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winter 2018 • volume 9 • issue 4

A leader in providing care for underserved patients in the Lexington community for OVER 30 YEARS

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CONTENTS Caring for the Underserved in Fayette County PAGE 5 PROFILE IN COMPASSION: Danesh Mazloomdoost, MD PAGE 8

PHYSICIAN HEALTH AND WELLBEING Promoting Resilience with Optimism & Mindfulness PAGE 11 George Privett, MD: Philanthropist PAGE 14 Surgery on Sunday PAGE 16 Community News PAGE 18 FROM THE COVER: Salvation Army Clinic PAGE 20 The University of Kentucky and Kidney Transplantation in Honduras PAGE 24 The 2018 Business Imperative PAGE 26 5 Tips on Marketing Your Practice PAGE 29


BOARD MEMBERS Robert P. Granacher Jr., MD, MBA editor of Kentucky Doc Magazine Tuyen Tran, MD Lowell Quenemoen, MD Tom Goodenow, MD John Patterson, MD Thomas Waid, MD Danesh Mazloomdoost, MD

STAFF Brian Lord Publisher

FROMTHEEDITOR • WINTER 2018 Robert P. Granacher Jr., MD, MBA, Editor-in-Chief, Kentucky Doc Magazine Welcome to the Winter 2018 Edition of KentuckyDoc Magazine. The theme for this quarter’s production is to showcase physicians working in areas outside of their normal clinical roles in order to serve others. Please notice the cover, which emphasizes the University of Kentucky’s COM Salvation Army Clinic. Dr. Quenemoen leads the charge this quarter with his article, “Caring for the Underserved in Fayette County.” Lowell profiles UK’s contributions to this Salvation Army Clinic and those of Chris Skidmore, the Executive Director. The free care offered in Fayette County includes not only primary care but dentistry, vision clinics, pharmacy services and an outpatient surgical clinic as well. The next article in our Winter series is by John Patterson, MD. John profiles Dr. Mazloomdoost in his Profile and Compassion Series, which runs on a regular basis in our magazine. Dr. Mazloomdoost is at the forefront of pain care in this geographical region, and he has been a stalwart in providing physician education on appropriate pain management with judicious prescription of opioids. Danesh practices with his wife, and Dr. Patterson profiles Dr. Mazloomdoost’s immigrant parents from Iran and the tremendous role models he had in his own physician parents. Dr. Patterson also profiles, in his Physician Health and Wellbeing Section, how to promote resilience with optimism and mindfulness. He points out that resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress, such as family and relationships, serious health problems, or workplace and financial stressors. Dr. Granacher profiles one of our more visible LMS physicians in the community, George Privett, MD, as a philanthropist and board leader. No one can drive near the Lexington Hope Center without seeing Dr. Privett’s name across the building. Dr. Privett has been a public leader in assisting Lexington to develop not only the Hope Center, but also the Don and Kathy Jacob’s House, the Barbara H. Rouse Apartments, and the Ball-Quantrell Jones Center for Women. In my interview of George, I also learned about his extraordinary leadership to improve opera and choral music in Lexington, and his work with Dr. Everett McCorvey, head of the Opera Program at the University of Kentucky. Dr. Privett is known for his humanitarian work to improve the lot-in-life of the homeless, addicted, and mentally ill populations. Dr. Tom Goodenow profiles Surgery on Sunday and the development of this program, which was founded by LMS

member Dr. Andrew Moore in 2005. About 5,700 persons have been provided surgical service through this program, which is provided to individuals who lack the financial means or insurance coverage to obtain surgical services that they require. Those patients who are serviced in the Surgery on Sunday Program never receive a bill for medical care. To qualify for services, patients generally may have household income of up to 250% of the Federal Poverty Guidelines, and they must be uninsured or have a deductible plan that requires payment of 10% or more of household income. When Andy first visualized Surgery on Sunday, he reviewed what was available across the United States and was surprised to find nothing similar anywhere else. Surgery on Sunday is truly the first of its kind, and its success has not gone unnoticed. Louisville has developed a Surgery on Sunday Program, and similar organizations can now be found or contemplated in Ohio, Tennessee, Alabama, and Texas. Connor Appelman and Marc Kai provide us with an excellent article on the team of 22 COM second-year medical students who oversee the operations of the Salvation Army Clinic each year. They are supervised by fully trained physicians who act as attendings and volunteer at the clinic. Thus, the UK medical students who participate in this program have the opportunity to observe compassionate medicine at its best. Tom Waid, MD provides us an interesting view of compassionate medicine outside the United States. He profiles the University of Kentucky Program for kidney transplantation in Honduras. In 2013, the UK Transplantation Program sent a team of three surgeons and physicians to Honduras to rekindle this program and get Honduras up to speed to provide international level transplant care to its citizens. Since that time, kidney transplantation has been performed independently of UK and without donor or recipient complications. In September 2017, one of Dr. Waid’s colleagues, Analia Castellanos MD travelled to Honduras as an invited speaker and participated in the first Transplant Symposium ever held in that country. Leaving compassionate medical care for a moment, please do not overlook the business article by Jim Ray, “The 2018 Business Imperative.” Jim provides physician guidelines for business planning at the start of 2018. He points out that it is necessary to take time to step away from one’s work in the medical business to spend time working on the medical business. Also to further improve business practices, Tonya Howe, a digital marketing strategist, provides us “5 Tips on Marketing and Why It Matters.” She gives important information about using digital marketing to entice patients to join your practice. Those of us on the Board of KentuckyDoc wish you a happy and prosperous New Year, and encourage you to review your business practices and also find ways to help those in need who cannot access mainstream medicine.

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© Copyright Kentucky Doc Magazine 2017. All rights reserved. Any reproduction of the material in this magazine in whole or in part without written prior consent is prohibited. Articles and other material in this magazine are not necessarily the views of Kentucky Doc Magazine. Kentucky Doc Magazine reserves the right to publish and edit, or not publish any material that is sent. Kentucky Doc Magazine will not knowingly publish any advertisement which is illegal or misleading to its readers. Kentucky Doc Magazine is a proud product of Rock Point Publishing.

Caring for the Underserved in Fayette County “If a free society cannot help the many who are poor, it cannot save the few who are rich.� – John F. Kennedy By Lowell Quenemoen, MD As Americans most have been secure in our needs for food, housing, safety and health. Health care has become more of a right than a privilege and has become more accessible thru expanded Medicaid, Medicare and the more recent Affordable Care Act. In spite of these, many continue to fall thru the cracks and that number may again increase with proposed changes in public health policy and program coverages. The underprivileged will continue to require care often not covered by government programs or limited insurance coverage and again are likely to fall back on the emergency room or urgent care facilities for primary health care. In Fayette County we are fortunate to have a number of medical programs for the uninsured, the under insured and the indigent and often homeless. Free clinics include Mission Lexington, Refuge Clinic at Southland, The Salvation Army Clinic and Surgery On Sunday. These clinics are staffed by volunteer unpaid physicians and operation of the program usually funded by donations, church congregations and fund raising events as well as foundations. The Salvation Army Clinic is staffed by medical students from UK and is supervised by a number of practitioners. Not only does it provide free care it also provides beginning medical students with early patient care experiences (See other article in this issue) Mission Lexington is a free clinic providing medical, dental, vision and pharmaceutical services to Fayette County residents whose incomes are below the federal poverty level. These are adults over age eighteen and may be self referred or sent by other agencies. Support comes from a number of churches including Calvary Baptist, Maxwell Street Presbyterian, First

Presbyterian, Good Shepherd Episcopal, Immanuel Baptist, Faith Lutheran and South Elkhorn Christian. Other support comes from individual donations as well as annual fundraisers, The Mission Lexington Gala. The clinic is located downtown at 230 S Martin Luther King and houses a large dental clinic with room for five dentists as well as techs and dental students. It opened in 2006 and now serves 180 to 190 patients per month and has a waiting list about 6 times as long. First appointments are 10 months out. The medical clinic opened in 2008 and is staffed by a number of physicians. Dr. Sam McGee is the medical director. The clinic currently sees about 85 patients per month with a slowed growth rate after the Affordable Care Act was put in place and Medicaid expanded. Dr. McGee relates that a number of patients were added with the demise of the Nathaniel Mission which for many of years had served the residents of Davis Bottom southwest of Rupp Arena. The area was disrupted with the Newtown Pike extension and the residents displaced to other areas of Lexington. Faith Pharmacy became part of Mission Lexington in 2015. Medications are donated by physicians and drug companies but recent regulation changes have limited donations and medications have to be purchased at wholesale prices. Controlled substances cannot be dispensed. It is estimated that 35 million dollars worth of prescription medications have been dispensed since 2002. It serves 135 patients each month. The most recent clinic added is the vision clinic staffed by volunteer opthalmologists and optometrists. Patients are evaluated with acuity exams and prescriptions given. Frames and lenses are available on a limited basis. The waiting list runs to about 75 patients.

Chris Skidmore, Executive Director, states that major accomplishments include care for 3,200 patients (a number growing each year), the growth of the medical and dental services and the recent addition on the vision clinic. These included 771 medical clinic patients, 1,531 dental clinic visits and 887 pharmacy visits. Ongoing needs include volunteers for the optometry clinic as well as more ophthalmologist volunteers. Dentists are in high demand as are Spanish speaking volunteers (5060% of patients are Hispanic). The major limiting factor as with most voluntary service organizations, remains funding. Free care programs in Fayette County include not only primary care, dentistry and vision clinics but outpatient surgical care as well. This is available thru the Surgery On Sunday (SOS) which is now in its twelfth year. Dr. Andrew Moore, ll initiated the program in 2005 with seed money from St. Joseph Hospital and with surgical suites and equipment provided by the Lexington Surgical Center. Over the years the program has grown to 400+ volunteers (physicians, nurses, clinical staff and administrative staff) who provide outpatient surgery on the third Sunday of every month. To date five thousand five hundred patients have been served. Procedures include hernia repair, cyst removal, gall bladder removal, cataract removal, carpal tunnel and other problems not requiring post op hospitalization. Cataract removal is in particular high demand with a long waiting list. At times diagnostic/treatment procedure are done such as colonoscopy with polyp removal. Usually each procedure is a three step process with a pre-surgical evaluation, the procedure and a post- op followup. Listed needs for the organization include more funding. The annual total revenue is about $300,000. Financial support for SOS is entirely thru individual donations,


doc • Winter 2018


In Fayette County we are fortunate to have a number of medical programs for the uninsured, the under insured and the indigent and often homeless.

grants and special events. The Lexington Rotary Club’s “ Dancing With The Stars” has become a significant contributor. Good Samaritan Foundation grants have also been a major contribution. Other needs include surgical supplies, office equipment and office supplies. More volunteer SOS anesthesiologists, orthopedic surgeons and gynecologists are in demand as well. Amanda Ferguson was appointed Executive Director in May, 2017. She has lived in Lexington all of her life and has been involved in many local organizations giving her a well founded knowledge of the community’s needs as well as its resources. In her role as executor for the local SOS her goal has been to provide services as inexpensively as possible compared to their free market value. SOS has established a permanent office at St. Joseph Hospital at 533 Waller Avenue and is identified with new signage. It is also initiating the REDCap system (Research Electronic Data Capture), a program developed at Vanderbilt to collect data for research studies and also for operational purposes. The success of SOS is reflected in similar programs being developed across the country. SOS has exported a template for many other communities who have recognized not only the humanitarian value but also the economic value of free outpatient surgical care. Hospitals have seen the value in treating the patients at earlier stages before major complexities develop and the patient requires a more extensive in hospital procedure and subsequent long hospital stays which may not be reimbursed. Similar programs are in operation in Omaha, Nebraska, Dallas, Texas, Macon, Georgia and close to home in Louisville. Thru an endowment fund at SOS they hope to provide seed grants and to “pay forward” with other similar programs. About the Author Lowell Quenemoen MD is a retired clinical neurologist having practiced in Columbus, Ohio for 20 years before moving to Billings, Montana for a further 15 years of practice. At the time of his retirement he was a Clinical Associate Professor at the University of Washington Medical School Department of Neurology. He is a graduate of the University of Minnesota Medical.

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Winter 2018 • Kentucky

Free care programs in Fayette County include not only primary care, dentistry and vision clinics but outpatient surgical care as well.

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doc • Winter 2018


Profile in Compassion

Friend to those who are ailing: Danesh Mazloomdoost, MD By John A. Patterson MD, MSPH, FAAFP Danesh Mazloomdoost, MD has inherited a tradition reflected in his name itself. In his family’s native Iran, Mazloomdoost means “friend to those who are ailing.” His life in medicine seems almost preordained by his family history. His father (a U.S. trained anesthesiologist who specialized in pain management) and mother (who trained in anesthesiology in Iran and retrained in psychiatry in the U.S.) built their practice around a comprehensive mindbody approach to pain management, long before such a collaborative approach was common. Their names are Manoochehr and Camellia (Shirazi) Mazloomdoost. In keeping with the family tradition, Danesh now practices with his psychologist wife, Andrea Z. Omidy, PhD. What inspired you to become a physician? “There were influences from both sides of my family. I never met my maternal grandfather; nevertheless, he was a tremendous posthumous influence. He



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was the quintessential family physician in a small Iranian town who then later became the regional health director and defender of human rights at a politically tumultuous time in Iran. Incidentally, before my parents met, my father worked under him in the department of public health. It was through my grandfather's encouragement that my mother pursued medicine when it was unpopular for women to do so. Unfortunately, in my mother's second year of medical school, her father, mother, youngest sister, grandmother and cousin were all killed in a tragic car accident. My grandfather had such an influence on the region that his body was hand carried 50 miles back to his hometown. Growing up, I was always reminded of his selflessness and compassion. This has been a value closely held by all members of my family. I was always drawn to the humanism of medicine and it's embodiment of our family values.” Why pain medicine? “When my parents immigrated to the US, they were both anesthesiologists but escaped Iran, like many other immigrants, starting from scratch. They had seen a lot of human suffering during the political fall-out from the revolution and war in Iran. So, after they immigrated, my mother sought psychiatry and my father pain management. All my free time growing up was spent at the family medical office helping in anyway I could. It was a large influence on my thinking as I sought higher education. While it was not intentional, my interests in pain started philosophically. Having heard the stories and seen the struggles of my parents both in immigration and in starting a practice in a novel field, the endurance of human strife and suffering fascinated me. What differentiated someone who coped well

from someone who capitulated to their stressors? What is the purpose of pain and discomfort? As an aside, Buddhism & Sufism more than any other philosophy helped me understand this. This combined with curiosity in physiology, neuroanatomy, and the existential perplexities of anesthesiology (where does the mind/soul go when anesthetized?) led me toward anesthesiology and subsequently pain. Beyond the immediate symptomatic complaints, every patient I see is a fascinating puzzle. It's a privilege to have insight into the physiology causing symptoms of pain as well as to gain insight into the variety of ways of coping with every patient I meet. It gives me a tremendous respect for the aging process -- our physiology and the limitations imposed by aging bodies. When I followed this line of thought, it was a natural evolution from managing the symptoms of pain, which is primarily my training, to ‘why is this hurting in the first place, and how can it be fixed?’ This is the reason we changed our name from Pain Management Medicine to Wellward Regenerative Medicine. I don't think it's enough to simply minimize the impact of pain with palliation. Rather, my thoughts go to the kinetics and pathophysiology causing pain, and then to ‘how do we leverage the healing mechanisms of the body to maximize its ability to heal?’ So I guess, it's not ‘why I chose pain’ but rather ‘how did I evolve from pain and into the regenerative practice that I now do.’ “ What role did kindness and compassion play in your parents’ pain management practice? “My parents were never in medicine for the money. If anything, they both turned down better paying jobs to do what they did with their practice. Many pain clinics with histories as old as theirs


Winter 2018 • Kentucky

Pain is not a condition, it is a symptom, and the underlying cause needs to be diagnostically worked-up. grew into mega-practices and devolved into impersonal operations. My parents intentionally chose to remain small so they could have 1:1 contact with their patients. And they often served the underserved, under-insured, or uninsured. I remember driving hours with my father to Corbin, Hazard, and Cumberland as he sought to aid those with limited access to healthcare. My parents’ embodiment of the humanistic side of medicine is largely what influenced my values and those of my siblings. As medicine has changed, I know that how they practiced is no longer sustainable, which is very disappointing. Even in the short time that I have taken over the practice, there have been so many changes in healthcare, making it evident that the system and values they embodied are challenging to sustain financially and personally. These days it seems that the volume of patients needed to make a private practice sustainable makes it idealistic (and uncommon) to invest emotionally as deeply as my parents did in the lives of their patients.” How do you and your wife practice together? “We practice kindness and compassion to each other regularly. I think if I wasn't married to a psychologist, I would have gone crazy by now. Her fellowship was in disordered eating. She meets individually with patients, focusing on over-eating and under-eating as part of our comprehensive regenerative medicine program that includes the association between diet and chronic pain. These lifestyle approaches complement our other regenerative modalities, including stem cell, PRP (platelet-rich plasma), and prolotherapy injections that mobilize the patient’s own cellular healing mechanisms, as opposed to the conventional injection therapies that can actually hinder progress with supra-physiologic steroid doses.” How does delivering compassionate care impact you, your marriage, your family? “It's difficult. I've always imagined myself as a father, but frankly we have tabled having kids because of the vision and mission we have sought in building this practice. It has a huge impact on our stress levels and endurance for additional challenges. Every individual can only delay gratification (starting a family, having financial stability) for so long, and setting limits has been an important lesson for me.”

What role does compassion play in addressing our opioid crisis? “It is really the loss of compassion, manifested by complacency and greed, that has created this epidemic. Chronic pain patients are stripped of their goals, vitality, sense of purpose, and dignity on top of any physical manifestations of pain. Yet, our healthcare system seems to enable dysfunction and hopelessness sometimes in subtle messages and other times in very blunt ways. Patients with pain have a morbid quality of life and are in a desperately vulnerable state. They have often been told ‘there is nothing that can be done for you and so you need to take this medicine – opioid‘ when in reality there are many non-surgical options yet unexplored. If they become problematic or have pain after what is deemed as a fix (surgery), then as a palliative option they are sent to a pain specialist to ‘get your meds because the government prevents me from helping you,’ For years, they'd been told that the solution to their ailment is a one-sizefits-all pill, we just need to get the dose right. This is an injustice, deftly marketed by pharmaceutical manufacturers. Often the evidence-based workup to understand the pain is ignored while palliating with opioids and as time goes on, the line is blurred between the original pain and the subsequent opioid dependency, hyperalgesia, or even addiction. Through an over-reliance on opioids, healthcare has forgotten that there are identifiable cause and effect relationships in pain. Pain is not a condition, it is a symptom, and the underlying cause needs to be diagnostically worked-up. Pain cannot be diagnosed simply from a radiographic image any more than hypertension can. Compassion comes in recognizing that the patient did not choose this direction. Yes, they share accountability but we also need to acknowledge the role society, healthcare and pharmaceuticals have played in creating this problem. Patients may cling to their medications because it's the only thing that gives the illusion of comfort. It is incumbent on all healthcare practitioners to correct the myths around opioids and pain. Patients often feel abandoned because they have been maintained on opioids for years and now all of a sudden, the system is changing around them. They become distrustful of the healthcare system because of the subtle messaging that conveys complacency or stigma around this topic. It is so critical for all clinicians to speak with a unified message to patients

Danesh Mazloomdoost, MD

that pain is a natural reflection of tissue damage that needs attention, some pain is unavoidable, and mitigating the symptom does not eliminate the disease. Most important of all, is changing how we approach the patient with a new onset of pain. The current model of health provides very little training in understanding pain. All clinicians need a better understanding of how injuries heal and why some do not- eventually becoming chronic pain. We need more centers that focus on the fundamentals of treating pain as a result of tissue damage, instead of just palliating symptoms or prematurely jumping to invasive surgery. Our rates of failed treatments (failed back surgery, unavoidable surgeries, routine steroid injections, or persistently painful joint replacements) are too high. This can change. “ How can we keep compassion alive? “My grandfather use to say, ‘People may act out but they do so because they are sick. It's my obligation as a physician to help them back to health.’ Compassion is easy when the other side is friendly and compliant. Our patience grows thin when they are not. What has helped me keep compassion alive is keeping that in mind. “ Lexington and southeastern Kentucky have been fortunate to have two generations of Mazloomdoosts offering innovative pain management based on a compassionate, humanistic, whole-person model of medicine- truly ‘friends to those who are ailing.’ About the Author Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine. He operates the Mind Body Studio in Lexington, specializing in stressrelated chronic disease and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org


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Winter 2018 • Kentucky


Promoting Resilience with Optimism and Mindfulness “Perpetual optimism is a force multiplier.” – General Colin Powell By John A. Patterson MD, MSPH, FAAFP The American Psychological Association (APA) recently documented a worrisome increase in stress in the U.S. population (Stress in America https://www.apa.org/ news/press/releases/stress/2016/copingwith-change.PDF ). Uncontrolled stress can cause or worsen anxiety, depression, PTSD and a wide range of clinical conditions affecting every organ system. Medical students, residents and practicing physicians experience higher levels of stress than their age-matched counterparts at all levels of medical training (Dyrbye, Academic Medicine 2014, vol 89). Burnout affects over half the physician workforce and suicides claim the lives of several hundred physicians yearly (Shanafelt, Mayo Clin Proc, 2015, vol 90). Yet most physicians are glad they chose medicine as a career and would recommend it to their children (AMA survey https:// www.ama-assn.org/survey-us-physiciansoverwhelmingly-satisfied-career-choice ). Why do some physicians suffer, leave medicine or die prematurely while others thrive? Resilience is a crucial protective factor against stress, job dissatisfaction, marital discord, the stress of parenting, substance misuse, burnout and suicide. What is resilience? The APA defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress–such as family and relationship problems, serious health problems or workplace and financial stressors. It means "bouncing back" from

difficult experiences.” The APA points out that “research has shown that resilience is ordinary, not extraordinary. Being resilient does not mean that a person doesn't experience difficulty or distress. Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed in anyone. (The road to resilience, http://www. apa.org/helpcenter/road-resilience.aspx ). The CEO of a resilience training company says “More than education, more than experience, more than training, a person’s level of resilience will determine who succeeds and who fails. That’s true in the cancer ward, it’s true in the Olympics, and it’s true in the boardroom.” (Harvard Business Review https://hbr.org/2002/05/ how-resilience-works ).

difference can mean living a long life or dying young. A pessimist is more likely to be selfcritical and take negative events personally whereas an optimist is more likely to be accepting of life’s ups and downs. Pessimists are more likely to interpret adversity as a permanent condition and stop trying whereas optimists accept a setback as temporary and try again. Pessimists are more likely to view negative external events as reflective of who they are as a person whereas optimists are more likely to compartmentalize such events to one area of their life and maintain their self-identity independent of external circumstances (Explanatory styles–How to boost optimism, https://positivepsychologyprogram.com/ explanatory-styles-optimism/ ).

Optimism promotes resilience Martin Seligman PhD is the director of the Positive Psychology Center at the University of Pennsylvania. His research suggests that optimists are more resilient than pessimists and more predictably bounce back from failures, divorce, job loss, financial insecurity and disability. Optimists are more likely to succeed in relationships, business, personal health, sports and academics. Pessimists tend to feel overwhelmed, anxious, depressed and give up rather than bouncing back. In Seligman’s model, optimists and pessimists differ dramatically in their ‘explanatory styles’, which he defines as “the manner in which you habitually explain to yourself why events happen” (Learned Optimism. Seligman, M., 2006). Optimists and pessimists differ in the stories they tell themselves to make sense of events in their lives. Simply put, an optimist’s cup is half full and a pessimist’s cup is half empty? The

Cultivating optimism with mindfulness The Center for Mindfulness at the University of Massachusetts Medical Center is the home of mindfulness-based stress reduction (MBSR), the ‘gold standard’ mindfulness program worldwide. MBSR training has been shown to benefit many clinical conditions and improve one’s quality of life and relationships. (Center for Mindfulness in Medicine, Health Care and Society https://www.umassmed.edu/cfm/ research/ ) The Mindful Practice Program at the University of Rochester School of Medicine includes MBSR in its curriculum for medical students, residents and physicians. (https:// www.urmc.rochester.edu/family-medicine/ mindful-practice.aspx ) Mindfulness training helps physicians improve communication, promote resilience, manage stress, prevent burnout, and improve the quality of care and the quality of caring by cultivating optimism



doc • Winter 2018


and compassion. Below are several foundational skills for living mindfully and becoming more optimistic and resilient. Here’s a suggestion. Take an openminded, experimental attitude and weave one or two of these practices into your life on a regular daily basis. They require no gym membership, no gear and no extra time- just your intention and commitment.

3. Practice being fully present. Be present rather than our common habit of thinking about the past or the future. Bringing your attention to your present experience (physically, mentally and emotionally) is a simple, but not so easy, way to widen your vision to a 3-D view of what is actually happening right now. This could reduce medical errors as you pick up on nonverbal cues in the doctor-patient conversation. It can help you spend quality time with loved ones and ‘smell the roses’ along life’s path. See How to practice the art of being present – https://www.mindful.org/ practice-art-being-present/ .

Proud to Partner with You 1. Slow down. The pace of our hurrying and worrying modern lifestyles is a form of self-violence that results in errors, chronic disease and premature death. Unhooking from the adrenaline habit of speed and simply slowing down, with intention, as you move throughout your day is a good beginning to mindful, optimistic, resilient living. See Slow down to get ahead – https://www.mindful. org/slow-down-to-get-ahead/ .

4. Listen deeply. Listen as others speak rather than being distracted by planning your response. The greatest gift you have for someone at home or work may be your genuine interest in what they have to say. Relationship-centered care is based on active listening and kind speech. See Deep listening – https://www. mindful.org/deep-listening/ .

6. Cultivate gratitude. Gratitude is the personality trait that some consider the #1 promoter of life satisfaction and emotional wellbeing. Consider keeping a daily journal of What went well and why, listing 3 things that happened this day that went well and anything you did that helped. Paying attention to the small things that went well is actually more effective as we learn to carry the attentiveness of things going well throughout our daily routine. See A Simple Exercise to Increase Well-Being and Lower Depression – https://www.brainpickings. org/2014/02/18/martin-seligmangratitude-visit-three-blessings/ .

5. Feel your emotions. Feel your emotions without wondering if it is ok to feel them. Though emotional intelligence (EQ) may not have been part of your medical training, it plays a huge role in both professional and personal

7. Allow awe into your life. It is increasingly recognized as good medicine. Hit the pause button and pull the car to the side of the road the next time you see a beautiful sunset or moonrise. Spend unhurried time in nature, with children and

Five Star Senior Living 2) Truly pay attention. Referral Pay attention ratherGuide than multi-tasking and running the risk of making errors and missing out on what’s actually going on around you. Skillfully, intentionally attend to patients, procedures and conversations with colleagues, staff and your own family members. Don’t drive distracted. See Three simple ways to pay attention – https://www. mindful.org/meditation-start-here/ .

life. Emotional journaling is a simple tool for raising your EQ. Whether pleasant or unpleasant, happy or sad, positive or negative- putting emotions into spoken or written words can have significant physical, psychological and interpersonal benefits. See Writing to heal – http://www.apa.org/ monitor/jun02/writing.aspx .

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Winter 2018 • Kentucky

CULTIVATE GRATITUDE List 3 things that happened today that went well and anything you did that helped.

pets. Be in awe of the wisdom of your own body’s function, the growth of your children and your good fortune to have friends or a life partner. Replenish your cup of awe regularly. See The art and science of awe – https://ggsc.berkeley.edu/what_we_do/ event/the_art_and_science_of_awe . 8. Trust your intuition, your 6th sense, your gut instinct. The more we learn about the ‘brain in the gut’ the more scientifically credible this deeply human sense becomes. At a minimum, don’t discount your ‘hunches’ about a patient’s diagnosis or the subjective experience of your own health and your family’s needs. See The science behind intuition – https://www.psychologytoday. com/blog/radical-remission/201405/thescience-behind-intuition . 9. Make and keep friends. This is an increasingly recognized crucial ingredient in wellbeing, happiness and even longevity. The impact of social support on physical and emotional health is compelling. As our society ages, this protective factor is becoming increasingly appreciated and cultivated. Being with positive people who help you laugh (and cry) is powerful medicine. See Enrich your life and improve your health – https://www.mayoclinic.org/ healthy-lifestyle/adult-health/in-depth/ friendships/art-20044860 .

10. Practice forgiveness. Forgive, not to condone a past injustice, but to take the heavy burden of resentment off your heart and mind. One of my favorite teachers describes holding a grudge as taking poison and expecting the other person to get sick. Thankfully, forgiveness is beginning to receive long-overdue scientific support. See Forgiveness- A sampling of research results, APA – https://www.apa. org/international/resources/publications/ forgiveness.pdf . 11. Be kind and friendly to yourself and to everyone else. Sadly, this is one of the most challenging tasks I encounter in my classes. So many of us are able to be kind to others but not ourselves. Self-kindness and friendliness are not selfishness or self-centered conceit. Rather, true kindness and compassion for others depend on a foundation of kindness and compassion for ourselves. All my classes end with a brief formal compassion practice. If I get in a hurry and forget- the class reminds me. See Compassion meditation – https://ggia.berkeley.edu/practice/ compassion_meditation . As we strive to keep alive the idealism, altruism and compassion that led us to choose medicine as a life’s calling, let us remember that our own well being is crucial to the well being of our patients, colleagues, staff, family and community. Taking good

care of others demands that we take good care of ourselves. Living mindfully and cultivating optimism can help us listen deeply, speak kindly, build resilience, manage stress, prevent burnout, cultivate compassion, promote health and even save lives- our own and those of all those we serve and love. May these thoughts, suggestions and resources serve you well. About the Author Dr. Patterson Chairs the Lexington Medical Society’s Physician Wellness Commission, is past president of the Kentucky Academy of Family Physicians and is certified in family medicine, mind-body medicine, integrative holistic medicine, mindfulness-based stress reduction (MBSR) and yoga therapy. He is a certified Physician Coach. He teaches MBSR for the UK Health and Wellness Program and Saybrook College of Integrative Medicine and Health Sciences (Oakland CA). He owns Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations and coaching, specializing in stress-related chronic conditions and burnout prevention for health professionals. He can be reached through his website at www.mindbodystudio.org



doc • Winter 2018


George Privett, MD:

Philanthropist and Board Leader By Robert P. Granacher Jr., MD, MBA Dr. Privett has practiced medicine in Lexington since 1973. After finishing his residency, he spent two years in the United States Army from 1971 to 1973 at Fort Bragg, North Carolina. He returned to Lexington thereafter to begin his neurology practice. He practiced clinical neurology for 15 years, from 1973 until about 1988. In 1988, he developed the Lexington Diagnostic Center shortly after MRI equipment was introduced into the United States. He continued there as Owner/ Medical Director until he sold his building, equipment, and practice in 2017. Dr. Privett has devoted his life outside neurology to philanthropy and board leadership in Lexington. During the 1980s, affordable low-income housing units disappeared and poverty expanded, which increased homelessness nationally and locally. In Lexington, the Fayette Urban County Government, formed the Mayor’s Task Force on Homelessness, chaired by Lexington social advocate Debra Hensley. This task force issued a report in October 1990 and called for the establishment of a 24-hour comprehensive service facility. Operating in Lexington at that time were the Community Kitchen and the Horizon Center. These two centers were merged into one facility and named the Hope Center. Cecil Dunn, the current Executive Director of the Hope Center, contacted George Privett MD and asked him to be on the board. He agreed, and Dr. Privett remains on the board of the Hope Center to this day. The Hope Center, started as an emergency food shelter, but it was used significantly by addicts and alcoholics, and Dr. Privett was instrumental in leading the Hope Center to begin a recovery center for these individuals using a modified 12-step program. Dr. Privett gave the lead donation to build the current building which opened

in 2008. Later, Don and Kathy Jacobs of Lexington helped build a cafeteria directly across the street from the new building. Currently, the Hope Center has expanded to include the Women’s Center on Versailles Road. Dr. Privett has joined the Hope Center Foundation board as well. In my recent interview of Dr. Privett, he related to me that currently, the Hope Center admits about 500 persons who sleep there each night. The Recovery Center for Men opened in March 2007, and in May 2008, the George Privett Recovery Center was opened. In 2009, again in part with Dr. Privett’s leadership, the Barbara H. Rouse Apartments, a 44-unit building, next to the Ball-Quantrell Jones Center for Women, opened in November 2010. This facility provides drug-free and alcohol-free permanent housing to women in recovery and provides an atmosphere that supports their continued sobriety. In 2012, again with support in part from Dr. Privett, the Don and Kathy Jacobs House was opened, a 154-bed facility that houses men learning to overcome addiction, mental health issues, employability deficits, and other challenges. The Jacob’s Hope Cafeteria provides three meals daily to those housed at the emergency shelter, the Don and Kathy Jacobs House, as well as those in the community in need. Four hundred and fifty meals daily are served. Dr. Privett’s benevolent philanthropy and medical leadership have led to the current Hope Center as a central part of Lexington’s service to the homeless, addicted, and mentally ill populations. Currently the Hope Center also operates the Jail Recovery Program for addicts who have been incarcerated in Lexington. Another project that has benefitted from Dr. Privett’s involvement is the One Parent Scholar House on Horseman’s Lane in Lexington, near Red Mile Road. This is a community program for single parents who are full-time students in a college educational program. The primary purpose of the program is to help single parents and their young children develop

the educational and family life skills needed to achieve self-sufficiency. Single parents can more easily attend to their college studies, knowing their children are safe in an accredited daycare program. The Hope Center board oversees this program and provides philanthropy and administrative support to it. In addition to his Hope Center duties, Dr. Privett served five years on the board of Recovery Kentucky. Recovery Kentucky was created to help Kentuckians recover from substance abuse, which often leads to chronic homelessness. There are 13 Recovery Kentucky centers across the Commonwealth that range geographically from Paducah to Hindman. These centers provide housing and recovery services for up to 2,000 Kentuckians simultaneously across the state. To build one of these centers, the State of Kentucky requires the selected city to provide the land, an active board, and a mission of commitment to the specialized housing and programs therein. Dr. Privett has always had a special place in his heart for music. When Dr. Everett McCorvey came to the University of Kentucky in 1991 to join the University of Kentucky Music Department, while directing its opera studies program, he recruited Dr. Privett to financially assist with developing the Lexington Opera Company. Later, Dr. Privett assisted Dr. McCorvey to develop the “It’s a Grand Night for Singing” program presented yearly in Lexington. Dr. Privett remains an emeritus member of Opera Lexington, formerly Lexington Opera Company, and he remains an active donor. He has been a long-time donor to the University of Kentucky Symphony Orchestra and the UK Chorale Program. Among his many achievements, George serves on the Board of Trustees of Centre College, and he has previously served on advisory boards of the Florence Crittenden Home in Lexington, and as an elder at Maxwell Street Presbyterian Church. Dr. Privett and his wife received the UK Community Service Award in 2012. He was awarded the Distinguished Service Award by

Dr. Privett’s benevolent philanthropy and medical leadership have led to the current Hope Center as a central part of Lexington’s service to the homeless, addicted, and mentally ill populations.

the Kentucky Music Education Association. In 2008, George was given the Lauren K. Weinberg Humanitarian Award by the Kentucky Conference for Community Justice. Dr. Privett’s life has been a sterling example of practicing medicine for the benefit of the citizens of Kentucky while at the same time maintaining a life of great service and philanthropy to the homeless, addicted, and mentally ill. On the lighter side, he has helped advance opera, chorale music, and orchestral music in our community. He is to be admired for his life successes and the immeasurable social benefits, beyond medical practice, he has provided to the Lexington community.

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doc • Winter 2018


A Lifeline for Kentuckians By Thomas J. Goodenow, MD Early on a cool, crisp autumn morning, Dr. Paul Kearney addresses his fellow surgeons and other volunteer medical professionals just before they embark on a busy day at the Lexington Surgery Center (LSC). Many of them have already been preparing the facility since before sunrise as a part of the monthly ritual known as Surgery on Sunday (SoS).  Dr. Kearney chairs the board of directors for this organization, which is the brainchild of Dr. Andy Moore, who has served Lexington as a plastic surgeon for about forty years.  SoS was founded by Dr. Moore in 2005, fulfilling a longstanding dream to help people who were difficult to care for because they were "falling through the cracks" of the health care system – specifically, patients who needed outpatient surgical procedures but lacked the financial wherewithal or adequate insurance coverage.    The not-for-profit SoS is now in its thirteenth year of providing essential outpatient surgical services, at no cost to the patient, for income-eligible, uninsured or under-insured individuals who do not qualify for federal or state assistance.  Some procedures – for example, endoscopies and some eye or dental care – are performed by volunteer specialists in their offices, but most operations are performed by other volunteer surgeons and staff at the LSC, which has generously provided free use of its outpatient facility on Harrodsburg Road since the program's inception. SoS patients never receive a bill.  The program pays for most of the surgical supplies (about $300-350 for most cases) through the help of generous donations from the community and sometimes with

materials donated by surgical supply vendors themselves. All of this brings down the cost of the operations with no sacrifice in quality.  Each individual receives the same attention and excellent care that would be afforded to a private patient with excellent insurance. Pre- and postoperative evaluation and diagnostic testing are covered.  In the rare circumstance where postoperative hospitalization is needed, coverage is also provided through an agreement with all of the local hospitals and their volunteer staff.  No payment for the operation and these services is required of the patient, who merely needs to complete a survey afterward and is asked to provide a testimonial.

SoS patients never receive a bill. The program pays for most of the surgical supplies (about $300-350 for most cases) through the help of generous donations The SoS service area basically encompasses a circle within a 250-mile radius of Lexington.  Originally the program was intended for the uninsured who were earning less than 200% of the federal poverty level, but the financial eligibility criteria have changed in the last few years.  With the implementation of the Affordable Care Act, the uninsured population in Kentucky fell by over half, but deductibles became more expensive.  So, to qualify for SoS now, patients generally may have household incomes up to 250% of the federal poverty

guidelines, and they must be uninsured or have a deductible plan that requires payment of 10% or more of household income. (SoS does not provide financial assistance for individual needs.) In addition to geographical and financial criteria, patients are ineligible if their body mass index (BMI) exceeds 35, if the surgery is purely for cosmetic purposes, or if the procedure or operation cannot be performed on an outpatient basis.  The main goal of SoS is "to rid the patient of disease and pain without a financial burden."  A wide range of operations in several surgical subspecialties is provided.  (For examples, see the SoS web page.) Most patients are referred by private or governmental agencies – for example, health departments or occupational groups – but private physicians often make referrals, and even self-referrals are permitted.  A preoperative evaluation by an appropriate surgeon is necessary, a process that might take 30-60 days. Total wait time from referral to operation is generally about 60-90 days. Over the life of the program, 400+ medical professionals, including about eighty surgeons, have freely donated their time and expertise.  "We've got a great group of surgeons, anesthesiologists, nurses, and other clinical staff,”  says Dr. Moore.  "They're the real core of our organization – just amazing people!" SoS has handled about 10,000 referrals.  Not all have required surgery, but over 5,700 of these have been provided a surgical service through the program. At the LSC itself, typically ten to twenty operations in about five operating rooms are performed monthly, with 5-8 volunteer personnel involved in each OR.  To provide these services, SoS depends not only on individual volunteer participation.  It also partners with several local organizations and relies on charitable


Winter 2018 • Kentucky

contributions, aided by its own special fundraising events. A tight budget and efficient management reduce the cost of surgery to a level below what is typical for the service provided. This also means that eight out of every nine dollars that is raised will go directly to patient care.  When Dr. Moore first visualized SoS, he looked for ideas and inspiration from other cities across the country but was surprised

to find nothing similar anywhere else. SoS is truly the first of its kind, and its success has not gone unnoticed.  It has received several awards; and it has confirmed the old adage that imitation is the sincerest form of flattery.  Now Louisville has an SoS program, and similar organizations can be found or are being contemplated in Ohio, Tennessee, Alabama, and Texas as Lexington's Surgery on Sunday continues to epitomize the best of

community involvement through physician volunteerism. (To learn more about SoS and how to become involved, see www.surgeryonsunday. org or call [859] 246-0046.) About the Author Dr. Goodenow practiced medicine for 42 years, the last 37 as an endocrinologist at the Lexington Clinic.



doc • Winter 2018



EMAIL brian@rockpointpublishing.com TO SUBMIT YOUR NEWS

Saint Joseph East Named Center of Excellence in Robotic Surgery Saint Joseph East only facility in region to receive designation by Surgical Review Corporation Lexington, Ky. (December 28, 2017) – The Surgical Review Corporation has named Saint Joseph East, part of KentuckyOne Health, a Center of Excellence in Robotic Surgery. Saint Joseph East is the only hospital in the central Kentucky area to receive this designation, which is based on volume, outcomes and the different types of procedures offered within a program. Saint Joseph East offers the da Vinci Xi surgical system, the most advanced technology available for minimally invasive surgery. The da Vinci Xi Robot allows surgeons to perform the most complex and delicate gynecological, urological and general surgery procedures through very small incisions with unmatched precision. Using a console, surgeons control in real-time the equipment being used on the patient, offering surgeons precision and vision far beyond what their own hands and eyes could provide. “It is an honor to be the only hospital in the region to receive this designation from the Surgical Review Corporation, which further demonstrates our strength in robotic surgery,” said Mike Guiler, MD, Saint Joseph East. “Robotic surgery helps our hospital offer patients the most advanced technology, leading to shorter hospital stays, faster recoveries and minimal scarring. At Saint Joseph East, we have dedicated staff with leading-edge technology skills that are specifically trained for robotic surgery. This technology is certainly an asset to our hospital, patients and the community.” Robotic surgery offers a minimally-invasive surgical option for patients facing an open procedure, helping give surgeons magnified and high-definition vision. Using the da Vinci technology, the surgeon can both see inside the body and control the surgical instruments with much smaller incisions.

The Center of Excellence in Robotic Surgery (COERS) program was developed to recognize surgeons and facilities worldwide performing robotic procedures and achieving defined standards for patient safety and care quality. The COERS designation requirements were developed to address the present and future needs of patients and providers, and they are coupled with an objective evaluation process that enables a thorough review of each candidate. Along with Saint Joseph East, Saint Joseph Hospital also offers the da Vinci Xi surgical system.

Brian Chaney MD, CPE, FAAFP of Baptist Health Medical Group Powderly receives Certified Physician Executive credentialing through American Association for Physician Leadership® Madisonville, KY. (December 28, 2017): The American Association for Physician Leadership® announced Dr. Brian Chaney of Baptist Health Medical Group Powderly has earned the prestigious Certified Physician Executive (CPE) certification. CPE designation indicates a physician has achieved superior levels of professional excellence and management education while also demonstrating effective health care industry knowledge and leadership skills. “Physicians are becoming increasingly involved in healthcare management roles,” said Chaney. “Leadership skills such as collaboration, communication, change management and conflict management are essential. Medical school and residency training does not prepare physicians for these areas. In becoming a certified physician executive, I have taken courses to learn these skills which will make me a more effective member of the healthcare management team. It also puts me in a position to help problem solve and improve the overall

quality of care that is delivered to patients,” Chaney added. Dr. Chaney currently practices Family Medicine at Baptist Health in Powderly. He also serves as Medical Director of Primary Care, Madisonville Market, Baptist Health Medical Group and Medical Director of Hospice for Baptist Health Madisonville. The certification is the industry benchmark for CEOs and executive recruiters seeking the most accomplished and influential physician leaders. It speaks to the physician’s commitment to improving patient care. “The contemporary challenges facing health care today require physician leaders who can interlace clinical knowledge, seasoned leadership skills and superior management acumen,” said Dr. Peter Angood, president and CEO of the American Association for Physician Leadership®. The American Association for Physician Leadership® is the nation’s largest organization solely focused on leadership education and management training for physicians. Chartered by the American Association for Physician Leadership® to establish and maintain the high standards required for physician executive certification, the Certifying Commission in Medical Management has a 20-year history as a national, not-for-profit corporation certifying physicians specializing in medical management. The Certifying Commission in Medical Management currently lists more than 3300 Certified Physician Executives.

University of Kentucky Markey Cancer Center Study A new study published in Nature Communications and led by University of Kentucky Markey Cancer Center researcher Qing-Bai She identifies biomarker targets that may make existing drugs more effective in fighting certain cancers. The mTOR protein is a central regulator of cell growth and division. Abnormal activation of mTOR protein results in limitless cell divi-


Winter 2018 • Kentucky sion in many human cancers. Though mTORtargeted drugs exist, their effectiveness has so far been limited, possibly due to the loss of the mTOR downstream effector 4E-BP1, a key repressor of protein production. The study identifies Snail, a nuclear transcription regulator known to promote cancer progression, as a strong repressor of 4E-BP1 expression. She’s team found an inverse correlation between Snail and 4E-BP1 levels in colorectal cancer, the second leading cause of cancer-related mortality in the United States. This study shows promise that the Snail level may serve as a predictive marker to tailor personalized treatments using mTOR-targeted drugs. Physicians may be able to prescribe treatment for cancers that have high Snail/low 4E-BP1 activities, using cancer drugs that are already in clinical development. "This finding has significant clinical ramifi-

cation, because incorporating the analysis of Snail and 4E-BP1 expression in cancers may help to prospectively identify resistance to mTOR-targeted drugs in the clinic," said She, associate professor in the UK Department of Pharmacology & Nutritional Sciences.

KentuckyOne Health and Appalachian Regional Healthcare Sign Letter of Intent for Exclusive Negotiations for the Sale of Saint Joseph Martin Lexington, Ky. (December 19, 2017) – KentuckyOne Health and Appalachian Regional Healthcare (ARH) have confirmed today a Letter of Intent for the exclusive negotiation of the sale of Saint Joseph Martin. This

agreement is the next step for the future of health care in the Martin, Kentucky community. If a definitive agreement is reached, it would establish the continuation of local ownership and operation of this important care facility. Saint Joseph Martin has served the people of Floyd County since 1947, delivering care to meet the unique needs of this community with excellence, quality and compassion. By working with Appalachian Regional Healthcare, a leading local care provider with a deep understanding of the needs of patients, community partners and care providers in Martin and across Floyd County, KentuckyOne Health believes the vision for health and wellness in this area will continue.

DID YOU KNOW? • 38,000+ Kentuckians are infected with Hepatitis C.*

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doc • Winter 2018



Salvatio By Connor Appelman and Marc Kai


rom humble beginnings as a curtainedoff corner of the Salvation Army cafeteria to a 3-room acute care clinic serving hundreds of patients every year, the University of Kentucky Salvation Army Clinic (SAC) has been a leader in providing care for underserved patients in the Lexington community for over 30 years. The SAC provides free medical services to patients while working to increase community awareness of local healthcare resources. Primary care services are delivered onsite every Tuesday and Thursday evening along with basic lab and pharmacy services. In recent years, the SAC has expanded its scope of service by adding clinics for smoking cessation counseling, nutrition, pediatrics, women’s health and ophthalmology. A partnership with the Bluegrass Community Health Center allows the SAC to refer patients to a clinic where they may establish more comprehensive and affordable long-term care. Patients are also offered free taxi vouchers to transport them to these outside appointments, helping to eliminate lack of transportation as a barrier to care.


Winter 2018 • Kentucky



A team of 22 second-year medical students oversee the operations of the clinic each year. These students go above and beyond to balance the workload of a medical education with their duties managing the clinic. Each officer team works to build upon the successes of previous teams while implementing new creative ideas and initiatives to further the mission of the SAC. Providing treatment to patients in need and bridging gaps in access to care is no small task, but this weekly challenge is met by the tireless dedication of dozens of medical student and physician volunteers. Benjamin Wagner, a third-year student in the University of Kentucky College of Medicine (UKCOM), cites the opportunity to work at the SAC as one of the primary factors in pursuing a medical education at the University of Kentucky. He said, “I really appreciate our school's commitment to providing care to those who need it, starting from our first year in med school.” Wagner, a recent recipient of the Brian W. Adkins Award for Outstanding Service at the Salvation Army Clinic, relishes the opportunity to play a role in extending care to women and children with severely limited access to healthcare at the Salvation Army. “We may not be able to fix every problem a patient comes in with at SAC, but we can start to address them in a systematic way, connecting them with resources and next

steps,” Wagner said. “Refills on prescription meds that haven't been filled in six months because the patient is between jobs, or access to a smoking cessation clinic because a patient has always wanted to quit but didn't know how to start, or even navigating the insurance system in an environment that is often not here to serve them, goes such a long way in keeping these women and

children healthy.” Wagner considers his time at the clinic as central to his medical education saying, “The attendings who volunteer at SAC have such a huge heart for this patient population and are so gentle, respectful, and affirming in their bedside manner – often I leave SAC having gleaned a better picture of the kind of doctor I want to be.”

SAC Officers; Pictured: (Front L-R) Erika Russ, Hannah Ruggles, Ashley Wicker, Jacob Meece, Sara Keshtvarz, Taylor Moody, Maria Alkhasova, Whitney Powell, Molly Sullivan, Kandice Roberts, Mitch Gigandet; (Back L-R) Connor Appelman, Lewis Winder, Michael Miller, Hasanki Warnakula, Paran Davari, Marc Kai, Sarah Boden, Elise Garrett, Anna Hansen, Jacob Hambrick, Matt Silverman. Not pictured: Abby Bray.


doc • Winter 2018


“The attendings who volunteer at SAC have such a huge heart for this patient population and are so gentle, respectful, and affirming in their bedside manner – often I leave SAC having gleaned a better picture of the kind of doctor I want to be.” – Benjamin Wagner, third-year student in the University of Kentucky College of Medicine

This highlights the role of the Salvation Army Clinic as an important teaching environment where students at the UKCOM receive instruction and mentorship from physician volunteers. Dr. Reema Patel, a fellow at the University of Kentucky, embraces her role as a teacher. She said, “We make an impact by grooming young medical students into caring and adept physicians,” she says, noting that “early exposure to patient care allows us to see them grow into the next generation and this is extremely satisfying.” She went on to say, “Working with our medical students is always a fresh reminder of why I signed up for lifelong learning and patient care. Their excitement at learning new skills or facts keeps me motivated and can wear an entire day of stress away.” Patel is proud of the work volunteers do at the SAC and through her service, she hopes to inspire her colleagues to embrace and share their passion with students. Dr. Terrence Barrett, Chief of Digestive and Nutrition Sciences at UK

HealthCare, has volunteered at the SAC for over four years and has mentored many students along the way. “I think it is important for physicians to set an example of service for students who will become future doctors,” Barrett said. Despite his often-busy schedule, Barrett draws upon a sense of empathy and justice to make time to extend care to patients with limited healthcare access. For decades, the spirit of service and compassion exemplified by these extraordinary volunteers, and so many others, has created a welcoming clinic environment for patients with extraordinary needs. Each week at the Salvation Army Clinic, teams of volunteers proudly continue this tradition of service while working diligently to improve the health and wellbeing of vulnerable patients in the Lexington community. For more information please visit: http://uksac.org/ To apply to become a physician volunteer email: connor.appelman@uky. edu or marc.kai@uky.edu

University of Kentucky Salvation Army Clinic Hours: Tuesday and Thursdays 5:30-9:00pm Patients seen on a first-come, first-serve basis. Please sign in at the front desk of the W. Arnold Hanger Lodge beginning at 4:30pm. Location: 736 West Main Street, Lexington, KY 40508 Phone: (859) 488-1223 Fax: (859) 243-0206

About the Authors Marc Kai and Connor Appelman are second year medical students at the University of Kentucky College of Medicine. They serve as the Salvation Army Clinic Managers for the 2017-2018 year.




Winter 2018 • Kentucky

Grand Estate 4667 WINCHESTER RD. FAYETTE COUNTY | $1,595,000 LEXINGTON, KY 40509 Grand estate home with idyllic manicured grounds to please the most discernible buyer! This estate home is on 12.28 acres of beautiful land. The copious master bedroom with it’s own secret room is located upstairs with 3 additional bedrooms plus 1 bedroom/bath/kitchen/ sitting room apartment/in-law suite is located on 1st floor. Architectural details in this home create a very distinctive grandeur which is easily perceived from the stately gated entrance. Views of the property are magnificent from virtually every window inside the home. Please verify schools with Fayette County Public Schools due to potential redistricting for the 201617 school year and beyond. Black barn with six stalls on corner of property is negotiable! Home featured in the KY Home Garden Magazine Jan./Feb. issue 2017.

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Woman Physician Leadership Series Tuesday, March 13, 2018 Ardis Hoven, MD: Perspectives on Leadership In honor of Women’s History Month Registration Fee: Free to LMS Members. $60 for non-members.

Register at: Lexingtondoctors.org 6:00pm–8:00pm 21C Museum Hotel (167 W. Main St., Lexington) 6:00 Social, browse the art museum 6:30 Dinner 7:15 Program

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The University of Kentucky and Kidney Transplantation in Honduras:

Compassion & Coo By Thomas Waid, MD Compassion does not know city limits or county lines. Neither state nor international borders can contain such acts of altruism. For the last four years two surgeons and one nephrologist have travelled to Honduras to perform living donor kidney transplantation thereby expanding the art and science of transplant surgery and medicine in Central America. In August 2006 a young Honduran woman arrived in Lexington accompanied by her mother and brother. She was referred by her nephrologists, Plutarco and Prospero Castellanos, to be evaluated for kidney transplantation. Although kidney transplantation had been performed in Honduras since 1986, the program was not active at that time. Because of medical coverage issues the transplant couldn’t be done expeditiously, so the UK Transplant center’s social workers arranged accommodations in Lexington until a suitable contract could be negotiated with

the insurance company. Eventually the patient was able to undergo live donor transplantation from her mother prior to starting dialysis and travelled home to Honduras four weeks later to be followed by her nephrologist, Dr. Prospero Castellanos. Eleven years later she is still doing well with excellent kidney function. Why was UK chosen to transplant this patient when centers in Mexico or Florida were closer? Indeed, it was because of our nephrologist Analia Castellanos MD, daughter and niece of Plutarco and Prospero respectively. However, the story doesn’t end with one patient encounter. The Social Security Hospital in Honduras had accomplished living donor kidney transplantation in the past with members of the team being trained in different countries and with affiliated efforts afforded by the Social Security Hospital in Mexico. More recently transplant surgeons and a nephrologist from Toledo Hospital in Spain also participated in the transplant activities from 2008 to 2010. The program often stalled because of inconsistent staffing and support.

In 2013, the UK Transplantation program sent a team of three surgeons and physicians to Honduras to rekindle the program. The team consisted of Dr. Steve Strup, Chairman of Urology and laparoscopic donor surgeon, Dr. Roberto Gedaly, Chief of Abdominal Transplantation and Dr. Analia Castellanos, transplant nephrologist. Laparoscopic live donor kidney donation had not been done in Central America and the first procedure of its kind in Honduras was performed by Dr. Strup. The donors and recipients all did well and were cared for by nephrologists, Plutarco and Prospero Castellanos. These clinical efforts established a Central American teleconference to provide transplant education and to discuss difficult cases with other transplantation programs. Then, in 2015, Drs. Gedaly, Strup and Castellanos travelled for a second time to Honduras to perform more live donor kidney transplantations and to continue the training of local surgeons and transplant team members thereby making the program more self-sufficient. Since then, and with close contact and ongoing discussion between UK and the Honduran team, living related donor


Winter 2018 • Kentucky


operation kidney transplantations have been performed independently and without donor or recipient complications. In September 2017, Dr. Analia Castellanos travelled to Honduras as an invited speaker participating in the first transplant symposium ever held in Honduras. In addition to participating in that symposium, she helped to provide education and training to nurses and ancillary personnel caring for patients with chronic kidney disease, end stage renal failure and kidney transplantations. Compassion and altruism are borne out of love and respect for ones fellow man, and such is the origin of the effort described above. However, this effort has gone several steps beyond by providing training and self-sufficiency to those involved. In so doing it improved the lives and wellbeing of the patients who received care and also enhanced the skills and confidence of those practitioners who rendered the service. Compassion and altruism have thus become beneficence, and the collaboration has taken a major step toward sustainability. About the Author Thomas Waid, MD, MS, is a professor of internal medicine specializing in nephrology at the University of Kentucky College of Medicine. He graduated with a Bachelor of Science degree in pharmacy from the University of Cincinnati in 1972. He received his master’s degree and medical degree from the University of Kentucky in 1980.

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2018 doc • Winter 2018 • Business Section





Business Section • Winter 2018 • Kentucky

By Jim Ray Have you begun your business planning for 2018? If you’re looking for a few places to start, I’d like to offer some recommendations. The process of putting together a detailed plan is what I refer to as The 2018 Business Imperative. There’s an old adage, “If you aim at nothing, you’ll hit it every time.” Quite frankly, we work too hard to let that be the case. Performing a deep dive into your key metrics, not just revenue numbers, will show you things you may have missed during the year. Outliers are one thing, but identifying specific trends and comparing them to the assumptions you made at the start of 2017 can be quite telling. Nonetheless, this is simply a postmortem. It’s historical. We need to turn our attention to the upcoming year. There are new markets emerging, new technologies to help you and new capabilities you’ve developed, even if it’s just because you’re a year more experienced than you were. How can you leverage these changes (this evolution) in terms of your business as well as your clients’? Where will you invest in 2018? I recommend you divide this into 2 key areas: Money and Time. In terms of your financial investment, it usually can be broken out into personnel, training and equipment. As for your time, take a hard look at your processes. Are you actually spending the majority of your time on the activities that generate the most cash? If so, continue the DIY approach. If not, it may be time to consider outsourcing or delegating. For most of us, letting go of the reins can be one of our greatest challenges. Remember, this may be the very decision that’s been holding us back from achieving significant progress. One important question I’ve often asked clients is: What are you willing to put down on paper? I’m trying to get you to consider defining those goals, actions, activities and changes that will significantly impact your business in 2018. More importantly, I want you to define for yourself those issues you’re willing to actually commit to, on paper. Something interesting happens when we actually write it down. We begin the process of visualizing the goal(s), as well as the steps necessary to achieve them. Like any road trip, you have to begin with the destination in mind. It’s interesting how many people don’t take their planning to this logical step. It’s almost as if they’re afraid of committing,

because that creates the risk that they may fail in the endeavor. Can I share a secret? There are really only 3 outcomes in this process: • Growth • Stagnation • Irrelevance The point is, it’s your choice. In many cases, it’s up to you. It’s the very reason you started this journey in the first place. Beginning right now, you have the opportunity to reinforce, refocus and refine your vision. Aligning your 2018 business goals with your overall vision provides clarity. Then, it’s simply a case of laying out the path you’ll use to get there. This exercise provides you the opportunity to look objectively at your situation and to move toward the desired outcome. You have a clean slate, if you’ll take advantage of it. As you wrap up 2017, it’s time to focus on the 2018 business imperative. Understand what happened this year. Evaluate it against the assumptions you made. Adjust to take advantage of what’s changed. Then charge forward with clarity and determination. I hope you’ll take time to step away from working in your business, to spend time working on your business. If you’ve never gone through this type of exercise, I can help. If you want to tackle it on your own and then discuss your plan,

that’s another option. Let me encourage you to have someone review your plan. It’s a way to gain valuable perspectives that can validate where you’re heading, or possibly keep you from going down the wrong path. Business planning enables you to stretch beyond your comfort zone. It may be what keeps you from stagnating or worse yet, achieving irrelevance. The new year will be full of changes and opportunities. Thanks to those of you who trusted me to help impact 2017. Now it’s time to climb higher so we can reach for bigger dreams. After all, we work too hard to settle for anything less, right? About the Author Jim Ray earned a BA in Business and his MBA. He managed two multi-million dollar businesses before transitioning into Internet consulting. He later launched his regional consulting practice to help professionals operate more effectively and more profitably. Jim presents an ongoing seminar series and contributes business development articles to a variety of professional publications. He has been invited to speak at national meetings for Internet marketing and has lead several, national webinars on various marketing topics. For more information, visit www. JimRayConsultingServices.com or connect with him on Linkedin.

Performing a deep dive into your key metrics, not just revenue numbers, will show you things you may have missed during the year.





It’s a Conversation, Not a Consultation

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


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Identifying if and where Sound Voids® are occurring


Finding the right hearing solution for your needs

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

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on Marketing Your Practice

Website Content Branding Email Marketing Social Media

and Why It Matters

By Tonya Howe, Digital Marketing Strategist PurplePatch Innovations Marketing for a practice is just as important as a retail store or online business. With patients having the ability to choose their general practitioners and their specialists alike, it's more important than ever to have a marketing strategy so you aren't lost in the mix. Long gone are the days of there being only one doctor in town that everyone went to see with no questions asked. Now, people have the opportunity to make their decision based on patient feedback, ratings, etc. Here are 5 Tips to market your practice and why it's important. 1. Have a website The importance of a site is that you are allowing potential patients and their families to get to know you and your colleagues before they come into visit you. This should be a professionally designed and maintained site, and should be updated consistently and not outdated. Also, a site that is maintained properly and has SEO performed on a regular basis will build your ranking on google so potential patients can find you. According to Pew Research Center, 72% of U.S. Adults have searched online for health information. You want to be the one they find in that search. 2. Content You want to create custom content for your site and it should be of a quality that will attract and inform patients about your practice, your qualifications, services and procedures that you offer. This includes the content on your site as well as incorporating a blog that adds new information on a regular basis. This helps in searches to bring potential patients to you. People today are hungry for information and they take to the internet to get that information. You want to be the one that is offering the best information that is written for the lay person and is helpful and educational in nature.

3. Branding Establishing a brand for your practice will help patients recognize your practice through different mediums, i.e. your website, social media, blogging, advertising, etc. Your branding should be relevant, eye-catching, professional and evergreen in nature. Create one message and look that will carry through all of your digital and print marketing efforts. 4. Email Marketing Marketing through email is still one of the highest converting forms of marketing. There is so much you can do with even a simple email campaign. This keeps your patients engaged with you and allows you to keep them informed with new information and services or products that you offer. It allows them to get to know you even better which builds trust and if they trust you they are more likely to refer you to others that they know and word of mouth is the best form of advertising. 5. Social Media This is such a great way to connect with your patients and influencers in your field. Being on social media personally is one thing but for a business, it's imperative if you want to really connect with your customers and your patients are your customers. It's where they live and that is where you need to be. It also helps to keep your patients updated on what is going on with your practice and offers an easy way for you to keep them informed with health tips and other educational information. Bonus Tip - YouTube Creating short, educational videos that can be posted on your site, your blog, social media pages and used in online advertising is monumental in reaching existing patients as well as new patients. Video has been proven to be the best way to get your message across as most people will stop to watch a video with subtitles than take time to read a post with no video or image.

When you are ready to either update your online presence or create one from scratch it is recommended to work with a professional that can create a marketing strategy for your practice. There are so many other aspects that dictate your success online and are just too numerous to include in this article. Your marketing strategy should address what your goals are and include a marketing plan that fulfills your needs in what potential and current patients see about you and your practice as well as meet the needs of your patients. When all of this is done correctly and in concert with each other, it builds trust and a connection with the one person that your patients trust with their lives‌You! About the Author Tonya is the owner of PurplePatch Innovations and an expert in digital marketing strategies. She works with businesses all over the world to help them bring their business online in a way that is beneficial not only for the business but also the customer. She works closely with each client to map out and execute a strategy to help them grow their business online through multiple mediums. Tonya's education spans over many years and started in computer programming. With the invention of social media, she continues her education on a regular basis to keep up with changing strategies and techniques to be able to bring them to her clients. PurplePatch Innovations offers a full suite of services from custom websites to digital marketing and advertising to content creation. Their passion is working with small to mid-sized businesses and they strive to do it in a way that is affordable and profitable to the client. Contact Information tonya@purplepatchinnovations.com www.purplepatchinnovations.com 859-363-5680


Family Practice Associates of Lexington, P.S.C.







Take Care of Your Patients by Taking Care of Yourself

The Lexington Medical Society

Physician Wellness Program

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

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

Some examples of those difficulties include: •

Family issues

Depression & anxiety

Relationship problems

Difficulty managing




Mood swings

Alcohol/drug abuse

Suicidal thoughts

How PWP Works We have contracted our program with The Woodland Group. The Woodland Group will provide counseling to active physician members of the Lexington Medical Society and UK Graduate Medical Education 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 8 free sessions each calendar year Complete confidentiality Easy access Convenient location (535 W. 2nd Street, Suite 207) 24/7 availability


Helping you Develop the Practice

20+ Years of Driving Results, and Being Measured by Them

You Envisioned

businesses grow. I work to

What can a consultant do for you? Think of me as both an “outsource resource,” as well as a coach to help:  Make sense of your competitive environment,  Leverage available tools to your advantage, and  Ensure you accomplish goals important to your personal vision.

Arrange a confidential discussion about the challenges you face.

I’m a coach with practical experience helping professional help you market your practice, differentiate your services and increase your patient base.

 502.208.9639  jimrayconsultingservices.com  /JimRayConsultingServices  /jimray4  Listen to My Business Podcast on iTunes

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Kentucky Doc Winter 2018  

Kentucky Doc Winter 2018