning.

In such situations families want to be sure their loved ones have received the best care possible. KODA wants everyone to know donation is not an option until care teams have done everything possible to save a patient.

Even if patients are registered donors, donation is not considered until no care options are left, and all donors are treated with great respect.

Organ recovery takes place in an OR where an anesthesiologist, scrub nurses, and the recovery team work together. KODA recently hired its own recovery surgeon, Cosme Manzarbeitia, MD, FACS. This strategic move helps lighten the hospital care teams’ heavy workloads.

Raising Awareness, Quashing Misperceptions KODA strives to raise awareness about the importance of organ donation. For example, a February art exhibit at Louisville’s KULA Gallery compared organ wait time among minorities (up to 10 years) vs. that for Caucasians (7 years). The Faces of Donation exhibit was coordinated by Donate Life KY to kick off National Minorities Month.

On April 8 the Live to Save Lives Concert took place at Ashland, Kentucky’s Paramount Arts Center. It featured local and regional stars and was co-hosted by the Kentucky Circuit Court Clerks’ Trust For Life.

On national Blue & Green Day, April 12, people were encouraged to wear the colors of the day and register as organ donors. Louisville’s Big Four Bridge, Churchill Downs’ Twin Spires, and other venues statewide lit up to honor those who save lives through the gift of donation.

Advocacy is a key part of KODA’s work 24

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and has contributed to two recent pieces of encouraging legislation.

• SB30, a bill sponsored by Kentucky State Senator Brandon Storm (R), was signed into law in March and adds a donor registry question to online car tag renewals.

• HB777 looks at addressing Kentucky’s ambulance shortage. It includes provisions to facilitate organ transportation after recovery. Ambulance availability is crucial for transporting donated hearts and lungs, which have tight viability windows.

People may assume only young, healthy people can donate organs. Not so, says Bergin.

In 2021 a 95-year-old man from West Virginia became the oldest organ donor in U.S. history. His liver saved a woman’s life and his tissue and corneas helped 77 people.

“You’re never too sick or too old to register to be a donor,” says Bergin.

Many people mistakenly believe illnesses such as hepatitis C or HIV rule out organ donation. Now that hepatitis C can be cured,

it is not a barrier to organ donation. The HOPE Act of 2013 made it possible for those with a history of HIV to be organ donors.

All major religious and faith systems support organ donation. They widely view it as an ultimate act of charity and love. Ultimately, this is something we should all be able to agree about and act upon.

VISIT US ONLINE

Public Health

Infectious Disease Prevention is So Much More Than COVID-19

Surveillance, testing and guidance on everything from salmonella to syphilis

BY BETHANY HODGE, MD, MPH FRANKFORT The Infectious Disease Branch in the Division of Epidemiology and Vital Statistics at the Kentucky Department for Public Health was a busy place before the pandemic. This group of public health workers were the ones putting together surveillance, coordinating testing and providing guidance to healthcare providers on everything from salmonella to syphilis. Then COVID-19 brought unprecedented new challenges. The Kentucky Department for Public Health ramped up personnel and activities to bring their knowledge and experience to combat a previously unknown disease that has affected every facet of how we work and live in Kentucky for the past two years. The staff that typically worked on viral hepatitis, sexually transmitted diseases, insect vector illness, tuberculosis, and much more have been serving the COVID-19 response while trying to maintain the programs addressing those other ongoing health threats.

Now that the case numbers of COVID-19 are receding in the population, these experts are returning more of their attention to areas of work that are vital for the continued health and safety of the Commonwealth.

The following is a briefing from Kentucky public health leaders regarding the current state of affairs for important infectious diseases being tracked and addressed by Kentucky’s public health infrastructure.

Viral Hepatitis: Prior to COVID-19, an estimated 78,000 Kentuckians were living with hepatitis C (HCV). Given the stress of the pandemic on individuals and on harm reduction services, we anticipate rates of substance use disorder (SUD)-related infectious diseases have increased in the past two years, and that the previous hepatitis C estimate is now low.

Already, we know Kentucky saw increases in overdose deaths and instances of HIV clusters during the pandemic. In a state with a high burden of new HCV infections, it would follow that prevalence of HCV has also increased. Because public health staff, at local and state levels, have been necessarily focused on COVID-19, it will take time to demonstrate how HCV rates have changed the past two years.

In 2021, the AIDS Institute estimated curing HCV to cost, on average, $19,051; the average cost of caring for someone who develops chronic hepatitis C is $205,760.

More importantly, HCV devastates individuals, families, and communities as chronic infection impacts quality and length of life.

Disease transmission modeling shows why these individuals should be prioritized for treatment. It is a real-time intervention into drug-user networks and an opportunity to reduce transmission. While HCV remains grossly underfunded at all levels, Kentucky is positioned to make identifying and treating HCV a priority and a winnable battle.

— Amanda Wilburn, MPH, Viral Hepatitis Program Manager

Sexually Transmitted Diseases (STDs): In the STD Prevention and Control Program, the primary goal is to ensure the citizens of the Commonwealth are protected from common STDs. The national trend of increasing rates of STDs for the past seven years has been very discouraging, especially for syphilis. Treatment for syphilis is very simple, yet since 2015, there has been a 70% increase in syphilis in the United States. Although not as high as the national average, Kentucky has experienced a 12 percent increase in reported syphilis since 2015, with an infectious rate of 5.5 cases per 100,000.

Syphilis surveillance efforts have been expanded to ensure we are monitoring, analyzing and evaluating all incoming morbidities and properly investigate all infectious syphilis cases within 48 hours. The goal of the Kentucky STD Prevention and Control Program is to be proactive and ensure any emerging disease trends are met with timely intervention and thorough investigation.

— KY STD Prevention and Control Program

Tuberculosis: Tuberculosis (TB) programs around the world faced significant challenges during the COVID-19 pandemic. With staffing capacities being stretched to the limit, reporting of other infectious conditions suffered, particularly with respiratory conditions such as TB. COVID-19 and TB can have similar clinical presentations, so differentiating these diagnoses was sometimes challenging. In fact, several TB cases in Kentucky counted in late 2020 and 2021 had significant reporting and testing delays as they were suspected to have COVID-19 and active TB was not initially considered. It will be interesting to learn more about the long-term effects from COVID-19 on TB patient clinical outcomes and staffing shortages towards TB prevention and control.

As we are beginning to, hopefully, see the light at the end of the COVID-19 pandemic tunnel, we encourage Kentucky medical providers, community partners, and LHDs to “think TB” once again. Timely identification and reporting benefit the patient and also help significantly control the spread of TB within our communities.

— Emily Anderson, BSN, RN, KY TB Program Controller/Manager — Charles Rhea, MPH, TB Program Epidemiologist ISSUE #139

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Tickborne Diseases: As spring and summer are just around the corner, there is another waiting for the warm weather. You may have guessed it already: it is our little arthropod, the tick. They are known to be blood-sucking, opportunistic parasites that attach to the skin of a variety of hosts.

Interaction between humans and ticks have been most commonly observed during the spring and summer months when outdoor activities are increased in wooded areas.

The most common ticks we can find in Kentucky are the lone star tick (Amblyomma americanum), American dog tick (Dermacentor variabilis), blacklegged tick (Ixodes scapularis), and the brown dog tick (Rhipicephalus sanguineus). These tick species can be important vectors of disease that can be extremely harmful to humans. At times, when a tick feeds on a host it will pass along pathogens that can cause disease such as bacteria, viruses, or protozoa.

In Kentucky the most common tick-borne

diseases we see here are spotted fever rickettsiosis (commonly referred to Rocky-Mountain spotted fever), lyme disease, and ehrlichiosis. It is important to note that not all tick species can serve as a vector for every pathogen, and not every tick bite will result in disease. However, monitoring and giving guidance to prevent or treat tick-borne diseases will be increasingly important as more people get outside to enjoy the spring weather together.

— Morgan Taylor, MPH, Vector-borne Epidemiologist

Enteric Diseases: Heading into warmer weather, it’s important to remember that foodborne illness can have a significant impact on outdoor gatherings. Warmer temperatures encourage growth of foodborne pathogens, so remember to follow these steps this grilling season: separate meat (including poultry and seafood) items from other items to help avoid cross-contam-

Give Hope. Change Lives.

June 18, 2022 Please join us for an Evening of Hope as we come together through intimate dinner parties across the state to benefit our cancer patients and families.

By participating in Evening of Hope you will allow us to continue to help every person, regardless of their ability to pay, access critical cancer care.

Call 859.313.1705 or visit CHISaintJosephHealth.org/WaysToHelp to learn how you can help!

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ination; chill proteins until you are ready to grill them; wash your hands and work surfaces thoroughly before and after preparing and cooking raw meat; don’t cross-contaminate food items with marinades or utensils that have touched raw meat juices; use clean utensils and plates to remove items from the grill; use a food thermometer to ensure proteins are cooked hot enough to kill pathogens; hold hot food items at 140⁰F or warmer until serving; and refrigerate leftovers within two hours (sooner if above 90⁰F outside) of cooking.

Following the above steps should help ensure that your gathering does not become memorable for the wrong reasons.

—Jennifer Khoury, MPH, Foodborne/ Waterborne Diseases Epidemiologist For more information, contact Bethany Hodge, MD, MPH; Infectious Disease Branch Manager; Division of Epidemiology and Health Planning; Kentucky Department for Public Health; Mobile: 502.382.8959; Bethany.hodge@ky.gov

Mental Wellness

The Relationship Pulse Check: A Ridiculously Easy Way to Reconnect and Recharge

BY JAN ANDERSON, PSYD, LPCC

The Relationship Pulse Check is more than a “date night” Band-Aid approach to reconnecting with your partner. Think of it as a way to supercharge and safeguard your relationship connection.

Amidst the natural ebb and flow of relationships, how can you tell you’re seriously losing touch? Some types of “relationship disconnect” are slow and corrosive. Sometimes losing the connection is so subtle that the relationship seems to evaporate into thin air.

It’s a little scary!

Here are some signs that always get my attention in counseling sessions: • Are your interactions mostly superficial and have a “roommate” feel?

• Have your interactions become way too volatile? With no makeup sex — or making up, period?

• Has the relationship taken on an airless quality, like there’s little room to move or breathe?

• Are you politely living parallel lives?

The Relationship Pulse Check is a quick, easy way to keep track of relationship stress sneaking up on you, so you can snuff it out before it becomes combustible. Think of it as an early warning system that alerts you to slow, subtle relationship corrosion and gives you a way to quickly reconnect and recharge.

BTW: If your partner isn’t willing to participate, no worries. There’s a saying, “It only takes one person to change a relationship,” and I’ve found it to be true. Doing your own work will not only help you. It will also give you tools to better connect with your partner.

From there, the relationship has a chance to go where it naturally needs to go.

Here’s how to jump-start the process, depending on the degree of relationship disconnect you’re experiencing:

1. Work on your own.

If you’re one of those rare couples with a high degree of emotional intelligence, just a few simple tools and a commitment to a regular schedule may be all you need.

I recommend you begin the journey with an evidence-based questionnaire designed by marriage researcher John Gottman. If your partner is willing to participate, you can each take what Dr. Gottman calls his “Relationship Poop Detector” questionnaire.

Use this link to spot areas of relationship stress: https://counselinghuntsville.com/ wp-content/uploads/2020/07/RelationshipPoop-Detector.pdf Make it quick, easy, and automatic to check in on your relationship regularly. Plug in the Marital Poop Detector as a recurring monthly appointment on your calendar, just like you schedule all your other regular couple activi-

ties. Share your answers and discuss them with your partner once a month. Rinse and repeat.

If you find yourself backsliding, getting stuck, or simply forgetting to do it, consider moving on to Option #2.

2. Work on your own and kick it up a notch.

Keep doing your own work with the Relationship Poop Detector and supplement it with a couples counseling session. This is the option my husband and I have landed on. Whether we think we need it or not, we regularly show up for a monthly marriage counseling session.

Here’s why: 1. Like most regular people, my marriage is important to me. As a professional, I know how and why couples therapy works, so why wouldn’t I use an evidence-based approach to make my own marriage (consisting of two radically different human beings who happen to love each other) the best it can be?

NOTE: If you’re reluctant to seek professional help with your relationship, you’re not alone. A sad statistic is that unhappy couples suffer for an average of 6 years before seeking professional help. At this stage of my life, I don’t have that kind of time to waste.

2. It makes me a better therapist. It’s vulnerable to show up for counseling!

Putting myself in the same vulnerable position as my clients gives me plenty of empathy and an appreciation of how the process works from their perspective.

That perspective has helped me come up with ways to meet couples where they are as individuals, as well as relationship partners.

Sometimes the traditional approach of both partners showing up together from the get-go for couples counseling isn’t the best option.

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3. W hat if starting with traditional couples counseling isn’t going to happen … or isn’t even a good idea?

Here are some creative strategies that can work surprisingly well to get the relationship ball rolling: • Start with doing your own individual work first. Let your own work on yourself be the primary driver to change how you interact with your partner. The crazy thing is this may be all you need to improve the reaction you get from your partner. It seems to have something to do with the saying I mentioned earlier, “It only takes one person to change a relationship.”

• Do your own individual work and occasionally request or allow your partner to share their perspective.

Oftentimes the less interested partner is willing to at least share their perspective with me. I find this

Values Count

Even in Investment Strategy

extremely valuable in two ways: 1. It helps me get up to speed much faster when I get the whole picture.

2. It allows your partner to subtly check me out and take a closer look at what I’m doing before possibly taking a step closer.

• Start with a “1-1-2” style of couples counseling that includes private individual time for each partner, followed by a session together.

As long as neither partner dumps a massive “secret” bomb on me, this approach can work very well. It allows each person to put their thoughts and feelings on the table, unfiltered, in their individual session. This approach can provide a safe starting point to: 1. Air your dissatisfactions without fear of hurting your partner.

2. Confide your needs and concerns without the risk of getting too vulnerable yourself.

One of the things we believe our clients appreciate most about D. Scott Neal, Inc. is our commitment to values we share with them: We respect our clients’ individual values and we treat them as team members, informing them on strategy and the purpose of investment that fits their unique financial goals.

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Once I have the raw data, we can strategize how to communicate it in an emotionally intelligent way.

• Start with a “shuttle diplomacy” style of couples work. In other words, don’t even think about meeting together in the same room, at least not yet. You’d think this approach would be designed primarily for volatile couples, but I actually find it most helpful when one or both partners is highly conflict avoidant.

I originally thought of this approach as mediating separately as a way to prepare to sit down together as a couple. But after working with a few couples who successfully reconciled and never met with me together in the same room, my attitude has become, “Who cares what approach we use, as long as it works?”

4. Set Up Automatic Refills.

Regardless of the approach, I find the Gottman Relationship Poop Detector a helpful tool. It’s a quick, easy way to take the pulse of your relationship on a regular basis. It also gives us a concrete way to start or focus a couples session, which (as you can imagine) is not always an easy thing to do.

Since every couple has their own unique relationship dynamic, I started creating a customized version for couples I call Your Relationship Pulse Check. Based on what I learn about a couple’s unique interests, concerns, and priorities for their relationship, this tool can supercharge your relationship connection by targeting what matters most to you.

Here’s the most important part: How do you create a simple, easy way to keep track of your relationship connection regularly? I call my version Your Relationship Pulse Check Monthly Tracker. However you keep track, think of it as a way to safeguard your relationship with “overdraft protection,” just like you regularly monitor your bank account.

Suppose either you or your partner checks four or more items on the Relationship Poop Detector or Your Relationship Pulse Check.

Think of it as a reminder to check the balance of your relationship connection account. It may be time to make a deposit!

News

SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com

Lexington Clinic Names New Operations Leadership LEXINGTON Lexington Clinic announced two

key executive leadership positions to support the organization’s strategic objectives for future growth. Under this new structure, L. Ranee Guard, PhD, and S. Craig Gillispie, MHS, FACMPE, joined Lexington Clinic as chief operations officer – surgical and technical services, and chief operations officer – medicine services, respectively.

L. Ranee Guard has a PhD in human and molecular genetics from Baylor College of Medicine in Houston, Texas. Previously, she had numerous roles at L. Ranee Guard, Summit Medical Group PhD and oversaw the Summit Central Laboratory, four diagnostic imaging centers, eight physical therapy facilities, Summit Sleep Services, three Summit Express Clinics, clinical trials, and the Occupational Health and Wellness program, along with 50 physician offices.

She also served as chief operations and development officer for KDL Pathology in Knoxville; director of business development for Genuity Clinical Research Services & Molecular Pathology Laboratory Network,

Inc., and as a scientist at the University of Iowa Hospitals and Clinics.

S. Craig Gillispie, MHS, FACMPE, has returned to Lexington Clinic, after serving as chief executive officer of Family Practice Associates of Lexington, S. Craig Gillispie, where he led practice MHS, FACMPE transformation efforts to emphasize value-based care for 25 providers, inclusive of comprehensive lab services and physical therapy.

From 2011-2013, Gillispie served at Lexington Clinic as practice administrator of Commonwealth Urology — a 19 physician group with 70 employees at nine locations. He was responsible for the transition of the practice to Lexington Clinic as an affiliate practice, integrating all financial, operational and information technology systems.

“Ranee and Craig exude a servant leadership approach, a commitment to patient experience and a transformative vision for the future of Lexington Clinic as a high-performing health care organization,” said Behnke.

Saint Joseph Berea Recognizes Medical Surgical Unit Team with DAISY Award BEREA Saint Joseph Berea recognized an

entire team with a DAISY Award for the first time. This local honor is part of a nationwide program that celebrates nurses’ extraordinary clinical skills and compassionate care. All of the team members on the third-floor medical-surgical unit of Saint Joseph Berea were recognized for outstanding patient care.

Saint Joseph Berea is a DAISY Award Partner, recognizing a nurse with this special honor every quarter. The DAISY Award was given to the medical-surgical unit based on multiple nominations about the team’s exceptional service and patient care.

The Saint Joseph Berea third-floor medical-

surgical unit team members, led at the time by Aaron Morgan, RN, recognized with this group DAISY Award, include Stephanie Alexander, Andrea Baker, Kelly Barnhill, Kelly Chambers, Sheila Chasteen, Andi Cochran, Carolyn Cornett, Natasha Davis, Chelsea Day, Holly Fort, Brooke Gabbard, Morgan Gray, Tamara Griggs, Marissa Hacker, Rayette Harrison, Anita Jackson, Stephanie Kauer, Sharlene Lamb, Sarah McDaniel, Mary Mullins, Courtney Neeley, Britney Petrey, Christy Robinson, Jessica Sanchez, Mariah Sanders, Sydney Slone, Jenny Smith, Brianna Swanson, Kelsey VickersDuncan, Sharee Welch, Roxanne Wooton, and Babs Wright.

Lexington Welcomes New Commissioner of Health LEXINGTON Joel McCullough, MD, joined the Lexington-Fayette County Health Department on February 14, 2022, as the new commissioner of health.

McCullough has extensive history in public health, including time as a medical epidemiologist for the Centers for Disease Control and Prevention (CDC) and Joel McCullough, as medical director of enviMD ronmental health for the Chicago Department of Public Health. He describes himself as “someone who focuses on the health and well-being of people and the communities that I serve.”

“Lexington will continue with strong public health leadership with Dr. McCullough joining us as the next commissioner of health,” said Michael Friesen, chair of the LexingtonFayette County Board of Health. “We are excited about the next steps for public health in central Kentucky.”

McCullough earned an undergraduate degree from Stanford University and a medical degree from the Vanderbilt University School of Medicine. He has a master of public health degree from the University of Washington.

McCullough replaces Kraig Humbaugh, MD, who had served as commissioner of health since June 2016.

Jason Mullins, PA-C, Joins Baptist Health Cardiology LEXINGTON Jason Mullins,

PA-C, has joined the Baptist Health Cardiology team. As a certified physician assistant, Mullins offers cardiac care, from managing acute and Jason Mullins, PA-C chronic cardiovascular conditions to providing patient education.

He received a master’s in physician assistant studies at the University of Kentucky and a bachelor’s in psychology at Transylvania University. Mullins is accepting new patients at Baptist Health Medical Group Cardiology, 1002 Leawood Drive in Frankfort.

PHOTOS PROVIDED BY LEXINGTON CLINIC, BAPTIST HEALTH, LFUCG HEALTH DEPARTMENT

ISSUE #139

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Events

Central Kentucky Heart Ball Raises Funds and Remembers Former Executive Director LEXINGTON The American Heart Association’s (AHA) Central Kentucky Heart Ball, presented by WesBanco, took place on March 5, 2022 at the Central Bank Center in Lexington. This year’s event was a tremendous

Lauryn Johnson, 2yr nursing student at EKU, with her mother, Kristy Salley, APRN, CHC

Ashar Aslam, MD, director of chest pain center at Baptist Health Lexington, and wife Uzma, MD, UTC

success, raising more than $438,000 to fund the battle against heart disease in Central and Eastern Kentucky. During the event, the AHA recognized the healthcare community for their efforts throughout the pandemic

Pete Hester, MD, Lexington Clinic, with daughters Ava (l) and Lily (r)

Karen and Todd Ziegler, market president, Republic Bank

Joseph Thomas, MD, FACC, associate professor, UK Gill Heart & Vascular Institute, with wife, Priya Warrier, MD, Family Allergy & Asthma, Sam Tyagi, MD, UK Gill Heart & Vascular Institute, and his wife Richa 30

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and beyond. University of Kentucky football player and cardiovascular disease survivor, Kenneth Horsey, spoke about the difference the AHA makes in the lives of himself and other survivors.

PHOTOS BY JOE OMIELAN

Jeff Koonce, market president, WesBanco, and wife Diane Koonce, who were co-chairs of the 2022 Central KY Heart Ball

Navin Rajagopalan, MD, director UK Gill Heart & Vascular Affiliate Network, John Gurley, MD, UK Healthcare cardiologist, and Geri Tomassoni, MD, Baptist Health Lexington

Shannon and Michael Schaffer, MD, interventional cardiologist, CHI Saint Joseph Health

Rebecca and Tony Houston, FACHE, market CEO, CHI Saint Joseph Health

Events

Tony Houston, market CEO, CHI Saint Joseph Health raises a toast to Joey Maggard, deceased, former director of Central Kentucky American Heart Association

John and Leslie Smart, president, CHI Saint Joseph Health Foundation

John Gurley, MD, director, Structural Heart Program at UK Healthcare, with wife Anette

Malia and George Dimeling, MD, cardiothoracic surgeon, CHI Saint Joseph Health

Neil and Sheila Griffeth, MSN, RN, market VP, CHI Saint Joseph Health

Amanda and Vince Sorrell, MD, acting chief, division of cardiology, UK Healthcare

Gary and Karen Harbin, CEO, Commonwealth Credit Union ISSUE #139

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Events

Jerry and Mimi Sims, Paige McMillan, Eric Zipperie, Maggie Liter, Jake Miller, and Ken and Susan McMillan

Heart of Louisville Heart Ball Returns with Huge Success!

LOUISVILLE The American Heart Association’s

(AHA) Heart of Louisville Heart Ball was held on March 26 at the Kentucky International Convention Center in Louisville, raising nearly $800,000 to fund the fight against cardiovas-

cular disease. The AHA also recognized two individuals who have made a significant impact in Kentuckiana. Dr. Sarah Moyer, director of the Louisville Metro Department of Public Health, was presented the “Live Fierce. Stand

Greg Hostettler, VP of strategic accounts at HealthTrust, with wife, Peggy, checking in.

Jill Mangold and Sean Muldoon, MD, ScionHealth 32

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for All.” Award for her equitable health efforts, and Abby Mulvihill was recognized as the top fundraiser in the nation for Leaders for Life, a class of changemakers dedicated to improving the health of their communities.

Heart of Louisville Heart Ball volunteers, Edith Wright, Claudia Beamus, Karen Pearce, Cricket Bland, and Missy Bennett

Sandra Guerra, MD, AHA Kentuckiana board chair, and CMO, WellCare of Kentucky, with daughter, Maya PHOTOS PROVIDED BY AMERICAN HEART ASSOCIATION

Rob Jay, CEO, ScionHealth, and Ashley Sokoler, executive director, AHA in Kentuckiana

RESEARCH. CENTERED ON YOU. RESEARCH IS AN ESSENTIAL SCIENTIFIC TOOL USED TO DEVELOP NEW, EVIDENCE-BASED THERAPIES AND DIAGNOSTIC METHODS.

Clinical trials conducted at Baptist Health play a significant role in the development of new or improved techniques to diagnose, treat or prevent diseases and conditions.

Our research studies allow patients to stay in their community, continuing to see the healthcare providers they are familiar with, while taking advantage of new drugs or therapies being tested on a national level. Patients who enroll in research studies at Baptist Health participate in treatment regimens at the forefront of patient care.

David Dougherty, MD Infectious Disease

David Dougherty, MD, specializes in infectious disease. He is a Lexington native and graduate of the University of Louisville School of Medicine. He completed his internal medicine residency at the University of Alabama at Birmingham and a subsequent infectious disease fellowship at Vanderbilt University. Dr. Dougherty is board certified in internal medicine and infectious disease. He is a member of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, and the American College of Physicians.

He is currently conducting two research studies at Baptist Health Lexington. The first study looks at the efficacy and safety of asapiprant in hospitalized patients, ages 50 and up, with COVID-19. The second assesses safety, immunogenicity and efficacy of the GSK S. aureus vaccine, in patients with recent S. aureus skin and soft tissue infection.

For more information about patient referral, or to see if your patient is eligible for a clinical trial, call 866.213.3025. To view clinical trials offered by Baptist Health, visit BaptistHealth.com/Research.

For more information about infectious disease research, contact Jamie Wilder, BS, clinical research coordinator, at 859.260.3197 or Jamie.Wilder@BHSI.com.

LEXINGTON MEDICAL SOCIETY FOUNDATION

32nd ANNUAL

GOLF TOURNAMENT

WEDNESDAY, MAY 25 | 12p REGISTRATION/LUNCH | 1p START University Club of Kentucky | 4850 Leestown Road, Lexington, KY Presented by

SCRAMBLE format • Lunch & Awards Dinner $150/player or $500/foursome All proceeds to benefit Medical non-profits in the Lexington area CONTRIBUTING SPONSORS

VISIT LEXINGTONDOCTORS.ORG TO REGISTER