Kentucky Doc Spring 2017 by Rockpoint Publishing

spring 2017 • volume 9 • issue 1

Passion for the Practice of Medicine 2017 Essay Contest Winners Experiences that Ignite • Sustain • Rekindle

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Contents | Spring 2017

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

Iron Man: A New Frontier by Michael Kaufman, MD

Thank You For the Lesson by Rebecca Ba'Gah, MD

PHYSICIAN HEALTH & WELL-BEING

Life is Short. Live Accordingly. by John A. Patterson MD, MSPH, FAAFP The Switch by Karen Tran-Harding, MD

08 10

Paying it Forward by Elizabeth Alma Harvey

The Wildfires that Ignited Medical Aspirations by Sarah Bugg

COMMUNITY NEWS

PROFILE IN COMPASSION

Doctor Johnny is Coming Home by John A. Patterson MD, MSPH, FAAFP

We welcome readers to the spring edition of KentuckyDoc. This edition features UK residents and medical students who submitted essays on the topic of “Passion for the Practice of Medicine.” For this annual contest, participants were instructed to write an essay on experiences in their life that ignited, sustained, or rekindled their passion for medical practice. Michael Kaufman, MD is the winner of the resident category with his essay, Ironman: A New Frontier. He is an Otolaryngology Head and Neck Surgery resident at the University of Kentucky Medical Center. The second place winner in the resident category was Rebecca Ba'Gah, MD providing her essay, Thank You for the Lesson. Dr. Ba'Gah is a UK resident in Pediatrics, Psychiatry, and Child and Adolescent Psychiatry. Karen Tran-Harding, MD is a second-year Radiology resident at UK and submitted the third place essay, The Switch. In the medical student category, Elizabeth Harvey wins the top award with her essay, Paying it Forward. She is followed by medical student, Sarah Bugg, a second place winner with The Wildfires that Ignited Medical Aspirations. Last and not least, Kara Jolly wins third place in the medical student category with her essay, There Goes My Heart. We will award prizes to our UK resident and student winners May 9, 2017 during the 6:00 pm Lexington Medical Society dinner meeting at the UK Boone Center. John Patterson, MD penned an article on Physician Health and Wellbeing: Life Is Short. Live Accordingly. John gives us an insight and a portrayal of Neena Thomas-Eapen, MD, a Family Practice physician in the UK Department of Community Medicine. Dr. Patterson introduces us to Neena as a practitioner of integrative

medicine and how she claims 30 to 40 minutes each morning as time for caring for herself. This enables her to be better at caring for her patients. Dr. Patterson also writes a profile in compassion: Dr. Johnny is Coming Home. He portrays John D. Stewart II, who is a Past President of the Lexington Medical Society (1997) and recently retired from 32 years of surgical practice with Fayette Surgical Associates. Dr. Stewart is now the Chief Administrator of the Stewart Home School, a 124-yearold family medical business in Franklin County. He is the fifth generation of Stewarts to lead this facility whose mission is “dedicated to education and care for special people with special needs.” Another timely article was provided by Dr. Dani Vandiviere, Staying On Top of Caregiver Burnout Syndrome. Caregiver stress reactions are very common in those who care for ill or impaired family members at home, and our readers may learn important information on how to recognize and assist caregivers in their practice. I hope you enjoy this edition of KentuckyDoc, and I am sure you will enjoy reading the aspirations and trials of our resident and medical student essay contest winners.

Editorial Board Members Robert P. Granacher Jr., MD, MBA editor of Kentucky Doc Magazine Tuyen Tran, MD Lowell Quenemoen, MD Tom Goodenow, MD

There Goes My Heart by Kara Jolly

John Patterson, MD

Thomas Waid, MD Brent Morris, MD

Staying on Top of Caregiver Burnout Syndrome by Dr. Dani Vandiviere

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Iron Man:

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By Michael Kaufman, MD

It is not often you get the chance to meet a celebrity in the emergency department, especially at 2 a.m., and when that opportunity arises you must seize it. When Iron Man strolls through the door notice is taken. As a child I was fascinated by superheroes. Superman, Batman, Iron Man, Wonder Woman; my appetite was insatiable. I felt a connection to these figures, wishing I was only a radioactive spider bite away from saving the world. That sense of wonderment and enthusiasm was what I saw when I first walked into emergency examination room 14. A five-year-old child clutching an Iron Man action figure. Moving his arms and legs up and down the bed, fighting invisible foes. He barely noticed me as I strolled into the room and began my usual questioning of the parents. He had been transferred to the University of Kentucky for a nasal foreign body. My curiosity could not be contained and I asked the parents what I would be looking for in the child's nose. He sprung to life, waving Iron man in my direction, and yelled, "Iron Man's fist!" This was not the first attempt at removal and the child was understandably wary of anyone who remotely resembled a healthcare worker. His parents relayed the harrowing story of an attempted flushing out of the foreign body in Hazard, Kentucky. From their description the child was nearly tortured to no avail. They then traveled to London, Kentucky for another attempted removal. This time he was held down forcibly and multiple attempts were made to slide a foley balloon past the object and drag it out. This was successful in creating a nosebleed, but unfortunately the object remained.

I have taken multiple strange and wonderful objects out of children’s nasal passages. Beads, buttons, magic grow super snakes; anything imaginable and can remotely fit. However, this young child yearned to make his superhero whole again. He glanced my way and calmly stated, "Mister, can you give me his missing hand?" Upon glancing back at Iron Man he began crying. Five-year-old children can be challenging patients. They are too strong to be forcefully held down and too aware to be tricked. They have a heightened sense of adventure that is only matched by their sense of fear. As with all my patients, I had to earn his trust before attempting to restore his toy to its original glory. I needed to visualize the foreign body and that required placing a small scope in the child's nose. I allowed the child to look through the scope, feel the tip, understand that this piece of equipment he had never seen posed no real threat. Once

That day I got to be a superhero. he understood he allowed me to insert the scope gently into the left nasal passage. Nothing was seen. I then inserted the scope into the right nasal passage. A red, fist-like object was well visualized. I touched it with the scope. It was anterior and mobile, the two criteria that made me confident it could be taken out then and there. I asked the child if he wanted the fist back. This was met with an emphatic, "Yes!", as he raised the action figure. His mom came over and slid her hand gently up and

down his back. His dad congratulated his son on his bravery, telling him Iron Man would be proud. The child agreed to close his eyes and began singing his favorite song at my instruction. I gently slid a curette behind the object and with one swift motion popped it onto his lap. He screamed and pulled away from me but the deed was done. I picked up the fist, washed it off in the sink and placed it back in its rightful place. The child shook off his shock from the removal and slowly placed his arms around my neck, bracing me in a hug for saving Iron Man. I glanced over to his parents who were equally appreciative. Their 12-hour ordeal was finally over. Removing a nasal foreign body is not curing cancer. While I am confident he will not place Iron Man's fist anywhere near his nose ever again, this experience will play a very small part in a long and healthy childhood. In a few months his visit to the emergency room will be a small afterthought in the entire family’s mind. However, that day I got to be a superhero. The immediate impact on a child and the family at large is one of the reasons I became a surgeon. In the simplest terms a surgeon assesses a problem and then does something to fix it. The act of "doing something" and the effects of those actions are what I truly love above medicine. This one small act allowed me bridge the gap between the child I used to be and the surgeon I have grown into. I won’t soon forget it. About the Author Michael Kaufman, M.D., attended Emory University for his undergraduate education where he majored in neuroscience and behavioral biology and played on the varsity tennis team for four years. I completed my medical degree at Wayne State University in Detroit, Michigan. He is currently an Otolaryngology Head and Neck Surgery resident at University of Kentucky Medical Center.

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Thank You For the Lesson

By Rebecca Ba'Gah, MD Monday mornings on the unit are always a little chaotic. Even though during pre-rounds, without anyone stating it, there seemed to be a universal understanding that the weekend was over, it was time to try and get back to business. I didn’t have the chance to meet Christopher before the individual treatment team meetings. Sally * insisted that she share her newest poems with me. I knew I’d eventually see everyone sometime that day so I remained a captive audience. She was working with me and taking her Lithium without a fuss so the least I could do was listen.

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We all gathered round the small wooden rectangular table that has 3 sides with a single empty chair all by itself on the 4th side. There were quick pleasantries among the physicians, social workers, and nurses as we waited for our first patient to be brought in to us. At times, it felt like we were the parole board, and the patients were prisoners coming to plead their cases at parole hearings. We made it through most of the patients without incidence. There were a few tears, many curse words, a couple of threats… nothing unexpected. Then we came to our last patient. This was the one I had failed to see earlier. I did have the chance to quickly skim his file: overdose on Xanax and Zoloft in a failed suicide attempt, history of molestation by

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“I have been gifted with the responsibility of being someone’s advocate. I can have the empathy and compassion they require, but also a tough exterior to be the defender they so deserve." – Dr. Rebecca Ba'Gah

his mother, and voluntary admission. Into the room walked a gentle giant and with him an air of complete defeat and overwhelming sadness. Hunched over, he cautiously sat down in the empty chair. The black pea coat, white t-shirt, and blue jeans he wore all hung loosely on his gangly frame. Then Dr. Tron broke the silence. “Christopher, do you know why you are here?” Scared dark eyes looked up. “Yes, sir. I tried to kill myself, and I promised my father that I would get help.” The interview continued in regular fashion. An abridged version of Christopher’s story was related to the team, a medication regimen was agreed upon, and he was sent on his way to be seen again tomorrow. Regrettably, depressed teenagers are not the rarity these days with the pressures of social media and reality television, so I wasn’t that shaken by Christopher’s sad tale. Initially, I was always worried about going into psychiatry because as a self-proclaimed marshmallow what good would I be to my patients if I am crying in the corner because a 13 years old cuts herself daily because she’s teased at school? I was nearing the end of my 3rd year of medical school when career decisions are usually made. But something in me transformed this day. After treatment team, I went to place orders and prepare discharges. The PA who performs the intake physical examinations came over for a chat. “Are you familiar with the new kid that was admitted last night… the 19-year-old overdose?” She was referring to Christopher. “Yes?” I responded. “Well, he’s got a pretty significant lump on his left testicle. It needs further work-up.” “Oh, OK.” I acknowledged. I approached Dr. Tron, who’s the unit director about Christopher. “Well, you handle it Rebecca. I haven’t thought about those tests since medical school back in Vietnam.” I set up an ultrasound and went to talk to Christopher. He was sitting up in his bed still in the black pea coat. It seemed like he was wearing it like armor to help protect him from the world surrounding him that had felt too much to bear. I re-introduced myself and did a cursory check on how he was doing. Did he have any current thoughts of hurting himself? Others? Hearing voices? etc. I then proceeded to tell him that when he was being examined earlier the PA found a lump on one of his testicles and that he would need some tests so we can figure out what it is. He politely listened and didn’t ask any questions.

Right before I left the unit for the day, I checked to see if Christopher’s ultrasound results had returned. I read a few of the words over and over in disbelief: CONCERNING FOR CANCER. My heart actually hurt. I distinctly remember walking to my car and literally shaking my fist at the sky. How could it be that this young man who had his innocence stolen from him by a mother who never received proper psychiatric care, who felt so alone and hopeless that he tried to take his life, now has to deal with having testicular cancer too? Once I reached my car, I actually cried. It just didn’t seem fair. And what could I do? At that moment I felt so helpless and powerless. I had lost my perspective. The next day my morning on the unit started as usual: on pre-rounds, I briefly chatted with Dracula, Sally had another poem. I took a deep breath before I entered Christopher’s room. There he was like yesterday sitting up in bed still with the pea coat on. “How did you sleep last night, Christopher? “OK,” he responded. “Christopher, do you like to read? Would you like me to get you some books? “Yes, please,” he replied. Come to find out, the unit had about 6 books and none looked rather appealing. I settled on the one that was some sort of US historical fiction. Be careful what you offer! is what I quickly learned. Note to self: get some donations to build up this “library.” In order to confirm his diagnosis of cancer, some blood work had to be obtained. It felt like a century waiting for the results to return. I hadn’t yet used the “C” word with Christopher. There was no point in scaring him until we knew for sure. He seemed to be having a better day than yesterday. I got a big smile when I brought him the book. That was a first. In between, the ordering of labs and taking care of my other patients, I noticed something. I was not sad. I was feeling empowered. I was taking action. I wasn’t sitting in the corner crying, hurting because of the bad hand my patients had been dealt. I was equipped with training and knowledge to help turn that hand around. My perspective had shifted. Eventually the results retuned, and they were, in fact, indicative of cancer. My heart sank a little, but my head was held high. I knew that he was responding well to his psychiatric treatment and would be discharged from the unit soon. But I was going to make sure that he was set up to receive all the nec-

essary appointments and referrals. It felt like an act of Congress getting someone from urology to come and examine him in the unit, but it was done. Regrettably, psychiatry and other medicine are sometimes like oil and water. I remember having that conversation with Christopher. I was a little worried. I was afraid that he would break down and lose all hope. The progress he had made would vanish. But then this happened. “You know, I actually feel really good. I feel like I have something to fight for. I am going to have to be strong to beat this. I have a reason,” he proclaimed. I couldn’t believe it. This tortured soul didn’t turn into a pile of despair. He was hopeful. His perspective was that he had been given a reason to fight, to stay alive, to beat this cancer. I still get chills thinking about it. Though it may seem a cliché, life is about perspective. I am grateful to Christopher for showing me this early in my medical career. Because of him, I chose to do my residency in Pediatrics, Psychiatry and Child Psychiatry. With this decision, I not only have the ability to bring about an acute change in someone’s mental status but also tend to their acute and chronic medical illnesses as well. I have been gifted with the responsibility of being someone’s advocate. When I keep my perspective on the positive side, I can still have the marshmallow inside that gives me the empathy and compassion they require, but I have a tough exterior to be the defender my patients so deserve. *Names have been changed to protect privacy 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.

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Physician Health and Well Being

Life is Short. Live Accordingly. By John A. Patterson MD, MSPH, FAAFP Neena Thomas-Eapen, MD is a family practice physician in the UK Department of Family and Community Medicine. She has completed the University of Arizona’s fellowship in integrative medicine and brings that broader perspective to the department’s faculty, staff and residents. Growing up in India, she liked biology and always thought she would be a teacher. She had seen the poor conditions in Indian government hospitals and didn’t initially consider medicine as a career. Nevertheless, she tentatively went to medical school at age 18, saw the modern and clean basic science laboratories and was surprised how much she liked it. Influenced largely by a supportive mentorship relationship with a senior surgery professor, she did three years of general surgical training and research after medical school. Having always felt an altruistic impulse to serve needy people, she served for a year in a Christian mission facility before marrying and moving to the US with her new husband who had permanent US residency.

From India to North Dakota

In the mission hospital she saw a different kind of medicine from medical school, surgical training and research–a type of medicine that addressed the whole person, not just the biomedical, anatomical or surgical perspective. After passing her US licensing exam and having two young children, she wondered how to train and practice in the US. She decided that practicing surgery in the US was not an attractive option for a woman with young children. At that time, in the 1990s, family medicine included a lot of procedures and would permit her to

use her surgical training. She completed a family practice residency in North Dakota after which she was employed by the local hospital. She was able to practice the wholeperson medicine she had loved so much in her mission work.

Discovering Integrative Medicine

She emphasized lifestyle medicine, behavioral approaches, the importance of social connections and spirituality in patient care in her small-town North Dakota practice. She also felt a strong desire to advance her training but was not sure what training to pursue. After reading a book by Andrew Weil, MD, she applied and was accepted to his Integrative Medicine Fellowship in Tucson Arizona in 2005. After spending 2 years in the sunny and warm Southwest for the fellowship, she went back to snowy and cold North Dakota and joined her former residency as faculty for 7 years. She offered the 200 hour Integrative Medicine in Residency program as an elective for residents. She then moved to Lexington when her son was accepted for the BS/MD program at UK.

Taking Self Care for Granted

Despite the responsibilities of training and practice and feeling like a single parent for many years due to her husband’s travel demands, she never really felt severe stress or burnout. She practiced daily liturgical prayer from her Christian tradition as well as prayerful talking to a higher being. She also had a more personal meditation practice involving spending time with a thought or a word. Simply spending time with a higher power was always a part of her life. She maintained close relations with friends from her Orthodox Christian community. She

also felt tremendous support speaking regularly by Skype with her long-time surgical mentor in India (a Muslim). It has only been recently that she has realized how much these formal and informal practices have been protective of her physical and mental health and well being- sustaining her joy in life and her joy in medical practice.

Losing Hope and Losing her Husband

Life became more complicated after moving to Lexington and beginning work in an RVU-based compensation and productivity model. She began to feel like she was drowning. She was beginning to lose hope of regaining her life’s balance. She was losing the sense of freedom and autonomy she had taken for granted in North Dakota. She was heading toward burnout and considered resigning her position. Instead, she made several patient care changes with the help of the clinic director, streamlined some of her charting practices and made adjustments in her weekend time management. She also discussed her needs with the department chair who agreed to reduce her time to four days a week with a three day weekend. These changes have helped tremendously. This improvement in her quality of life could not have been better timed. Not long after making these practice changes and recovering some sense of coping and control, her husband had a sudden cardiac arrest. He was on life support and had no advanced directives. She and her two sons had to make the decision to withdraw life support after attempts to revive him proved futile. She credits a single casual family conversation about end-of-life wishes with guiding their decision-making. They all knew that he did not want to be kept alive without any reasonable hope of recovery. She was also guided by her

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own management of patients who lived in long-term care with little or no conscious awareness.

using alternate nostril breathing. This 30-40 minute morning routine ends with hatha yoga postures.

Coming Home to Self Care

Healthy Lifestyle and Work-style Tips

That was September 2016. Her New Year’s resolution this January was to re-commit to more regular observance of her longterm self-care rituals, combining prayer, meditation and exercise. She now claims 30-40 minutes each morning as her time for caring for herself. She walks on the treadmill for 10-15 minutes to a target heart rate, sits down cross-legged on her yoga mat and pauses with a quiet mind until her breathing returns to normal. Next comes heart-centered meditation, beginning with an intention to welcome and grow the following qualities of the heartlimitless compassion (with both hands placed on her heart), innate harmony (a sense of calm in the eye of the storm), healing presence, unconditional love, reverence for the way things are and a feeling of ‘Wow’. Throughout her day, she can simply say to herself ‘innate harmony–calm in the midst,’ anytime she needs to calm and quiet her mind and body. This meditation is followed by chanting out loud a liturgical prayer from her childhood and lifelong Christian tradition, ending with the Lord’s Prayer recited in her mother tongue. She sometimes adds a healing touch practice to her feet and a brief energy practice followed by 4 deep breaths

Thomas-Eapen now claims 30-40 minutes each morning as her time for caring for herself.

She tries to weave the following tips for healthy living and healthy working into her own life and her counseling to residents and patients: • Clarify advanced directives to assist your family in end-of-life decisions. • Create a healing environment in the office for yourself and for your patients–providing informational and inspirational books, pictures, décor, relaxing music, flowers/plants. • Create a healing environment at home for yourself and your family–with relaxing and healing pictures, photos of loved ones, inspirational reading and movies, music, plants, flowers, gardening, wind chimes for healing sound. • Healthy eating–focusing on vegetables, fruits, whole grains, legumes and healthy fats. • Sleep–recognize sleep as the foundation for health and make sure you know your personal physiologic sleep needs- usually 7-8 hours and not less than 6 hours. If you wake up in the middle of the night, use mindfulness of breathing or light reading to go back to sleep. • Rituals and Daily Routine–a consciously chosen set of daily self-care practices may include walking (outside if possible),

•

• • • •

mindful breathing, meditation, yoga poses and self-massage, ending the day with quiet evening activities, talking with family, avoiding screen time at least an hour before bed, prayer or inspirational reading first thing each morning and last thing each evening. Maintain social connections–nurture friendships, both old and new–social support can heal. She spends time with her university son at least weekly and her high school son each evening, including prayer time before bed. Know yourself! Be true to yourself! Speak up for what you believe! Acknowledge that life is short and live accordingly!

About the Author Dr. Patterson chairs the Lexington Medical Society’s Physician Wellness Commission, is past president of the Kentucky Academy of Family Physicians, is board certified in family medicine and integrative holistic medicine and is a certified Physician Coach. He teaches Mindfulness-Based Stress Reduction for the UK Health and Wellness Program and Saybrook College of Integrative Medicine and Health Sciences (San Francisco). He owns Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations, specializing in stress-related chronic conditions and burnout prevention for health professionals. He can be reached through his website at www.mindbodystudio.org

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The Switch

“So if you don’t mind me asking, why did you make the switch?” I get that question quite often. I honestly never grow tired of answering it because that’s always when I launch into what rekindled my spark for being a physician. I still remember running down the hallway, balancing on one foot, ferociously pulling on knee high booties while trying desperately to tie on a shield mask simultaneously. I was both excited and anxious, ecstatic and scared, because I was about to deliver life. I was about to be that person that introduces that life to mom, who has been waiting for this moment for months. Sure, that was absolutely the best part of being an OB/GYN, the part that you dream about as an eager medical student that just wants to finish medical school and finally become a doctor. But after my intern year, something in me changed. Over time I no longer had that fire and drive. I seemingly lost all motivation. I felt tired and defeated most days. I was definitely having more “bad days” than “good days.” Maybe I just didn’t have what it took to be a good doctor. Did I still want to even be a doctor anymore? I was running in my neighborhood on a warm October morning my second year of OB/GYN residency. As I was admiring how pretty the swirling orange and yellow leaves were, and suddenly the image of me sitting in a room and poring over details of an axial pelvic CT scan popped into my head. How great would it be to be a radiologist? I could help a ton of patients in a small amount of time, and also help a lot of physicians in their diagnostic dilemmas as well. I had rotated through radiology quite late in medical school, after finishing all my interviews for OB/GYN residency so I always had a great interest, but knew it was too late. After seemingly endless months, tremendous spousal support, what felt like a traumatic break-up, and lots of stressful waiting, I was extremely lucky to get accepted into a radiology residency spot at the same institution. I was elated. At the same time, I was so, so scared. I was petrified at changing my life so much, leaving behind the familiar,

that I had “wasted” so much of my time training already. The biggest fear of course was that I wouldn’t like radiology either, that maybe, just maybe the world of medicine really wasn’t for me. Nevertheless, I started reading about radiology right away. I relearned the circle of Willis, lesser trochanter muscle attachments, lymph node levels, and so on – things that I may not have thought much about in my years as an OB/GYN. I found that I really enjoyed learning about whole system disease processes and imaging findings and how to interpret them. Reading wasn’t a chore, it was really fun because I was so eager to gain knowledge and prove to myself that I could be a really great radiologist. This need to prove myself and not disappoint the people who helped me obtain the residency position kept me going when I finally started on July 1. I always came to the reading rooms early and stayed late or until I was excused because I wanted to make sure no one was stuck with leftover studies on the list. Any answers that I didn’t know while reading out studies with my attending, I went home and pored over books and articles to make sure I remembered it the next time. I attended every conference I could and always paid attention because the lectures reinforced concepts that I had read about. Within a year, I had completed numerous projects including multiple educational exhibits presented at various national conferences, publications, research, and quality improvement projects. Academic projects were things that I never thought I would be so involved in, but I found that it was so fulfilling working on every one that I keep picking up more projects happily. Even during my limited interactions with patients, I had even more sympathy and ran that extra mile for them because honestly, I just really missed interacting with patients sometimes. Now I am definitely not trying to say that OB/GYN was what made me lose my spark for becoming a physician. It was that unfortunately, it just wasn’t for me anymore and maybe it never was for me. I will always have the utmost respect and admiration for the OB/GYNs and the OB/GYN nurses and staff because they are the most selfless human beings and so wonderful at what they do. My realization that I needed to

change my life was the catalyst for making me a better physician and I will always have OB/GYN to thank for that. A few months ago, I met a lovely woman on my breast imaging rotation. She presented herself to the clinic with a new palpable mass in her left breast and bilateral axillary lymphadenopathy that looked very suspicious on imaging. She also happened to be 34 weeks pregnant. Sadly, her biopsy yielded invasive ductal carcinoma. She returned to the clinic later that week to have her lymph nodes biopsied and this time we had good news – her contralateral lymph nodes were cancer free. When I came back alone to tell her, she burst into tears because she had lots of questions – not questions about her cancer, but questions about her pregnancy. She wanted to know if she would be able to hold her baby after he was delivered, if she would be able to breastfeed, if she would lose her hair from chemotherapy. Thanks to my background training, I was able to answer each and every one of her questions. And because of that, I have another reason to be eternally grateful to the practice of OB/GYN. I tell those that ask me why I made the switch, that sometimes in your life, there will be moments that you have to make a life changing choice. Change is scary because you know you are about to embark on the unknown. But the unknown can be a good thing because it can lead to the life you didn’t know you wanted. I always say, it truly never is too late to really try something different because time and experience is never really “wasted”, that time always adds to knowledge and value. After all, it was that experience and drastic change in my life that made me realize that I was correct all along. I didn’t have what it took to be a good doctor – I discovered I had the potential to be a great doctor. It just happened to take a switch to get there. About the Author Hailing from Orange County, California, this second year radiology resident at the University of Kentucky found love, education, 1.5 residencies, and two corgis in the heart of the bluegrass.

“Change is scary because you know you are about to embark on the unknown. But the unknown can be a good thing because it can lead to the life you didn’t know you wanted.” – Karen Tran-Harding, MD

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When my dad went in for heart surgery, I never expected that he wouldn’t wake up. Not to say that I was worry-free, just that I worried about different things. I worried about his aneurysm bursting in the handful of days between our learning of its existence and the surgery scheduled to correct it. I worried about complications during surgery. Embarrassingly, I even worried about the size and shape of the scar that would remain on his chest. (I wanted him to ask if it could

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“There is no magic bullet in modern medicine. Every case requires the close supervision of medical professionals, and sometimes things go wrong for no discernable reason.” – Elizabeth Alma Harvey As I remember it now, the morning of the surgery seems more like a starting line, the last moment of normalcy before a harrowing months-long ordeal that changed how I thought about medicine. By the time we found out about my father’s aneurysm, I had already decided, with certainty, that I would become a doctor. I liked science, and I wanted to help people, so it seemed like a logical choice. I had an unfailing conviction in the power of modern medicine to cure, most likely because I had watched a few too many episodes of House over summer vacation. To me, the hard part of medicine was figuring out what was wrong with a person, and surgery was a quick fix that saved the patient. Once the doctors got the diagnosis right, the patient was as good as cured. My memories of the beginning of my junior year of high school are scattered. There was a growing familiarity with the ICU’s prayer room, which my extended family had converted into their own personal waiting area, smiling hollowly for my mother’s camera on the first day of school, and my vision blurring with tears as I watched my father’s chest rise and fall with perfect unison with the click and swoosh of the machine that was keeping him alive. These memories also included looking out onto the crowd at my soccer games, and then remembering that dad would not be there and my friend taking a detour as she drove me home, allowing me time to get my wracking sobs under control before she dropped me off at my house. Finally, almost two months after I kissed him goodbye on the way to the hospital, he started to regain consciousness. The relief was indescribable. He was awake. He was talking. Suddenly, the last few months of worry and hopelessness were like a bad dream. He would be home soon. He would laugh, and watch my soccer games, and cook his inventive dinners, and everything would return to normal. It seemed that, at last, we had reached that finish line. How could I have known the extensive rehab that he would have to go through? How would any sixteen year-old girl have known what it was like to have to watch her father cry because he could no longer taste his food? How could I have known how to handle his embarrassed anger after he ruined his shorts because he could no longer control his bowels? They never mentioned this particular aspect of modern medicine on television shows. Not sexy enough, I guess. Viewers would not tune in to see an accurate depiction of the true cost of illness and surgery.

The experience was eye opening, but if he needed anything. And so I made sure rather than repelling me from a career in to do those things, striving to be the kind of medicine, it made me more certain than caregiver that I hope treated my father. ever that I would become a doctor. There is Sometimes, my father’s surgery and its no magic bullet in modern medicine. Every aftermath seem like a bad dream. He was case requires the close supervision of mediable to resume his former life almost seamcal professionals, and sometimes things go lessly. It is tempting to forget the whole wrong for no discernable reason. My father experience, and imagine that it never hapis proof enough of that. But the very fact pened. However, now that I have started my that each case is an uphill battle with no clinical clerkships I think about it often, and guaranteed success underscores the need use it as motivation to give my patients and for committed, innovative caregivers to heal their families the kind of attention and suppatients. port that mine received almost ten years ago. I started my third year of medical school this July, and I was placed on the transplant About the Author service for my first three weeks. Given my Elizabeth Harvey is a native of Portsmouth, past experience with surgery outcomes, I New Hampshire, and graduated from Harvard had been dreading my surgery clerkship, College with a BA in Human Evolutionary and had even scheduled it first in the year Biology with a minor in Classical Studies. She in an attempt to get it over with quickly, so I is currently a third year medical student at the could enjoy the rest of the year. No one was University of Kentucky College of Medicine, more surprised than I was when I finished and is interested in pursuing a residency in my clerkship having truly enjoyed surgery. I Obstetrics and Gynecology. had found the procedural aspect of it interesting and challenging, but more than that, I had enjoyed having the opportunity to spend time with the patients on the wards. Changing the dressing of a patient’s wound vac became my personal task every other day. And it was so satisfying to get to know her and her husband as I did my work. I would mop up the brown-yellow liqYou’ve thought about it for years. You know you need to do uid oozing from it. And there’s no time like the present. But you aren’t quite her abdomen, and think about sure how to quit smoking. Your doctor is here to help. all the medical professionals who Visit us online to learn what questions to ask your doctor, might have helped access all available resources, and stick to the plan so you my father in such can hit pause on smoking. a way, years ago. I hoped that they asked him about his family, and www.committoquitky.org watched videos on his phone. I hoped they had stopped in at other times in the day, to see how he was doing and

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C O NT E Y A

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PLACE

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By Sarah Bugg I ran from my first fire. As a seasonal worker with the Forest Service, there were very few days between my fire boot fitting and the first time I trampled embers in them. I was trained to be part of a wildland fire hand crew. Hand crews serve a crude, but essential purpose. Forest fires often burn on difficult terrain. Machines cannot operate on the steep inclines or navigate the dense vegetation. Where machines are ineffective, hand crews hike in. With chainsaws and sharpened garden tools they attempt to take down trees, turnover soil, and establish a circumferential barrier around the blaze. My training was complete. I had demonstrated I could safely fell trees, lay hose line, account for weather conditions, work with aircraft, estimate the burn rates of every native Rocky Mountain tree, and complied with all of OSHA’s standards—which went so far as to dictate the material of my underwear. Our first fire consumed seven hundred acres. Upon arrival, we gathered in the charred space to await our marching orders. A breeze was driving the heat away from us, but already rivulets of sweat were forming under my hard hat, running down my fire-proof shirt, down my OSHA-approved underwear, and gathering in little pools in my fire boots. I looked out at the work ahead. Flames licked the horizon as far as I could see. We took hourly weather readings. A crew member would measure wind, humidity, smoke dispersion, cloud cover, and other data that could help us anticipate the behav-

The Wildfires that Ignited Medical Aspirations ior of our fire. The men who have been around for many seasons— whose fire boots are so worn-in that the leather perfectly molds each toe— know that sometimes it matters nothing how much meteorological, topographic, or horoscopic data you have on your fire. Fire is wily. Sometimes it just burns however it pleases. We were thankful this day that the wind was slight and consistently urged our fire one direction. All morning we worked just ahead of the blaze, cutting at its flanks, reducing the fuel available up ahead. Little by little, it shrank. Midafternoon, I worked on a finger of the fire that threatened to separate from the main body. With my head tucked and my tool furiously hacking at the grass, I worked to expose the nonorganic soil beneath, for which the flames have no taste. I heard an indistinct shouting from a ridge nearby. The “burn boss,” the overseer of the entire operation, was waving his arms and calling out to us. I felt the wave of heat wash over me just before the wall of flames entered my peripheral vision. The wind had shifted suddenly and directed the flame front on a new course, one that created a semicircle around me. It was rapidly closing in. I learned many things during fire training. At the end of laborious discussions about convection currents and conifer combustibility, there is a simple principle to be found: Fire can move. The application from this principle is as follows: When fire decides to move, humans should get out of the way. Theoretically, I understood the application. However, as I looked up and saw a wall of fire closing in, every rational thought dropped out of my head. The knowledge my ancestors had endowed to me in genetic material— the same ances-

tors that outran their clawed predators— urged me to get a move on. I dropped my tool and began to sprint. The forty-pound pack bounced on my back and my open blisters throbbed in time. As I ran, my brain switched back on. I knew I should not be trying to outrun a grassland fire. I stopped and looked back. The flames had grown to my shoulder level. It seemed foolish to consider crossing through it, into the safety of the “black”— the already charred grass. I spotted my boss some distance off, flailing his arms and cursing at me. The heat felt so near. I turned and began running again. The fire was clearly gaining on me. I once again paused and considered the wisdom of my sprint. I was not brave enough to cross through the flames. For a third time, I turned and ran. Almost instantly, I saw the flight was futile. I stopped, swiveled around, and heard my boss’s string of expletives, punctuated by orders to get into the “black.” I stepped toward the flames and something deep inside me shuddered. Stepping into a fire wall felt distinctly incompatible with my desire to continue living. I closed my eyes and passed through. On the other side, I opened them and continued moving toward the cooler ground, aware that my boots were too warm, my face feverish, my hair singed. My boss finished expressing to me how he felt about my firefighting strategy and told me to take lunch. On my piteous lunch break, I was just pulling my Meal-Ready-to-Eat out when the burn boss approached. He pulled a roll of duct tape out of his pack. I stood there as he ripped strips of tape and slapped them on the front of my hardhat. He finished; I removed it to see how I had been branded.

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Spring 2017 • Kentucky “What the hell were you thinking? Out there running zig-zags in the field! We’ll call you “Z” from now on.” I looked at the duct tape “Z” plastered on the front of my hard hat and managed a halfsmile. All right, boss. That was not my last fire, but thankfully was the last that earned me a nickname. I improved, but still I watched my crew mates and knew that I was not wired to fight fires until my toes molded into my fire boots. I learned a great deal about a great many things that season, but I lacked a passion for the work I did. On mornings especially lacking in motivation, I played a game. After I awoke, I would lay in my bed and perform a mental anatomical survey, methodically considering the state of each muscle in my body, starting with my neck and finishing with my toes. The game was lost when I discovered a body part that was not yet sore from the physical nature of our work. Upon losing the game, I was then required to climb out of bed and get dressed for our morning hike. I nearly won on several occasions. Two days after the end of the fire season, I found myself onstage, slipping into a white coat held for me by a physician. Earlier that morning, I had gazed at it hanging in my closet. My new uniform was unnervingly

white and devoid of smokiness. I looked down at my neat curls, my dress, my heels. In truth, I had not been this clean for quite some time. Though I had guessed on the size, I found that my white coat fit just right. Classes began and I plunged into my studies. I learned the names of each of the muscles that used to fuel my morning game. I found that the practice of accumulating this knowledge strummed my heart strings— my chordae tendineae, if you will. Each afternoon, I camped in the library and worked through the day’s material. I found that I needed to set an alarm for any obligations later in the day. When I began to learn I would lose track of hours. The knowledge that I will get to spend the rest of my life practicing medicine makes me giddy with anticipation. I know now that I am not an outstanding firefighter. I have come to terms with this fact. However, I do, in good faith, believe that I will be a fine doctor. In some ways, the work of firefighting is comparable to that of doctoring. My faith leads me to believe that a fruit snack led to the fall that caused a need for both of these professions in the world. Nature is glorious, but its full glory is tainted by human and natural acts that hurt it. Forests catch on

fire. Infestations ravage the trees and create hazards. Men must be trained to right these wrongs, and the work is hard. Similarly, the human body is not what it was originally made to be. Bodies catch disease. Cancers ravage its organs, causing pain and suffering. I am training to fight these wrongs. I am eager to be a part of this battle, even as I applaud the brave men in the woods who continue to fight separate battles. There is much beauty in the world— so much to be probed and enjoyed. However, there is brokenness in every sector too. I have been given passions and gifts to work at the redemption of a single pocket of the brokenness. This work is doctoring. I am so pleased to be training for this work, because I find it enormously satisfying. In the years ahead, I look forward to working as a doctor and to taking hikes on my days off. About the Author Sarah Bugg is completing her second year of medical school at the University of Kentucky College of Medicine. She is a Lexington native and attended Centre College where she studied English. In her essay she writes about her experiences working with the Forest Service in Colorado after college.

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

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R. J. Corman 5K Run/Walk to benefit Chrysalis House on May 20 Lexington, KY--Chrysalis House Executive Director Lisa Minton announced today that the R. J. Corman 5K Run/Walk benefit Chrysalis House will be held Saturday, May 20, at R. J. Corman’s in Nicholasville. Walkers and runners may register online at www.cormanracesforchrysalis.com or call (859) 977-2502. Online registration will be available until 5:00pm, Wednesday, May 17($20). Early packet pickup will be Thursday, May 18 (11am-5pm) and Friday, May 19 (9am-1pm) at Chrysalis Community Center, 1589 Hill Rise Drive, Lexington. Race day registration ($25) will be open at 7:30 a.m. at R. J. Corman Railroad Group, 101 R. J. Corman Drive, Nicholasville, KY; the events will begin at 9:00 a.m. • Prize Money for Top 3 Male and Female Finishers1st Place $750 Cash • 2nd Place $250 Cash • 3rd Place $100 Cash • Five (5) $200 Random Drawing Cash Giveaways • The R. J. Corman facility includes a heated pavilion and indoor restrooms • Post race food prepared by My Old Kentucky Dinner Train's Executive Chef-burgers, grilled chicken sandwiches, wraps, fruit and churned HOMEMADE ice cream • Chip timed by 3 Way Racing with scrolling results • The race course is completely closed to the public • Safe, convenient and free parking to all participants • Photographer will be there to capture your "race face" • Pre-registrants are guaranteed a race t-shirt • Activities for children Minton commented “Chrysalis House appreciates the support of the R. J. Corman Railroad Group. The course and facilities are second

to none and we anticipate a great crowd for this family-friendly event! Chrysalis House is Kentucky's oldest and largest licensed substance abuse treatment program for women. We have been saving lives for almost 40 years. Over 200 women and children were helped last year. The 5K is one of our major annual fund raisers with proceeds directly benefiting our clients.” Chrysalis House, Inc. programs are licensed by the Kentucky Cabinet for Health and Family Services. Register early at www.cormanracesforchrysalis.com or for more information call (859) 9772502.

KentuckyOne Health Encouraging Screenings During Colon Cancer Awareness Month Kentucky ranks fourth in nation for colon cancer deaths Lexington, Ky. (March 14, 2017) – Compared with the national average, Kentuckians experience higher rates of colorectal cancer. In 2013, the latest year data was provided, Kentucky ranked fourth in the nation for colon cancer deaths. As part of National Colon Cancer Awareness month, KentuckyOne Health is working to reduce deaths by encouraging regular screenings. Through early detection and treatment, colon cancer deaths can be significantly reduced. When detected early, the five-year survival rate for colon cancer is 90 percent. Colorectal cancer is the third leading cause of cancer-related deaths in women in the United States and the second leading cause of death in men. It is expected to cause about 50,260 deaths during 2017, according to the American Cancer Society. It is also one of the most preventable cancers when diagnosed early. At least 60 percent of deaths from this cancer could be avoided if those 50 years or older had regular screening tests, according to the Centers for Disease Control and Prevention (CDC).

Colorectal cancer refers to a cancer that starts in either the colon or the rectum. The cancer is often slow-developing, and often begins with a polyp – a growth tissue that starts in the lining. A study published this year in the Journal of the National Cancer Institute found that while overall colorectal cancer rates have been declining in the United States, incidence rates have actually been increasing among young adults in their 20s and 30s, for reasons yet to be determined. “Those who are in the early stages of colorectal cancer often do not experience symptoms, so regular screenings can be critical to catching the cancer early,” said June Yong, MD, KentuckyOne Health Gastroenterology Associates. “Screenings can help catch the cancer before it spreads to other areas of the body, or reaches advanced stages.” Risk factors for colon cancer include age, family history, inherited gene mutation, racial and ethnic background, type 2 diabetes, inflammatory bowel disease and other associated syndromes. There are also modifiable risk factors that can be managed to reduce your risk. Managing modifiable risk factors like diet, exercise, obesity, smoking and heavy alcohol consumption can improve your risk of developing colon cancer. Screening for colorectal cancers is widely available. Most screenings search for potentially cancerous polyps (abnormal cell growths on the inside lining of the colon or rectum). If polyps are removed before they become malignant, cancer can be avoided altogether. The American Cancer Society currently recommends regular screening for colon cancer beginning at age 50. Earlier and more frequent screening may be recommended for individuals at high risk due to family history of colon cancer or polyps, or other risk factors. African Americans should begin screenings at age 45. Colonoscopy, the most common method of screening, allows physicians to identify potentially problem-causing polyps and remove them

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Spring 2017 • Kentucky at the same time. A colonoscopy allows a physician to look at the entirety of the colon using a flexible scope with a camera attached. The exam usually takes 30 to 60 minutes and the patient is sedated. If no abnormalities are found and the individual is not at high risk for cancer, it can be repeated about every 10 years. “The most important thing individuals can do during Colon Cancer Awareness Month is to get a screening,” said Dr. Yong. “Fear often stops people from getting a screening, but this test could potentially help save a life.” Some warning signs of colon cancer may include changes in bowel movements, blood in stool, abdominal discomfort, unexplained fatigue, loss of appetite, weight loss and pelvic pain. To schedule a colonoscopy or to contact to a primary care physician about symptoms you may be experiencing, visithttp://www.kentuckyonehealth.org/colon-cancer to find the nearest KentuckyOne Health facility. 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.

Lexington Clinic Announces New Primary Care Physician Lexington, Ky. (January 4, 2017) – Lexington Clinic is pleased to announce the arrival of Jordan M. Prendergast, D.O., family medicine physician. Dr. Prendergast, boardcertified in Family Medicine, completed a residency in Family and Community Medicine at the University of Kentucky, where she also received her undergraduate degree. She received her Doctorate of Osteopathic Medicine from Pikeville College School of Osteopathic Medicine. She provides services in general family medicine for adults and children and preventive medicine. Her professional interests include chronic disease management, geriatrics, women’s health and preventive medicine. Dr. Prendergast adds her experience and expertise in family medicine to Lexington Clinic Veterans Park. With her arrival, Dr. Prendergast

offers patients in the Veterans Park area another option when looking to establish care with a primary care provider. For more information about Dr. Prendergast and her services, or to schedule an appointment to establish care with her, please contact her office at 859.272.1948 or visit LexingtonClinic.com. About Lexington Clinic: Lexington Clinic, accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) is Central Kentucky’s oldest and largest group practice, with more than 190 providers offering primary and specialty care services. Founded in 1920, Lexington Clinic offers more than 30 specialties and operates offices in more than 25 locations throughout Central and Eastern Kentucky. For more information about Lexington Clinic, visit LexingtonClinic.com. To follow Lexington Clinic on Facebook, visit www.facebook.com/ LexingtonClinicky.

Fourth Annual Saint Joseph Berea Gala for Healing and Hope Raises $25,000

Care, received the Physician Service Award during the gala. Dr. Greene specializes in internal medicine. “Dr. Greene is an outstanding physician who provides exceptional service to the community,” said Keith Riley, chair, Saint Joseph Berea Foundation. “We are fortunate to have such a wonderful physician in Berea who cares so much for his patients, and we’re thrilled to honor him with the Physician Service Award. Money raised at the Saint Joseph Berea Gala invests in outstanding patient care facilities and services, the education of health caregivers, advanced clinical research and improved access to quality medical care. Sponsors of the Saint Joseph Berea Foundation Gala included Cumberland Valley National Bank (Entertainment sponsor), and Realm Construction Company, Inc. (Hope Sponsor).

Berea, Ky. (March 8, 2017) – The eighth annual Saint Joseph Berea Gala raised $25,000 for the Saint Joseph Berea Foundation, part of KentuckyOne Health. The event Q: How many Central Kentuckians read featuring dinner, Health&Wellness Magazine every month? dancing, and a silent auction was held Saturday, March 4, 2017 at The Churchill Company. “This important event allows us to further the success of health care initiatives at Saint Joseph Berea, and we are thrilled that so many people came out to show support,” said Leslie Smart, division vice president Put your practice in front of over 75,000 Central of development, Kentucky readers every month! Web packages KentuckyOne are also available to reach 100,000+ every month. Build trust with future patients as you share your Health. “Money knowledge and expertise! raised will ensure that Saint Joseph Berea patients and families receive the & highest quality of Brian Lord, Owner/Publisher care possible.” David Greene, 859-368-0778 brian@rockpointpublishing.com MD, Berea Primary

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Profile in Compassion

Doctor Johnny is Coming Home

By John A. Patterson MD, MSPH, FAAFP John D. Stewart II, past president of Lexington Medical Society (1997), retired 3 months ago after 32 years with Fayette Surgical Associates. He was managing partner the last 14 years. As a member of a large, high volume surgical practice, he was much admired by staff, colleagues and patients for his surgical expertise and especially for the quality of his interpersonal relations. In talking with this vascular surgeon, one gets the sense that the physician-patient relationship was his real specialty. For the last several months, he has been transitioning into the chief administrator role of the Stewart Home School, a 124 year-old family business in Franklin County, just outside Frankfort KY. He is the fifth generation of Stewarts to lead this facility that is “dedicated to education and care for special people with special needs.”

Stewart Home School

The School was founded in 1893 by John’s great-great-grandfather, who was president of the Kentucky Medical Association in the 1890s and ran Kentucky’s state institute for the mentally handicapped in Frankfort. He concluded his career by buying the sprawling 800 acre working farm and residential facility from the Kentucky Military Institute and creating a tuitionbased private school. Stewart Home School provides full-time, residential, lifelong education for adults with intellectual disabilities. The school’s mission is to be the best residential facility in the world for adults with special intellectual needs.

There are currently 340 students from 38 states and 6 foreign countries. Tuition is paid by the students’ families or trusts. The tuition cost is in line with other full-time residential facilities such as assisted living for the elderly. This student population comprises a very complex patient group. Over a hundred students have seizure disorders and about 140 have clinical psychiatric problems. Psychiatry and neurology consultants see students on campus once a month. The average resident is on five prescription medications. About 30 require van transportation around campus. While there is no minimum age, and they do have a few residents under age eighteen, most children today have access to public programs that provide special education and medical care. Therefore, the vast majority of Stewart Home School students are over age 18. One student lived at the school for eighty-three years, arriving there at age eight and living there until his death at age ninety-one. One of the current students has lived there since 1947 (seventy years and counting) and is currently under hospice care. In addition to receiving three meals a day, students enjoy daily recreational activities, festivities for all holidays and the opportunity to formally participate in Special Olympics. There has been an equestrian program since the school’s inception and today about half the students are involved therapeutically with horses. Students are transported to Catholic and Protestant churches and synagogues according to resident and family preference. The staff members have their own personal faith community involvement and bring that ethic to the campus.

John has transitioned over the last year by spending three half days a week at the school and is continuing to learn the administrative duties of being the full-time CEO. His vision for the Stewart Home School is “to provide a lifetime educational experience for the intellectually disabled, including medical, health, fitness, social and spiritual quality of life.”

A Family Tradition

John’s father was a Frankfort physician, instrumental in the construction of today’s Kings Daughters Hospital. He set an example of the dual dedication to the practice of medicine and to the Stewart Home School. In addition to his radiology practice, John’s father saw students part-time in the school’s clinic- a practice John has continued throughout his surgical career. John grew up on the school grounds, interacting daily with residents in athletic activities and crafts. As a teen, he mowed grass and worked in the farm’s dairy from 4 AM- 4 PM, six days a week. As a youngster, he learned the importance of treating these special people with dignity and respect. He considers himself a ‘graduate’ of the school. John spent five years in surgical training at the University of Texas-Houston. He returned to Kentucky in 1984 and began his career with Lexington Surgical Associates. This offered the opportunity to be engaged in a high-volume, full-spectrum surgical practice and still be less than an hour from the school ‘because of my love for the place. “The passion for this is part of my roots though there has never been any pressure to be here.” Throughout his 32-year surgery career, he talked daily with the infirmary and ran

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About half the students are involved therapeutically with horses.

a clinic himself every Monday night. The infirmary has been staffed for several years now by an ARNP. They out-source this PCP service. He still will see patients with possible surgical issues or at family request. He may also visit during a student’s hospitalization to help coordinate discharge planning. John is married to Lexington gynecologist Magdalene Karon. When they met during their medical training in Texas, he told her he would be going back to Kentucky to practice close to Stewart Home School. She says they have a great relationship (‘a love affair’) and work well together, personally and professionally. John’s last surgical case was a procedure performed alongside Magdalene on one of her gynecological patients with endometriosis. While Magdalene performed an innovative robotic pelvic procedure, John excised an abdominal wall tumor. She manages gynecological problems that arise for female students at Stewart Home School. She says the students receive excellent overall health and medical care. They have a very low obesity rate and have never had a pregnancy. Though both of their children have professional careers and live out of state, she and John think one of them will carry on the tradition and be the sixth generation to run the Stewart Home School. Their son grew up working part-time on the farm when it was operating at full capacity.

On being a doctor

Medicine is tremendously rewarding if you focus on taking care of people who are sick and in need. – John D. Stewart II

John always wanted to be a doctor. He admired his father’s commitment to Stewart Home School, his work as a Frankfort radiologist and his active engagement in organized medicine, including the presidency of KMA (1978). “What I love about medicine is the combination of science and humanism. The physician-patient relationship was my forte in practice. Science is the foundation of medicine but we use it to take care of people. The physician-patient relationship is what I love most about medicine. I like the idea of taking care of people, knowing their families, where they were from and what they did. I felt that was an important part of the physician-patient relationship. I tell young people that medicine is a great career choice. You are respected, make a good living and have great flexibility in where you work.” He reminds young physicians that it is important to be committed to taking care of people- not just be skilled at the intellectual and technical aspects of medicine. “Medicine is tremendously rewarding if you focus on taking care of people who are sick and in need. You are well prepared to practice medicine if you combine intellectual ability with the idealistic desire to take care of people and are realistic about the emo-

tional demands and rewards of practice.” He is hoping to spend the next 20 years at the Stewart Home School, “because I love it. I am invigorated by a new phase in my career that is doubly exciting because I am returning to my roots and taking care of these special people. It is an honor, a privilege, a challenge and an opportunity to carry on this legacy. “ Roxane Newby worked with John more than thirty years at Fayette Surgical Associates, the last fifteen as office manager. She says, “He is one of the most caring physicians I’ve ever known. He always puts the patient first. He would put himself in the call schedule when there were gaps and often continue to follow patients after the change of shift, when he was supposed to be off-call. He just seems driven from inside to take good care of patients. He was also the one I went to when important office staff decisions needed to be made.” Sandra Bell came to the Stewart Home School 47 years ago as a speech pathologist and is now is the Director. She describes working with John Stewart as “a complete inspiration. He outworks all of us and is willing to do anything he asks of the staff. He has such a grasp of the many things that affect our students and their families. He grew up on this campus, went away to study and practice surgery and has now come back home.” Magdalene Karon points to the fact that husband John was never sued during 32 years in surgical practice- a testimony to the quality of his surgical expertise and patient rapport. She says her husband loves the interface between surgical practice and compassionate care. “He has always been praised for his compassionate care. He just doesn’t have a short fuse or ego. He is always a gentleman- a class act.” Reflecting on the quality of his relationships with Stewart Home School students, she says, “Students run to him on campus, calling him “Dr. Johnny.” Stewart Home School students and staff are all happy that Dr. Johnny is coming home. About the Author Dr. Patterson chairs the Lexington Medical Society’s Physician Wellness Commission, is past president of the Kentucky Academy of Family Physicians, is board certified in family medicine and integrative holistic medicine and is a certified Physician Coach. He teaches Mindfulness-Based Stress Reduction for the UK Health and Wellness Program and Saybrook College of Integrative Medicine and Health Sciences (San Francisco). He owns Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations, specializing in stress-related chronic conditions and burnout prevention for health professionals. He can be reached through his website at www.mindbodystudio.org

There Goes My Heart By Kara Jolly

My heart was racing by the time we made it across the parking lot, but I assumed it would slow down like it normally does. It never did though.

“That could never happen to me!” is a phrase most of us say about near death experiences, especially when you are in your twenties. However, the reality of the matter is that medical emergencies can happen to anyone, including you and me. I learned this lesson the hard way when I went into ventricular tachycardia for several hours on Thanksgiving Day last year. As a medical student, I am learning how to diagnose and treat all kinds of conditions and diseases, but studying medicine does not always prepare you for being an inpatient at a hospital. Thanksgiving started with an overabundance of pies and a mountain of turkey. My family went for a walk after dinner. It was so much fun being outside–laughing and goofing off. At the end of the trail there was a park, and my siblings took off running in a full-on sprint. I chased after them, running faster than I had in years, just loving the

feel of my feet pushing off the ground, not standing a chance at catching up to my longlimbed siblings. My heart was racing by the time we made it across the parking lot, but I assumed it would slow down like it normally does. It never did though. I kept telling my heart to slow down–hoping it would stop racing. It had raced before, but never for this long. I sat outside with my dad, hoping the cold weather would help. Then I sat inside on the couch, shifting positions–sitting, laying on the couch, laying on the floor, leaning into the tripod position. My body temperature started fluctuating from one extreme to the next–hot, cold, hot, cold. And then I felt nauseous, ran to the bathroom and lost all of Thanksgiving dinner. The veins in my neck had a pulse of their own. I had convinced myself that the problem would fix itself like it had always done before, but this time was different than before. Two hours was way too long for my heart to be beating this fast. My parents drove me thirty minutes to the nearest emergency room, and along the

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“I viewed the medical field through the perspective of a patient and saw how the dedication and empathy of the medical staff can make a difference in the lives of their patients.” – Kara Jolly

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way I succeeded in throwing up even more of my Thanksgiving meal. I did not think that there had been anything left after the first time. I sat in the waiting room of the ER for several minutes. My heart was racing, but I did not look too bad on the outside. I was fully awake, talking normal, making jokes. When the nurse triaged me, he had a difficult time taking my pulse because it was going so fast. I was brought to a room, told to change into a gown, and waited again. I was attached to an EKG machine and a peripheral IV. My heart was beating at 240 beats per minute at this point, and the ER staff did not understand how I was still conscious after two and a half hours of tachycardia. The physician gave me two doses of adenosine to restart my heart. However, adenosine only works to fix atrial tachycardia, not ventricular. Up to this point the ER had been relatively calm and only a few nurses and the physician were in my room. However, when the adenosine did not work the doctor pulled my parents outside, told them I was in critical condition and called a helicopter. Meanwhile in my ER room, I am getting AED pads stuck to my torso as my blood pressure drops. I was then told that the shock would hurt a little which was the understatement of the year. Every nerve in my torso was turned on, and I instinctively curled up with my knees coming in towards my chest. Then, just as quickly as it started, it stopped, leaving me to wonder what had just happened. I felt a million times better though–my heart was back to normal and the pulse in my neck was gone. However, I did feel like I had taken a plunge in an icy Maine lake in the dead of winter. I was holding my chattering teeth apart so they would not hit each other and break. The heated blankets in the hospital are lifesavers–they make all the difference in the world to a cold patient. Even though my heart had converted, I was still flown in a helicopter to the closest

major hospital. The hospital I was currently in did not have a cardiology unit, and they did not want to deal with anymore cardiac emergencies. The helicopter ride went fine despite the turbulence. The nurse and paramedic then wheeled me from the landing pad, and I was offered a dollar discount off my ride since they bumped into a wall while pushing me. I told them it would need to be a lot more than a dollar to make that helicopter flight affordable. In the hospital, I finally lost the remains of Thanksgiving dinner. The room was madness in their hurry to transfer me from the helicopter bed to the hospital bed. My parents arrived shortly after me, and my mom spent the night in the cardiac ICU with me. Everything happened so fast, and I never truly realized how bad things were until after the fact. I guess the scariest patients are the ones who seem fine on the outside, but all the tests are telling you that something is wrong on the inside. The next day, the doctor took me off the amiodarone because I was beginning to be bradycardic rather than tachycardic. I had to keep the IV leads in my arms in case anything happened according to ICU protocol. IV leads are not comfortable and the needles in your arm prevent bending your arm at the elbow unless you want to feel the needle moving. I spent the rest of Black Friday discussing options with my physicians and nurses about the best course of action. The nurses and doctors called my cardiologists from home to ask them their opinion, and the consensus was that I needed to have an implantable cardioverter defibrillator (ICD) put in as soon as possible. Once you have a tachycardic event you are susceptible to have future events. My experience at the hospital was a good one because of the wonderful medical staff. My nurses came in to check on me and my parents every hour. They told me I was their best patient, but I guess it is not too hard when you are one of the few patients in the

ICU who is conscious enough to have a conversation. One of my nurses even came in before my surgery to French braid my hair so I would not get blood in it. My nurses were also my greatest advocates in getting my paperwork completed quickly so that I could be discharged before seven o’clock to go see the musical Wicked that night with my family. The doctor thought the musical was a great idea since I had to sit still somewhere so it might as well be at the theatre. I am very lucky to still be alive today. You never think that it will happen to you until it is too late. My medical emergency has already made a difference in my dad’s life. He has been postponing getting an ICD for fifteen years, and my incident opened his eyes. The doctors said that I was able to last so long in ventricular tachycardia because I am young and in shape. My mom turned to my dad after they made that comment and told him he was not young or in shape and that it was time. He did not argue after that. My experience in the hospital has taught me so much about the patient’s experience, and I know that I can use that knowledge to help my future patients. Despite the chaos of events and the turmoil of emotions, I am grateful for my experience. I viewed the medical field through the perspective of a patient and saw how the dedication and empathy of the medical staff can make a difference in the lives of their patients. Every nurse, doctor, and technician in the hospital inspired me to strive to be the best physician possible. I am honored to be joining their ranks and look forward to working beside them. 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.

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Summit Mediation

Staying on Top of Caregiver Burnout Syndrome By Dr. Dani Vandiviere If you are the physician, recognizing the symptoms of Caregiver Burnout Syndrome is essential. According to A.A.R.P. it is estimated less than 50% of doctors ask caregivers if they are experiencing any burnout symptoms or high stress. Symptoms are characterized by physical and emotional exhaustion, depression, anxiety, bouts of anger, withdrawal, impaired thinking and performance, and most often a feeling of being overwhelmed and guilt. These symptoms are often manifested in actual or phantom aches and pains giving the individual an excuse for not dealing with the real issues of the burnout. When we think of caregivers we most often imagine someone taking care of an elderly or disabled person. However, we should consider another group as well and that is grandparents taking on the role of raising their grandchildren. The stresses encountered by both groups can be debilitating. Caregivers are some of the most selfless and underappreciated people you will ever encounter and are also extremely high on the list for stress related disease. They push themselves beyond reasonable limits to be accountable 24 hours a day 7 days a week to care for their loved ones. The additional responsibilities often result in neglecting their own needs. Many have neglected to tell their health care providers that they have become caregivers and it is therefore incumbent upon the physician to enquire about the home situation. As medical professionals, you and your staff are the first line of defense. As burnout occurs you may notice the signs far more readily than family members due to your separation from the emotions and associated stress a caregiver may be experiencing. Symptoms to watch for with both the caregiver and those they care for: • Decreased immunity – more frequent colds/flu symptoms • Seeking medications to alleviate fatigue and sleep loss

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Most family caregivers can wear down quickly due to the added responsibility.

• • • • • • • • • • • •

Chronic back or joint pain Weight gain or loss – malnutrition Increased irritability and anxiety Depression Feelings of hopelessness and inadequacy Withdrawing from family, friends, and social activities Looking unkempt, clothing not clean, unwashed hair Confusion and lack of attention Snapping angrily at the those around them–especially between the one they care for and themselves Bruising and too many ‘accidents’ resulting in need of medical attention Sometimes quiet and will avoid eye contact, disinterested Failing to refill Rx or wanting medications refilled too often

Many families who try to take on the responsibilities of the caregiver role act out of a sense of obligation and guilt. Usually a wife, daughter, or daughter in law becomes the primary caregiver, however there are some men who find themselves with the responsibility. For the Grandparent who has taken the role it is often the only possible choice. Other family members tend to back away from helping as time goes on. Unfortunately, as time passes the individual being cared for will require the same care or more attention than they did the first day of care. Family relationships become strained. Anger and resentment may develop. As a medical professional, you can give your patients advice concerning ways to reduce the stress and anxiety that often comes with caregiving. Some of the following steps may make a meaningful difference: • Expand the support system for the caregiver – Establish a network of friends, family, and community. • Seek out support groups that are already established • Find out details of who they are taking care of and why • Ask if there is a Case Manager or Case Worker to help them with setting up resources

We should consider another caregiver group: grandparents taking on the role of raising their grandchildren.

• Give the caregiver respite time • Family should step up and take turns on some of the more mundane tasks • Have a professional agency come in to help a couple times a week. There may be funds available from local programs to finance this option. • Suggest the caregiver experience social activities • Get weekly massages • Family members could help supply meals for proper diet and nutrition, not leaving the full responsibility on the shoulders of the caregiver • Engage in exercise activities that will include the caregiver and possibly all family members • Schedule family meetings to review the week and any new concerns. • Families need to be aware of what is happening with the caregiver. Brain storm new ideas and ways to help. • They may need a counselor to talk to. Have a good resource available. Most family caregivers can wear down quickly due to the added responsibility. As a medical professional, it is important to support and follow up. As we all know recommendations coming from a doctor are more likely to be followed than a suggestion from a family member. About the Author Dr. Dani Vandiviere is a conflict and bullying specialist and CEO of Summit Conflict Resolutions and Trainings. She is the President of the Bluegrass Continuity of Care Association, a founding member of KY Association of Senior Services, a member Association for Gerontology, and an Elder Care Conflict Trainer and Mediator. She also offers training programs for the workers in the Eldercare industry, medical professional, elder’s families, organizations and businesses. To learn more contact Dr. Dani at www.summitcrt.com, dani@summitcrt.com or 859-305-1900.

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

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Kentucky

When, Why & How of Opioids: New Guidelines on Treating Pain This has been approved for 4.5 HB1 hours. What: About Dr. Mazloomdoost Danesh Mazloomdoost, M.D. is fellowship-trained and dual-board certified in Anesthesiology & Pain Management. He is at the frontier of pain management innovation, having trained at prestigious institutions including Johns Hopkins and MD Anderson. Dr. Mazloomdoost’s main clinical interest is in non-narcotic management of pain. Dr. Mazloomdoost works at Wellward in Lexington.

This CME meets the requirements of HB1 which mandates physicians who prescribe or dispense controlled substances in Kentucky to complete 4.5 hours of CME. This activity has been approved by the Kentucky Board of Medical Licensure for 4.5 HB1 hours and 4.5 hours AMA PRA category 1 CME.

When: April 29, 2017 | 8:00am: Registration and continental breakfast; 8:30am–1:00pm CME program

Where: Lexington Center (near Rupp Arena), Thoroughbred Room 4 430 West Vine Street, Lexington, KY 40507

Costs: No charge for LMS members. Non-LMS physicians, $50.

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Kentucky

4 Ways to Leverage Your Business By Andrew Van Horn Let’s talk leverage this quarter. Leverage is doing ever more with ever less, and your team is the group of people that can make that happen. In fact, without leverage and a team you are never going to take your business to the next level and have a business that will work without you. You are stuck in a job that you own and nothing more. How does one leverage their business? The only to leverage your business is what I call The 4 Ways. They are People and Education, Systems and Technology, Delivery and Distribution, and Testing and Measuring. Each of the four can be broken down and worked on at the same time. Let’s start by looking at People and Education.

People and Education

If your business is growing it will require you to hire a team, there is only so much that an individual owner can do, time is the limiting factor. To achieve wealth and massive cash-flow, you must hire. Once you hire employees, you have to start to leverage their

time. That is where People and Education come in. As a business owner, it is imperative for your survival that you train and educate your staff. Educating your staff requires time and money to be invested in your workforce. The most common excuse I get from business owners is that if I train my people they might leave. The answer is yes, they might, but if you don’t train them, they will stay, and an untrained employee is a cost, not an asset. There are many strategies that you can sue for this, here are my favorites: • Scripting out everything that needs to be done and said. • Doing personality assessments and training. • Skills training for each person in their role. • Have each employee read one book a month. • Individual and group coaching sessions focused on growth and goal setting in their job.

Systems and Technology One of the best books I ever read on Systems and Technology is Frank Gerber’s

E-myth. It is a good book, and if you have not read it, I encourage you to go out there and buy it today. Systems allow you to replicate a great result consistently regardless of the employee performing the task. Everything in your business should have a system attached to it, this allows for consistent delivery over a consistent period so you can maximize the profit of your business. The biggest excuse most owners give me about systems is that they just don’t have the time to implement, come up with, or create a system in their already busy days. I tell that their days are busy because they do not have a system in place. Again, a system allows anyone the path to getting the same result. Systems are the gold mine that allow you to free up your time, and they can be easy to create. Here are some simple tips that can get started on creating systems for your business. • Use your phone camera to take pictures and video of how to perform daily tasks, then everyone can duplicate that. • Download a voice recording app on your phone and simply record how something to do a task Then you can get on Fiverr.com or a similar site to have it transcribed into a system.

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Without leverage and a team you are never going to take your business to the next level and have a business that will work without you.

• Create a flow-chart of a process, this can be done on a piece of notebook paper in about 10 minutes. • Invest 5 minutes as you perform a task to write down how you did it step by step. The most important to remember when creating systems is this rule: do the work once and get paid forever for it. Systems are about doing it once and then making money from that process forever.

The central idea to most of the strategies listed above is research, learning and innovating from what you learned for your business. Ask yourself how it can be it achieved not if it’s a good idea to do. The how questions generate ideas that allow you to achieve leverage in your delivery and distribution.

By using the above strategies, you can start to forecast the effect on your profit the actions you take will have. Testing and measuring also gives you quick feedback on mistakes and successes that are happening within your business allowing you the ability to change direction and adjust.

Testing and Measuring

Delivery and Distribution

The last of the 4 Ways to look at and I think the most important, is a fundamental strategy for every business to work on immediately. Testing and Measuring gives you the data you need to make educated choices about your business. Without testing and measuring going on in your business, you are doomed to making changes without knowing if they were effective or not. Everything in your business should have a couple of key performance indicators (KPI) to help you measure it. KPI’s are easy to figure and track if you follow the below strategies. • Use a spreadsheet to tally what you want to track. Then use formulas to convert the raw data into percentages. As you make changes see if the percentage are moving up or down. • Run the numbers first to see if a new venture/product/idea will produce enough revenue to be a viable Idea. • Use and track your business with 5 Ways Formula:

People and Education, Systems and Technology, Delivery and Distribution, Testing and Measuring are the 4 Ways that you start to get your business to become a highly profitable cash machine that does not require your daily direction. A business machine gives you the freedom to choose what you want to do with your time. You can invest time in a non-profit, travel, and whatever interests you have. I encourage you to start creating a business that is truly a commercial, profitable, enterprise that will work without you.

A great way to leverage your business and exceed customer expectation is looking at how you deliver and distribute your products or services. Distribution was WalMart’s advantage and what help them to expand nationally. They could get the goods everywhere in the country cheaper than anyone else. Look at your business. What sort of innovations can you create or reuse? In my business, I leverage delivery through the use of my cell phone and moving my clients to phone coaching instead of in person coaching. It was a win for me and the clients because it greatly reduced drive time for each of us, and we were still able to get the same amount done. Here are some thoughts to get you started. • Switch from in-person to the phone or video conference. • Use someone else’s delivery network, or copy how they do it. • Look outside of your industry for ideas that can give you a competitive edge. • Use cloud based programs for greater collaboration and efficiency.

Leads X Conversion Rate = Clients X AVG $ Sale X # Trans. = Revenue X Profit Margin = Profit

The 4 Ways

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.

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Kentucky

Workplace Violence By Beverly Clemons In August 2015 in Roanoke, VA, 2 television station employees were gunned down live on the air. The attention of employers and employees nationwide focused once again on violence, and more specifically, workplace related violence. Since the 1980s, violence has been recognized as a leading cause of occupational mortality and morbidity. According to the Bureau of Justice Statistics, an estimated 1.7 million workers are injured each year during workplace assaults and hundreds are fatally wounded. In addition, violent workplace incidents account for 18% of all violent crime in the United States. Nearly 2 million American workers report having been victims of workplace violence each year and unfortunately, many more cases than that go unreported according to the United States Department of Labor website. The National Institute for Prevention of Workplace Violence, Inc. has released its 2013 Workplace Violence Fact Sheet, a repository of information, statistics

and charts on workplace violence presented to give Human Resources, Threat Management, Security, Risk Management and Operational Managers current information on workplace violence. Data for the report was provided by the Bureau of Labor Statistics, Department of Justice, National Institute of Safety and Health (NIOSH), NCCI Research and more.

Key Findings:

• Workplace homicides and other violent acts are the second leading cause of death for women at work • In 2013 9% of all workplace fatalities were homicides. • For the first 10 years of the 21st century, an average of 558 work-related homicides occurred annually in the U.S • Workplace suicides rose to an all-time high of 270 incidents in 2010. • Estimated more than half a million incidents reported each year • Most often occur in nursing homes, social services, hospitals and late-night convenient stores • Workplace violence costs an estimated $121 billion a year nationwide • Non-fatal assaults alone result in more

than 876,000 lost workdays and $16 million in lost wages While workplace homicides are not common, an analysis by The Washington Post shows the share of workplace homicides appears to be increasing as is the desire by the perpetrators to make a statement, or be famous. So many of the recent events that have occurred have had the element of individuals who want their story recorded, broadcast, publicized, and shared around the world. This is a very scary and disturbing trend. Interestingly enough, many experts and professionals are also linking the use of anti-depressive drugs to increased rates of workplace violence. Fueling the perception that America is an overmedicated society, a new Mayo Clinic study finds that nearly 70 percent of Americans are on at least one prescription drug, and more than half take two. Researchers found that the “second most common prescription was for antidepressants – which suggests that mental health is a huge issue and is something we should focus on. The third most common drugs were opioids, which is a bit concerning considering

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Business Section • Spring 2017 • Kentucky

“I think there’s a public policy question there that we need to address in a larger level, that’s less about workplace violence and more about the violence in our society today.” – Jo-Ellen Pozner, Professor, UC Haas School of Business

their addicting nature” according to Rick Nauert, PhD, Psych Central. In a paper titled “Antidepressants and Violence: Problems at the Interface of Medicine and Law,” David Healy, a British professor of psychiatry at Cardiff University and an authority on side effects of psychiatric drugs, writes: “Legal systems are likely to continue to be faced with cases of violence associated with the use of psychotropic drugs, and it may fall to the courts to demand access to currently unavailable data. The problem is international and calls for an international response.” UC Haas School of Business professor Jo-Ellen Pozner says one possible key to addressing workplace violence is to find ways to address employees’ mental health and wellness. “It seems clear that there was an emotional, mental health issue going on here (Roanoke shootings) and that’s I think the key to figuring out how to deal with these things in the workplace,” Pozner said, “I think there’s a public policy question there that we need to address in a larger level, that’s less about workplace violence and more about the violence in our society today.” Obviously, this issue is a complicated issue.

So What Can, and Should, An Employer Do? Employers have a legal and ethical obligation to provide employees with an environment free from threats and violence. Beginning this process before you even hire someone is the first step in prevention and that starts with your recruiting and hiring process. Organizations should have a comprehensive hiring system and strategy, and be clear regarding the knowledge, skills, abilities, and attitudes that are required for each position within the organization. Prospective employees should be

screened and evaluated extremely carefully to make sure there is a close match. Conducting background checks prior to hire and then developing clear, enforceable policies for your organization are also vitally important. Some of the policies you should have in your handbook to address this issue include Harassment, Anti-bullying, Open Door, Dispute Resolution, Progressive Discipline and Electronic and Social Media. In addition, employers should adopt and practice fair and consistent disciplinary procedures, foster a climate of trust and respect in the workplace, and have appropriate and safe reporting mechanisms in place. Best practices for employers also include providing regular training in the areas of Harassment, Bullying and Workplace Violence for new and current employees as well as managers and supervisors. The training for employees helps them to identify the early stages of a threat or potential violence and coaches them on how to report their concerns. Training for your managers will assist them with recognizing and being more aware of possible threats, being familiar with internal policies and understanding the law and OSHA guidelines. In addition, employers should remember that two other key components to all of this is to take immediate action when a concern is reported and having an Employee Support System in place (EAP / Mental Health Services through your insurance plan.) Many companies now are taking additional steps to ensure that their buildings and offices have adequate building security, and that employees have proper employee identification. While some people may exhibit what is deemed as bizarre or eccentric behavior, it might not be anything, according to Dr. Andrew Franklin, Norfolk State University Assistant Professor of Psychology. While all employers and employees need to be

diligent and observant, it is important that we do not fall into a state where we are constantly paranoid or suspicious … just cautious. About the Author Beverly Clemons is president of CMI Consulting, based in Lexington, Kentucky, a KGA/KACS partner company that provides organizations with human resource solutions. She can be reached at beverly@cmiconsulting. com. Learn more by visiting www.cmiconsulting.com.

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