ISSUE WWW.MD-UPDATE.COM#139 THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS 12VOLUME • #2 • 2022ILrPA Infectious Enthusiasm 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 CHIBENJAMINGASTROENTEROLOGYPHYSICIANS,NELTNER,MD,SAINTJOSEPHHEALTH,INTERNALMEDICINE
Know A Good Doctor? We Do. YOUR RESOURCE FOR THE BEST IN KENTUCKY HEALTHCARE Now available online OVER 100,000+ visits! www.md-update.com .com
THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS 2022 Editorial Calendar Gil Dunn, Publisher • GDUNN@MD-UPDATE.COM • 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com To participate, please contact ISSUE #140 (June) WOMEN’S & CHILDREN’S HEALTH OB-GYN, Women’s Cardiology, Oncology, Urology, Pediatrics, Radiology, Travel Medicine ISSUE #141 MUSCULOSKELETAL(September)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
Jennifer Khoury MPH Scott Neal, CPA, CFP
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.”
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Adam Shewmaker, CPA, FHFMA Morgan Taylor, MPH
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Physician Retirement Advice
Volume 12, Number 2 ISSUE #139
Welcome to the Internal Systems issue of MD-Update
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Tort Reform and Noneconomic Damage “Caps”
COPY EDITOR Amanda DeBord
Upcoming Issue and Topics
Laura Doolittle, Provations Group
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.
Until next time, all
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CONTRIBUTORS: Emily Anderson, BSN, rN Jan Anderson, PSYD, LPCC robert P. Granacher, Jr. MD, MBA
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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.
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Amanda Wilburn, MPH
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.
Thank Individualyou.copies of MD-Update are available for $9.95.
2 MD-UPDATE
MD-Update is peer reviewed for accuracy. However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials.
Joshua Owen, Esquire Charles rhea, MPH
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.
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.
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SEND YOUR LETTERS TO THE EDITOR TO: Gil Dunn, Publisher gdunn@md-update.com, or 859.309.0720 phone and fax
ISSUE #139 3 GASTrOENTErOLOGY • PULMONOLOGY-CrITICAL CArE • INTErNAL MEDICINE/PrIMArY CArE ISSUE #139 16 GASTROENTEROLOGY 18 CRITICALPULMONOLOGY-CARE 22 INTERNAL MEDICINE/ PRIMARY CARE CONTENTS SPECIAL SECTIONS 4 HEADLINES 6 ACCOUNTING 7 LEGAL 8 FINANCE 10 OP/ED 12 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 12 Infectious Enthusiasm Infectious disease specialist Mark Burns, MD, loves his job, and it shows COVEr PHOTOGrAPHY BY ALEXANDrA rOGErS
4 MD-UPDATE PHOTO PROVIDED BY UOFL HEALTH
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 depart ment that integrates clinical, educational, and research missions, while fostering a culture of collaboration, equity, and inclusion.
Williams aims to expand healthcare access and advance provider wellness in Louisville
associate dean for fac ulty diversity, equity, and inclusion. He specializes in cardiol ogy, radiology.andpreventivecardio-nephrology,cardio-rheumatology,cardio-nutrition,cardiology,cardiovascularApastpresident 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 dispar ities. 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.
Kim Williams, Sr., MD
HEADLInES
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 dispar ities, health care delivery, and advanced access to cardiac imaging. He currently is chief of the Division of Cardiology at Rush University and
“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 commu nity. His work will enhance and augment our work with strategic partners in health equity.”
“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 fundamen tals 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.”
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.
Leading Cardiologist, Health Equity Expert Named Chair of UofL Department of Medicine
LOUISVILLE Norton Infectious Diseases Institute has been chosen to study how to effectively detect respiratory syncytial virus (RSV) in adults.
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 respi ratory symptoms and admitted to one of
More than 2 million Kentuckians are cur rently 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.
have a history of alcohol and drug usage are safe, healthy, and acceptable for dona tion. This innovative partnership to increase donors across the state has also received atten tion from national organizations.
Norton Infectious Diseases Institute was chosen for this study because of the team’s
“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.”
Norton Healthcare’s four adult-service hospi tals in Louisville are invited to participate in the study. Once enrolled, nasopharyngeal, saliva, sputum and blood samples will be collected.
ISSUE #139 5
Norton Infectious Diseases Institute enrolling patients
Study Looks at How to Detect RSV in Adults
if they want to join the organ donor registry as they apply for or renew their drivers’ licenses.
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.
Organs recovered from individuals who
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.
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.
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 groundbreak ing 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 ser vices, 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
“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 stud ies have suggested that up to 10% of adults with respiratory illness have RSV.”
RSV may also play a part in making under lying chronic health conditions worse, includ ing cardiovascular, pulmonary, metabolic, and immune systems conditions.
Volunteers of America Provides “Hope and Healing” by Registering Over 500 Organ Donors
HEADLInES
“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.”
6 MD-UPDATE
• Secondary claims submission: Submitting claims to additional insurers, such as Medicaid
Revenue Cycle Management (RCM) in Healthcare: Part 1
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.
• Patient registration: Collecting patient demographics, including billing address and insurance eligibility
• Denial management: Determining cause of claim denial and assessing if the denial can be appealed
• Medical coding: Applying universal medical codes to the diagnoses of and procedures performed upon the patient
Adam Shewmaker can be reached at 502.566.1054 or ashewmaker@ddafhealthcare.com.
• Insurance verification: Validating patient insurance
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.
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.Apatient-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.
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.
Overview of the Revenue Cycle Process
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
• Payment and posting: Applying payments by insurers to the balance of the patient’s claim
ACCOUNTING
Revenue Cycle Management: What Is It?
• Medical appeals: Appealing a payment denial by an insurer
• Refunds: Determining if any parties are owed refunds after the balance of payments has been received from all billable parties.
• 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.
• Claim rejections: Instances where claims are rejected for payment by insurers
Advantages of Revenue Cycle Management
• Medical transcription: Transcribing patient reports supplied by doctors and nurses
• Patient collections: Determining amount owed by patient after insurance payments are applied and collecting payment
• Simplified Claims, Faster Payment
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 patientPrimarycare. functions involved in RCM include:
• Claim submission: Determining amount of reimbursement the provider seeks from insurance and applying for that amount
• Charge entry and billing: Applying a dollar amount to services provided and creating a claim
BY ADAM SHEWMAKER, FHFMA, HEALTHCARE CONSULTING DIRECTOR
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.
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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 consid ered the bill on the floor.
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.
BY JOSHUA J. OWEN
Limits on “Noneconomic” Damages
LEgAL
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 legis lature would have the ability to place “caps” on damage awards. Furthermore, the legislation seeks to provide a uniform statute of limita tions or statutes of repose, or both, for any civil action for injuries resulting in death or for inju ries 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 dramat ically due to a variety of legal claims for dam ages. Economic damages, i.e., a loss of earning power, would not be “capped.”
Is Kentucky Ready for Damage “Caps?”
Is Kentucky Legislature ready to cap eco nomic damages? We will know by the end of the 2022 legislative session, which is set to end on April 14, 2022.
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
Higher Damages, Higher Costs?
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.
ISSUE #139 7
Twenty-six States Have Similar “Caps”
Legislation Challenges
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.
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 med ical malpractice claims. The “caps” range from $250,000.00 to $2,350,000.00, with the median cap being $465,900.00.
According to the Kentucky Chamber of Commerce, the rising costs associated with medical malpractice liability are taking a signif icant toll on the health care industry, resulting in increased costs for consumers and a con tinued inability to attract and retain enough physicians in all regions of Kentucky. The high price of liability insurance and the lack of rea sonable tort limitations in Kentucky, including the lack of “caps,” are believed to have contrib uted to a shortage of medical professionals.
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 suc cessful at curtailing medical malpractice litiga tion in the states that have implemented them, and average malpractice insurance premiums have typically dropped.
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.”
The United States has the world’s cost liest 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 cli mate. Furthermore, per the Institute for Legal Reform, 89 percent of company executives and attorneys surveyed say a state’s legal environ ment impacts important decisions about where to locate or conduct business, which is a 14 percent increase from the same survey in 2015.
FiNANCE
for maximum lifetime family benefit.
BY SCOTT NEAL
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 mar ried, your spouse has the same options, mak ing the possible combinations ginormous. His or her decision is independent of yours, but their decision should be integrated with yours
Meet the new best-in-class, where the principle of fair treatment guides every action we take in defense of our medical professionals.
PROFESSIONALSHEALTHCARE
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.
Four Common Financial Mistakes to Avoid
Starting Social Security Benefits at a Time That is Not Optimal for Your Circumstances.
“Life’s biggest danger isn’t dying, it’s living.” — Laurence Kotlikoff
treatedProAssurance.comfairly
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.”
With the recent acquisition of NORCAL Group, ProAssurance is now the nation’s third largest medical professional insurance carrier with claims and risk management expertise in every major healthcare region.
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 prop erty 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
Your Source for Graphic Design since 2003 GRAPHIC DESIGN • INTERACTIVE PUBLICATIONS • PROJECT MANAGEMENT and more... www.provationsgroup.com FiNANCE
ISSUE #139 9
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.
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.
We address this question by carefully con sidering 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 con sider, but this gets to the financial impact of the decision.
We all make various decisions throughout the year. Many of those impact the tax bill either resulting in a refund and the govern ment using our money without paying inter est 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 imple mented. Once the transaction is complete, there is usually nothing more that can be done to change the outcome.
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 proposi tion, 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.
Remember my coach’s admonition and avoid these very common mistakes made by so many.
Misunderstanding the Risk Your Advisor is Trying to Address.
Failing to Prepare for the Tax Impact of Decisions.
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 avoid ing volatility risk, which is very different from drawdown or other forms of risk. Indeed, mitigating the effects of volatility is import ant 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 mis aligned expectation regarding risk and then to be disappointed with the result.
• 31% between ages 65 and 70
Non-Financial Retirement Planning for Physicians
• 14% after age 75
• 13% between ages 71 and 74
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.
Many physicians practice into their 80s. On the other hand, often physicians are sur prised by the need for retirement due to poor health. Many are aware of the record-break ing 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.
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.
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.
• 12% before age 60
It is the most overlooked part of retirement planning. Unfortunately, when most physi cians 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
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 life style with quickly reducing health function and increasing body weight.
In terms of non-financial planning for retire ment, 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 vol unteer 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.
10 MD-UPDATE
• 29% between ages 60 and 65
• Sustain the relationships in your life that have meant the most to you. Your relation ships may change, such as through divorce or death. As children and grandchildren move away, consider how retirement may affect your family relationships. Many phy sicians actually move to geographic areas where they can keep better contact with their children and grandchildren.
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 Physicianssubject.2are 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
When the time comes to think about retire ment, 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.
What is RetirementNon-FinancialPlanning?
BY ROBERT P. GRANACHER JR., MD, MBA
• 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 import ant question. Creating and implementing a personal plan can help frame the answer for each of us. All of us can make an impact.
• 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.
• 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.
3. Clark, Dorie. Planning your post-retirement career. HBR. org, April 28, 2016. Site accessed February 4, 2022.
ISSUE #139 11
1. https://www.ama-assn.org/practice-management/career-development/top-considerations-physicians-ahead-retirement.SiteaccessedFebruary4,2022
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.
4. Retire to something, not from medicine.
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.
8. Live within your means.
OTHER READING
3. Farouk, A. 2018. Six key physician retirement insights from doctors already there. insights-doctors-already-there.management/career/development/six-key-phsyician-retirement-https://www.ama-assn.org/pratice/SiteaccessedFebruary3,2022.
Summary:
Robert Granacher, MD, can be reached at 859.333.0068 or rgranacher@aol.com.
7. Do your best to pursue good health.
2. Sass, SA. How do non-financial factors affect retirement decisions? Center for Retirement Research at Boston College, February 2016.
REFERENCES
• Retire to something, not from medicine. Retired physicians underscored the impor tance 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 men tally active. Spend time before retirement assessing personal life goals for this new
strong during the popular retirement ages of 62 to The67.studies reviewed in this research arti cle 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 keep ing some workers in the labor force and pull ing 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
• 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 finan cial 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 attor ney, etc.), then enjoy the experience. Use a professional planner to advise.
include your spouse or partner in all decisions.
5. Map out activities that give you a sense of purpose.
1. Seegert, L. I want to retire, but I can’t quite say goodbye. Medscape May 5,2020.
6. Cultivate non-medical areas of interest.
4. Miller, R.N. Life after medicine: 3 keys to a fulfilling accesseddevelopment/life-medicine-3-keys-fulfilling-retirement.https://www.ama-assn.org/practice-management/career-retirement.SitFeb4,2022.
1. Enlist the services of a certified finan cial planner (CFP) early in your career,
deandortonhealthcaresolutions.com Practice management and advisory services Medical billing and credentialing Revenue cycle management Compliance and risk management Interim practice management Accounting and financial outsourcing HumanTechnologyresourcesEmpowering physicians to focus solely on the demands of their clinical practice OP/ED
• 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!
3. Remember, relationships should be the core of your planning.
2. Farouk, A. Early retirement? 5 factors physicians should evaluate. January 4, 2019. accessedearly-retirement-5-factors-physicians-should-evaluate.Practice-management/career-development/SiteFebruary4,2022.
12 MD-UPDATE
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 medi cine in the Division of Infectious Diseases at University of Louisville School of Medicine and in his practice with UofL Health.
PHOTOS BY MARK MAHAN
Infectious Enthusiasm
BY JIM KELSEY
Treating a Wide Patient Population
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 fellow ship in infectious disease.
“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.”
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.
“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 great est impact that way.”
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.
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 trans ferred to The Ohio State University, where he earned a bachelor’s degree in respiratory therapy.
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
COvER STORY
“My philosophy is simple. You treat everyone as though they were a member of your family or a loved one.” — Mark Burns, MD
“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.’”
“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 medi cal 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 real ized that maybe medical school was not such a foregone conclusion. The rest is history.”
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
Infectious disease specialist Dr. Mark Burns loves his job, and it shows
Burns then came back to Louisville, attend ing the University of Louisville School of
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.
“When they have an infectious disease prob lem, 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.”
“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.”Burnslikens infectious disease specialists to any expert in a field of study. Everyone needs to ask a specialist for help sometime.
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.
“COVID-19 opened up a new chapter
Comorbidities and COVID-19
As a physician and educator, Burns’ passion for what he does is indeed spreading.
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’vepreached 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 peo ple had questions and they just wanted their questions answered.”
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.
Infectious Disease is a Specialty
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.
Like most of the world, Burns has been heavily impacted by the COVID-19 pandem ic. He found himself frequently collaborating with other physicians treating those patients hit hardest by the virus.
A Spokesperson During a Pandemic
14 MD-UPDATE
“The primary danger comes when COVID19 affects the lungs,” Burns says. “Our col leagues in pulmonary critical care were deal ing with the complications of that, and they relied upon our expertise to see if there was anything we could do to help facilitate treat ment of the virus.”
“The body recognizes when something is for eign 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 sup press the immune system. It is a double-edged sword because it can suppress the immune sys tem 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 medi cations ahead of time to avoid some of the more common problems that can occur.”
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 coronavi ruses 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 develop ment of MERS (Middle East respiratory syn drome). 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.”
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 immu nocompromised 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.
Mark Burns, MD Infectious Diseases
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. expertise covers a full spectrum of services: Infectious Diseases and Joint Infections and International Travel Center and Translational Research Support Center (CTRSC)
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n Bone
In addition, because of his expertise in complicated colon polyps, Liu often receives referrals from other surgeons and gastroenter ologists 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
Gastroenterologists with UofL Health are leading the way with new tools and techniques for both common and complex conditions
In his role as an interventional gastroen terologist, 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 diag nose pancreatic cancer. I also do ERCP [endo scopic retrograde pancreatography], which allows us to remove stones in the bile duct.”
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.
BY DONNA ISON
Nathan Liu, MD, and medical assistant Emily Billingsly
Along with the ongoing treatment of more common conditions, such as GERD (gastric reflux), celiac disease, and irritable bowel syn drome, the gastroenterologists within UofL Health address the most complex condi tions—using the latest therapeutic agents, endoscopic procedures, and surgical tech niques to combat Crohn’s disease, gastropa resis, and the full range of gastrointestinal cancers (colorectal, esophageal, gastric, small bowel, pancreatic, and liver).
back. As for his brother, he continues to thrive and just graduated medical school last year.
Improved Techniques and Technologies
Bringing ProceduresPioneeringtoKentucky
LOUISVILLE In the field of gastroenterolo gy, 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 move ment. 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.”
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 pre vented 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 intro duced to gastroenterology and has not looked
16 MD-UPDATE PHOTOGRAPHY BY ALEXANDRA ROGERS
ISSUE #139 17
As the field continues to move away from open surgery, Liu is looking forward to adopt ing new tools and new skills and offering his patients an even greater number of minimally invasive, safe, and
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 life time. New recommendations dictate that individuals should begin scheduling colonos copies at age 45.
“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 per form 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 hospitalAchalasiastay.is an incredibly challenging con dition, 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
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.”Athird emerging area in the field is bar iatric 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 gas troplasty.” UofL Health is in the early stages of incorporating bariatric endoscopy into its long list of procedures.
In Conclusion
Several factors play into a person’s likeli hood of developing colon cancer: age, obesity, smoking, high cholesterol, and a genetic com ponent, such as familial adenomatous pol yposis (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.”
effective procedures. The Lexington Medical Society is the principal voice & resource for Central Kentucky physicians to enhance their professional lives & improve the health of the community • Physician Wellness Program – Take care of your patients by taking care of yourself. » 8 free counseling sessions per calendar year » Completely confidential and easy access » Call (800) 350-6438 • Credentialing • 24/7 Medical Call Center • Legislative advocacy in partnership with the Kentucky Medical Association • Events and programing throughout the year LEXINGTON MEDICAL SOCIETY Physicians taking care of the community since 1799 For more information visit lexingtondoctors.org or call (859) 278-0569 SPECIAL SECTION GASTROENTEROLOGY
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.
New Screening Guidelines
“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.”
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 pur poses on patients who absolutely need it. These patients often present with jaundice, abnormal liver tests, and intermittent right upper quad rant 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 physi cians who perfected the procedure.
valves,Endo-bronchialapproved by the FDA 3 years ago, are designed to reduce gas trapping and hyperinflation in patients with severe emphysema.
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 symp toms — fatigue, shortness of breath, physical
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.
Long Covid: Diagnosing, Treating and Understanding
Colon is also excited about a computer guided navigational tool that aids in the detec tion of small peripheral nodules that are possi ble 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
Colon, a native of Puerto Rico, was edu cated 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.
BY TIM CORKRAN
After 18 months in the depths of the pandemic, Colon and his fellow pulmonolo gists 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 advo cate 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.
Getting Back to What He Does Best
Emerging primary concerns current ly 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 embo lism. 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-morbidi ties tend to exacerbate the symptoms of long COVID, says Colon.
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 con cern than treating the symptoms.
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.
SPECIAL SECTION PULMONOLOGY
DR. COLON PHOTO BY GIL DUNN
18 MD-UPDATE
BiFocal: The COVIDPreoccupationsDualoftheEraPulmonologist
Long-haul COVID-19 is one of may challenges for pulmonologists
Eliseo Colon, MD, practice leader at CHI Saint Joseph Medical Group – Pulmonary and Critical Care Medicine
Electromagnetic navigational bronchoscopy provides access to the most distant regions of the lungs. “After a CAT scan suggests a point of concern, this allows us to reach and biopsy those peripheral lesions.”- Eli Colon, MD
more closely.” He says that the screen readout provides a path way 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.
1401 Harrodsburg Road Suite C 405 Lexington, KY 40504 859.276.4429
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ISSUE #139 19
Eli Colon, MD
Colon is adamant about smok ing cessation and really values the bronchoscopy tool, but, more than anything, he wants his gen eral practitioner colleagues to push their high-risk patients to seek opportunities for early detec tion. He says that “The survival rate of lung cancer patients is over 90% for people who go through earlyWithscreening.”apersonal medical phi losophy that “You have to take care of your mind and your body,” Colon is glad to be back helping
patients avoid the worst outcomes of severe respiratory illness. He will continue to con tribute to his field’s understanding of long COVID, but his primary focus will be utiliz ing the technology and treatment programs proven to aid early detection efforts.
CHI SAINT JOSEPH MEDICAL GROUP - PULMONOLOGY AND CRITICAL CARE MEDICINE
Different Ways of “Seeing” Patients
LEXINGTON If you spend very much time talking shop with Ben Neltner, MD, the word “under served” is likely to come up.
Neltner has enjoyed the challeng es of navigating his first few months of full-time practice and all the new ness. For him, the key is building relationships.“Alotoftimes when you meet the patients for the first time, there can be mistrust and ques tioning,” he says. “But, when they get to know you, it can be like helping a family member. With a lot of the patients I’ve had, even in the short time — nine months — I’ve been here, there is already a great relationship.”
So far, his job in primary care includes seeing patients coming in for one of three primary things: wellness exams, chronic disease management, and acute visits.
“Telehealthstride.been wonderful for our prac tice,” he says. “What I have found, especially in my patients that are underserved, is they don’t have dependable transportation and utilize loved ones to help them.”
Ben Neltner, MD, joined CHI Saint Joseph Health Medical Group – Primary Care as a general practitioner last July.
SPECIAL SECTION INTERNAL MEDICINE
The two did a couples match for residen cy in Charlottesville, Virginia, before being called back to their home state last summer: Ben to work at CHI Saint Joseph Health and Caitlyn to work at Commonwealth Pediatrics.
PHOTO BY GIL DUNN
“We wanted to move back to Kentucky,
To be sure, he sees a broad cross-section of patients as part of his primary care practice in Lexington with CHI Saint. Joseph Health Medical Group – Primary Care. But the tone in his voice changes — and the passion comes through — when he discusses helping the underserved.
BY PAT HENDERSON
and Lexington was in between our hometowns, so it worked out really well for us,” says Neltner, who became a first-time dad in January when he and Caitlyn welcomed a baby girl.
“The patients are coming to you for anything, and we have to be flexible,” he says. “I love the wide scope of patients we see.”
Like the motto of the Hard Rock Café, “Love All, Serve All,” he embodies the popular chain’s tagline“Whatdaily.Ilove 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,” he says. “It is a wide variety of patients from all kinds of back grounds; I have CEOs and people who are Whilehomeless.”Neltnerdidn’t intentionally seek out the underserved, circumstances during his training lit a fire in the Northern Kentucky native that still burns bright. When he was in high school, he volunteered at St. Elizabeth’s hospice center. During residency, he worked in a free clinic with mostly uninsured patients and also helped staff a refugee clinic in Charlottesville, Virginia.
After graduating from Covington Catholic High School, Neltner attended the University of Louisville for both undergraduate and University of Louisville School of Medicine. It was at UofL where he met his future wife Caitlyn, a budding pediatrician and Winchester, Kentucky, native.
The rapid introduction and implementa tion of telemedicine over the past couple of years has altered the way doctors interact with patients. For Neltner, it is another new thing he takes in
“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.”
“Those experiences were absolutely invalu able,” he says, “and it was great training to work with those underserved popula tions. I have refugees in my patient group in Lexington, so my experience really helped me to understand what they face.”
Ben Neltner, MD, enjoys the challenges of being a general practitioner
New City, New Job, New Baby, New Challenges
Serving the Underserved
20 MD-UPDATE
“It is important to me to establish, from a patient’s very first visit, that this is a mutual
This can be especially beneficial for people who come to Lexington from rural commu nities, where such resources may not be avail able, and certainly aren’t found in one place.
CHI SAINT JOSEPH MEDICAL GROUP - PRIMARY CARE Benjamin Neltner, MD 1401 Harrodsburg Road Suite B 160 Lexington, KY 40504 859.276.4486
He cites having access to other profession als on the CHI Saint Joseph Health team, ranging from referral specialists and imaging schedulers to social workers and case manag ers to on-site pharmacists, as making it easier to provide more comprehensive care.
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.
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.
ISSUE #139 21
“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.”
“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 special ists,” Neltner says. “Our preference is still for the in-office visit, but it is better than them not being seen.”
Telehealth also has been impactful for peo ple with mental health issues. Neltner notes that patients with severe anxiety and depres sion, for instance, have a hard time getting out of the house and may skip an appointment.
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 obvi ous result is fewer cancelled appointments, but another benefit is allowing an extra set of ears to hear care instructions.
SPECIAL SECTION 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.”
“With the geriatric population, I’ve had instances where getting a visual on their living room or their kitchen gives me an under standing of what their home situation is, and that’s been helpful,” Neltner says.
Teamwork Really Does Make the Dream Work
PHOTO
of hypertension such as renal artery stenosis, hyperaldosteronism, or pheochromocytoma.
Cardiology and Salley began the specialized in-office hypertension program in May 2021. Obstacles with COVID-19 restric tions initially affected patient flow. Salley says that the practice used telehealth visits effec tively and has seen a return of in-office visits as COVID-19 infection rates have declined.
Salleysystem.isthe first APRN in Kentucky to achieve certification in hypertension from the American Hypertension Specialist Certification Program. She has been a cardi ology nurse practitioner for six years, having received her nursing degree and APRN certi fication at Eastern Kentucky University. On her own initiative she researched the steps necessary to pass the certification test.
Individualized Patient Care
“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.
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The patient population that Salley believes she can help the most are patients with refractory hypertension who are on multiple anti-hypertensive medications with comor bidities such as coronary artery disease, dia betes mellitus, chronic kidney disease, obesity, and peripheral vascular disease. She says she often rules out patients for secondary causes
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 rea son, she chose to pursue this avenue to help theSalleycommunity.recallsa 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 medica tions 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 consis tently around 120 over 70, and she is thrilled.”
Kristy Salley, APRN, CHC, with Lexington Cardiology, is a certified hypertension clinician.
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 spe cializes in uncontrolled hypertension and is accepting patients through the Baptist Health referral
“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.
Silent No More
BY GIL DUNN
PROVIDED BY BAPTIST HEALTH LEXINGTON
“No one in the practice knew I was study ing for this,” she says, “but when I received my official hypertension clinician certifica tion, my colleagues were elated and very supportive.”Lexington
“Each case is so patient specific,” says Salley.
Specialized hypertension program is now available in Central Kentucky
COmPLEmENTARY CARE
“We’re proud of achieving the most dona tions ever seen in Kentucky and hope to con tinue this trend,” Bergin says.
Tissue donations include skin, bones, ten dons, and saphenous veins. These typically come from hospital patients who experience cardiac standstill. A carefully controlled pro cess allows tissue donations up to 24 hours after heart standstill occurs.
In 2021 KODA facilitiated 189 donations that changed the lives of 496 organ recipi ents. This marked a fifth consecutive annu al increase in donations. Since 2017 organ donations have increased 75%, and tissue donations have increased 45%.
beingexcludesautomaticallyyoufromacandidatefororgandonation.” COmPLEmENTARY CARE
• Registering to be an organ donor saves lives.
BY mENISA mARSHALL
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 sim ilarKODAconnections.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.
About 1,000 people are on Kentucky’s organ wait list. Nationwide more than 100,000 people are in need of a transplant.
• Everyone has the potential to be an organ donor.
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 dona tions with families.
Organ and tissue donations have increased 75% in the last five years
Historically, Kentucky’s small rural hospi tals 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.
“Nothing automatically excludes you from being a candidate for organ donation,” BerginBergin’ssays.passion for healthcare began at age 16 while working during school breaks at a hos pital where her mother was a nurse. She joined KODA in 2003 as an organ recovery coordi nator. 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.
tion. They may come from recently deceased individuals or patients with no brain func tion, typically due to injury or cardiac death. Donations that involve discontinuing ventila tion often reflect a patient’s desires expressed through a living will or advance directive.
Organ Donation: Anyone Can Be a Lifesaver
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.
LOUISVILLE As president and CEO of Kentucky Organ Donor Affiliates, Julie Bergin, BSN, FACHE wants you to remem ber two things:
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Numbers Speak Loudly
“Quick action is critical,” Bergin says. “We sometimes have only a 2- to 4-hour window for recovery.”
Lungs account for a relatively small per centage of transplants. KODA has seen a twoyear decline in lungs recovered for transplant although the need may grow due to COVID complications.
“Nothing
Nationwide, kidneys are the most frequent ly donated organs, followed by livers and hearts. KODA facilitated 130 liver transplants and 60 heart transplants last year.
Julie Bergin, BSN, FACHE, president and CEO of Kentucky Organ Donor Affiliates
Six organs — hearts, lungs, livers, kidneys, pancreas, and intestines — qualify for dona
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. histo ry. His liver saved a woman’s life and his tissue and corneas helped 77 people.
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 sup port 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.
• 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.
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.InKentucky 63% of the adult population are registered donors with one of country’s fastest growing registries.
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.
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.
“You’re never too sick or too old to register to be a donor,” says Bergin.
KODA encourages everyone to document their wishes by signing up for the donor reg istry. This “act of love” spares loved ones the pain of making hard decisions in situations that may occur with little advance warning.
VISIT US ONLINE
COmPLEmENTARY CARE
and has contributed to two recent pieces of encouraging legislation.
Many people mistakenly believe illnesses such as hepatitis C or HIV rule out organ donation. Now that hepatitis C can be cured,
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Organ recovery takes place in an OR where an anesthesiologist, scrub nurses, and the recovery team work together. KODA recent ly hired its own recovery surgeon, Cosme Manzarbeitia, MD, FACS. This strategic move helps lighten the hospital care teams’ heavy workloads.
Raising QuashingAwareness,Misperceptions
KODA strives to raise awareness about the importance of organ donation. For exam ple, 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 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
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.
Viral Hepatitis:
Surveillance, testing and guidance on everything from salmonella to syphilis
Syphilis surveillance efforts have been expanded to ensure we are monitoring, ana lyzing and evaluating all incoming morbid ities 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.
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 disor der (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.
— Charles Rhea, MPH, TB EpidemiologistProgram
Sexually DiseasesTransmitted(STDs):
The following is a briefing from Kentucky public health leaders regarding the current state of affairs for important infectious diseas es being tracked and addressed by Kentucky’s public health infrastructure.
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 individ uals, 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.
— KY STD Prevention and Control Program
— Emily Anderson, BSN, RN, KY TB Program Controller/Manager
BY BETHANY HODGE, MD, MPH
Tuberculosis (TB) programs around the world faced significant challenges during the COVID-19 pandemic. With staffing capaci ties being stretched to the limit, reporting of other infectious conditions suffered, particu larly with respiratory conditions such as TB. COVID-19 and TB can have similar clin ical 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 andAscontrol.weare beginning to, hopefully, see the light at the end of the COVID-19 pandemic tunnel, we encourage Kentucky medical pro viders, 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.
— Amanda Wilburn, MPH, Viral Hepatitis Program Manager
Tuberculosis:
Infectious Disease Prevention is So Much More Than COVID-19
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PuBlic HEAlTH
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 sal monella to syphilis. Then COVID-19 brought unprecedented new challenges. The Kentucky Department for Public Health ramped up personnel and activities to bring their knowl edge 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 dis eases, 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.
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.
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 uten sils 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 serv ing; 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 memo rable for the wrong reasons.
PuBlic HEAlTH
— Morgan Taylor, MPH,EpidemiologistVector-borne
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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 san guineus). 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
Tickborne Diseases:
Enteric Diseases:
—Jennifer Khoury, MPH, Foodborne/ Waterborne Diseases Epidemiologist
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!
Give Hope. Change Lives.
diseases we see here are spotted fever rickettsi osis (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.
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
Heading into warmer weather, it’s import ant to remember that foodborne illness can have a significant impact on outdoor gather ings. 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
BY JAN ANDERSON, PSYD, LPCC
The Relationship Pulse Check is more than a “date night” Band-Aid approach to reconnect ing with your partner. Think of it as a way to supercharge and safeguard your relationship connection.Amidstthe natural ebb and flow of rela tionships, how can you tell you’re seriously losing touch? Some types of “relationship dis connect” 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!
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. Work on your own and kick it up a notch.
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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1. Work on your own.
The Relationship Pulse Check: A Ridiculously Easy Way to Reconnect and Recharge
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.
Here’s how to jump-start the process, depending on the degree of relationship dis connect you’re experiencing:
• Has the relationship taken on an airless quality, like there’s little room to move or breathe?
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: scheduleappointmentMaritalinPoop-Detector.pdfwp-content/uploads/2020/07/Relationship-https://counselinghuntsville.com/Makeitquick,easy,andautomatictocheckonyourrelationshipregularly.PluginthePoopDetectorasarecurringmonthlyonyourcalendar,justlikeyouallyourotherregularcoupleactivi
Here’s why:
MENtAL WELLNESS
• Are you politely living parallel lives?
BTW: If your partner isn’t willing to par ticipate, 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.
• Are your interactions mostly superficial and have a “roommate” feel?
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.
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.
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?
Here are some signs that always get my attention in counseling sessions:
• Have your interactions become way too volatile? With no makeup sex — or making up, period?
1. It helps me get up to speed much faster when I get the whole picture.
Regardless of the approach, I find the Gottman Relationship Poop Detector a help ful 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.
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:
extremely valuable in two ways:
• Start with a “1-1-2” style of couples counseling that includes private individual time for each partner, followed by a session together.
Lexington | Louisville | Cincinnati 800.344.9098 | DSNEAL.COM Call for our simplyassessmentcomplimentarytoolorscanthiscode. MENtAL WELLNESS
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 “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
One of the things we believe our clients appreciate most about D. Scott Neal, Inc. is our commitment to values we share with them:
FEE-ONLY FINANCIAL PLANNING
Here are some creative strategies that can work surprisingly well to get the relationship ball rolling:
2. Confide your needs and concerns without the risk of getting too vulnerable yourself.
1. Air your dissatisfactions without fear of hurting your partner.
• 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
• 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.”
Once I have the raw data, we can strategize how to communicate it in an emotionally intelligent way.
Iavoidant.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.
3. What if starting with traditional couples counseling isn’t going to happen … or isn’t even a good idea?
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 relation ship 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!
Values
Even in Investment Strategy
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, con cerns, and priorities for their relationship, this tool can supercharge your relationship connec tion by targeting what matters most to you.
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. After all, wealth without purpose is just numbers. At D. Scott Neal, we “walk the walk” when it comes to values –just one of the ways we try to distinguish ourselves from other financial planners.
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He received a master’s in physician assis tant 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.
LEXINGTON Jason Mullins, PA-C, has joined the Baptist Health Cardiology team. As a certified physi cian assistant, Mullins offers cardiac care, from managing acute and chronic cardiovascular conditions to providing patient education.
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.
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.
S. Craig Gillispie, MHS, FACMPE, has returned to Lexington Clinic, after serving as chief executive officer of Family Practice Associates of Lexington, where he led practice transformation efforts to emphasize value-based care for 25 provid ers, inclusive of comprehensive lab services and physical therapy.
McCullough has extensive history in public health, including time as a medical epidemiologist for the Centers for Disease Control and Prevention (CDC) and as medical director of envi 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.”
Jason Mullins, PA-C
McCullough replaces Kraig Humbaugh, MD, who had served as commissioner of health since June 2016.
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 medi cal-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 excep tional service and patient care.
“Ranee and Craig exude a servant lead ership 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.
“Lexington will continue with strong public health leadership with Dr. McCullough join ing 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 McCulloughKentucky.”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.
Saint Joseph Berea Recognizes Medical Surgical Unit Team with DAISY Award
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.
PHOTOS
PROVIDED BY LEXINGTON CLINIC, BAPTIST HEALTH, LFUCG HEALTH DEPARTMENT
Joel McCullough,MD
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,
L. RaneePhDGuard,
Inc., and as a scientist at the University of Iowa Hospitals and Clinics.
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 Summit Medical Group 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.
S. Craig Gillispie, MHS, FACMPE
SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.comNews ISSUE #139 29
Jason Mullins, PA-C, Joins Baptist Health Cardiology
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
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Pete Hester, MD, Lexington Clinic, with daughters Ava (l) and Lily (r)
LEXINGTON The American Heart Association’s (AHA) Central Kentucky Heart Ball, pre sented by WesBanco, took place on March 5, 2022 at the Central Bank Center in Lexington. This year’s event was a tremendous 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 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.
Karen and Todd Ziegler, marketRepublicpresident,Bank
Central Kentucky Heart Ball Raises Funds and Remembers Former Executive Director
Lauryn Johnson, 2yr nursing student at EKU, with her mother, Kristy Salley, APRN, CHC
Shannon and Michael Schaffer, MD, interventional cardiologist, CHI Saint Joseph Health
EVENTS
Jeff Koonce, market president, WesBanco, and wife Diane Koonce, who were co-chairs of the 2022 Central KY Heart Ball
PHOTOS BY JOE OMIELAN
Navin Rajagopalan, MD, director UK Gill Heart & Vascular Affiliate Network, John Gurley, MD, UK Healthcare cardiologist, and Geri Tomassoni, MD, Baptist Health Lexington
Rebecca and Tony Houston, FACHE, market CEO, CHI Saint Joseph Health
Ashar Aslam, MD, director of chest pain center at Baptist Health Lexington, and wife Uzma, MD, UTC
Amanda and Vince Sorrell, MD, acting chief, division of cardiology, UK Healthcare
John and Leslie Smart, president, CHI Saint Joseph Health Foundation
Gary and Karen Harbin, CEO,
John Gurley, MD, director, Structural Heart Program at UK Healthcare, with wife Anette
Malia and George Dimeling, MD, cardiothoracic surgeon, CHI Saint Joseph Health
Tony Houston, market CEO, CHI Saint Joseph Health raises a toast to Joey Maggard, deceased, former director of Central Kentucky American Heart Association
Neil and Sheila Griffeth, MSN, RN, market VP, CHI Saint Joseph Health
CreditCommonwealthUnionEVENTS
ISSUE #139 31
Jill Mangold and Sean Muldoon, MD, ScionHealth
PHOTOS PROVIDED
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
BY AMERICAN HEART ASSOCIATION
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Rob Jay, CEO, ScionHealth, and Ashley Sokoler, executive director, AHA in Kentuckiana
MD-UPDATEHeart
Heart of Louisville Heart Ball volunteers, Edith Wright, Claudia Beamus, Karen Pearce, Cricket Bland, and Missy Bennett
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.
Jerry and Mimi Sims, Paige McMillan, Eric Zipperie, Maggie Liter, Jake Miller, and Ken and Susan McMillan
Greg Hostettler, VP of strategic accounts at HealthTrust, with wife, Peggy, checking in.
EVENTS
Sandra Guerra, MD, AHA Kentuckiana board chair, and CMO, WellCare of Kentucky, with daughter, Maya
of Louisville Heart Ball Returns with Huge Success!
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.
For more information about infectious disease research, contact Jamie Wilder, BS, clinical research coordinator, at 859.260.3197 or Jamie.Wilder@BHSI.com.
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.
CENTEREDRESEARCH.ONYOU.
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.
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.
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
WEDNESDAY, MAY 25 | 12p REGISTRATION/LUNCH | 1p START VISIT LEXINGTONDOCTORS.ORG TO REGISTER 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 LEXINGTON MEDICAL SOCIETY FOUNDATION 32nd ANNUAL GOLF TOURNAMENT CONTRIBUTING SPONSORS
