Page 1

fall 2016 • volume 8 • issue 3

Profile in Compassion

Medicine is Calling John Gurley MD ALSO INSIDE:

WINNING ESSAYS ES S

ST

C O NT E AY

NNERS WI

“Healthy and happy doctors provide better care, define barriers and solutions to physician wellness.”


2

doc • Fall 2016

Kentucky

Begin Living Life Today At Trilogy Health Services, we believe in living

life with no boundaries or limitations! Here, you’ll enjoy life to the fullest with meals prepared based

HEALTH CAMPUS SERVICES:

on your preferences, non-stop activities, a variety of five-star amenities and a dedicated staff that’s

always ready with a friendly smile and a helping

hand. Come see just how good life can be at your

local Trilogy Health Services campus – stop by or call to schedule a personal tour today.

Follow us on your favorite social networks

Cedar Ridge Health Campus 859-234-2702 • cedarridgehs.com • Cynthiana, KY The Willows at Citation 859-277-0320 • willowsatcitation.com • Lexington, KY The Willows at Hamburg 859-543-0337 • willowsathamburg.com • Lexington, KY

Personal Care Short-Term Rehab Long-Term Care Memory Care Skilled Nursing Outpatient Therapy Respite Care


BE THERE FOR THEM. HEAR EVERY MOMENT. NOW IS THE TIME.

THE FIRST

4

It’s a Conversation, Not a Consultation

259 Southland Dr Lexington, KY 40503 Other convenient locations: Prestonsburg • Pikeville

1

Answering questions about your health history and current lifestyle

2

Ensuring your ears are healthy

3

Identifying if and where Sound Voids® are occurring

4

Finding the right hearing solution for your needs

www.kyhearing.com Dr. Robert Manning, Au.D., Doctor of Audiology Dr. Tiffany Brewer, Au.D., Doctor of Audiology Jake Manning, HIS, Hearing Instrument Specialist

Get back on track, call 859.963.2958 to learn what your path to better hearing looks like.


4

doc • Fall 2016

Kentucky

Contents | Fall 2016

FROMTHEEDITOR Robert P. Granacher Jr., MD, MBA, Editor-in-Chief, Kentucky Doc Magazine

The Conversation Has Changed by Christopher R. Simmons, MD

05

We are the problem are we willing to be the solution? by Anh-Thu Le, MD

06

PHYSICIAN HEALTH AND WELL BEING What Keeps You Awake at Night? by John A. Patterson MD, MSPH, FAAFP

08

Wellness for me... Wellness for you by Rebecca Ba’Gah, MD Independence is Old News: How Doctors Can Provide Better Patient Care by Tara Shrout

10

12

For the Greater Good… by Kara Jolly

14

COMMUNITY NEWS

16

Welcome to all to the Fall 2016 edition of KentuckyDoc magazine. For this edition we are featuring the winners of our 2nd annual essay contest. This year’s request is: “Healthy and happy doctors provide better care: define barriers and solutions to physician wellness.” We have three winners from our University of Kentucky residents and three winners from the University of Kentucky College of Medicine students. Please read all six essays as they demonstrate that our young physicians in training have the future of medicine well in hand. UK resident Christopher Simmons MD won the first place in the residency contest with his essay: “ The Conversation has Changed.” He is followed by the 2nd place residency winner, Ahn-Thu Le, MD with her essay: “We are the Problem: Are We Willing to be the Solution?” Third place in the resident category was won by Rebecca Ba’ Gah, MD, with an essay titled: “Wellness for Me…Wellness for You.” All three essays are thoughtful and inspiring. In the medical student category, we have first place winner, Tara Shrout, with her perceptions of: “Independence Is Old News: How Doctors Can Provide Better Patient Care.” She is followed by medical student category second place winner, Kara Jolly, and her entry: “For the Greater Good.” Third place medical student winner is Amanda Jolly with her essay: “Physician Accountability for Wellness in Today’s America.” All three students provide us with thoughtful musings relevant to today’s medical climate. LMS member John Patterson, MD shares his insights into physician wellness by asking 10 physician colleagues to share what keeps them awake at night. Their answers are a window into the collective concerns of our medical community. In a second article John profiles interventional cardiologist John Gurley, MD and his compassionate philosophy of caring for the very ill while caring for and being mindful of his own wellness and peace of mind. Please see the article, “Factors to Consider in End-of-Life Decisions, by Nicholasville attorney Bobby E Reynolds. He provides very useful advice to physicians as they help their families and patients through this potential mine field as life’s end approaches. Lastly, addiction medicine specialist Dr. Johnston, provides pearls and guidance (“There are many Paths to Recovery”) to those of us providing recovery care to addicted persons. Please enjoy the thoughts of our medical students and physicians-in-training. Don’t forget that Dike Drummond, MD will be at Keenland October 15, for our LMS sponsored burnout proof program and horse racing at its finest, for physicians, spouses and significant others. Until next edition, be well.

– Bob

Editorial Board Members

Robert P. Granacher Jr., MD, MBA editor of Kentucky Doc Magazine Tuyen Tran, MD Lowell Quenemoen, MD Amanda Faulkner, MD

PROFILE IN COMPASSION Medicine is a Calling: John Gurley MD by John A. Patterson MD, MSPH, FAAFP Physician Accountability for Wellness in Today’s America by Amanda Pursell Factors To Consider In End-Of-Life Decision-Making by Bobby E. Reynolds There Are Many Paths to Recovery by Dr. Johnston, Recovery Works BUSINESS ActionCOACH for Better Business by Andrew Van Horn HOUSE CALLS Real Estate Listings

Tom Goodenow, MD

18

John Patterson, MD Thomas Waid, MD Brent Morris, MD Danesh Mazloomdoost, MD

20 Mailed to 100% of physicians licensed in Fayette County. Mailed to 75% of doctor office managers & other decision makers in Fayette County Practices. For advertising rates and to find out how to get your article published, please call

22

859-368-0778

brian@rockpointpublishing.com

24

ROCKPOINT Publishing

26

28

© Copyright Kentucky Doc Magazine 2016. All rights reserved. Any reproduction of the material in this magazine in whole or in part without written prior consent is prohibited. Articles and other material in this magazine are not necessarily the views of Kentucky Doc Magazine. Kentucky Doc Magazine reserves the right to publish and edit, or not publish any material that is sent. Kentucky Doc Magazine will not knowingly publish any advertisement which is illegal or misleading to its readers. Kentucky Doc Magazine is a proud product of Rock Point Publishing.

Staff Brian Lord Publisher Kim Blackburn Sales Representative Jennifer Lord Customer Relations Specialist Barry Lord Sales Representative Anastassia Zikkos Sales Representative Janet Roy Graphic Designer


doc

Fall 2016 • Kentucky

ST

ES S

C O NT E AY

R

ES

IDE

Y

NNER I W

The Conversation Has Changed

N T C AT E G

OR

By Christopher R. Simmons, MD What we need now is more than just a pill. Genomes have been sequenced. Immunotherapy and personalized medicine have arrived. Billions of dollars have been spent. Many sleepless hours have gone by, yet our clinicians and scientists have failed to solve the world’s problems. Perhaps, in part, this is because wellness cannot be quantified in the laboratory. Perhaps our ability to provide true, compassionate care has been hampered by the weight of our own knowledge. Perhaps what we need now is a reminder that we have the right to be happy regardless of our circumstances and that we are not alone. It has been fifteen years since I left home to pursue my dreams. I have come to realize how much I left behind. The road has been long but amazing. It doesn’t matter how many grants I have submitted (with marginal success), or how many central lines I have put in. What matters most is that when I look into my patient’s eyes I see their desire to get better and to go home. They have all touched my life and made me realize how much I miss home. Unfortunately, neither they nor I can be fixed with the flick of a wrist and a prescription pad. I am certainly more knowledgeable than when I left home, and that knowledge has undoubtedly helped many of my patients. I have also accepted that knowledge without prudence only goes so far. Often times my patients do not need to hear my meticulous differential and treatment plan. Rather, they need to hear that they are not alone. They need to hear that life going forward may be different, however, there is a path not only to recovery, but to happiness as well. They need to know that time spent with their loved ones, their favorite songs and their hobbies may be just as important as the tests

that we run and medicines we administer. They need to understand that getting up is more important than falling down, that healing does not stop once the visit is over, and that wellness will require a communal effort. Years have gone by and the squeak of my sneakers has not echoed through a gym, nor has my former garden seen much tilling or sowing. The free weights seem heavier now and my plants, they are a little more yellow than I recall. As the days go on and my residency training winds down I am able recall what it was like to be human. I have begun rediscovering the joys, and the hardships, of living a wholesome life. I have also come to understand that many of these hardships are in no way unfamiliar to my patients. I may not be recovering from a stroke, or sepsis, or motor vehicle trauma. I never once required IV antibiotics, chemotherapy or dialysis as a result of residency. Yet, I still feel as though I lost part of myself in that hospital. Ultimately, I have the joy of knowing that with a little work I will find myself again. I have the joy of going home, spending more time with my family and to investing in my own wellness. I have learned to remind my patients of their right to celebrate a life well lived. Others I try to remind of their right to be happy, even if what makes them happy is killing them. Not everyone will change. Spending a little more time sharing stories with my patients and a little less time focusing on documentation has reminded me why I got into medicine. It has given me the chance to reflect on the many blessings in my life. It reminds me to enjoy hugs from my daughter, sloppy kisses from my dog, and quiet time alone with my wife. Realizing now how addicted I was to work, to perfection and to success reminds me of the power of addiction in the lives of my patients. Now that I see the light at the end of the tunnel I can turn my conversation with them toward happiness and the things in our lives that have made us feel true joy.

The conversation is different now. During my earlier years in training I hoped to educate patients as to the marvels of modern medicine. After several years at the bench and several more at the bedside I have realized how tremendously technology has outpaced modern society, and to some extent even modern physicians. Even if I could interpret a patient’s genotype in such a way to explain to them how that their genetic risk for diabetes is magnified by their sedentary lifestyle, could I convince them to lose weight? What if I take the time to get to know them and to understand what makes them happy? Could I motivate them to change their lives, to maintain and enhance their independence rather than just their A1c? I have a lot yet to learn. That doesn’t mean I get to ignore the indications and contraindications of new pharmaceuticals that seem to roll out every day. I won’t stop reminding my patients of the many implications smoking has on their health. I will however continue to focus on wellbeing, and to address the emotional as well as physical (and perhaps even genetic) stumbling blocks we face in life. In doing so I will be reminded of the joys of health and independence that some of my patients have lost. I still need to face the challenge of getting back in shape and catching up on lost time with my family. I need to remind my patients of the importance of doing the same. In spite of the inevitable pillboxes in our futures I hope we never lose sight of the value of happiness and the knowledge that wellness cannot simply be measured in milligrams per deciliter. About the Author Dr. Simmons is a fourth year Internal Medicine-Pediatrics resident at the University of Kentucky. He intends to pursue a career in academic medicine and has interests in clinical and translational research as well as medical education.

5


6

doc • Fall 2016

Kentucky

We are the problem

ST

ES S

C O NT E Y A

2 R

ES

IDE

PLACE

ARE WE WILLING TO BE THE SOLUTION?

Y

nd

N T C AT

R EGO

By Anh-Thu Le, MD Medical schools have a tradition where students are bequeathed a white coat. These coats announce to all and sundry that we are about to start our shaky foray into the clinical realm. Although I remember feeling no different before I slipped the white coat on than I had after, it meant something to the people who saw me wear it. Now, the white coat is just a garment. It does not bestow any blessings or bring any hexes upon its wearer. But it indicated that I was now (supposedly) experienced and knowledgeable,

capable of handling any medical crisis in the hospital. Although it was never meant to symbolize anything else in our lives but our profession, somehow, it tacitly indicated we could also wrangle away all the messiness in our personal lives, that we were capable of smoothing over disputes with loved ones or illnesses or even death itself without faltering in the hospital. And that we could do it all alone. I was taught to venerate the human body in medical school. Early on, I realized we had come to regard our own bodies as inconveniences and an enemy working against us. I remember clearly the chief of my general surgery rotation when I was a

Conflict Resolution & Trainings 400 Etter Drive, Suite 1 Nicholasville, Kentucky, 40356 www.summitcrt.com Phone: 859-305-1900 Email: contact@summitcrt.com Family Services

Business Services

   

 Workplace Investigation  Leadership Building  Team Building

Conflict Resolution/Mediation Life & Crisis Coaching Care Community Investigation

Parenting Classes Family Classes

 Are Your Kids Bullying You?  Case Management for Families: Making the Right Choices for Your Loved One

 Thinking Beyond Retirement

Industry Classes

 Planning For The End of Retirement

 Business Etiquette Workshops  All In The Family: Inspiring Families To Choose You!

medical student. She had come down with a gastrointestinal virus, looking incredibly wan as she gowned up, but had stoically soldiered through an elective cholecystectomy until she made a strange, muffled exclamation and, without warning, vomited into her mask. Calmly placing her instruments down, gastric contents sliding from the edges of her mask, she walked out of the OR to the sinks where we scrubbed and rinsed her face and neck. She snapped a clean mask on and re-scrubbed. The entire process had taken perhaps four minutes or so. I watched as the attending nodded his approval at her return through the swinging doors. Neither of them referred to what had happened after


doc

Fall 2016 • Kentucky the case was done. Co-residents who found out about it laughed and clapped her on the back, congratulating her on what I found to be a confusing victory. “My stupid stomach.” She said wryly, shaking her head. Nothing was said to me directly, but I had absorbed the message thoroughly. It told me that illnesses could be overcome with willpower and that perseverance at the cost of my health would legitimize me as a surgeon. That time, the message had come from the top down. When I started residency, I realized that though we came from different towns and different medical schools, my colleagues had also received the same message and that it nestled quietly in our brains with sharp teeth, pricking us any time we thought we were safe. As luck would have it, one of my colleagues came down with gastroenteritis. They were on a particularly difficult rotation with unsympathetic attendings. Despite their best effort, at one point in the night, this resident had to concede that they were too dehydrated and weak to continue their clinical duties. At the first opportunity, they hid themselves off to the emergency department where a sympathetic nurse administered two liters of IV fluids. Thus self-doctored, the resident walked slowly back to the workroom to continue writing notes. Physical ailments afflicted these two residents. Unfortunately, I am also well acquainted with the effects the more insidious mental ailments had on my colleagues. A fourth year resident I knew clearly struggled with depression and anxiety. In clinic, his hair was uncombed, he wore wrinkled shirts, and he smelled faintly of mildew. He worked inefficiently and was distant with the patients, his performance only worsening as time went on. The attendings and the residents all watched as he eventually faded from the program and was quietly dismissed one random day. In fact, no one even knew he was gone until we realized we hadn’t seen him in a few weeks. One of his colleagues was relieved, stating that he had never pulled his weight and was a nuisance. I think about how all of us were witnesses to his disease, complicit in its progression. If he had had a non-healing ulcer on his leg, growing ever larger each month, one of us would surely have piped up and dragged him away for wound care. As it was, we all watched him silently and judged him not so silently until he had vanished into the ether. I didn’t blame him for not seeking help. In his shoes, I wouldn’t have either.

As surgeons, we tend to defer to the concrete. We want algorithms and rely on diagnostic criteria and clearly defined actions. “If this patient has a stab wound where bowel is eviscerated, I will operate. I will take him to the operating room for a laparotomy. In doing so, I will save his life.” I would dearly love to present literature-rich, experimentally proven papers to show my colleagues and myself how to be healthier and happier people, but none exist. We have all contributed to a culture of machismo where suffering is good and communication is lax. I do not believe mandated mentorship or required meetings where we sit around discussing our feelings or mandatory work hours will contribute much because it will not change the atmosphere of the hospital and that is the true culprit of our ill health. What we residents, and even the attendings, need is much more simple, but maddeningly difficult to enforce. We need to create a culture in each hospital where those who are floundering can ask for help and a solid program is available to give that help. As with all change, the culture needs to start from the top. It is of no use to anyone to have a leader say that we can always ask for help but then rolls their eyes or who, by their tone of voice or manner, clearly want us to repress it all. If you are an attending and catch yourself wanting to make a disparaging remark against a sick resident or one who has been overwhelmed by family tragedies, that is the moment to offer sympathy and not stony silence. There are no courses that can teach this. There is only yourself and other attendings who need to hold one another accountable. It is in these seemingly small acts that we residents learn how to be attendings ourselves. Throwaway remarks about the inconveniences of motherhood, depressed residents, or those who take time off for family tragedies are the ones we internalize about our worth. It seeds self-doubt, even in the seemingly confident ones of us. We use these moments to determine who we can trust with our vulnerabilities and who we cannot. One of the reasons I chose this residency program was for the strength of its residents. It is incredibly relieving to be able to commiserate with the women in my program about frustrations or troubles. I have come to them with struggles and come away with their empathy and their advice, comforted that I am not alone. Having colleagues I can openly communicate with is paramount in making it through this training program. It is

something I never fully realized the value of and am making a priority in any future jobs I consider. I know exactly which residents I would come to for help and they are the ones who don’t insult those having a difficult time with mental illness, motherhood, or who are struggling with ABSITE scores or operative skills. They are the ones who listen and laugh or rage with you and insist you seek help when you are over your head. They do not judge and they do not gossip about you with other residents, creating a shameful environment for you. They listen. Our graduate medical education and hospital administrative folks can help us by making available discreet professional counselors (preferably those with experience in working with physicians), posting contact information for help in the call rooms and work rooms and around the hospital, and being available to facilitate absences or make-up time for those residents who take time off unexpectedly. The public, and we ourselves, hold our profession to high standards and I believe strongly in those standards. But we are, in the end, human as well and need each other as a source of support and help. To varying degrees, humans are social creatures. There is a primal need to be understood and validated and we can provide that for each other by being open and non-judgmental about those physicians we know who are struggling. We have created a culture where physicians who struggle are isolated and ostracized. We shouldn’t be surprised when that leads to suicide or attrition. This profession calls on us to be empathetic and professional with our patients. Why can’t we be a part of the solution and do the same for one another and ourselves? About the Author Dr. Ahn Thu-Le attended the University of Florida for both undergraduate education and then for medical school. Her undergraduate studies were in biochemistry and entomology.  She was a part of the Junior Honors Medical Program for medical school.  Currently, she is  a general surgery resident at the University of Kentucky and am in my 2nd year in the research lab.  In the future, she hopes to specialize in cardiothoracic surgery. 

“We need to create a culture in each hospital where those who are floundering can ask for help and a solid program is available to give that help.” – Dr. Ahn Thu-Le

7


8

doc • Fall 2016

Kentucky

Physician Health and Well Being

What Keeps You Awake at Night? By John A. Patterson MD, MSPH, FAAFP I recently asked 10 physician colleagues this question: What keeps you awake at night? Some of the answers were predictable. Some were surprising. Some were downright inspirational. Here they are. See what you think. A solo, rural physician in his 60’s recently retired due to “the hassle factor.” He still enjoyed patients and caring for them but had finally had enough of the interference by insurers, government and the demands of conversion to an electronic medical record (EMR). He was spending more time looking at the computer than the patient. “I finally felt I could not take care of my patients any longer.” An academic department chair feels constrained by the inability to manage patients and coordinate care in a timely fashion. Despite the EMR’s initial hope and hoopla, the slowness of the functionality of his department’s system has made this worse. “It has become a major challenge. The shortage of various sub-specialties has made access to care very difficult, especially for marginalized and underserved populations.” He struggles to find high-quality rotations for the training

of clinical year students and residents to help them develop their diagnostic acumen. An early career academic physician loses sleep directly from staying up late finishing her clinic notes. She knows the screen time so close to bedtime is not good sleep hygiene. She views all the individual elements of her teaching and patient care as worthwhile but admits to anxiety over how to get it all done. Improving her time management is crucial to prioritizing tasks and knowing how much to take on and when to say NO. She wants to give quality time to her patients, keep up with research in her field and continually improve her teaching and presentations to students and residents. “I also want to give quality time to my family, my own personal growth and to public advocacy activities. Trying to figure out what is really the most important from day to day is often really difficult.” A late career physician worries about getting in trouble with the medical licensing board over controlled substances. He joined a practice recently without knowing that one of the physician partners had questionable prescribing habits for controlled substances. He is being flooded with requests for controlled substances since his partner’s prescribing privileges have been restricted. “I worry I may have to leave this practice to avoid being caught in the middle between demanding, unhappy patients and the licensing board.”

A mid-career physician considers work-life balance to be her biggest challenge. Her mentors have told her for years that her generation doesn’t want to work as much as they did. She simply feels an obligation to balance her family life and her work life in a way that is fulfilling. Some days she actually feels like she is doing it pretty well- but not consistently. “Some days I feel like I don’t make the grade. Most physicians don’t spend enough time on self care. Some days I need to self preserve- I feel washed out. We are all challenged to find love and peace in life.” A late career academic physician struggles with “things I can’t control. I can’t control my patients’ lives. You can talk about lifestyle change all day long but they can’t make time for it. It takes a lot of practice to understand you’re just guiding patients, not controlling them.” She now recommends meditation to all new patients, referring them to HeadSpace. com and InsightTimer.com. “If you want to learn to meditate you have to practice a little every day. This also offers an opportunity for patients to see me as a provider in a new light.” She often combines the meditation recommendation with a little speech about exercise and diet. A late career physician developed several personal health problems in recent years and gradually eliminated hospital, house calls and nursing home work. She recently retired


doc

Fall 2016 • Kentucky

“Will my savings hold up? It’s so hard to keep up the house- will I be able to stay in it? How rapidly will my poor health get worse? I always put myself last and wish I’d taken better care of myself.” – late career physician

completely due to the physical challenge of even seeing patients in the office. She worries, “Did I retire too young? Will my savings hold up? It’s so hard to keep up the house- will I be able to stay in it? How rapidly will my poor health get worse? I always put myself last and wish I’d taken better care of myself.” An early career academic physician is frustrated by our health care system’s lack of focus on the health of the patient. “The focus is too heavily financial. It manifests in various ways but that is the biggest issue. The Physician Quality Reporting System PQRS is supposed to be about patients but seems to be more focused on revenues than the determinants of health. You see it in everything we do. I ask myself- Can I actually enjoy this anymore? Do I want to continue in medicine at all?” A rural, mid-career academic physician says with regret, “We don’t really provide the care we set out to in medicine. We send them on their way and their life exists between these episodes of care. How do we cross the chasm from fee-for-service to comprehensive care of patients? If I see a patient 15 minutes for diabetes, obesity, mental health problems and social issues, we don’t have the ability to keep in contact with the patient and touch base on the mental health and social issues. Specifically, we don’t have a cohesive medical

record to help us communicate with patients. We have a billion people on Facebook but hospitals that can’t communicate with our clinic.” A late career, hospital-based physician and leader in organized medicine, worries about three big challenges. “The biggest challenge that troubles me is the lack of health care access for the entire American population. The second biggest challenge is the health consequences of climate change. I volunteer time working on both of these as personal and professional priorities. The third thing is the loss of global human productivity from a lack of education, often due to preventable illness and disease.” The thing that strikes me most about these physician responses is the values they reflect. They are filled with concern for the common good, humane patient care and the Hippocratic ideals of professional excellence, putting patients first, compassion, causing no harm, service, generosity, trust, healing partnerships and medicine as a calling. The emphasis on the art of medicine comes shining through. These values run deep in physicians. Reconnecting with them and honoring them may be an important part of serving our fellow physicians at risk of burnout and in despair over their current lives in medicine.

No other profession attracts a higher caliber of human beings than those who enter medicine- committed to applying body, mind and heart in service to the relief of suffering. Perhaps we can each draw on this sense of membership in our most honorable of professions as we assist a struggling colleague in despair- or while laying awake at night ourselves. About the Author Dr. Patterson Chairs the Lexington Medical Society’s Physician Wellness Commission, is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty UK College of Medicine and U of L School of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org

ARE YOU DISABLED? HAVE YOU APPLIED FOR SOCIAL SECURITY DISABILITY? ARE YOU CAUGHT UP IN RED TAPE? An experienced Social Security Claims Advocate can help you: • By assisting you in filing your initial application. • Filling out and filing your appeals. • Gather medical and other important information to submit to Social Security. • Contact your doctors to obtain a report of your medical condition. • By obtaining documents from your Social Security file and review them. • By presenting opening and closing statements at your hearing that will state how you meet the Social Security listing of being disabled.

For a FREE CONSULTATION of your claim call Patsy R. Hughes, Disability Claims Advocate,

1-859-263-7780.

NO FEE IS PAID UNLESS YOU WIN

RENT THIS CABIN

In the Beautiful Red River Gorge CAMPING CABINS AND PRIMITIVE CAMPSITES ALSO AVAILABLE

Call or visit website for reservations.

(606) 668-2599 ksbrown@mrtc.com www.kentuckywildflowersllc.com

9


doc • Fall 2016

Kentucky

C O NT E AY

ST

ES S

rd

3 R

ES

IDE

PLACE Y

10

N T C AT E G

OR

Wellness for me… Wellness for you By Rebecca Ba’Gah, MD “The light in me salutes and honors the light within you.” My favorite yoga class always ends this way.  There’s just something about having just spent the last 75 minutes stretching, contorting, flexing and most importantly breathing in a humidified 104 F room that makes that inner light shine a little brighter and is just what this doctor ordered for herself: a prescription for a well woman empowered to be a great physician. When I first made the bold decision to switch paths in life to the one that would lead me to medicine, I knew that a large part of my practice would involve helping others.  At its bare minimum being a doc is a being a problem solver...other people’s problems.  However, to be effective one has to be right within oneself. As physicians we are also purveyors of wellness. Those who are unwell come to us to get better whether that involves antibiotic treatment for a terrible cellulitis or mood stabilization for a lifetime plagued by bipolar disorder. We take our years of dedicated study, coupled with hours of on the job training, to make things right for someone we helped deliver into this world to a complete stranger we just met in the Emergency Room. In a profession that at its essence is about putting healthy energy out to others to heal, doctors must pay special mind to replenish themselves. The proverbial well “that has run dry” cannot quench anyone’s thirst. I was rather surprised that little effort was made during medical school to ensure that we were taking proper care of ourselves. I thought it a great irony: here we are making a career based on the principles of and purporting wellness but were living lives that were anything but “well.” Night fueled by super caffeinated beverages, days run

on sugar, and post-exam nights that could simply be described as bacchanalian were the norm. Some effort was made to teach us self-care. There was a weekly meeting that focused on mindfulness, which proved to be completely invaluable during those stressful exams. These sessions were not well attended because not enough emphasis has ever been placed on practitioner well-being. Regrettably too much focus was placed on scores and posters. Taking time to refuel is essential to a successful career. We sometimes need to be reminded, in some cases taught, that self-care must be part of our daily practice because without it we are simply not the best, and we owe it to those who’ve entrusted us with their lives to be the best for them. Perhaps, because I have chosen the specific fields of psychiatry coupled with pediatrics, I have always been more aware of what can go so easily wrong when stress takes over our minds and then our bodies. I have seen first-hand adults lose the ability to speak because the brain was on overload and needed a break. Children who’ve become physically sick because they won’t stop…can’t stop. Theoretically, as very well educated adults, this should come naturally to us, but as most of us are over-achievers, classic type A, we rarely want to take the time to pause and check-in with ourselves. Having just started my intern year, I keep hearing tales of the dreaded “intern 30” similar to that awful “freshman 15.” However, the later was to supposedly come from excessive beer intake and high sodium containing dorm food. I wondered how this could be. What are we doing to ourselves? How can we possibly expect ourselves to work 80 weeks without proper fuel…physically and emotionally? And therein lies the problem. Without sounding like I am waiting for doomsday to arrive, why spend years, thousands of dollars, missed wed-

dings and birthdays to have a degree and then embark on a career that will so easily fall to pieces if we are not constantly refilling the foundation? Step one to a solution is awareness. I hear stories of my predecessors where their work was so consuming that hours, days, weeks, and years blended into one. We are fortunate that we are training in a time where there are limitations. Because of the boundaries that were created for us, we are able to have “lives.” It is imperative that we remember this. We do have moments that can best be utilized not in reading another journal article, but in mediation, taking a walk, having a telephone conversation with a loved one…whatever it takes to make us feel whole again. Many of us feel the need to present an infallible front; we’re doctors after all. Ah, yes, but we are human too. Like Shylock, Shakespeare’s great villain cries, “If you prick us, do we not bleed?” Indeed, we do. If our lights have burned out, how can we be the sparks some of our patients so desperately require? I ask that you remember to take time for yourself to see that you are physically and mentally well so that you may continue to provide the best care for both you and your patients. The light in me salutes and honors the lights in all of you, my fellow physicians. About the Author Dr. Rebecca Ba’Gah is originally from Los Angeles, CA where she attended UCLA’s school of Theater, Film and Television and she spent many years in show business. She eventually found true fulfillment in medicine. She recently moved to Lexington for residency at UK in Pediatrics, Psychiatry, and Child and Adolescent Psychiatry. She hopes to one day be a part of Médecins Sans Frontières and continue to change the public perception of mental illness.


If our lights have burned out, how can we be the sparks some of our patients so desperately require? Remember to take time for yourself.


12

doc • Fall 2016

Kentucky

Independence is Old News: NNER to I Proud W ST

ES S

C O NT E AY

DOCTORS CAN PROVIDE Partner HOW BETTER PATIENT CARE with You M

RY

ED O STU DENT CATEG

By Tara Shrout

Do you remember the scene in the movie Mean Girls where everyone in the mall begins acting as if they were wild animals, fighting at a water hole? With limited resources, judgment among each other, and the idea of success in mind, people in our real world can act in similar ways. While this analogy is a bit dramatic, I think that it addresses a core issue that we all have a desire to survive and succeed, but that our society and educational structure has rewarded mainly individual success in the process of achieving these

goals. Our natural world, and especially our healthcare system, does not achieve success through individual efforts though. Many studies have shown that people who have strong support systems and teamwork skills are happier, and other studies show that happier and healthier doctors provide better patient care. The question is not if we should focus on physician wellness, but how do we improve it? I think that one core way we can improve physician wellness is by designing and rewarding ways to not encourage independence, but interdependence. It is difficult to formally study physician wellness because measures are based on perceptions, timing, and uncontrolled

Five Star Senior Living Referral Guide

variables. As a scientist, I understand these limitations. But as a medical student, I have witnessed and experienced some stages of training required to become a physician and believe that these stages significantly affect how physicians eventually develop, practice, and interact with each other and patients. While our stages of training can act as a barrier to becoming happy and healthy physicians, I think that they have more potential to help foster the development of skills that allow physicians to more likely be happier and healthier. Thus, one part of the equation is to understand how we can improve the wellness of trainees before they even become physicians.

Working with seniors each day, you know better than anyone what they need to live healthy, happy lives. We’re here to help.

Proud to Partner Working with seniors each day, you know better than anyone what they need to live healthy, happy lives. We’re here to help. with You If you know seniors who: Five Star Senior Living decline • Are lonely or experiencing Referral • Live in Guide environments that pose fall risks • Often call for emergency assistance • Mismanage medications

• Have frequent

If you know seniors who: • Are lonely or experiencing decline • Live in environments that pose fall risks • Often call for emergency assistance • Mismanage medications • Have frequent exacerbations of chronic diseases • Appear disheveled or lack proper nutrition • Could benefit from a warm, loving, engaging senior living community exacerbations of chronic diseases

• Appear disheveled oryour lack proper nutrition Call on friends at Five Star Senior Living – The Lafayette & Lexington Country Place • Could benefit from a warm, loving, engaging With Independent Living, Personal Care, Skilled senior living community Nursing and Rehabilitation, we’re the one

Call on your friends at Five Star Senior Living — The Lafayette &

campus to call for it all. Our All Day Dining, Five Star service, and Lifestyle 360 program make Lexington Country Place every day exceptional.

With Independent Living, Personal Care, Skilled Nursing and Rehabilitation, we’re the one campus to call Call 859-278-9080 to make a referral. for it all. Our All Day Dining, Five Star service, and Lifestyle360 program make every day24 exceptional. Welcoming referrals hours a day, 7 days a week. Call 859-278-9080 to make a referral. Welcoming referrals 24 hours a day, 7 days a week.

Working with seniors each day, you know better than anyone what they need to live healthy, happy 690 Mason Headley Road lives. We’re here to help. If you know seniors who: • Are lonely or experiencing decline • Live in environments that pose fall risks • Often call for emergency assistance • Mismanage medications

Lexington, KY 40504

700 Mason Headley Road Lexington, KY 40504

www.LafayetteLexington.com • Appear disheveled or lack proper nutrition

www.LexingtonCountryPlace.com

859-278-9080 • Have frequent exacerbations of chronic diseases ©2015 Five •Star Quality Care, Inc.a warm, loving, engaging Could benefit from senior living community

Call on your friends at Five Star Senior Living — The Lafayette & Lexington Country Place

859-259-3486

©2015 Five Star Quality Care, Inc. Pet Friendly


doc

Fall 2016 • Kentucky

Training to become a physician officially begins with pre-medical education, during which we are told that our courses are designed to extract those not smart or strong enough for medical school. At my very competitive undergraduate institution, we students retreated to the library corners for hours of solidary studying, created study guides that were tucked away in public places, and heard rumors of those who cheated on assignments and exams. Looking back, the worst part is that those behaviors were seemingly accepted as what must be done to succeed, defined at that time as high grades and acceptance to medical school. However, these behaviors are not rewarded in the practice of medicine. When I began my studies at the University of Kentucky College of Medicine, it was so exciting to make new friends and share in the joy of learning about medicine. I was given a leadership opportunity to help improve our academic curriculum by working with course directors, older students, and my peers. I soon realized that each person I spoke with had something to contribute: an idea, interest, or background. This drove me to help create and foster a shared College of Medicine website that allows students in all years to post shared academic resources, advice, and suggestions for improvement. I imagined that different students would contribute throughout the year, as some students had strong biochemistry backgrounds while others were more passionate about genetics or neuroscience. Unfortunately, sharing such strengths and resources were not rewarded in the beginning and the academic structure of grades based solely on individual exam scores posed such limitations. The culture began to change though once we began small group discussions and working on projects and team-based learning sessions together. In these settings, we were able to recognize and celebrate our individual strengths to achieve a shared goal. Team-based learning has become a buzz topic in medical education over the past year, and it deserves the publicity. Not only do students seem to remember material better under team-based learning conditions, but they also seem to enjoy it more. Such teamwork skills are crucial for clinical patient care and are essential to develop as part of a solution towards improving physician wellness. Today, patient teams consist of not only of physicians, but also specialized nurses, pharmacists, physical therapists, nutrition advisors, social workers, and more. Each member of the team has a necessary role, but if any member acts independently, then communication and patient care can become compromised. Teams succeed when they work in an interdisciplinary manner, appreciating each member’s role and working together towards a shared goal. Team-based skills are also necessary in order to achieve patient-centered care.

Interdependence and teamwork can only programs have begun to develop such soluwork when individuals are able to take care tions with positive results for physicians and of themselves. This is where it becomes patient care. important to also focus on how physicians It is important to recognize the barriers to and trainees can develop healthy habits. An developing happier and healthier physicians obvious place to start in terms of barriers to and create realistic and simple solutions a healthy lifestyle is a lack of personal time because a healthy lifestyle and work-life baldue to long and odd hours at the hospital. ance has been shown to create physicians The long working hours are at their peak that make fewer mistakes and want to be during residency, a time when physicians are more involved in their patient’s long-term really developing behavioral traits that will well being. This is best achieved through a carry with them as attendings and they will perspective of interdependent learning, trainteach to medical students. Long working ing, and work environments. hours are a necessary part of residency, but creating solutions to reduce stress inside and About the Author outside of the hospital for all physicians will Tara is from Frankfort, KY and went to create better patient care. To start with, it is Vanderbilt University for her undergraduate important to recognize that most residents studies in Molecular Biology and Political do not have spouses to help take care of Science. She now attends the University of household needs perhaps as much as in the Kentucky College of Medicine, where she is past. Personal lives and responsibilities can currently on an NIH-funded research year to become very hectic, and spill over into the pursue her interests in improving cardiovascular work environment in the form of poor sleep, health care through research and advocacy. Jeff stress, and disorganization. is from Toronto, Canada and went to McMaster If we remember Maslow’s hierarchy of University for Biomedical Engineering. He now needs, then we know that at the very core of works for Brainlab as a clinical specialist in happiness is the need for nutrition and sleep. intraoperative navigation during neurosurgical In fact, it is known that nutrition has effects procedures, and he is currently applying to medon energy and that a lack of sleep decreases ical school to pursue his interest in patient care. the effectiveness of the immune system. Despite these known facts, nutrition and sleep seem to be sacrificed during medical training. There are many solutions to help address these issues, but the most important is the culture that endorses that success and strength in medicine includes such sacrifices. While training methods discussed before are a bottom-up solution, these solutions act in a top-down manner. Physicians You’ve thought about it for years. You know you need to do themselves must set an example that it. And there’s no time like the present. But you aren’t quite nutrition cannot be sure how to quit smoking. Your doctor is here to help. scarified and they should advocate Visit us online to learn what questions to ask your doctor, for healthy food in access all available resources, and stick to the plan so you work environments can hit pause on smoking. and even provide breakfast and lunches for trainees. Additionally, www.committoquitky.org programs can hire people who can help with personal needs, such as grocery shopping, laundry, and childcare in hospitals. Many residency

Commit to

Quit

13


doc • Fall 2016

Kentucky

nd

2

ST

C O NT E AY

ES S

PLACE

M

ED O STU DENT CATEG

RY

14

For the Greater Good… By Kara Jolly America loves superheroes. Good versus evil, sacrifice for the greater good, saving lives, and saving the day. We dream of these heroes and try to embody their characteristics of courage, intelligence, morality, commitment, and honesty. Superheroes put the needs of the world and others before their own desires. Their efforts are noble and far from easy. We may not see Superman flying overhead, but we do see heroes amongst us. Doctors are heroes. We see it every day at the hospital when a diagnosis is made, the correct medication is given, or a surgery is successful. Hollywood depicts this war on disease in a glamorous light with the doctors and nurses working together to save a life and ultimately save the day. The knowledge of medicine comes with great responsibility and sacrifice. Every decision made impacts a person’s life; there is little room for error. There is also such high demand and need for doctors’ services that physicians can hardly keep up. Doctors work long hours and try to help as many people as they can in what always seems to be too little time. Many of us chose to practice medicine to help people live healthy lives. We are compassionate and put the needs of others before our own just like superheroes. We

feel selfish for taking time to take care of ourselves. Other people need our help, and we should not be hiking, painting, baking, or any other hobby that takes us away from that commitment. By focusing all of our time and energy into medicine we will be the best doctors possible. However, in reality, if we give up everything that is not medically related, we lose pieces of our identity and slowly spiral into burnout. We come to dread the valuable work we once loved and do not provide the best care for our patients. If we do not take care of our own health in all aspects- mental, physical, emotional, and spiritual- how are we supposed to take care of others? I came to medical school with the dream to make a difference in people’s lives by becoming a physician. I knew the classwork would be difficult, but neither my classmates nor I truly knew what we were up against until our first anatomy exam. I spent my mornings in a windowless lecture hall learning the human body, and I spent my afternoons and my evenings studying. I would fall asleep each night mentally exhausted from learning the vast amount of material presented that day. I found myself being drawn to buildings and rooms that had windows so that I could experience a small portion of sunshine. After a month of mostly just studying, I realized that I had completely lost all sense of balance in my life and was not my nor-

mal happy self. I dreaded the long hours of studying even though it was in subjects that I had previously loved. Why did I lack the stamina of my classmates who studied long hours? Was I a bad medical student if could not study ten hours a day? How was I supposed to be a great physician and help those in need if I could not take care of my own health? I was experiencing burnout just like many medical students and physicians do at some point in their lives, so I made a few changes in my life. I started to swim again a couple days a week. I found the water calming and reassuring. The pool was my mental break between class and studying. On days when I swam I was more focused and found more joy in learning the material. I began to study smarter rather than longer. Studying more hours was not going to help me learn the material if I dreaded every hour. I needed breaks if I was going to be able to learn the avalanche of knowledge necessary for medical school. An hour a day to do something I love was a step in the right direction for reestablishing balance in my life. Last semester I took an elective called Healer’s Art which is a national class that helps both medical students and physicians try to balance the many components of their lives. This class provided a safe discussion environment where we delved into how to preserve the human dimension of healthcare. The course emphasized the


doc

Fall 2016 • Kentucky

15

“We may not see Superman flying overhead, but we do see heroes amongst us. Doctors are heroes. We see it every day at the hospital when a diagnosis is made, the correct medication is given, or a surgery is successful. ” – Kara Jolly, UK Medical Student

importance of taking care of oneself in order to take care of others. Through this class I found camaraderie with my classmates who were struggling just as much as I was in finding the right balance between studying and everything else in our lives. Society pressures us to hide our struggles and to push past them, but there are some aspects of healthcare that are not easily ignored like death, loss, and faith. I believe that creating safe discussion groups in hospitals and medical schools where students and physicians talk about these difficult topics could improve the mental and emotional health of the participants. Healer’s Art reminded all of us to work towards finding that balance, and I believe that discussion groups could do the same for other medical students and doctors.

As physicians, we are both our greatest barrier and greatest advocate for our own health. We have a hero complex that drives us to sacrifice our health and happiness because we feel selfish taking time for ourselves. In reality, by taking those short breaks to pursue activities that we love, we are re-energizing so that we can better care for our patients. Being a physician is difficult; we see all sides of humanity- the good and the bad. If we are not mentally prepared to face hardships that come our way we will not survive in the medical field. As physicians, we want to be heroes who save the day. But just like in the movies, the world always finds itself in trouble again. If we want to have the strength to save the day over and over again, then we need to take care of ourselves by setting aside time to

re-energize. We need to continue to pursue our non-medical hobbies and to build relationships with others. We are physicians, but we are also human, and the world benefits if we take the time to take a break. It is for the greater good. About the Author Kara Jolly is a second year medical student at the University of Kentucky. She is from Merrimack, New Hampshire, and has a BS in Biological Sciences from Clemson University.  She is currently considering a career in pediatrics or Med-Peds.

Now and then, we don’t get all the time we wanted

With Hospice you can make the most of the time left

(859) 296-6100 (800) 876-6005 www.hospicebg.org

The day we enter your lives, the Hospice team treats you with the respect, kindness, and dignity typically reserved for one’s own family. • Providing medical care and symptom management in the home, nursing facility, assisted living facility and Hospice Care Center • Joint Commission accredited • Medicare/Medicaid certified • Counseling and bereavement services provided to the community, as well as to Hospice families • Dedicated hospice unit Hospice makes this unfamiliar journey one filled with comfort, dignity, and compassion © stock.xchng

Kentucky’s Leading Hair Replacement Facility • Genetic Hair Loss • Chemotherapy • Alopecia • Cosmetic Hair Replacement

859.263.9811 Hair Institute offers several surgical and non-surgical hair restoration options, including Virtual Reality®, full and partial prostheses, hand-knotted wigs, and human hair extensions. - Laser Light Hair Therapy - Surgical Hair Restoration Options

- Full Cranial Vacuum Prostheses - Enhancements and Integrations

1795 Alysheba Way Suite 7101 Lexington, Kentucky 40509

HAIR REPLACEMENT • HAIR RESTORATION • HAIR EXTENSIONS Professional • Confidential • Meticulous AMERICAN HAIR LOSS COUNCIL

www.hairinstitutelexington.com

®


16

doc • Fall 2016

Kentucky

ANNOUNCEMENTS AWA R D S N E W S TA F F EVENTS AND MORE

EMAIL brian@rockpointpublishing.com TO SUBMIT YOUR NEWS

Saint Joseph Berea Discussed the Effect of Stress on Overall Health During Bite Size Learning Event

Appalachian Outreach Program Celebrated 30 Years of Improving Access to Healthcare Program

Saint Joseph Berea, part of KentuckyOne Health, invited the community to learn more about the effect of stress on overall health at the free Bite Size Learning event on Thursday, September 29. The event took place from noon to 1:00 pm at the Baird Lounge at Berea College, located in the Alumni Building on Scaffold Cane Road. Elizabeth Coblentz, APRN, KentuckyOne Health Primary Care Associates, was the featured guest speaker at the program.   This was part of a series of Bite Size Learning events for the year, sponsored by Saint Joseph Berea and Thrive!, Berea College’s health and wellness program. At each event, a physician or staff member from Saint Joseph Berea hosts a special lunch-and-learn-style presentation on a different health topic to increase awareness and educate the public.

KentuckyOne Health celebrated a major milestone with its Appalachian Outreach Program. The outreach program was launched in 1986 to serve those living in rural eastern Kentucky who are unable to travel the often long distances needed to get medical care. In the past 30 years, outreach staff have traveled nearly 1.4 million miles to provide more than 350,000 follow-up and nutritional visits to patients in Kentucky. The program started in nine counties and has since expanded to cover 39 counties in the state and continues to grow. The program offers free services to patients in their homes who have been discharged from Saint Joseph Hospital, Saint Joseph East, Saint Joseph Mount Sterling, Saint Joseph Berea and Saint Joseph London. The Appalachian Outreach Program provides a variety of services to patients, including grief counseling, family support, end of life support, prayer, guidance with community resources, transportation, food/housing, medication assistance, emotional support, meal planning, and dietary assistance for diabetes, heart disease, high blood pressure and weight.

About KentuckyOne Health KentuckyOne Health, the largest and most comprehensive health system in the Commonwealth, has more than 200 locations including, hospitals, physician groups, clinics, primary care centers, specialty institutes and home health agencies in Kentucky and southern Indiana. KentuckyOne Health is dedicated to bringing wellness, healing and hope to all, including the underserved. The system is made up of the former Jewish Hospital & St. Mary’s HealthCare and Saint Joseph Health System, along with the University of Louisville Hospital and James Graham Brown Cancer Center. KentuckyOne Health is proud of and strengthened by its Catholic, Jewish and academic heritages.

Genetic Testing May Help Identify Women at a Higher Risk for Breast Cancer With Breast Cancer Awareness Month in October, KentuckyOne Health is encouraging women to consider genetic testing, which may help identify women at a higher risk for breast cancer. Testing for inherited abnormal genes through BRCA genetic testing can help save the lives of those at an increased risk for breast cancer.

“Genetic testing is not recommended for all women, but can be helpful for those with a strong family history of breast cancer to determine if they are at an increased risk,” said Kimberly Stigers, MD, breast imaging specialist, KentuckyOne Health Breast Care at Saint Joseph East. “There is only a small chance that your family carries gene mutations, which account for about five to 10 percent of all breast cancers, but it may be beneficial for women with an elevated risk to be tested for these genes.” Some women inherit altered versions of the human genes BRCA1, BRCA2, and PALB2, which can increase a woman’s lifetime risk for developing breast cancer. About 12 percent of women in the general population will develop breast cancer sometime during their lives. By contrast, it’s estimated that women with BRCA1 gene mutation carry a 55 to 65 percent risk, and those with a BRCA2 mutation carry a 45 percent risk of developing breast cancer by age 70.   BRCA1 and BRCA2 produce tumor suppressing proteins and work with PALB2 to help ensure the stability of the cell’s genetic material. Thus, when these genes are not working properly, cells are more likely to develop genetic alterations that can lead to cancer. These gene mutations can be inherited from a person’s mother or father. Men can also inherit these gene mutations and have an increased risk of developing breast cancer. For more information about BRCA genetic counseling within KentuckyOne Health, please visit www.kentuckyonehealth.org/cancer-geneticcounseling or call toll-free at 844.835.GENE (4363).


doc

Fall 2016 • Kentucky

As a Physician in the U.S. Air Force, you’ll have one job: treat patients. We’ll give you all the support you need so you can be the doctor you were meant to be. For more information, contact your local recruiter or visit airforce.com.

Call 1-800-588-5260 or

E-Mail: James.Porter.18@us.af.mil ©2014 Paid for by the U.S. Air Force. All rights reserved.

17


18

doc • Fall 2016

Kentucky

Profile in Compassion

Medicine is a Calling John Gurley MD By John A. Patterson MD, MSPH, FAAFP John Gurley MD has practiced interventional cardiology at UK for over 30 years. He well remembers deciding to be a doctor in his teens growing up in a small Ohio town where his father was a dentist. His mother worked briefly as a nurse, but eventually devoted herself to raising 6 sons. John loved science, technology and gadgets. He notes, “In that sense, I really haven’t changed- that’s still what I do. I develop new techniques and new tools in my academic and clinical life.” He could easily have taken the engineering path in college but chose premed instead. He gives credit for this decision to his parents. He remembers asking, along with his 5 brothers, ‘When is Dad coming home? Why can’t we go out in the boat?”- as his father often worked well beyond 9 to 5 to care for his patients. Their mother explained that their father had something more important to do. If one patient needed him, he had to be there. She made clear to him that being able to help other people in their time of need was something special. He says, “We all feel good when we do something to help someone- start the car, cut down a tree, anything. But to be able to help your fellow human being preserve their body and health and mind- that is something special.” John found in medicine an opportunity to unite these two worlds- using gadgets and technology to do something really special for other people. Interventional cardiology provides an opportunity to use elaborate technology and develop new technology in service to doing something special for people with cardiovascular disease. He says, “I feel so fortunate to have landed in just the right spot, developing new technology for a purpose that is special. I ended up doing what I was supposed to do.” John says, “Medicine was never a job. Medicine is a calling. If you go into medicine as a job, expecting a certain income and having a certain lifestyle, it will never be as fulfilling as it could be. If you go into medicine because you know it’s what you were meant to do, you have a purpose every day. You know you’re making a big difference.”

John admits to sometimes staying awake at night but not because of worrying. Rather, he uses the peace and quiet of those private moments to figure out how he will approach a difficult case, how he will deal with possible complications, essentially devising an algorithm of cardiac intervention unique to a given patient with a problem for which there is no established standard of care. He says, “I enjoy the problem solving. It’s like a puzzle.” He might spend days or weeks thinking about an innovative strategy for a patient with a unique problem. He feels a close kinship with the primary care physicians that refer their difficult cardiovascular patients to his tertiary care lab. “We approach the patient from a different perspective but we share the goal of helping solve difficult problems for our shared patients. Every day I go to work is something new. Every day I look forward to going to work.” UK internist Connie Jennings MD says, “John and I have been close partners in care for decades—he is the best! He tries to be more than the cardiologist to his patients. He listens to all their concerns and seems to never get tired, is always patient, friendly— and devoted to the whole patient. The heart is his focus in the physiology of care, but more importantly, it is the focus in his commitment to the patient” Cardiologist Tom Whayne has worked with John for 18 years. He says, “I consider him to be the most talented and innovative interventionalist I know, with very special skills to accomplish the most difficult of case procedures. He deals very well with patients and families and has true empathy for the anxiety and suffering he is trying to alleviate.  If I ever need an interventional cardiologist, I hope he is available.” Kevin Pearce MD is UK chair of family and community medicine and has co-managed many patients with Gurley, who he describes as “one of the finest cardiologists (and finest physicians, in general) with whom I have ever worked. He is responsive to patient needs and to primary care physicians’ concerns about their patients.  He has special expertise in endovascular procedures; expertise which he regularly expands.  He is extremely busy, but my patients report good doctor-patient interactions with him.” Chipper Griffith MD is an internist and vice-dean for medical education at the UK College of Medicine. He says, “When

I think of John Gurley, I think of excellence. Whenever doctors at UK think about the “best” in terms of advanced and difficult cardiac procedures, John is the first name that comes to all of our minds. He is the one we would want for our friends and loved ones if they need such procedures. But also he is caring. One of the most impressive things he did was being one of the founders in the 1990s of our student-run Salvation Army Clinic, which has provided free medical care to Lexington’s indigent population for over 25 years, a testament to John’s vision.” Kim Morton, RN is the manager of the UK interventional cardiology lab and has worked with John Gurley for over 20 years. She says the staff have developed a staggered schedule so some can plan on a definite quitting time at day’s end while others know they will be staying with Dr. Gurley until the last case is finished- often well after 5 PM. She says, “We have sick patients and they need to see him. He doesn’t take ‘no’ for an answer and will do whatever is necessary for his patients.” Despite loving the challenge of his work and feeling he is making a difference in people’s lives, he admits to having periods of stress that could even be labeled as burnoutbut never for more than a couple of days at a time. He thinks all physicians experience this at times. He says, “Our empathy and compassion well is not endless. Patient care can sometimes feel like a battle. I’ve had times I’ve sacrificed time with my family and friends and it isn’t healthy but I can’t help it. Patients need help. At the end of a long day, who needs the rest more- me or the patient who has been waiting all day and is hungry and scared? A lot of us choose to take care of our patients. You’re tired but your patient is in need.” Academic healthcare and corporate bureaucracy can take a toll. Sometimes it’s hard to just do the right thing for one patient at a time. He also feels the burden of futility treating IV drug abuse patients with vegetative valvular lesions. Yet they also need our professionalism and service. He says,“We can’t say they won’t turn their life around.” His self-care strategy for stress management includes being in nature, hiking among the trees and horseback riding in Eastern Kentucky forests. As someone who is “not much of an organized religion person”, he finds a kind of spirituality in this contact with nature, seeing how determined life is, just


doc

Fall 2016 • Kentucky

“...to be able to help your fellow human being preserve their body and health and mind- that is something special.” – John Gurley MD

looking at a tree and knowing it was there before he was born and will be there after he is gone. He says, “This connection reminds me that whatever my purpose is in the overall context of life is not that important except in the difference it can make for other people in their time of need.” He loves working hard in the yard in his plants and flowers, spending Sunday afternoon cooking the week’s meals with his wife and enjoying all the little things in life- good conversation, sharing a meal or a cup of coffee or tea. He says, “These things bring me joy. I still love what I do. I get up every day looking forward to my work and seeing my patients. What do we all need in life? Nice stuff? Nice car? Nice house? Or do we want to be relevant and make a difference in people’s lives? I think that’s ultimately what most people want.” “The gift of medicine, if you accept it, is that you have an opportunity to do that all day every day. There’s no other walk of life that offers you that gift. If you take that

gift- you are in.” His approach to medical colleagues who struggle with job and career dissatisfaction is based on this philosophy- that we physicians are part of something special that transcends our own problems. We have chosen medicine as a calling- to make a difference for others. He imparts this message and this ethos to medical students on rounds, introducing them to patients as young doctors-in-training. He urges them to adopt the professional persona of physicianhood without having to wait for medical graduation, saying “It’s not the diploma or piece of paper that make you a doctor.” He reminds them that they have made the commitment to dedicate their lives to medicine- and that is what makes them a doctor. He says, “Accumulating stuff and being entertained is pretty shallow. We are all passing through for a fairly short period of time. The privilege of medicine is the opportunity to make a difference in the lives of other people. Medicine is a calling.”

About the Author Dr. Patterson Chairs the Lexington Medical Society’s Physician Wellness Commission, is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty UK College of Medicine and U of L School of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org

19


doc • Fall 2016

Kentucky

C O NT E Y A

ST

ES S

rd

3

PLACE

M

ED O STU DENT CATEG

RY

20

By Amanda Pursell The rapidly growing numbers of cardiovascular disease, diabetes, and obesity in the United States are startling. With the rising number of Americans with so many medical co-morbidities, the issues of mental health and depression related to these illnesses cannot be ignored. These issues are not isolated to our patient population – they affect physicians as well. As physicians, we encourage our patients to follow a healthy lifestyle. In general, this means following a healthy diet, getting

Physician Accountability for Wellness in Today’s America enough exercise, and getting enough sleep. To me, this entails addressing your physical and mental health. In the medical field, do most of us even do this ourselves? Easier said than done, but I believe in practicing what I preach. As physicians, we need to help each other find solutions to our own health problems in order to better serve our patients. The barriers to physician wellness within an American culture focused on convenience are easy to find. It is easy to say you “don’t have time” to cook, so you eat out. It is also easy to say you “don’t have time” to work out, so you don’t. This is something within American culture that is imperative to change. As a physician, if patients were to ask

me about my exercise, diet, or sleep habits, I think I should be able to give them an honest answer that would help them lead healthier lives themselves. Encourage your peers and coworkers to adopt habits that make you feel happier and healthier – habits that help you find time to exercise and eat healthy with a busy schedule. Go beyond that – encourage them to be active and healthy with you! Diet, sleep, and exercise are all interconnected and affect each other. It is crucial to maintain healthy habits in all three simultaneously. For me, making most of my meals makes me happier because I am spending less money and I am eating healthier foods. I may

It’s time for your new beginning. Residential Treatment for Drug and Alcohol Abuse Intensive Outpatient Program Medically Assisted Inpatient Detoxification Home-like Environment

3107 Cincinnati Road, Georgetown, KY 40324

502-570-9313

Call the Recovery Works Admissions team today!


doc

Fall 2016 • Kentucky

21

healthy relationships in your life. Be kind to yourself, and take care of the one body you have. Be kind to your family, even if there is stress at work. Be kind to your patients and coworkers, even if there is stress at home. Finding our own ways to de-stress is important for the interactions with people in our lives. This is the foundation of maintaining strong support networks, and ultimately helps us better care for our patients. In addition to helping care for our patients, we also need to help care for each other. If a coworker or peer seems stressed, reach out to them. The increasing rates of physician suicide are startling. This spans across medical students, residents, and faculty alike. We live in an era of physician burnout and mental health issues. As physicians, we need to recognize when our peers are not at their happiest or healthiest, and know when to reach out. We also need to cognizant of when our patients need help, and be comfortable talking to them about getting help. In addition to holding our patients accountable, we also need to hold ourselves accountable. Undoubtedly, many physicians are able to find their own barriers and solutions in maintaining their own health and overall wellbeing. This makes it easier for us to identify those barriers, and possible solutions in our patients. The solutions to obesity, cardiovascular disease, diabetes, and mental health in the United States start with us as physicians.

Encourage your peers and coworkers to adopt habits that make you feel happier and healthier. – Amanda Pursell, UK Medical Student spend as much time making my meal as I would in a line or restaurant buying it. I see making a meal as a way to relieve stress with a creative outlet. It can be somewhat isolating at times – I have friends who bond over buying lunch on a daily basis and I’m the one with a lunchbox from home. However, I surround myself with people who also enjoy cooking, eating healthy, and saving money, and we connect over this. In order to make the early hours of a work schedule not as bad, it helps to wake up around the same time every day – even on days off. This allows for time to accomplish tasks or even spend the day doing something you enjoy, benefiting your psychological health. The hours of a physician have the propensity to change, especially during residency training. For the most part, it is possible to stick to consistent sleep/wake cycles. I find satisfaction in these aspects of my life – keeping consistent sleep cycles and being financially judicious with my lifestyle. I surround myself with people who share my values to not feel isolated with my lifestyle choices. As human beings, it is critical to have a healthy support network we can rely on. We need to ensure our patients have the same. For the average physician (or the average American) with a busy lifestyle, walking and running are great exercise options. Running and walking are free, efficient, and can be done at anytime (and with friends or family). It’s great to start the day with a workout to get moving, because it’s easy to skip over at the end of a long day. For some of my peers, it’s easier to for them workout at the end of their day. Whatever your preference, it is critical to schedule time for yourself. This process is restorative spiritually, physically, and mentally. As physicians, it’s easy to overlook these basic tenants of overall health. This self-restoration process ultimately helps maintain

About the Author Amanda Pursell is originally from Louisville, Kentucky. She completed her undergraduate education at the Western Kentucky University and is currently a fourth year medical student at the University of Kentucky. She enjoys running and hiking.

Document Storage ◆ Shredding Services

2325 Palumbo Drive • Lexington, KY 40509

GregWeFister are a provider of storage

GeneralforManager all types of documents, hard copy storage and we provide an Fax (859) 266-5850 environmentally controlled vault gfister@osrmgmt.com for tapes and film. We also take care company materials that need A Divisionofofany Fister, Inc. shredding/destruction.

Office (859) 266-1886 Cell (980) 229-3050

SECURE • WEB ACCESS

FREE

FIRST MONTH STORAGE for all new customers

859-266-1886 service@osrmgmt.com


22

doc • Fall 2016

Kentucky

Summit Mediation

Factors To Consider In End-Of-Life Decision-Making By Bobby E. Reynolds Advances in medical science and technology are rapidly escalating, creating the possibility to, among other things, procreate absent sexual intercourse, as well as to prolong life almost indefinitely. It is the latter subject that this Article explores. Physicians and other healthcare providers are often faced with complex decisions about whether to terminate life-prolonging treatments, such as artificial nutrition and hydration, in certain limited situations. Although the legal system provides a seemingly straightforward approach to resolving end-of-life decisions, in practice, the clinical setting sometimes presents healthcare providers with questions that are anything but straightforward and, rarely, solely legal matters. Rather, such questions and decisions must be made in the face of vague, abstract, complex, and somewhat confusing legal rules, divergent principles of bioethics, ethical codes for healthcare practitioners, religious beliefs of patients, sensitive feelings of spouse and family members, instructions from patients in legal documents (presumably legally valid), and/or healthcare providers and/or hospital ethics committees speculating what a patient’s wishes would be in the situation presented to the clinical team. Hospitals that religious organizations own and control implicate religion as a major factor in end-of-life clinical decision making. One would presume that if the patient has close family members, they could agree on whether to cease life-prolonging treatment. However, several of the most well-known cases involving end-of-life decision making involve disputes among various family members, who vehemently disagree on which course of action the clinical team should take, often leading to expensive, protracted litigation and ill feelings among family members. Such extreme adversarial measures can be avoided if patients plan, through the use of, among other things, living wills and healthcare advance directives, prior to los-


doc

Fall 2016 • Kentucky

Several of the most wellknown cases involving end-of-life decision making involve disputes among various family members, who vehemently disagree on which course of action the clinical team should take.

ing the capacity to make these sacrosanct decisions themselves. Therefore, advance healthcare directives permit patients to exercise “anticipatory” autonomy to provide “informed consent” regarding important healthcare decisions. Before proceeding further, it should be noted that end-of-life decision-making, as discussed herein, refers to situations in which a patient executes a legal document, while the patient has “decisional capacity” to make and communicate healthcare decisions, stating their preferences regarding medical treatment in very well-defined situations in a Kentucky Living Will, naming a surrogate decision maker in the Living Will or in an advance healthcare directive for physical and/ or mental health. The type of end-of-life decision-making addressed herein must be distinguished from what is commonly referred to as “physician-assisted suicide,” which is illegal in Kentucky. Briefly, Kentucky provides for two types of advance directives; (1) a Living Will, and (2) a healthcare surrogate or durable power of attorney for healthcare. A Living Will states the wishes of a patient lacking “decisional capacity” regarding life-prolonging treatment and artificially provided nutrition and hydration if the patient is near death or permanently unconscious. However, a Living Will also permits a patient to designate one or more healthcare surrogates to make decisions, limited in scope, according to the provisions in the Living Will. Because, among other concerns, a Living Will provides a designated healthcare surrogate limited authority, patients should execute an advance directive separate from the Living Will to give a surrogate broader powers, including the power to make decisions in situations that do not involve end-of-life. Kentucky also permits patients to execute advance healthcare directives for mental health decisions. On March 12, 2015, Kentucky provided new statutory authority granting patients at the end-of-life more control regarding their final care through the use of a Medical Order For Scope of Treatment (“MOST”) form, which the Kentucky Board of Medical Licensures issued in September, 2015. The Board stated that the MOST form is intended for patients who have an advanced chronic, progressive illness, with a life

expectancy of less than one year. The Board also provided guidance to physicians concerning the use of MOST forms which can be found at http://kbml. ky.gov/board/Documents/MOST%20 Form.pdf. It is extremely vital that all persons involved understand that advance directives become operative only if and when the patient loses “decisional capacity,” which means the ability to formulate and communicate a health care decision. Finally, it is also important for patients and/or their attorneys to widely distribute advance directives to family members, physicians, hospitals, and other healthcare providers. Statutorily, Kentucky mandates that the patient or their responsible party notify the patient’s attending physician and health care facility where the patient is being treated of the existence of any advance directives, and the attending physician must promptly include a copy of the advance directive(s) in the patient’s medical records. Absent possession of an advance directive to the contrary, healthcare providers must provide all life sustaining treatment to a patient lacking the ability to make their own decisions. The Kentucky Revised Statutes provide forms for Living Will Directives, and MOST’s, which if substantially followed, are presumed to be legally valid. All healthcare providers involved in end-of-life clinical settings should become thoroughly familiar with these forms. Although Kentucky and federal law provide many other rules concerning advance directives, such matters are well beyond the scope of this Article. About the Author Bobby E. Reynolds has been an attorney in Kentucky for several years. He practices law in Nicholasville, Kentucky, having previously clerked for a Judge on the United States Court of Appeals and having obtained an LL.M in taxation from the University of Florida College of Law Graduate Tax Program. Mr. Reynolds also teaches continuing legal education to attorneys in Kentucky. Email: bobby@summitcrt.com Phone: 859-270-6193

Summit Conflict Resolution & Trainings 400 Etter Drive, Suite 1 Nicholasville, KY 40356 www.summitcrt.com 859-305-1900 | contact@summitcrt.com Conflict Resolution & Trainings

23


24

doc • Fall 2016

Kentucky

Recovery Works

There Are Many Paths to Recovery By Dr. Johnston, Recovery Works Drug addiction is a treatable chronic brain disease. Recovery is possible, but it is not always easy. One of the most important components of recovery is finding and participating in a supportive sober network. Although many people try to go through withdrawal on their own, they often find it unpleasant, uncomfortable and difficult, and so they frequently wind up relapsing. This is why a supportive network along with professional facilities that medical staff trained in addiction recovery can help them avoid falling back into their old addictive ways. Other solutions for your clients might be 12-step program that utilized by recovery programs such as Alcohol Anonymous or Narcotics Anonymous is highly successful in helping addicts move into new relationships with themselves and others. Counseling is also important for someone who is struggling to discover what it means to be clean and live soberly. Every moment of substance abuse treatment should focus on helping address potential barriers to sobriety and giving the patient tools to cope with challenges encountered in everyday life. This includes prevention of relapse. The patient seeking sobriety should find a group or a counselor with whom he or she feels comfortable. But many time there is a need for the addict to find a recovery center that provide from them what is not available at home. The patient should also be prepared to face hard questions that may make him or her face up to past actions and present situations that are not pleasant to confront. One other factor in recovery is properly dealing with stress management. Stress Management should be part of an effective recovery-activity program. Stress can make people feel unable to cope with the ins and outs and ups and downs of daily living. Talking it over one-on-one with a compassionate counselor or sharing with an emphatic group of people who have faced and overcome similar trials and tribulations


doc

Fall 2016 • Kentucky

The first step is often to admit that one has a problem and one needs help to get sober.

are invaluable in helping someone start down the road to recovery. People who are addicted to various substances – be it opiates or alcohol or prescription drugs – need to remember one important insight psychiatrists and counselors often share: Being addicted does not mean someone is weak, stupid or hopeless. Drug addiction does terrible things to the brain. Drugs tap into a primitive part of the brain that often makes people do things they would not otherwise do. This makes changes in the brain that can actually be discerned in a brain scan. However, when someone starts working on recovering from her addition, the brain begins to recover and become more normal looking. It is possible to recover completely from addiction and to live a normal life once again. It is possible, but it is not easy. The first step is often to admit that one has a problem and one needs help to get sober. This provides motivation for doing the hard of work of recovering. It means telling yourself that your sobriety will be your life’s priority and you will stick to learning and performing coping skills. You would also make it a priority to learn about your disease and learn how to avoid relapse and the things that may trigger a relapse. Options for recovery include treatment centers, like the one’s offered by Recovery Works. These treatment centers can provide a person the much needed safe, drug-free environment to help get you started on the road to health and sobriety. The initial focus of a treatment center might be helping you deal with the sometimes debilitating withdrawal symptoms, which include a runny nose, sweating, chills, diarrhea, nausea, cramps, insomnia and joint pain. Some treatment centers offer transitional housing for those who are improving but who are not

quite ready to return to the former environment that might make them relapse. Outpatient counseling and drug treatment with methadone or suboxone. This option helps the patient gradually wean himself or herself from their addictive drug, giving them hope for getting completely off the substance. Families can be an important part of someone’s recovery. The more your family understands what you have gone through and what they can do to help you, the better your recovery experience may be. You may have to work even harder to regain the trust and love of people you might have hurt when you were actively addicted. The healing of broken relationships can be another powerful motivator for someone to get help. There is no stigma or shame in trying to get professional help for what seems to be a personal problem. There is a certain amount of admirable courage for someone who has made the decision to get their life back on track and makes a private covenant to do whatever it takes to become once again a sober and productive member of society. About the Author Dr. Johnston graduated from Medical School at CMDNJ New Jersey Medical School in Newark after obtaining a Bachelor’s Degree from Rutgers Camden College of Arts and Sciences. After a three year residency at West Jersey Hospital in Voorhees he became Board Certified in Family Practice and practiced in Camden County for 26 years. Dr. Johnston is also board certified in Addiction Medicine as of 2002.

3107 Cincinnati Road Georgetown, KY 40324 502-570-9313

25


26

doc • Fall 2016 • Business Section

Kentucky

ActionCOACH for Better Business By Andrew Van Horn If you are reading this, then you obviously want a better business. You are interested in doing what it takes to grow both personally and professionally so that you can achieve the results you want in your life and business. ActionCOACH has helped hundreds of thousands of business owners all over the world achieve not only greater profits, but a better life through our proven system of business growth. What I am going to do is give you every bit of our system, just to reward your time in reading this magazine. ActionCOACH trains you on several different formulas, all of which create the life and business that you want. We have The 6 Steps, The 5 Ways, The 4 Ways and BE, DO, HAVE. Within these four formulas are the keys to unlocking your potential as a business owner and achieving the life that you’ve always wanted. So here’s how it all works. The left side of this chart (figure 1) represents the path of every business owner as an entrepreneur through her or his life and whom you need to be to progress. We start out being employed by someone else. We then get struck by an entrepreneurial feeling,

moving us into the self-employed category. As your business grows, you start to hire people, and you become a manager. You start leaving the manager stage when your business starts to run without your daily input. When that happens you truly become a business owner. The next stage is to become an investor. You start to invest the profits from your business in other ventures, which could be stocks, real estate, or other businesses. You become a true entrepreneur when you start adopting the thoughts and ideas of others, as well as your own, and you create industries or innovate industries to become a key player. All of these steps require you to become a better person, your BE. Your business will never outgrow you, you must keep learning and growing to achieve the next level. The bottom axis represents the steps of your business along the entrepreneurial lifetime. This axis highlights everything that you must DO to achieve a better business. Where you are on this axis is a direct reflection of the actions you take every day. The primary step every business must achieve mastery, or control over money, product/service delivery, destination, and time. When those four areas are solid, you move onto the Niche part of your business.

BE

HAVE

Entrepreneur

Investor

Owner Manager Self-Employed Employee

FIGURE 1

Mastery

Niche

Leverage

Team

Synergy

Results

DO

This “niche” part is where you start to look at how you are better and different than all of your competitors and differentiate yourself in the marketplace. You accomplish differentiation through Unique Selling Propositions and Guarantees, both of which typically fall into the marketing and sales portion of your business. The best (and big!) way to know you have achieved this is when you are no longer competing by price. In other words, the cost of your good or service has become a very small part of why people purchase from you. The next stage of a business life cycle is that of Leverage. This step is all about putting systems in place for your business that allow it to run smoothly without owner input. Systems are the key for every business to become self-sufficient because they help the owner to leverage her or his time. Simply put: Do the work once; get paid from it over the long term. Sounds great, doesn’t it? Once the business has systems in place, it is about getting the right team members are in place to keep it running smoothly. With the right team in place, it is time to hire a general manager. Your business is running smoothly, growing consistently and is creating the cash flow that you will need in the investor stage. As an investor, you are now all about gaining your large monthly profit-based income to work for you by creating more money. You start to purchase other businesses, rental properties, stocks and other investments that put your money to work. Investing is about using your money to create more money. The results stage is where you start to enjoy the fruits of all your labor. You ensure a huge financial legacy for your family. You can take those dream trips you’ve always wanted. Most important, you have the freedom to do what you want to do. At the results stage, money is abundant, and you will always have enough. Now that you understand the basics of the business and investor life cycle let’s look at how it plays out for the owner. What do they want to have and how much money will they make? Between Niche and Leverage is where you start to get exponential profit increases.


doc

Business Section • Fall 2016 • Kentucky

Around that time frame is when your business is running efficiently, and most of the work you’ve done starts to pay off. Now that you’ve seen how the life cycle and steps work, and the return that you’ve achieved along the journey, you are probably wondering how to achieve the next step in your business. A proven process exists for doing just that, and it is used successfully in businesses all around the world. I am talking about The 5 Ways and The 4 Ways. The 5 Ways is a formula that allows you to achieve a 61.7% increase in your profits, and The 4 Ways are about systematizing your business to run without you.

The 5 Ways

In a nutshell, here is the formula: Leads x Conversion Rate = Customers Customers x # of Transactions x Avg. $ Sale = Revenue Revenue x Net Margins = Profits If you want to see a dramatic increase in your profits, start tracking your 5 Ways today. Get a solid count on the number of leads your business receives during an average day, and then figure out how many of them bought from you. Those two numbers give you your conversion rate. Then you can determine your number of Customers for the formula. To get more customers, you must focus your energy on Lead Generation, or marketing, and on your Conversion Rate or sales process. The next step is to track how many transactions they have with your business, and what they spend on average per transaction. If you want to increase your revenues, focus on getting your customers to buy more each time they show up, and convincing them to come back more often. These two areas also fall into your sales and marketing parts of your business. The fifth area is your Net Margins, or how much is left after you’ve covered all your expenses. Most business owners make a mistake here by not including a salary for themselves. You are time as the owner has a

cost and needs to be considered when looking at your Net Margins. There are three categories to improve for better margins. They are efficiency, budgeting, and costs per unit sold, which are functions of management. I’ve seen all of The 5 Ways work in businesses in which I’ve worked and even in my own business. Your focus on each of these five areas will exponentially increase both your profits, and the amount of cash available to your business.

The 4 Ways

There are only four categories to look at when it is time to systemize your business and leverage your time as the owner. They are People and Education; Systems and Technology; Delivery and Distribution; and Accounting, Testing, and Measuring. People and Education allow you to develop training programs and hiring processes that attract, retain, and train your employees to be the best. Employees are a must if you want to leverage your time and ability to make money. Once you have employees, it is your job to ensure that they are growing and achieving more each day improving turnover and helping your company grow. Systems and Technology address what sort of technology and systems are already out there that can allow you to leverage your time and money. It could be more cloudbased systems or communication systems. It could be in developing a mobile app, or creating a better work system. All sorts of possibilities exist in this category. Delivery and Distribution involves how you are delivering your products and service out to your clients and customers. One area that I’ve worked on to improve in my own business is getting my client to meet on the phone, instead of in-person gatherings. Phone meetings save both of us huge amounts of travel time and increase my capacity to take on even more clients. Another example of improving product delivery is Amazon. The e-commerce giant is now offering same-day delivery in certain markets and wants to deliver goods via drones. Be inventive when it comes to improving your product and service delivery.

The fourth area is in Accounting, Testing and Measuring; basically, how are you receiving and understanding the numbers in your business. By testing and measuring everything you do, you can assess if it has positive or negative impact on your business. With that data, you can make decisions faster on what to get rid of in your company, and what to keep doing. Look at how you can automatically track and account for things. Tracking could involve getting some additional phone numbers to track different parts of your advertising, or creating different offers to see where leads originate. Again, it is all about automating the accounting and tracking in your business, and then having that information flow through to you in usable formats. As the owner of your business, your job now is to look at each of these areas, so you can start to see the potential and growth of your business. You are probably also wondering how long this process takes. As with many things in life, the answer to that question depends entirely on how much time and energy you put into achieving the next steps. I do know, based on client results, that if you commit 4 hours to 6 hours of work on this per month, you’ll have reached the Results stage in 4 years to 6 years. Think of that: Just 50 hours to 60 hours of work on your business each year, and you can dramatically change your lifestyle and the results you see. That is the power of working within this proven system for growth. Be encouraged! Get to work on your business and achieve all the untapped potential within your business. About the Author Andrew Van Horn is best summed up in one word: Abundance. Abundance simply means having enough time and money to do the things that you want to do. As an ActionCOACH Business Coach Andrew helps owners all over the area in building a business that creates abundance for the owner that can be passed down for generations. He loves helping businesses grow into their full potential because a growing business creates jobs and money that can bring about positive change in the area. His goal is to help 1,000 businesses in the next five years achieve abundance.

27


28

doc • Fall 2016

Kentucky

2440 Astarita Way Lexington, KY 40509 List Price: $459,000 4580 sq. ft. 5 Bed, 5 Bath Outstanding home located in the heart of West Wind! Wonderful floor plan and exceptional amenities. Including gleaming hardwood floors, wide hallways, extensive moldings, central vac system, 2 story entry foyer, formal dining room, study, 1/2 bath, utility room and a large family room that opens to a spacious kitchen. Kitchen has stainless, granite and a breakfast area. The second level offers a large owner’s suite with trey ceiling, large bath with whirlpool tub, separate shower, dual vanity and dual walk-in closets. 4 additional spacious bedrooms with 2 full baths are also located on the second floor. The lower level has Owens Corning finishing system with excellent thermal performance, sound control and resistant to moisture and mold. Large rec room and full bath. Covered rear porch with skylights and fan. Beautifully landscaped grounds, neighborhood pool and much more. Don’t miss this opportunity. Truly a move-in ready home.

277 Cassidy Ave. Lexington, KY 40502 List Price: $510,000 2411 sq. ft. 3 Bed 3 Bath Prime Chevy Chase location. Immaculate 3 bedroom, 3 bath, brick Cape Cod with attractive curb appeal. Featuring a family room with fireplace, dinning room, wonderfully renovated kitchen with stainless appliances, granite countertops and laundry area. Nice 1st floor owner’s suite with beautiful bathroom, spacious closet and doors to rear patio. Second level offers two spacious bedrooms, fully updated bathroom and abundance of storage space. Unfinished basement and 2 car garage with concrete driveway. Totally updated throughout including insulated windows, interior blinds, roof, gutters, chimney rebuild, fence, landscaping, garage roof, siding and door. Move in ready home. Don’t miss this wonderful opportunity!

2376 The Woods Ln. Lexington, KY 40502 List Price: $645,000 4675 sq. ft. 5 Bed 3 Full Bath, 2 Half Bath Look no further!! Fabulous home on a 1/2 acre lot inside New Circle Road, in The Woods Subdivision! Features 1st floor owner’s suite, tall ceilings, hardwood floors, kitchen with granite tops & stainless appliances, finished basement, wet bar, 4 car garage, 2 fireplaces, 2 zoned HVAC systems, professionally landscaped grounds, rear fenced yard, in-ground heated pool, recent interior & exterior paint and front brick steps. Move-In-Ready home priced to sell. Exceptional opportunity. Square footage does not include finished space above garage (+/- 388 SF heated & Cooled)

Rick Queen 859-221-3616 Turf Town Properties | www.turftown.com

EQUAL HOUSING OPPORTUNITY

161 Old Cassidy Ave. Lexington, KY 40502 List Price: $449,500 2484 sq. ft. 3 Bed 2.5 Bath Charming Chevy Chase home! 3 Bedrooms, 2 full baths and 1 half bath with a 1st floor owner’s suite, formal living room, dinning room, family room, 2 fireplaces with gas logs, partially finished basement and hardwood floors throughout. Nice relaxing front porch, professionally landscaped grounds and a 2 car garage. Outstanding location! Convenient to UK, shopping, Romany Road, Ecton Park and much more.

681 Providence Rd. Lexington, KY 40502 List Price: $537,000 3150 sq. ft. 4 Bed 3 Bath Wonderful 4 Bedroom and 3 Bath, 1 1/2 story home with 3150 Sq.Ft. Great Location! Tastefully updated throughout with custom upgrades. Inviting entry foyer, large living room with fireplace, open dining room to kitchen. Kitchen has custom cabinets, upgraded stainless appliances and granite tops. 2 bedrooms and full bath on 1st level. Second level features spacious owner’s suite with walk-in closets, and a wonderful bath including heated tile floor. Nice laundry room, additional bedroom with bonus area and full bath. Lower level offers a den with fireplace and an abundance of storage. Hardwood floors throughout, new insulated windows, 2 zoned HVAC systems, 2 car garage and fenced yard. Attractive move-inready house! Convenient to UK, Downtown, and more!

2927 Four Pines Dr. Lexington, KY 40502 List Price: $725,000 4048 sq. ft. 3 Bed 4.5 Bath Classic home located in ever popular Four Pines with brick privacy wall and beautiful landscaped grounds, 10’ ceilings, hardwood floors, custom built ins, moldings and mantles, wonderful Kitchen with island and custom cherry cabinets, formal dining room, awesome living room with fireplace and french doors to private courtyard. Second level offers fabulous master suite with vaulted ceiling, fireplace, walk in closet and large bath, additional bedroom and bathroom. Third level offers additional bedroom with full bath. Finished lower level offers family room with fireplace, full bath, craft room or home office area. Spacious 2 car attached garage. Convenient to UK, downtown, numerous medical facilities, Chevy Chase, and more. Wonderful home in desirable area.

862 McMeekin Pl. Lexington, KY 40502 List Price: $1,399,000 5329 sq. ft. 5 Bed 3 Full Bath, 2 Half Bath Stunning 2 1/2 story, renovated home backing to green space. Close to UK, hospitals, and downtown. Outstanding renovation, Fabulous amenities, Gourmet Kitchen, Sumptuous Master Bathroom, Beautiful Hardwood Floors throughout, Resort like backyard, Professionally landscaped grounds, Front circular drive, Inground Pool.


doc

Fall 2016 • Kentucky

FOXBROOK FARM

29

5,100 SQUARE FEET | $1,900,000

Exquisite and stylish 19.5 acre country retreat yet a horse farm suitable for any discipline. The former Wintergreen Stallion Station, just outside Midway, has been converted to an estate-quality property enhanced by its natural beauty and privacy. Brilliantly transformed from a six-stall barn and adjoining office, this elegant 5,100 square foot Tudor-style home encompasses a mixture of traditional, contemporary, and rustic finishes. The stallion barn consists of 8 stalls plus a 38.5’ x 49’ breeding area. 20 minutes from Lexington and less than that to the Kentucky Horse Park, Foxbrook Farm is perfect in size, location, natural beauty, and serenity.

Justice Real Estate 518 East Main Street Lexington, Kentucky 40508

WOODFORD COUNTY

p : 859.255.3657 f : 859.233.3800 www.kyhorsefarms.com

77 ACRES | $749,500

Secluded and private 77 Woodford County acres. Custom cedar home in an incredible setting with spectacular views. 3 bedroom, 2 bath home with 2,900 square feet featuring hardwood floors, floor-to-ceiling stone fireplace, granite counter tops, large L-shaped covered porch, unfinished walk-out basement, and geothermal HVAC. The front of the farm is well-kept pasture land with a five bent tobacco barn. The rear of the farm features a great blend of woods and native grasses - perfect for deer and turkey hunting and fabulous dove hunts. There is also a 24’ x 42’ 3-bay detached garage/ equipment building. Owner may consider selling home with front 25 +/- acres.


APPOINTMENTS AVAILABLE WITH FPA PROVIDERS AT BOTH LOCATIONS

fpalex.com CHECK US OUT ON THE WEB

859.278.5007


Take Care of Your Patients by Taking Care of Yourself

The Lexington Medical Society

Physician Wellness Program

TAKE CARE OF YOUR PATIENTS BY TAKING CARE OF YOURSELF The Physician Wellness Program (PWP) was designed as a safe harbor for physicians to address normal life difficulties in a confidential and professional environment.

WHY WAS THIS PROGRAM CREATED? Being a physician isn’t easy. Difficulties with the current health care delivery system, maintaining a healthy work/ life/family balance, and dealing with the normal stresses of everyday life can take their toll on physicians. We serve not only as treating physicians, but many times as counselors to our patients who turn to us for guidance. Who do we turn to when we need to talk through an issue or get some coaching for how to handle stress in our life? Too often the answer is “no one,” and that is regrettable because it is imperative that we be as healthy as possible in our role as health care providers. We deserve to function at our best in all areas of our life. By addressing areas of difficulty, we can decrease our stress levels and increase our levels of resilience.

Some examples of those difficulties include: •

Family issues

Depression & anxiety

Relationship problems

Difficulty managing

Work-related

stress

difficulties

Mood swings

Alcohol/drug abuse

Suicidal thoughts

How PWP Works We have contracted our program with The Woodland Group. The Woodland Group will provide counseling to active physician members of the Lexington Medical Society and UK Graduate Medical Education program residents and fellows. Non-emergency sessions will be scheduled during regular business hours. Emergency sessions can be scheduled on a 24-hour, 7 days-a-week basis. Seven licensed psychologists make up the Woodland Group and have been vetted by LMS. Steven Smith, Ph.D. and Sandra Hough, Ph.D. are our program coordinators and will serve as points of contact to access PWP. The Woodland Group will maintain a confidential file for each physician, but no insurance will be billed and LMS will not be given any information about those who utilize the program. As such, this program is completely confidential which is crucial to its success. LMS will pay The Woodland Group a monthly bill based on the number of sessions provided. The Woodland Group will verify LMS membership from the physician finder on the LMS webpage.

TO MAKE YOUR APPOINTMENT 1) Call the confidential hotline at 1-800-350-6438 and leave a message in either Dr. Smith’s or Dr. Hough’s voice mailbox. 2) They will call you back to schedule an appointment. It’s that simple!

PWP Benefits 6 free sessions each calendar year Complete confidentiality Easy access Convenient location (535 W. 2nd Street, Suite 207) 24/7 availability


She’s one reason Passport is the top-ranked Medicaid MCO in Kentucky.

We can give you 23,483* more. Passport Health Plan is the only providersponsored, community-based Medicaid plan operating within the commonwealth. So, it’s no coincidence that Passport has the highest NCQA (National Committee for Quality Assurance) ranking of any Medicaid MCO in Kentucky.

Our providers make the difference. *Passport’s growing network of providers now includes 3,720 primary care physicians, 14,014 specialists, 131 hospitals, and 5,619 other health care providers. Ratings are compared to NCQA (National Committee for Quality Assurance) national averages and from information submitted by the health plans.

MARK-51677 | APP_11/16/2015

pass5449v1_KY Doc_8x5.0993.indd 1

11/25/15 12:37 PM

MEDICAL CODING certification First, Oldest & Best

14 years - 850+ students The ONLY PMCC taught in Kentucky by Patricia Cordy Henricksen, MS, CHCA, CPC-I, CPC, CCP-P, ACS-PM

Next PMC Class star C ts

Feb. 15 2017

REGISTER NOW www.soterionmedical.com

(859) 233-3900

e-mail us: soterion@windstream.net

Kentucky Doc Fall 2016  
Kentucky Doc Fall 2016  
Advertisement