winter 2017 â€˘ volume 8 â€˘ issue 4
Ardis D. Hoven, MD Chair of Council of the World Medical Association and Past President of the American Medical Association
The importance of advocacy on behalf of patients and medicine
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doc • Winter 2017
Contents | Winter 2017
Robert P. Granacher Jr., MD, MBA, Editor-in-Chief, Kentucky Doc Magazine
Growing Physician Leaders by Danesh Mazloomdoost, MD
Is Your Healthcare Team Warm Enough? by Joe Mull, M.Ed.
Physician Leadership Perspectives by Ardis D. Hoven, MD.
Leadership and the Brain by Robert P. Granacher Jr., MD, MBA
Physicians in Government A Historical Perspective by Lowell Quenemoen MD
PHYSICIAN HEALTH AND WELLBEING What makes you optimistic about the future of medicine? by John A. Patterson MD, MSPH, FAAFP
PROFILE IN COMPASSION
Latonia Rice Sweet MD by John A. Patterson MD, MSPH, FAAFP Physicians Role in Politics Involvement Crucial to the Commonwealth by Ralph Alvarado, MD FACP, Kentucky State Senate – 28th District
Welcome to our winter edition of KentuckyDoc magazine. Please take note of the cover. Ardis Hoven, M.D. has become one of the most accomplished advocates for the medical profession in the world. The cover speaks for itself with regard to her amazing accomplishments. The topic for this winter edition of KentuckyDoc is: Physician Leadership; Ardis is the poster child for this concept. We start this volume with a review by Danesh Mazloomdoost, M.D. of General Mark Hertling's book, Physician Leaders: Empowering Doctors to Improve Our Healthcare. It is written by a military leader of some repute who transferred his skills later in life to developing similar leadership qualities in working physicians. Next is an article by Joe Mull discussing the development of compassion in healthcare teams. His contribution, “Is Your Healthcare Team Warm Enough?” discusses how to infuse your team with a healthy dose of courtesy and kindness. This article discusses the four methods for doing this: 1. Hire right, 2. Manufacture fun, 3. Teach them how, and 4. Remove the frozen. Joe’s principles can be applied to the development of any high performing team, including those providing direct patient care. The article by Ardis Hoven, M.D., “Physician Leadership Perspectives,” shares her unique experiences as a world class physician leader. I believe our readers will find this a great learning experience, as well as a window to the exemplary leadership qualities of one of our own. Dr. Granacher takes a hard right to science with his article, “Leadership and the Brain,” sharing with us the known brain dynamics and anatomy involved in the mental functions of leadership. This article is followed by an interesting historical perspective by Lowell Quenemoen, M.D., “Physicians in Government.” Lowell provides a timeline of physicians in government from the early days of the origin of the United States to our own Kentucky physicians currently functioning in legislative positions. In our PHYSICIAN HEALTH AND WELLBEING section, John Patterson, M.D. asks: “What Makes You Optimistic About the Future of Medicine?” He queries past LMS presidents on this question. Their answers should give hope and good cheer to all of us. Dr. Patterson contributes a second article in our PROFILE IN COMPASSION section about Latonia Rice Sweet, M.D. Dr. Sweet is the Chief Medical Officer
of Bluegrass Regional Mental Health, previously known as Comprehensive Care. Dr. Patterson portrays her as a formerly hopeful neuroreceptor research psychiatrist, unexpectedly changing her career to community psychiatry, and he shares with us her contributions and leadership in improving the mental health of underprivileged people in the Bluegrass Region. Next we have a contribution from a physician who lives in politics as well as medicine. Ralph Alvarado M.D. penned the article, “Physician’s Role in Politics: Involvement Crucial to the Commonwealth.” Ralph argues that the lack of physicians in today’s political institutions “can only be damaging to a society.” His article notes the great contributions of early physician leaders in the politics of this country, and the more recent reduction of physicians at policymaking and political levels in our country. We end this volume of KentuckyDoc with three useful business articles. The first is by Tanya Howe: “Turning Your Personal Passion Into Your Business Purpose.” Tanya skillfully points out how one can use their personal passion as their business purpose, which aligns perfectly with the new Vision Statement recently adopted by Lexington Medical Society. The second article is by Bob Woods: “Social Selling and Your Business.” Bob gives useful pointers on combining the principles of marketing with the art of sales into a process called “social selling.” He gives guidance on how physicians might use digital social media to market their medical skills. Lastly, in the business series, Andrew Van Horn writes “4 Ways to Leverage Your Business.” Andrew suggests ways to leverage one’s medical practice by developing an exceptional team, incorporating systems and technology into the practice in order to replicate a consistent result from the practice, and methods to leverage one's practice and exceed customer (patient) expectations by examining how to deliver and distribute services. Please review the Lexington Medical Society, Physician Wellness Program, as it is portrayed in this Robert P. Granacher Jr., MD, MBA volume. You may editor of Kentucky Doc Magazine have a physician colleague who Tuyen Tran, MD needs the help that Lowell Quenemoen, MD this program can offer to him/her. Tom Goodenow, MD
Editorial Board Members
John Patterson, MD Thomas Waid, MD Brent Morris, MD Danesh Mazloomdoost, MD
Turning Your Personal Passion Into Your Business Purpose by Tonya Howe
Social Selling and Your Business by Bob Woods
4 Ways to Leverage Your Business by Andrew Van Horn
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Winter 2017 • Kentucky
Growing Physician Leaders By Danesh Mazloomdoost, MD What advice could a retired US General give a doctor, to improve healthcare? I recently read Growing Physician Leaders, by Lieutenant General Mark Hertling, US Army (Ret.). General Hertling, a recent retiree from the US Army, was at one time the commander for US Army Europe and the Seventh Army where he had over 40,000 soldiers under his command. As an Army general charged with the safekeeping of thousands of lives his post-Army experiences provide much to inform physicians about their command roles within the U.S. health system. Upon his retirement, General Hertling was hired by the Florida Hospital System (FHS) in Orlando to observe the roles physicians occupied in this healthcare system and to provide feedback on how physicians could foster enhanced leadership among FHS physicians. The general learned that FHS physicians felt disenfranchised, voiceless, and unhappy. General Hertling provides a novel perspective on medical leadership based upon his years of empowering soldiers to lead. Of the 6500 hospitals in the nation, General Hertling notes that less than 4% of them are led by physicians acting as a hospital/system CEO. In spite of the years physicians spend becoming experts in their fields, their medical education does not train them how to lead or to translate their medical expertise into the logistics skills and leadership needed in healthcare. As a result of the disconnection between administering healthcare and the practice of medicine, our nation spends nearly 1 of every 5 dollars of national GDP on healthcare. General Hertling suggests that physicians step back from their clinical roles and become introspective about their influence
as professionals and role models in our society. He parallels the respect and authority that physicians have with that of generals. Society looks up to physicians, but as a group we commonly fail to provide sufficient direction to healthcare using a macro-perspective. A good leader should demonstrate a command in “understanding motivations, influencing people/teams, and communicating purpose and direction…” To refine these skills, General Hertling advocates that physicians use introspection to better understand how they interact with individuals and teams in healthcare. When leaders fail it is often a result of failure to communicate values specific to the organization. As such, in order for leaders to align with their teams, he recommends establishing a core group of values and obtain buy-in from the team members. The Florida Hospital System formalized their values within an easy-to-remember acronym: IC-BEST (see above) . According to General Hertling, values always precede action. In medicine, it is probably impossible to design a decision tree that fully fleshes out the appropriate action for every decision. In the ever-growing team-based model of medical care, aligning values among team members helps to guide decision-making even when a team member lacks the immediate input of a supervisor or physician. Weaving these values into our fabric as professionals can guide decisions when no answer is immediately at hand. There are many patient problems we each face as physicians where the solution is not within a pill, injection, or surgery. National public health conditions such as obesity or
addiction cannot be fully treated without addressing larger societal problems, such as our population's diet and activity levels or how physicians address pain. Moreover, our input into the larger political sphere can significantly inform our profession on methods to improve clinical care to our nation. General Hertling recognizes that healthcare, represented as a group of professionals, faces monumental challenges. When we feel overwhelmed with our decisions as physicians, he leaves us with this quote from actor Will Smith: “I do not have to build a perfect wall today. I just have to lay one perfect brick.” Reference Hertling M. Growing Physician Leaders: Empowering Doctors to Improve Our Healthcare. New York, NY, Rosetta Books, 2016 About the Author Danesh Mazloomdoost MD, a born and raised Kentuckian, pursued his medical degree and anesthesiology training from Johns Hopkins and subsequently a fellowship in pain management at MD Anderson Cancer Institute. He is the Medical Director of Pain Management Medicine, a multi-disciplinary practice begun by his family of physicians in the 1990s. Dr. Danesh advocates for a paradigm shift in healthcare to reduce its reliance on opiates. He guides patients through rehabilitative and regenerative techniques in healing the underlying causes of pain using translational science and the latest innovations in the field.
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Is Your Healthcare Team Warm Enough? By Joe Mull, M.Ed. Tamika rushes into the clinic. She’s late. 32 minutes late, to be precise. As she arrives she meets the eyes of the Medical Receptionist, who glances at her disapprovingly. Darting into the back, she pulls off her gloves and hurriedly hangs her coat in her locker. Her manager, Kate, is suddenly there. “You’re late” she declares. “I know. The bus broke down,” she replies. “Sorry.” Her boss turns and walks out. Tamika quickly stashes her lunch in the
lounge refrigerator and clips on the badge that identifies her name and title (“Medical Assistant”). She rushes past two docs and an RN on her way to the floor. Tamika’s co-workers are annoyed. Today’s schedule is packed. It doesn’t help that the clinic’s been understaffed for weeks. Tamika’s late arrival complicates an already stressful day. No one says “Good morning, Tamika.” No one smiles at her. Instead, one of the nurses shoves a chart into her hands. Another comments off-handedly “Dr. Thomas is behind already. So much for lunch breaks.” Their annoyance is palpable and Tamika quickly picks up on it. She becomes defen-
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sive. For the rest of the day employee, team, and boss work amid tension, interacting only when necessary, each counting the minutes until the clock strikes 5pm. Sound familiar? I bet it does. Interactions like this one take place at hospitals and clinics across the country, each and every day. Healthcare workplaces are high-contact, high-stress, and compassiondemanding environments. The volume and pace of care delivery combined with the human instinct to view everything through the lens of our own self-interest means that little things can quickly erode even basic courtesy between people. Is it really a surprise that any instinct to be warm in interac-
Winter 2017 • Kentucky
“...warmth is a foundational component of high-performing teams and something leaders must tirelessly promote in a variety of ways.”
tions with others gets sacrificed in the name of efficiency or as a consequence of culture? Certainly not. And that’s a problem, because the presence of warmth in team interactions shapes their performance every single day. Warmth is related to a person’s affect – the way one’s facial expressions, tone of voice, and body language manifest their thoughts and emotions. Warmth is experienced when the affect of a person leads you to believe they care about your problem or concern and genuinely want to help. When we encounter warmth, it puts us at ease. When patients, colleagues, or leaders encounter someone with a warm affect, they describe them as approachable, genuine, or kind. We have, each of us, worked with bosses and colleagues who exuded warmth, and those who didn’t. Warmth, it turns out, plays a significant role in how well teams function and how much they achieve. Research shows that teams with higher levels of collegiality and caring are more engaged, more resilient, and have lower turnover. They navigate stress, overcome obstacles, and adapt to change more successfully than teams who report a less courteous or supportive atmosphere. They also report significantly higher patient satisfaction scores. Nice matters, folks. Consider all of the places a little bit of warmth might have made a difference upon Tamika’s arrival to work. If the Medical Receptionist had offered Tamika a reassuring smile, it may have put her at ease. If Tamika’s boss chose to ask “Are you okay?” instead of declaring “You’re late,” perhaps Tamika’s stress level would have started to diminish. If Tamika had instead told Kate “I’m really sorry I’m late. The bus’s engine started steaming while we were on the freeway. We had to pull over and wait for another bus to come take us the rest of the way. I feel terrible,” perhaps her added detail and sincere regret would have diffused her boss. If Kate had nodded and said “Okay, no problem. Catch your breath then jump in on Dr. Thomas’s schedule,” perhaps all would have ended up in a better state of mind. Though it may sound like a “squishy” topic, it’s not. The interpersonal dynamic
of warmth can be observed, documented, and, thankfully, nurtured. After more than 15 years training leaders and working with teams, I’ve come to believe that warmth is a foundational component of high-performing teams and something leaders must tirelessly promote in a variety of ways. If you need to infuse your team with a healthy dose of courtesy and kindness, do the following: 1. Hire right. Leaders must seek out warmth when hiring. Yes, qualifications, skills, experience, and talent are all key factors to consider when evaluating a candidate, but so too is the nature of their demeanor. As you interact with candidates, be aware of how their affect makes you feel. Do they put you at ease? Do they seem genuinely interested in your interaction? Also key in on the ways they describe their past workplaces. Do they articulate a nuanced understanding of the challenges others faced or do they scapegoat the boss, the team, or the organization for problems or failures? 2. Manufacture fun. Warmth is also present on teams where employees have been able to form meaningful, sophisticated relationships with one another. In fact those relationships, research suggests, are key to fostering employee engagement. Leaders who organize the celebration of birthdays, use teambuilding activities at meetings, host an occasional staff retreat, or support a monthly potluck lunch contribute to and even accelerate collegiality. This kind of “fun with a purpose” fosters more unity and affection between colleagues, making it more likely that warmth becomes a naturally occurring phenomenon. 3. Teach them how. Successful leaders help employees challenge assumptions. Teach your team to avoid the assumption of malice and snapping to judgment of others’ behavior or intentions. Also, give employees feedback on how their affect may be perceived by others. And since there are times when it’s much harder to remain warm toward others, remind employees of the need to deploy the facial expressions, tone of voice, and
body language that conveys warmth, even if they don’t feel authentic caring in the moment. Along the way, role model the kind of demeanor you expect from your team. 4. Remove the frozen. The most successful teams are led by managers who expect that all employee interactions are heavy on courtesy and respect. In fact, they insist on it. There’s no such thing as a high-performing team with toxic personalities. The best leaders simply do not tolerate the presence of discourteous or disrespectful behavior. Remove toxic contributors whose cold demeanor or icy barbs harms the team and fails to meet expectations. Every day employees face a phalanx of patients, families, co-workers, and providers, some of whom can be noisy, brusque, and demanding. It can be easy for kindness and courtesy to fall by the wayside. Don’t let it. Leaders who champion the presence of warmth, who set the expectation of its presence, who remind and refresh team members of its importance, and who rally to make it a part of the culture of the team, are creating the conditions necessary for teams to thrive. Those conditions, it turns out, are nice and warm. About the Author Joe Mull, M.Ed provides training to healthcare organizations that want their practice leaders to engage, inspire, and succeed. A national speaker on employee engagement in healthcare, he is the author of the book Cure for the Common Leader: What Physicians & Managers Must Do to Engage & Inspire Healthcare Teams. For more information or to contact him, visit www.joemull.com.
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Physician Leadership Perspectives By Ardis D. Hoven, MD It is not uncommon for me to be asked “Why do you do this and do you enjoy it?” At the onset of my career in medicine, the idea of being President of the American Medical Association or Chair of Council of the World Medical Association was never a consideration. In fact in those early years, I had very little knowledge about these organizations or what they could accomplish. It was not until the AIDS epidemic and the impact it had on patients and my practice did I recognize that part of my responsibility as a physician was to be engaged in health care in a different way. Through organized medicine I would soon learn that working collaboratively with colleagues of like mind, much could be accomplished. What I learned in the examination room with my patients would eventually propel me to take action to improve health care and the practice of medicine. Assuming a role of advocacy on behalf of patients and medicine is something of great importance and sorely needed in the changing environment of health care today. This is why I do this important work. In organizations such as the Lexington Medical Society, the Kentucky Medical Association and the American Medical Association, we learn from mentors and learn
to appreciate the work of those who have gone before us. The challenges can be many including the time required away from a busy practice or the family, learning to respect the diversity of opinion and recognizing that as a leader you will not have all of the answers. Dealing with variable levels of knowledge about process and procedure, and being challenged along the way by the “politics” of a situation can be stressful. . But I have learned that despite the challenges, physicians can and do come together to make the right decision, doing what is best for patients, their doctors and the practice of medicine. Leadership is both a learned and earned opportunity. We all learn by doing and by being engaged in the process where decisions are made and goals identified. Making mistakes is expected and strong mentors who teach and guide are invaluable. Humility is a valued commodity and flexibility is needed when attempting to engage a variety of personalities, many of whom have very strong opinions on a subject. Being respectful, no matter what is proposed or debated, is mandatory, and providing a level playing field for the participants is essential in order to achieve a good result. Congeniality helps as well. As chair of the AMA Board of Trustees during the year following the passage of The Affordable Care Act, I quickly understood what my position would require in addition
(Above): Dr. Cecil Wilson, Former WMA President, Dr. Hoven and Dr. Otmar Kloiber, WMA Secretary General.
to setting agendas and making sure the work of the AMA progressed appropriately. It was during that time that physicians, both inside and outside of the AMA, had become splintered regarding their support or lack thereof of the ACA in which political opinions dominated conversations. I have always believed that diverse and opposing ideas are good for the evaluation and management of an issue or a conflict. Taking the best of both sides of the debate, and putting them together collaboratively is an imperative for me. I am simply the facilitator of the activity, not the decider of the outcome. As that leader however, I recognize that people can’t read my mind and playing “What am I thinking?” doesn’t work. Being assertive but kind and generous goes a long way. Learning to engender trust is powerful and learning to be analytical and responsive is an absolute. Having a sense of humor helps but recognize that what you think is humorous may in fact be an insult to others, particularly if they come from a different background or culture. I am convinced that in many situations, by simply empowering those with whom I am working, I will earn their respect and trust and in turn they serve and contribute in significant and meaningful ways. I can’t stress how important communication is in accomplishing your goal. During the year that I served as Chair of the AMA Board of Trustees, I was reminded over and over again why it is so important to clarify and make transparent to your members, your partners in a practice or any governing body the work that is being attempted and why. I learned as I traveled around the country meeting with physicians in many venues, the value of articulating the challenge, the methods to manage the challenge and the hoped for outcomes. Is it easy? No. Is it necessary? Yes. As President of the AMA, I was honored to be able to represent the AMA testifying before members of Congress, in the media, in the states, at national organizations and internationally at the World Medical Association. The respect that physicians receive in the US and across the world is powerful yet humbling because of the responsibilities that we must carry. Being the spokesperson for the AMA is an amazing opportunity for which I am very grateful. As a President of the AMA I served as an official representative from the United States to the World Medical Association. The WMA is an organization of representatives from 112
Winter 2017 • Kentucky
“I learned as I traveled around the country meeting with physicians in many venues, the value of articulating the challenge, the methods to manage the challenge and the hoped for outcomes.” countries representing millions of physicians. Declaration of Helsinki (research on human Nonetheless, the opportunities are immense The WMA was formed in 1947 following subjects), protecting healthcare workers in and I recognize that there is much to be World War II and was created to ensure the areas of conflict so that they can provide care learned when we share our knowledge and our independence of physicians and to work for to anyone regardless of their politics, and the experiences. the highest standards of ethical behavior by need to protect data in bio-banks and other In answering the second part of the quesphysicians and the care that they provide. research entities, which are just a few of the tion, Yes, I do enjoy the work. It requires Today, the WMA is recognized as the authorrecent topics on our agenda. commitment and a willingness to be part of an ity in speaking for the doctors of the world on The challenges in leading an organization organization that has great potential to make international affairs. The WMA is governed by such as the WMA are significant but nonechange and make a difference. a Council which is made up of elected repretheless very gratifying. Different languages, I encourage you to take a chance, volunteer sentatives from each of the six major regions cultures, economies, variability in education to be part of the team and be a part of change. of the world (Africa, Europe, Latin America, and types of practice coupled with procedural North America and the Pacific). The Council knowledge differences add to the extent of elects its Chair, the position in which I am the work and the expertise that is required. now serving. So what do we do? RENT THIS CABIN The WMA constitutes ARE YOU DISABLED? In the Beautiful Red River Gorge a free and open forum HAVE YOU APPLIED FOR SOCIAL SECURITY DISABILITY? for frank discussions CAMPING CABINS AND ARE YOU CAUGHT UP IN RED TAPE? of issues related to PRIMITIVE CAMPSITES medical ethics, mediALSO AVAILABLE An experienced Social Security Claims Advocate can help you: • By assisting you in filing your initial application. cal education and the • Filling out and filing your appeals. practice of medicine. • Gather medical and other important information to submit to Social Security. Our deliberations then • Contact your doctors to obtain a report of your medical condition. • By obtaining documents from your Social Security file and review them. provide the evidence • By presenting opening and closing statements at your hearing that and recommendawill state how you meet the Social Security listing of being disabled. tions for physicians to utilize in their own For a FREE CONSULTATION of your claim call countries. Consider Patsy R. Hughes, Disability Claims Advocate, recent debates on the Call or visit website for 1-859-263-7780. reservations.
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Leadership and the Brain By Robert P. Granacher Jr., MD, MBA There has been a flurry of activity in the last decade regarding neuroscience and leadership. From a brain standpoint, much of leadership is based upon the cerebral functions underlying social cognition. Social cognition has evolved to contextualize the matters and outcomes under consideration, the effects of any decisions made on others, and to guide considerations of what others might or might not think. These cognitive functions are expected to lead to sound reasoning and rational judgment. From a behavioral neurological or neuropsychiatric standpoint, leadership includes domains of “comportment.” These are the complex mental processes that include insight, judgment, self-awareness, empathy, and social adaptation. Comportment does not include cognitive functions such as memory, language, planning, set-shifting, and attention.1 Good leadership often requires changes that are painful to individuals. Organizational change is unexpectedly difficult, because it provokes sensations of physiological discomfort. The challenge for the leader is to deal with the resistance to change, even when it is in the organization's or person’s best interest. Jeffrey Schwartz, M.D., a psychiatrist at UCLA, and David Rock, an academic at New York University School of Continuing Professional Studies, have outlined simple explanations for nor-
mal human resistance to change.2 Working memory is the brain’s information holding area, and it is frequently engaged when people encounter something new. When a leader, or an employee, is asked to make a change in action or thought, the benefits of the change are compared to the action or thought that one already uses. A +/valence is determined by lateral prefrontal, medial temporal and orbitofrontal regions. It is working memory that takes in the new information and matches it against the old. This, in turn, activates the prefrontal cortex of the brain, an energy-intensive area. On the other hand, the basal ganglia are activated by routine, familiar activity. In other words, activity continuing with the same behaviors and actions, or continuing with the same mode of thinking. The basal ganglia are very deep midline structures and sit above the brainstem. They are particularly involved in neural circuits that respond to the formation of longstanding habits. They require much less energy to function than working memory, and much less blood flow. The basal ganglia seamlessly link simple behaviors from brain modules that have already been shaped by extensive training and experience (e.g., management or surgical training). They can function exceedingly well without conscious thought. Since they work automatically without requiring conscious thought, this frees up the information processing resources of the prefrontal cortex. The basal ganglia operate analogous to an automatic transmission, shifting among patterns of deeply held thoughts and actions. Any strategic or organizational change
required by a leader or manager, and then secondarily required by employees/staff or those under a leader or manager, uses the same type of cognitive dynamics. In our own profession, surgeons are probably the best examples of this. After years of residency and fellowship training with surgical procedures, these become so well fixed and ingrained that the basal ganglia are running the show. If a surgeon attempts to change any hardwired habit or surgical technique with new learning, it requires much effort, which usually is in the form of demands on the cerebral attentional network. This leads surgeons to an uncomfortable feeling, and they do what they can to avoid changes to their routines. The same is true of leaders. Human brains have evolved a particularly strong capacity to detect what neuroscientists call “errors.” This is a perceived difference between the person's expectations and actuality.3 These error signals are generated by a part of the brain called the orbitofrontal cortex. In detecting error signals, the amygdalae are also activated. Error detection signals can push people to become highly emotional or to act more impulsive as they attempt to adjust, and animal instincts take over. This may be destructive to leadership or to the social cognitive functions of people being managed. Attempts to change routine behaviors sends out strong messages in the brain that "something is not right". Researchers are now expanding neuroscience research into social cognitive neuroscience and leadership.4 Neuroscientists are seeking to understand various aspects of leader decision-making, such as bold-
“Good leadership often requires changes that are painful to individuals. Organizational change is unexpectedly difficult, because it provokes sensations of physiological discomfort. ”
ness or risk-taking behavior, the tendency to “freeze with fear” when faced with important decisions, and how these may involve linkages between the cortex and thalamus with the limbic areas of the brain, specifically the amygdalae. The amygdalae appear to be a principle node in the neural network pertaining to emotions and reasoning. Further research is examining shared or distributed aspects of leadership. It is questioned whether a form of neuro-synchronicity is evident in groups in which a high degree of shared leadership is present. If this can be proved, what are the common or complimentary aspects of brain structures that exist in groups in which there is a high degree of shared leadership or shared strategic vision? These forms of leadership research have set off alarm bells among certain scientific groups with regard to the possible ethical implications of neuroscientific studies to identify and develop effective leaders.5 Lindebaum believes that neuroscience will influence leadership research considerably in years to come, but this begs significant ethical questions. He has asked that neuroethicists be involved in leadership and neuroscience management research as a matter of priority, and this approach should be extended to teaching these issues within MBA programs. He further warns that as neuroscientific methods move from the
laboratory and enter the real world, they simultaneously leave a relatively controlled environment of ethical protocols, rules, and IRB guidelines that apply to academic researchers. He believes that once leadership neuroscience research goes from academia to boardrooms, hospitals, or factories, these prior constraining forces may not be present. Using scientific methods and principles to identify and develop high performance leaders at work is an ethically and extremely sensitive issue. Lindebaum further points out that effective inspirational leaders can now be reliably identified by neuroimaging techniques, such as f MRI. He calls these the neurological brain profiles of the individual. He is concerned that those with “deficient” leadership profiles can be sorted out or even "cured", according to the claims of some researchers.4 He makes a call to action, because of the tendency for technological advances to evolve considerably swifter than our ethical understanding of the consequences for individuals and societies at large.5 References 1. Rosenbloom MH, Freudenreich O, Price BH. Comportment. In Arciniegas DB, Anderson CA, Filly CM, eds. Behavioral Neurology and Neuropsychiatry. Cambridge, UK: Cambridge University Press; 2013: 250-265.
2. Rock D, Schwartz J. The neuroscience of leadership. Strategy and Business. 2006; 43: 70-79. 3. Rolls ET. On the brain and emotion. Behavioral Brain Science. 2000; 23: 177234 4. Waldman DA, Balthazard PA, Peterson SJ. Social cognitive neuroscience and leadership. The Leadership Quarterly. 2011; 22: 1092-1106. 5. Lindebaum D. Pathologizing the healthy but ineffective: some ethical reflections on using neuroscience in leadership research. Journal of Management Inquiry. 2013; 20: 1-11. About the Author Robert P. Granacher, Jr., MD, MBA practices clinical and forensic neuropsychiaty in Lexington and Mt. Vernon, KY. He is a noted scientific author and past president of the Kentucky Psychiatric Medical Association. He is currently president-elect of the Lexington Medical Society and Clinical Professor of Psychiatry at the University of Kentucky College of Medicine.
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Physicians in Government
Proud A Historicalto Perspective Partner with You By Lowell Quenemoen MD
Rising healthcare costs and demands from the public for increased coverage have led to an ever increasing presence of government in the traditional patient-physician relationship. It has now become the patient-insurance/ government-physician relationship. The scope of practice legislation and health policy continue to become more complex increasing the need for more physician advocacy and commitment to the process. However, over the history of our country physician legislator involvement in government has declined. Physician participation in the founding of our country is seen in the Continental
Congress where thirty-one of three hundred and sixty-three members were physicians. These were people active in their communities, educated, articulate and aware of patient’s needs and fellow citizens concerns. They were willing to face the risks and the uncertainties of a new form of government. This effort carried thru to the Declaration of Independence with six physicians noted among the fifty six signers and to the Constitution with two physicians among the thirty-nine authors. In the first one hundred years of the US Congress two hundred and fifty-two served two year terms but subsequent numbers had dropped until a decade ago when the numbers again increased, doubling to nineteen physicians. In the One Hundred and Fourteenth Congress (2014-2015) physicians
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occupied three Senate seats including Rand Paul of Kentucky and fifteen House seats. A study by Mathew Petterson in 2016 looked at one hundred and two current legislative bodies including The US Congress, forty-nine states with bicameral legislatures, Nebraska with a unicameral legislature and DC with a unicameral council. Of the seven thousand nine hundred and seven seats reviewed 1.2% were held by physicians. In this group 10% were females and 90% males, 69% were 55 years old or older, 70% were Republican and 30% Democrat and 86% were MD’s, 10% DO’s and 3% were foreign medical graduates. At the Presidential level recent candidates have included Rand Paul (Senate R-KY), an ophthalmologist, Ben Carson, a neurosurgeon, Ron Paul (House L-TX), an
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obstetrician and Howard Dean (Governor D-VT), a family practitioner. Only one elected president, William Henry Harrison (9th president) had a medical background. He attended the University of Pennsylvania Medical School for a brief period but dropped out to pursue a military career. He came to national prominence with his defeat of Tecumseh and the Shawnees at the Battle of Tippecanoe. Shortly after his inauguration in 1841 he developed pneumonia and died three months later giving him the shortest tenure of any president in history A physician (and a native Kentucky son) has also served on the US Supreme Court. Samuel Freeman Miller received his medical degree from Transylvania College in 1835 and practiced in Barbourville, Kentucky for a decade. He was a self-taught lawyer, passing the bar in 1847. His opposition to slavery led to a move to Iowa and in 1862 Abraham Lincoln nominated him to the Supreme Court where he served until 1890. His legacy includes writing more opinions than any other Supreme Court judge in history. He was also known as a “maverick” often representing the dissenting opinion. Many factors appear to limit physician’s pursuit of public office. Medical education demands a long training period with medical school, residency and often a fellowship. This is followed by the time demands of starting a career and building a practice as well as trying to balance a family life. A continuous educational process is required to stay abreast with advances in diagnostics, pharmacology and other therapies. In contrast to physicians, attorneys make up the bulk of public office holders accounting for 70% of US Presidents, VP’s and cabinet members (25/44 Presidents, 32/45 VP’s). Since 1957 all Supreme Court Justices have been lawyers. Michael Riorden suggests that lawyers have become the “high priests of American politics” because they are willing to devote energy, time and money to politics since it enhances private careers and gives better access to the judicial system. He goes on to point out the differences between medical and legal education approaches. Law school encourages a linear, deductive method of thinking using case method – presenting the facts of the case, identifying the appropriate precedents and arguing the merits. Riorden argues that this does not foster the forward thinking and the open mind that a public official requires to weigh multiple points of view and to meet the needs of a diverse citizenry. He contrasts this deductive approach to the integrative method used in medical school i.e. looking at multiple sources of data; history, physical exam, lab studies, epidemiology, social and financial factors. This requires revising diagnosis and therapy as facts emerge during the course of therapy instead
of assuming a stance and arguing its value of physicians elected and serving in ex post facto. The legal approach requires state legislatures and the United States advancing a specific point of view that may Congress. MD Thesis, University of suborn larger societal values. Arizona Medical School. He concludes that elements of a medical 2. Physicians in the United States Congress. education “valuable to a governing official” Retrieved from https://en.m.wikipedia. include org/wiki/10/26/16 • the integrative thought process 3. Ross, Michael A. (2003) A Justice of • the study of population through epidemiShattered Dreams: Samuel Freeman Miller ology and the Supreme Court During the Civil • the constant regard for ethical context War. Louisiana State University Press. • the active pursuit of future improvement 4. Riorden, Michael L. (1986) “The path • the personal acquaintance with the ills of to public office: medicine versus law.” poverty Perspectives in Biology and Medicine Vol • the knowledge of the foundations of large 29, No2, 315-325. sectors of the economy 5. Huddle, TS and Maletz, K. Physicians • the extensive contact with many societal involvement with politics – obligation issues that have been “medicalized”: or avocation. Retrieved from http:// (Drug addiction, alcoholism, child abuse, journalofethics.ama.assn.org/2011/11/ hunger) ccas2-1111.html In addition medical school “provides an unparalleled view of human behavior” and About the Author fosters “imperturbability, a coolness to operLowell Quenemoen MD is a retired clinical ate during periods of crisis”. neurologist having practiced in Columbus, Thus, it would seem that physicians have Ohio for 20 years before moving to Billings, the temperament and training to contribute Montana for a further 15 years of practice. to a leadership role in the political process. At the time of his retirement he was a Clinical As to electability, a Gallop Poll in 2012 Associate Professor at the University of showed that 70% of Americans rated doctors Washington Medical School Department of as high or very high in their ethical stands Neurology. He is a graduate of the University and honesty compared to 50% for the clergy of Minnesota Medical. and 19% for lawyers. Greater involvement in the political process would require a great deal of soul searching. Can one focus his attention from caring for the individual to caring for society as a whole? Can he risk the insecurity of an elected office to the security of a protected income to meet his family's needs? Can he (and his family) bear the constant scrutiny of the pubYou’ve thought about it for years. You know you need to do lic spotlight? The recent elecit. And there’s no time like the present. But you aren’t quite tion has revealed sure how to quit smoking. Your doctor is here to help. multiple political currents likely to Visit us online to learn what questions to ask your doctor, reshape and reform access all available resources, and stick to the plan so you this country for many decades. can hit pause on smoking. Physicians do have a valuable voice to add!
References 1. Petterson, Mathew. (Nov. 2016) The characteristics
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PHYSICIAN HEALTH AND WELLBEING
What makes you optimistic about the future of medicine? By John A. Patterson MD, MSPH, FAAFP Medicine has always attracted the best and the brightest. Most applicants to medical school are also inspired by a desire to be of genuine service and express their deepest human values through their professional lives. This ethic of altruism, compassion, meaning and service distinguishes medical students from most other professional students. That makes it doubly tragic that some medical students, residents and practicing physicians suffer deeply from the demands of medical training and medical practice. Depression, anxiety, stress-related conditions, loss of meaning, thoughts of leaving medicine and suicide plague medical learners and practitioners alike- and the problem seems to be growing. Psychological resilience is a measure of the degree to which one adapts to or recovers from external and internal stressors. Because psychological resilience mitigates the effects of stress, efforts to promote resilience at all levels of the medical profession abound. Without denying the profession’s stresses and problems, one resilience strategy is to focus on restoring meaning and joy, recovering passion and compassion, reigniting the fire in the belly and the flame in the heart for the practice of medicine. Interestingly, the main determinant of resilience is one’s so-called ‘explanatory style.’ The way you think, whether your ‘cup is half full or half empty’, whether you are an optimist or a pessimist- determines the degree to which you adapt to life stresses in a healthy way or suffer from them in ways that degrade your personal life and professional work. With that in mind, it seems useful to ask powerful questions that evoke the bright side of medicine, giving ourselves and our colleagues in medical training and medical
practice an opportunity to promote resilience with a positive (‘cup is half full’) antidote to negativity and despair. This article contains the answers of several Lexington Medical Society past presidents to the question- What makes you optimistic about the future of medicine? I hope you enjoy their answers as much as I did. Like several others, UK transplant nephrologist Tom Waid MD (LMS President 2014) is fascinated and inspired by the continued advances in medical research that help physicians treat disease processes more effectively and care for our patients more humanely. He adds, “ I'm optimistic that medicine will always be a profession that will attract the best and brightest minds and be able to improve the quality of life for many patients who historically have not enjoyed good health” Likewise, Larry Cunningham DDS, MD (LMS President 2013), Chief of UK’s Division of Oral and Maxillofacial Surgery, is amazed by the pace of technological innovation and the unanticipated advances awaiting us in the future. He says, ”We can transplant almost anything.” In his field, the advances in dental, jaw and facial reconstruction are truly exciting. He admits this excitement is tempered for many physicians by the stresses and pressures of practice, the erosion of respect for physicians in some quarters, the large educational debt carried by many and the lack of physician input in many organizational decisions. Neurosurgeon James Bean MD (LMS President 2001) echoes this deep admiration and respect for the technological and scientific advances in medicine generally and in his field in particular. “The genomic revolution with its personalized immunotherapeutic treatment of brain tumors and endovascular clot extraction for strokes are phenomenal. People with life-threatening conditions that would have killed them several years ago are walking out of the hospital now. I see very
smart medical students more scientifically prepared than ever- some of whom have already written papers. They’re bright, motivated, altruistic and not so driven by commercial motivation. They seem to have a better understanding of work-life balance. Our neurosurgery training is improving- better documentation of milestones and objective ways to assess training goals. Yes, the EHR slows me down but it’s getting better and better and provides instant access to a wealth of patient information once you know how to access it.” Lexington Clinic pulmonologist Bruce Broudy MD (LMS President 2012) says “In spite of it all, medicine is still an intellectually challenging field. Talented young people will continue to be challenged, stimulated and satisfied with careers in medicine. From the systems perspective, we see loss of control by physicians and often inane regulations. Still, we are dealing with the health of individual patients. The practice of medicine can still be stimulating and rewarding. It is still an inviting career compared to other professions. A lot of doctors’ children, including my own son, are still going into medicine.” Anesthesiologist Kathryn White MD (LMS President 2006), affiliated with St Joseph Hospital in Lexington, echoes the parental influence theme. “One of my children is a physician and another is in medical school. Both are enthusiastic about the future. Appalachian folks suffer from so many chronic diseases. The Affordable Care Act is an effort in the right direction and, though it needs changes, it shouldn’t be completely abandoned.” Internist David Bensema MD (LMS President 2002) has been impressed with the caliber of medical students that have shadowed him in recent years. He is also impressed with the adaptability, creativity and entrepreneurship of his physician colleagues, some developing new IT or surgical products. He encourages physicians to get
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more involved in their medical staffs and professional organizations as a way to combat the demoralization that affects so many. He finds that those involved are in a better state of mind- whether born that way or as a benefit of collegial involvement. Pathologist Terry Clark MD (LMS President 2003) describes as “almost unbelievable” the advances in genomics in the last 10 years. “If we can just create a financial model that makes these advances available to the population, we will see increasing patient benefits in transplantation, nerve regeneration and many possible uses of stem cells in multiple organ systems.” He thinks physician burnout is largely a generational thing. “I think burnout is going to burn itself out” as more physicians become employed. He believes late career physicians are more affected than early career physicians by practice stress and systems changes. Emery Wilson MD (LMS President 2010), reproductive endocrinology and infertility specialist and former Dean of the UK College of Medicine, has a unique perspective on the course of medical technology and medical training. He sees a lot of medical school applicants and quips, “They are really intelligent young people. I was smart enough
to be dean but I’m not smart enough to be a medical student today.” He knows many of them have concerns about the future of medicine. When they ask physicians if they would go into medicine again, some say no. “But that’s asking the wrong question. If you ask physicians if they would give up the practice of medicine- almost everyone says no.” He believes every physician has an inspirational story- often about a patient that did surprisingly well. He especially remembers covering the ER while in the Air Force and being called to see a man who had been shot and presented with no pulse. Even though trained in ob-gyn, he immediately noticed neck veins distended up to the man’s ears and diagnosed a hemopericardium. He picked up the largest syringe he could find, withdrew blood from the pericardium and, with the same syringe, injected the man’s own blood back into his veins. The patient was sitting up in bed eating breakfast the next morning. He also remembers receiving a call and expression of gratitude one day from a young woman who had just graduated from UK. She shared with him her plans to fulfill a long-time aspiration of becoming a physician assistant. This young woman was the progeny of the first successful in-vitro fer-
tilization he had performed at UK in 1985. “The best way to think about the future of medicine is to look at the past. Penicillin was first used clinically in 1942. The Pap smear began to be widely used in the mid-1950s. The first in vitro fertilization procedure was performed at UK in 1985. Ninety percent of all we know in medicine has happened in our lifetime. It just makes you wonder how much we are going to learn in the future.” He says that physicians are a very conservative group and resistant to change. But he says, ”It’s important to keep in mind the difference between what we do and how we do it. People will try to change HOW we do what we do, often in the name of quality of care- and some of that may be good. But they can’t change WHAT we do- we care for others. Nobody can change that. Considering the history of medicine and the quality of young people entering the profession- the future of medicine is secure.” Hearing these answers from our LMS past presidents, I hope you feel that your cup is a little more full, that your professional community is supporting you and that there are many reasons to be optimistic about the future of medicine.
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doc • Winter 2017
2017 essay contest
2017 Lexington Medical Society 3rd Annual Essay Contest
2017 Essay Theme: “Describe an experience that has ignited, sustained, or rekindled your passion for the practice of medicine.”
Prizes awarded in each of three categories: • Active Physician • Resident • Medical Student 1st Place: $1,000 2nd Place: $200 3rd Place: $100 Essays due no later than MARCH 12, 2017 to LMS.
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winners will be published in the april, 2017 issue of
Winter 2017 • Kentucky
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doc • Winter 2017
PROFILE IN COMPASSION
Latonia Rice Sweet MD “I fell absolutely in love with those people” By John A. Patterson MD, MSPH, FAAFP Latonia Rice Sweet MD is Chief Medical Officer of Bluegrass Regional Mental Health (aka Bluegrass and formerly known as Comprehensive Care). I first met her in 1999 when she spent her 3rd year medical school family practice rotation in my office in Irvine (Estill County). She lived in Clark County, only 20 miles from my office, having chosen to attend classes in Lexington but live on a farm closer to her family’s Eastern Kentucky culture. She grew up very poor in Perry County, both parents having dropped out of high school to work and her father becoming a coal miner. Both went back to school as adults to pursue careers and provide a better life for their family. They encouraged her to get an education to guarantee a decent living and avoid the struggle of their own lives. Loving research As an undergraduate at Morehead State University, she worked as a lab assistant doing dopamine receptor research, including cocaine addiction. She loved the field and initially planned to get a PhD in neuroscience and make a career studying receptors and neural pathways. She eventually decided she would rather work with people. In her medical school interview, she told her interviewer she wanted to be a research psychiatrist – “and they took me anyway,” she says laughing. Loving people Her plans to be a research psychiatrist, standing in a lab all day studying neuroreceptors, changed unexpectedly during a required community psychiatry rotation in her UK psychiatric residency. To keep close to her rural Clark County home, she did the rotation in nearby Stanton in Powell County. For the first time, this placed her in the role of counselor and therapist to a culture in which
she was raised. “I fell absolutely in love with those people. Taking care of folks who don’t have anybody else to take care of them and for them to give you so much more than you give them is pretty significant.” She has maintained her clinical duties with the Powell County office of Bluegrass for the last 13 years, even as her actual job description has changed to full-time administration. The limits of perfectionism She has a tendency to put in tons of overtime to make sure everything is done right administratively. The continued growth of Bluegrass’s 17 county administrative duties has finally forced her to make the difficult decision to take another position effective January 1. Though she does not think she has ever experienced job burnout, she sees the possibility of being another physician burnout casualty unless she takes steps to prevent it. Though she knows this is the best next step in her life, she chokes back tears as she says, “It’s really hard right now saying goodbye. I’ve seen some of these folks for 14 years. I’ve watched their children and grandchildren grow up. I’m so grateful to these people for being part of their lives. They give me so much more than I give them. It’s really hard.” Being helpful Growing up, her entire extended Eastern Kentucky family taught her that- “The best you can do in life is to be helpful. Acquiring things isn’t important compared to the meaning of what you do. So, when I sit with those Powell County patients, it hits that nerve. This is how I can be helpful.” Continuing to see patients in Powell County helps her sustain that impulse to be helpful even though her job description is technically full-time administration. Sustaining the desire to serve “What sustains me is remembering what brought me to this profession in the first place- remembering who I am helping. The
patients remind me when they say, ’You helped me all those years ago.’ Focusing on that sustains me. Administration and regulations are what we do but it’s the people we serve that brought us into medicine.” “It’s also important to remember that medicine is not the only way to be helpful in life. Volunteering is often more satisfying than one’s actual job. I give talks that help judges, community groups and non-profits understand what is going on in people’s lives. Even though this is still about medicine and mental health, when you volunteer there’s a different kind of feeling.” Job stress and burnout Though she has never felt truly burned out, she admits there have been times when she was “not as helpful as I would like.” The increasing demands of full-time administration, combined with “a personality that takes the burdens of the world on my shoulders” has been tough. “I have made the very difficult decision to change jobs to avoid burnout. I simply couldn’t decrease my time and still do a good job. I realized I was going to burn out if I keep this up. I love Bluegrass. I’ve worked here over 20 years, beginning even before medical school, but it’s the patient care that fills my bucket up and I need to go back to that.” Personal self care She has lived with her family on a farm in Trapp in Clark County since medical school. There are lots of animals- goats, dogs, cats and chickens (she gives away eggs). “The animals’ only job is to get fat and smile a lot.” The family loves outdoor activities, including hiking, kayaking and just being outdoors. “Exercise is important to mental health.” She also knows that meditation, yoga and mindfulness are important but says she “isn’t the best at it.” She teaches patients to rub a coin or a stone in their pocket as a tactile focus or ‘worry stone’ to help center and ground to manage stress. She uses hers to “help bring me back to the moment “
Winter 2017 • Kentucky
I fell absolutely in love with those people. Taking care of folks who don’t have anybody else to take care of them and for them to give you so much more than you give them is pretty significant. – Latonia Rice Sweet MD
Happiness for medicine’s next generation Regarding the need to help medical students and residents maintain their mental health and avoid burnout, she says that we all need to remember what inspired our decision to be a physician in the first place. “You don’t chase happiness. You can’t find it. Choose a specialty you really connect withnot its hours or money or prestige. You won’t catch happiness that way. You need to truly connect with what you do.” What’s next? Don Rogers is a master’s level psychologist and Chief Clinical Officer at Bluegrass. He began working with Latonia Sweet when she was on psychiatry residency rotations. He says, ”I quickly realized how smart yet downto-earth she is. She is especially good with the impoverished population we see. I’ve never seen anyone so able to relate to those folks while also delivering excellent mental health care. She doesn’t think a pill fixes everything and treats the whole person. She is great communicator with colleagues, staff and patients and will bring compassionate values to her work wherever she is.” January 1, she will join the primary care clinic staff of Clark Regional Medical Center, with offices in Winchester and Stanton KY. She is excited about the creative opportunity to help build an integrated care service bring-
ing together internal medicine, pediatrics, mental health, psychiatry, addiction medicine and substance use disorders all under one roof and integrated in a seamless way to address the whole patient. “I love building things and this is a great opportunity.” It also means that her kids now have Mom cooking dinner on weeknights and working in an office 5 minutes from their schools. She will be joining Larry Ertel MD in this new endeavor. Dr. Ertel is delighted. He says, “She really cares about her patients and truly wants to make a difference in their lives. She has really blessed a lot of people with her care. This opportunity is truly a credit to Clark Regional. We don’t value mental health enough in the US. Treatment for substance use disorders and addiction is so needed, especially in Kentucky where entire families are affected, even the developing fetus. We often discover a young woman is addicted when her newborn infant starts to withdraw in the hospital nursery. Latonia Sweet has a lot of experience with this culture and with addiction medicine. We are so fortunate to have someone with her heart joining us.” She will continue to work locally, statewide and nationally in the same way that recently earned her the MediStar Physician of the Year award, presented by IGE Media, publisher of Medical News,
in recognition of her leadership, vision and legacy with her patients, organization and workplace. As a Kentucky Medical Association Community Connector, she will continue educating health professionals and communities about health behaviors, substance use and addiction. No doubt, it won’t take long for her to say about her new colleagues, staff and patients- “I fell absolutely in love with those people.” And the feeling will be mutual. About the Author Dr Patterson chairs the Lexington Medical Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org
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Physicians Role in Politics Involvement Crucial to the Commonwealth By Ralph Alvarado, MD FACP, Kentucky State Senate – 28th District In the immediate world of what most of us would consider "politics," there are only a select few that we actually see run for a public office. Behind the scenes in Kentucky, there are perhaps only a few thousand volunteers, office workers, and support staff who are also considered 'part of the political process' and often have very important roles in the realm of governance and development of policy. But, this is only a small percentage of our Commonwealth's overall population; and as physicians, we are perhaps one of the least involved groups in Frankfort. I think our country and our Commonwealth would be in much better shape if everyone were part of the political process. Physicians are some of the most widely respected, trained, and educated individuals in a community. The lack of involvement of such a group in leadership can only be damaging to a society. So as physicians, we should ask what is our role in the political process? From an ethical perspective, two principles from the AMA Code of Ethics speak to physician engagement in the democratic process: • "A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient." (Principle #3) • "A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health." (Principle #7) • "A physician shall advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well being." (Principle #8) Each of these highlight the idea that, as physicians, we have an ethical responsibility to contribute to political change that will benefit our patients. But, how do we best accomplish such change?
First, we can begin by voting. There are some who say that the irony of the American democracy is that it is run by an elite. But the common idea of one person, one vote does allow the ballot box to be the great equalizer, provided that citizens get the message to vote and that infrastructure exists to make voting easy. I don't have any research on the percentage of physicians who vote in every election for which they are eligible. However, we know that fewer than 60% of eligible American voters actually cast a ballot. In the last gubernatorial race, the turnout was less than 25%. This small percentage does not give us confidence that there is an informed electorate, willing and able to exercise their freedom to vote. As physicians, we should lead by example and encourage our patients to be more active participants in our democracy. The second way physicians can get involved in the political process is by contributing to the campaigns of medicine friendly candidates or to political committees. This can help ensure that medicinefriendly politicians get elected. KPPAC is a prime example of such an organization. As doctors, we're used to analyzing a problem and finding a quick solution. We then give an order to someone to carry something out and things are 'fixed.' That is how our world works. Others value our opinion and leadership and we never have to give money to make our message heard. But unfortunately, whether we like it or not, money is what allows a political message to be disseminated and heard. The message is your bullet, but the money raised is the size of gun with which you fire it. As you might imagine, sympathetic state and Congressional representatives are crucial to attaining our priority goals -- such as reforming a broken medical liability system, preventing cuts to Medicaid or Medicare payments, and continuing to solve the uninsured problem in America. But involvement is not just a matter of providing financial capital, it is a matter of offering intellectual capital -- and time. Physicians need to get involved with legislators at the grassroots level. Physician activists help get physician-friendly
politicians elected, and they also can develop relationships with these politicians who move medicine's agenda forward. Legislators crave our input, especially when it comes to medical bills. All too often, I have heard legislators complain that they did not 'hear from the doctors' on a certain issue. Only after they voted on something contrary to what we would want did they hear the complaints. By then, the law was enacted and it was 'too late.' The final way to get involved entails the most personal sacrifice: running for public office. There are both historical and present-day precedents for physicians on this front. Physicians signed the Declaration of Independence, among them, Dr. Benjamin Rush. These doctors put both their life and fortune at risk to bring a better nation into existence. In communities across the nation, physicians have served on school boards, in city and state governments, as well as in Congress. Dr. Bill Frist served as Senate majority leader. Dr. Rand Paul serves as our US Senator, and Dr. Ben Carson recently ran for President. However, today, there are proportionally far fewer physician representatives in Congress than there were physician signers of the Declaration of Independence. But each addition to Congress moves us back to where we should be in terms of our direct political involvement. You, too, can run for public office. AMA has offered Candidate Workshops where you learn how and when to make the decision to run, how to raise funds, and how to be a better public speaker. Physicians are naturally concerned with the health of their own patients, but to what extent are we also civic-minded? Are we concerned about social and economic issues that affect the health of our patients beyond the doors of our practices? Do we have a responsibility to advocate for public health issues and contribute to the society that grants us professional status? The answer, according to physicians themselves, is yes. A Commonwealth Fund study in 2006 ( JAMA) found that nearly all physicians believe they should play public roles, and two-thirds are actively involved in community activities, political work, or
Winter 2017 • Kentucky
“Physicians are some of the most widely respected, trained, and educated individuals in a community. The lack of involvement of such a group in leadership can only be damaging to a society. ”
advocacy. The researchers envisioned three types of public roles for physicians: community participation, political involvement in health issues (other than voting), and collective advocacy through professional organizations. 3500 physicians engaged in direct patient care (FP, IM, Peds) or in one of 3 specialties (Gen Surg, Anesth., Cardiology) responded to a mail survey. When asked to select from a list of factors, most physicians said it was very important to advocate for socioeconomic factors directly related to health: obesity, immunizations, tobacco control, substance abuse. Fewer said that advocating for expansion of insurance coverage was an important issue for them. To sum up, there are several things we all can do: Vote. Contribute money and/or
time as an activist. Support colleagues who are willing to serve in public office. Or, consider running yourself. Most of these are simples "asks" for each of us as physicians. It's time to act, and it's also time to reflect on the importance of such action. We are blessed in this country with many freedoms, including the freedom to practice medicine as we choose. We must be politically involved on a personal level to ensure that future physicians will be able to continue our proud tradition of human health. It is, simply put, the ethical thing to do. About the Author Ralph A. Alvarado, MD is an American physician and politician who was elected to the Kentucky State Senate in 2014, and is the first Hispanic member ever elected to
the Kentucky General Assembly. He represents Kentucky's 28th Senate district, which includes Fayette, Clark, and Montgomery counties. He serves as the Vice-chair of the Health & Welfare Committee, Co-chair of Medicaid Oversight Committee, Co-chair of the Budget Review Subcommittee on Human resources, as well as a member of the Senate Appropriations & Revenue Committee, and State & Local Government Committee. Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998.
doc • Winter 2017 • Business Section
Turning Your Personal Passion Into Your Business Purpose By Tonya Howe Many people have a passion in life whether it be in their personal lives or in their business. Some businesses are created around this passion because it’s something they love to do. For me, my passion was always to help others. In the past, I have worked with seniors in helping to aid in placement in a senior community such as, independent living, assisted living or nursing level of care or helped them to stay in their home by facilitating all of the things they would need to have in place that would be necessary to
do so safely. This included caregivers, transportation, home modifications, etc. In my work over the years I met my current business partner and we shared the same feelings about helping others. When we went into business together, we had long talks about our goals, dreams and what really moved us in the business world. It was through those conversations that our purpose for our business was born. We wanted to take what our passion was and turn it into our purpose for our business. This enabled us to create something that was meaningful to both of us and allows us to work on it every day. This fulfills our need in life to help others by bringing
awareness to the community of a terrible culture that has always been a part of society but is getting worse each day: Bullying. So how do you turn your passion into your purpose? There are many ways to discover this and I have found a simple yet efficient way of doing just that. One of my colleagues, Ranan Lachman, wrote a book called Purpose – How Small Things Can Create A Meaningful Life. His approach to finding your purpose in life is broken down into very simple, detailed steps that helped us find our business purpose. Make a list of things that you want to do. Narrow
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Business Section • Winter 2017 • Kentucky
“Make a list of things that you want to do. Narrow that list down to things that you think you can accomplish and then create a plan to carry it out.”
that list down to things that you think you can accomplish and then create a plan to carry it out. I realized in reading his book that you don’t have to solve world hunger to be successful in helping to change the world. The smallest things that we do each day can be beneficial to others. My business partner and I took what our passions were and found a common ground that we both were excited to combine with our business practices. Our company deals with conflict resolution and corporate training. We both had experiences with bullying while growing up and how that feels never goes away no matter how old you are. We then figured out a way that we could do something good for the community by using what we do on a daily basis and created the Initiative. What does this do for you as a company? This brings your passion into your daily work. It keeps your excitement level high and your work doesn’t become mundane. You strive harder to make things happen because you know that you are helping someone who really needs it. It also bring awareness to both your purpose and your business. Many companies donate money to charity and that is a wonderful thing, but if you feel in your heart you truly want to do something that makes a difference not only within yourself but also for someone in need, then think about either aligning your business with a charity and becoming an integral part of what they do or create something that your business can get behind 100% by making it your business purpose.
I think most everyone will agree with me when I say your goal in business is to be successful. Finding ways to advertise your business that are effective About the Author is a hurdle that most of us are trying to Tonya Howe is the Chief Operations Officer with Summit Conflict Resolutions & Trainings overcome daily. But what if we looked located in Nicholasville, Kentucky. She brings at it from a different angle. What if we her expertise as an Eldercare Specialist to approached it from a perspective of Summit to create and teach programs that focus on the care and well-being of the elderly, helping others, not necessarily helping the forgotten generation. She has also created ourselves. When I was in sales years The Bluegrass Anti-Bullying Initiative with her ago, and worrying about meeting business partner Dr. Dani Vandiviere to bring my sales goals, my director told me, awareness and raise funding to offer free programs to Kentucky schools to help stop bullying “Don’t think about the goals or money, and to teach our children that both the bully and concentrate on helping others and the victim can re-write their future. You can learn money will follow.” He was right. When more about Summit and the Initiative at www. summitcrt.com and www.antibullying-ky.com. I focused on helping others and not on me, the goals were met and the money came at the end of the month along with top Document Storage ◆ Shredding Services sales honors. We all want to 2325 Palumbo Drive • Lexington, KY 40509 be happy, at peace and have GregWeFister are a provider of storage a meaningful GeneralforManager all types of documents, hard life. What does copy storage and we provide an Fax (859) 266-5850 Office (859) 266-1886 that mean for environmentally controlled vault firstname.lastname@example.org Cell (980) 229-3050 you and your for tapes and film. We also take care business? That company materials that need A Divisionofofany Fister, Inc. shredding/destruction. is something you have to SECURE • WEB ACCESS figure out for yourself and no one can tell you, but I hope by sharing how we accomplished for all new customers this, it will help you find your business purpose.
FIRST MONTH STORAGE
doc • Winter 2017 • Business Section
Social Selling and Your Business By Bob Woods The world of sales in general, and the “behind-the-scenes” of the sales process in particular, are becoming much more socially powered than ever. Now that relationship building via social media is more than ever a part of our everyday lives, it’s finally time for the principals of marketing to combine with the art of sales—yes, sales is an “art” —into a process called “Social Selling.” Here’s a quick definition, via Wikipedia:
Social Selling is the process of developing relationships as part of the sales process. Today this often takes place via social networks such as LinkedIn, Twitter, Facebook, and Pinterest, but can take place either online or offline. Examples of social selling techniques include sharing relevant content, interacting directly with potential buyers and customers, personal branding, and social listening.
For those who sell in the businessto-business environment, LinkedIn is a key tool in the Social Selling portion of one’s sales toolbelt. Salespeople, business-development pros and business owners who use LinkedIn have to shift their efforts there from a message-driven monologue to an idea-driven and community-serving dialogue.
NOT Just the “New Black” STAGE TWO: EDUCATE YOUR NETWORK in Sales Philosophy Teach them how you can alleviate It’s very easy to say Social Selling is “just a trend.” Quite a few sales experts do it all the time; usually when they’re discounting it. In reality, Social Selling represents more of a shift in strategies and mindset. As Facebook, LinkedIn, Twitter and other social-media channels continue to grow, I’ve got news for those naysayers: While traditional prospecting techniques like cold calling are still important, Social Selling ain’t going nowhere. Whether you are hunting for new prospects, expanding your current base of customers or cross-selling to your clients, leveraging the strategies behind Social Selling for any salesperson and/ or company is now imperative to staying competitive in today’s topsyturvy business world.
It Takes Four (Stages) STAGE ONE: LISTEN TO YOUR TARGET MARKET
The foundation of Social Selling involves your “ears;” although when it comes to social media, you’ll use your eyes. You have to listen to your target market, and what’s happening with their clients and competition, and their industry as a whole. Use social platforms to identify articles your prospects “like”, blogs they share and their new connections. Doing this allows you to quickly understand what matters to them, and social media makes this activity easier than ever. Tools like Twitter, HootSuite and Google Alerts allow you to keep these tabs on your prospects.
their concerns, and you’ll have great relationships for life. Additionally, educating your prospects, clients and followers establishes your thought leadership and subject-matter expertise (further discussed in Stage Four). Educating prospects and building a strong reputation begins with a customer-centric LinkedIn profile. Leveraging the Summary area to provide value is a simple way to begin. To see an example of such a profile, visit mine at http://www.linkedin.com/ in/bobwoods. Using LinkedIn’s Publishing platform is a great way to offer educational content in a blog-like format. If you’d like to see some examples of this, please visit our posts at http://www.leveluponlinkedin.com. Blogging on a company or personal Website is another easy way to share knowledge and offer tips and strategies to your readers.
IDENTIFY THE RIGHT PEOPLE TO PROSPECT
When it comes to social selling, most people are interested in prospecting. There are many platforms that offer business development opportunities, including Facebook’s Fan Pages and Pinterest (for consumers), LinkedIn (for B2B) and Twitter and Google+ that overlap both worlds. LinkedIn offers many different ways to prospect, but here are my Top Five: • Make a list of companies that you are looking to prospect, search their company pages and identify who you have in common with their employees, and request introductions.
Business Section • Winter 2017 • Kentucky • Create Advanced and Saved Searches of your ideal prospects and choose “2nd degree relationships.” This allows you to identify who you know that knows who you want to know. This feature will email you when new people who fit your criteria enter your network. It will also tell you who your shared connections are. • Identify who your clients know that meet your criteria. When the time is right, ask for referrals.
POSITION YOURSELF AS A SUBJECTMATTER EXPERT (SME)
The era of the salesperson traveling with nothing but a kit full of samples, a smile and a strong handshake is gone. A key part of Social Selling entails the salesperson discussing industry insights, competitive advantages and thoughtful research through social channels, including LinkedIn. In effect, the sales pro either runs her
or his own publishing empire, or has their company’s help in running it. Because the salesperson is already “out there” with their information, it’s easier for a prospect to scrutinize the company’s products/services and the salesperson her/himself. This makes that all-important first call easier. The positioning doesn’t stop with branding and marketing. In fact, it is at the 1st call and/or appointment that your expertise is truly scrutinized and validated. Social Selling is about offering this information prior to your meeting. The key to well-position you and your company is to use your findings in your prospecting meetings. Often this step is targeted to the company background and individuals you are meeting with. Be sure to Google your prospects and their company, search industry trends and use their LinkedIn profile to help you build rapport. In addition, follow all the potential influencers, decision makers and
company pages, as well as other online and social sites, to have full visibility into current events and happenings. Being prepared will ultimately position you to be the subject-matter expert they need on their team. More and more professionals who “touch” a sales-type role in any way— salespeople, sales managers, channel sales, marketers, business-development pros, business owners who have to sell and the like—are gaining an edge over their counterparts by using Social Selling. By integrating this mindset into your daily routine, you will be more successful. About the Author Bob Woods is a partner and co-founder at Lexington, KY-based LevelUp Business Coaching & Training. He specializes in Social Selling, which uses platforms like LinkedIn to aid sales and marketing teams, business professionals and selling CEOs to generate better leads, close more business and develop strong professional relationships. Bob can be reached at: EMAIL: email@example.com PHONE: (859) 514-0700.
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doc • Winter 2017 • Business Section
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. • 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.
Delivery and Distribution 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 Wal-Mart’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. 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.
Testing and Measuring
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: Leads X Conversion Rate = Clients X AVG $ Sale X # Trans. = Revenue X Profit Margin = Profit 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.
The 4 Ways
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. 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.
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.
doc • Winter 2017
2440 Astarita Way Lexington, KY 40509 List Price: $459,000 4580 sq. ft. 5 Bed, 5 Bath Outstanding home located in the heart of West Wind! Wonderful floor plan and exceptional amenities. Including gleaming hardwood floors, wide hallways, extensive moldings, central vac system, 2 story entry foyer, formal dining room, study, 1/2 bath, utility room and a large family room that opens to a spacious kitchen. Kitchen has stainless, granite and a breakfast area. The second level offers a large owner’s suite with trey ceiling, large bath with whirlpool tub, separate shower, dual vanity and dual walk-in closets. 4 additional spacious bedrooms with 2 full baths are also located on the second floor. The lower level has Owens Corning finishing system with excellent thermal performance, sound control and resistant to moisture and mold. Large rec room and full bath. Covered rear porch with skylights and fan. Beautifully landscaped grounds, neighborhood pool and much more. Don’t miss this opportunity. Truly a move-in ready home.
277 Cassidy Ave. Lexington, KY 40502 List Price: $510,000 2411 sq. ft. 3 Bed 3 Bath Prime Chevy Chase location. Immaculate 3 bedroom, 3 bath, brick Cape Cod with attractive curb appeal. Featuring a family room with fireplace, dinning room, wonderfully renovated kitchen with stainless appliances, granite countertops and laundry area. Nice 1st floor owner’s suite with beautiful bathroom, spacious closet and doors to rear patio. Second level offers two spacious bedrooms, fully updated bathroom and abundance of storage space. Unfinished basement and 2 car garage with concrete driveway. Totally updated throughout including insulated windows, interior blinds, roof, gutters, chimney rebuild, fence, landscaping, garage roof, siding and door. Move in ready home. Don’t miss this wonderful opportunity!
2376 The Woods Ln. Lexington, KY 40502 List Price: $645,000 4675 sq. ft. 5 Bed 3 Full Bath, 2 Half Bath Look no further!! Fabulous home on a 1/2 acre lot inside New Circle Road, in The Woods Subdivision! Features 1st floor owner’s suite, tall ceilings, hardwood floors, kitchen with granite tops & stainless appliances, finished basement, wet bar, 4 car garage, 2 fireplaces, 2 zoned HVAC systems, professionally landscaped grounds, rear fenced yard, in-ground heated pool, recent interior & exterior paint and front brick steps. Move-In-Ready home priced to sell. Exceptional opportunity. Square footage does not include finished space above garage (+/- 388 SF heated & Cooled)
Rick Queen 859-221-3616 Turf Town Properties | www.turftown.com
EQUAL HOUSING OPPORTUNITY
161 Old Cassidy Ave. Lexington, KY 40502 List Price: $449,500 2484 sq. ft. 3 Bed 2.5 Bath Charming Chevy Chase home! 3 Bedrooms, 2 full baths and 1 half bath with a 1st floor owner’s suite, formal living room, dinning room, family room, 2 fireplaces with gas logs, partially finished basement and hardwood floors throughout. Nice relaxing front porch, professionally landscaped grounds and a 2 car garage. Outstanding location! Convenient to UK, shopping, Romany Road, Ecton Park and much more.
681 Providence Rd. Lexington, KY 40502 List Price: $537,000 3150 sq. ft. 4 Bed 3 Bath Wonderful 4 Bedroom and 3 Bath, 1 1/2 story home with 3150 Sq.Ft. Great Location! Tastefully updated throughout with custom upgrades. Inviting entry foyer, large living room with fireplace, open dining room to kitchen. Kitchen has custom cabinets, upgraded stainless appliances and granite tops. 2 bedrooms and full bath on 1st level. Second level features spacious owner’s suite with walk-in closets, and a wonderful bath including heated tile floor. Nice laundry room, additional bedroom with bonus area and full bath. Lower level offers a den with fireplace and an abundance of storage. Hardwood floors throughout, new insulated windows, 2 zoned HVAC systems, 2 car garage and fenced yard. Attractive move-inready house! Convenient to UK, Downtown, and more!
2927 Four Pines Dr. Lexington, KY 40502 List Price: $725,000 4048 sq. ft. 3 Bed 4.5 Bath Classic home located in ever popular Four Pines with brick privacy wall and beautiful landscaped grounds, 10’ ceilings, hardwood floors, custom built ins, moldings and mantles, wonderful Kitchen with island and custom cherry cabinets, formal dining room, awesome living room with fireplace and french doors to private courtyard. Second level offers fabulous master suite with vaulted ceiling, fireplace, walk in closet and large bath, additional bedroom and bathroom. Third level offers additional bedroom with full bath. Finished lower level offers family room with fireplace, full bath, craft room or home office area. Spacious 2 car attached garage. Convenient to UK, downtown, numerous medical facilities, Chevy Chase, and more. Wonderful home in desirable area.
862 McMeekin Pl. Lexington, KY 40502 List Price: $1,399,000 5329 sq. ft. 5 Bed 3 Full Bath, 2 Half Bath Stunning 2 1/2 story, renovated home backing to green space. Close to UK, hospitals, and downtown. Outstanding renovation, Fabulous amenities, Gourmet Kitchen, Sumptuous Master Bathroom, Beautiful Hardwood Floors throughout, Resort like backyard, Professionally landscaped grounds, Front circular drive, Inground Pool.
Winter 2017 • Kentucky
5,100 SQUARE FEET | $1,900,000
Exquisite and stylish 19.5 acre country retreat yet a horse farm suitable for any discipline. The former Wintergreen Stallion Station, just outside Midway, has been converted to an estate-quality property enhanced by its natural beauty and privacy. Brilliantly transformed from a six-stall barn and adjoining office, this elegant 5,100 square foot Tudor-style home encompasses a mixture of traditional, contemporary, and rustic finishes. The stallion barn consists of 8 stalls plus a 38.5’ x 49’ breeding area. 20 minutes from Lexington and less than that to the Kentucky Horse Park, Foxbrook Farm is perfect in size, location, natural beauty, and serenity.
Justice Real Estate 518 East Main Street Lexington, Kentucky 40508
p : 859.255.3657 f : 859.233.3800 www.kyhorsefarms.com
77 ACRES | $749,500
Secluded and private 77 Woodford County acres. Custom cedar home in an incredible setting with spectacular views. 3 bedroom, 2 bath home with 2,900 square feet featuring hardwood floors, floor-to-ceiling stone fireplace, granite counter tops, large L-shaped covered porch, unfinished walk-out basement, and geothermal HVAC. The front of the farm is well-kept pasture land with a five bent tobacco barn. The rear of the farm features a great blend of woods and native grasses - perfect for deer and turkey hunting and fabulous dove hunts. There is also a 24’ x 42’ 3-bay detached garage/ equipment building. Owner may consider selling home with front 25 +/- acres.
APPOINTMENTS AVAILABLE WITH FPA PROVIDERS AT BOTH LOCATIONS
Family Practice Associates of Lexington, P.S.C.
1775 ALYSHEBA WAY SUITE 201
2040 HARRODSBURG ROAD, SUITE 300 CHECK US OUT ON THE WEB
Take Care of Your Patients by Taking Care of Yourself
The Lexington Medical Society
Physician Wellness Program
TAKE CARE OF YOUR PATIENTS BY TAKING CARE OF YOURSELF The Physician Wellness Program (PWP) was designed as a safe harbor for physicians to address normal life difficulties in a confidential and professional environment.
WHY WAS THIS PROGRAM CREATED? Being a physician isn’t easy. Difficulties with the current health care delivery system, maintaining a healthy work/ life/family balance, and dealing with the normal stresses of everyday life can take their toll on physicians. We serve not only as treating physicians, but many times as counselors to our patients who turn to us for guidance. Who do we turn to when we need to talk through an issue or get some coaching for how to handle stress in our life? Too often the answer is “no one,” and that is regrettable because it is imperative that we be as healthy as possible in our role as health care providers. We deserve to function at our best in all areas of our life. By addressing areas of difficulty, we can decrease our stress levels and increase our levels of resilience.
Some examples of those difficulties include: •
Depression & anxiety
How PWP Works We have contracted our program with The Woodland Group. The Woodland Group will provide counseling to active physician members of the Lexington Medical Society and UK Graduate Medical Education program residents and fellows. Non-emergency sessions will be scheduled during regular business hours. Emergency sessions can be scheduled on a 24-hour, 7 days-a-week basis. Seven licensed psychologists make up the Woodland Group and have been vetted by LMS. Steven Smith, Ph.D. and Sandra Hough, Ph.D. are our program coordinators and will serve as points of contact to access PWP. The Woodland Group will maintain a confidential file for each physician, but no insurance will be billed and LMS will not be given any information about those who utilize the program. As such, this program is completely confidential which is crucial to its success. LMS will pay The Woodland Group a monthly bill based on the number of sessions provided. The Woodland Group will verify LMS membership from the physician finder on the LMS webpage.
TO MAKE YOUR APPOINTMENT 1) Call the confidential hotline at 1-800-350-6438 and leave a message in either Dr. Smith’s or Dr. Hough’s voice mailbox. 2) They will call you back to schedule an appointment. It’s that simple!
PWP Benefits 6 free sessions each calendar year Complete confidentiality Easy access Convenient location (535 W. 2nd Street, Suite 207) 24/7 availability
She’s one reason Passport is the top-ranked Medicaid MCO in Kentucky.
We can give you 23,483* more. Passport Health Plan is the only providersponsored, community-based Medicaid plan operating within the commonwealth. So, it’s no coincidence that Passport has the highest NCQA (National Committee for Quality Assurance) ranking of any Medicaid MCO in Kentucky.
Our providers make the difference. *Passport’s growing network of providers now includes 3,720 primary care physicians, 14,014 specialists, 131 hospitals, and 5,619 other health care providers. Ratings are compared to NCQA (National Committee for Quality Assurance) national averages and from information submitted by the health plans.
MARK-51677 | APP_11/16/2015
pass5449v1_KY Doc_8x5.0993.indd 1
11/25/15 12:37 PM
MEDICAL CODING certification First, Oldest & Best
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Next PMC Class star C ts
Feb. 15 2017
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