Living Between the Dates

As a cancer physician, reading obituaries is, unfortunately, part of my job description. I don't mean to be morbid about it. Not everyone who gets cancer dies from it - far from it. We cure two-thirds of cancer today. But we still have a long way to go.

I recently read my father's obituary. Oh, he hasn't died yet. My mother, you see, is nothing if not organized. So both of my parents' obituaries have pretty much been written for some time now.

Obituaries are fairly emotionless documents. They also don't often convey the true sense of who a person is. Usually, an obituary is a simple compendium of facts - dates - such as when a person was born and when they died. Others before me have said that what is important is not the date of birth or death, but the "dash" in between. That dash is what symbolizes who a person is, how they lived, what they accomplished.

My father just had his 81st birthday on Sunday. He has been working full time as a financial consultant at the same firm in Midland, Texas (RBC Wealth Management) for more than 48 years. That is a remarkable accomplishment in a field where jumping between firms is not uncommon. But loyalty was important to my dad, and to his clients. They knew they could trust him. His honesty and integrity were natural, unspoken expressions of his Christian faith. But that won't be in his obituary.

My parents love to travel, and they have taken quite a few overseas trips since he reached retirement age, even though he didn't retire! In September, my wife and I were able to go with them to Ireland on a fantastic trip. At 80, their vigor and stamina was amazing. Those two weeks together were so precious, even more so now in retrospect.

Just weeks after we got home, my father was diagnosed with pancreatic cancer. He had the usual tests and meetings with specialists to determine what, if anything to do. His liver is involved and his prognosis is quite poor.

I consult often with patients who are bombarded by well-meaning friends and relatives who think they know what is best and are, frankly, a bit too vocal with their opinions. Thus, seeing my father have to deal with the "You ARE going to MD Anderson, aren't you?" pretentiousness was particularly difficult. Those of you who want to comfort someone dealing with a cancer diagnosis need to learn simply to listen. Don't give advice, because 1) your story or experience is almost always irrelevant, and 2) you unknowingly aggravate the situation by making the patient feel guilty or second guess their decision. Please remember: It's not about you!

Ultimately, after much deliberation, my father opted for comfort care only. I am incredibly proud of the strength it took to make that brave decision. His cancer is not curable and his prognosis is less than six months under the best of circumstances. He chose instead to share quality time with friends and colleagues, with each of his three sons' families, and with his wife of nearly 60 years. What a blessing that time has been!

The apostle Paul wrote that he has fought the good fight and finished the race well. Thank you, Dad, for finishing strong. For demonstrating integrity and commitment in your work for more than 50 years. For your quiet faith, service, and generosity. For your love of family. For filling that "dash" between birth and death with a life well lived and memories we will cherish. Maybe we can insert that into your obituary!

Tips for Success in Any Office Environment

My wife, Catherine, starting working for St. Cyprian's Episcopal Church as Parish Administrator about four and a half years ago. We were close to empty nesting at the time, and she felt she wanted to get back in the workforce in a meaningful, purposeful way. St. Cyprian's has been a blessing for her, and she for them.

Catherine was recently asked to provide her job description for other churches in the diocese. She wisely commented that the key to being a successful admin is understanding that your calling is to make someone else successful. A well-written job description is a great starting place, but a smart admin thinks beyond the dry description. What follows are her guiding principles, in her own words:

Smile. Every parishioner deserves to be welcomed into the office with a cheerful attitude. Not because they pay your wage, or you might need them to do something for you, or simply because you regard them as a friend beyond the walls of the church, but because this is God’s house and we are a very small reflection of Him and the joy He has in His people.

Menial Work. Every job has tasks that seem menial. When I’m feeling a little weighted down by such chores, I remember that Martin Luther once said that a dairy maid could milk cows to the glory of God. So I milk the cows and am surprised by how the more enjoyable aspects of my job pop up unexpectedly in the middle of the humdrum.

Don’t bring troubles to work. Don’t come to work thinking that you are coming to therapy or your own counseling session. Yes, be open and honest with your co-workers, but remember how much emotional baggage they are expected to carry for others already.

Wear multiple hats. Learn how to compartmentalize within your work relationships. That sounds bad, but think about the different roles that are necessary to function smoothly in an office. With my former rector, I would put on my Employee/Employer hat to discuss things like salary or vacation or working conditions. The Friendship hat I wore outside the office when I would invite him and his wife to events or would socialize with them away from the office. The Big Sister hat was worn when I needed to try and teach him something about parenting or life (I am 15 years older).

Listen closely. As you gain trust and credibility, people will begin to solicit your opinion. Note that sometimes they are simply practicing or working out their own thoughts and ideas by talking them through. You can be a valuable asset by listening closely, reflecting back what they have said, and helping them think through the implications of what they are discussing. Sometimes you will be able to contribute an original idea, but what the ministerial staff really need is a safe ear to listen. The freedom to think out loud in confidence is a gift you can give them. Most of them are very verbal people who talk things out and sometimes don’t want to just talk to themselves.

Finally, try to say yes more than you say no. This job is full of the humdrum, the interesting, and the surprising. Be flexible and enthusiastic. It is a valuable ministry. Every day I am blessed to further God’s kingdom in some small manner by helping his shepherds and their sheep to follow him better.

What Catherine has written is great advice for all of us, regardless of our position or job or ministry. Thanks, Catherine!

One Teacher's Story of Cancer and Community Support

I have had the privilege over the last few months of speaking at Lions and Rotary Club lunches about cancer and the work of the American Cancer Society. My tag team partner in these presentations has been the lovely Jean Ann Keen, a two-time cancer survivor and mother/teacher extraordinaire.

Jean Ann has had the misfortune to be diagnosed with two different cancers decades apart. When she had her first cancer while pregnant with her now 25 year-old daughter, Kylie, there were no local support resources to speak of. Thankfully, surgery alone was curative for that cancer.

However, when Jean Ann was diagnosed with breast cancer last year, she learned her treatment course was going to be more complicated this time, involving both surgery and multiple cycles of chemotherapy. She felt a bit lost and overwhelmed. Luckily, someone told her about the American Cancer Society and the wonderful office we have in Lufkin.

In our Lions and Rotary Club presentations, Jean Ann tells a wonderful story of driving back from Waco one night. She decided to pull out a GPS unit for the first time, as she was unfamiliar with the dark roads and wanted some extra assistance. She plugged it in, turned it on, input her home address, and - lo and behold! - a map appeared with directions to her destination! She was fascinated to be able to see ahead what was coming – every turn, every intersection – with a voice telling her when to change course and how long it would take to get to where she was going.

Jean Ann goes on to explain that the American Cancer Society was like that GPS for her when it came to dealing with breast cancer. It was unfamiliar territory, and she needed that guidance to help her see ahead what was coming, where the intersections were, what roads to take. There were questions that she didn’t even know to ask that she had answers to right from the beginning.

Why am I telling her story?

Ten years ago, Louise Maxwell and I co-chaired a highly successful campaign to raise support for a new office building for the American Cancer Society to manage a 54-county region in East Texas. This building was subsequently named in Louise and Harold Maxwell’s honor. Through the generous support of the TLL Temple Foundation, Memorial Health System of East Texas, the Polk family, the Lufkin Host Lions Club/Angelina Benefit Rodeo, Temple Inland Foundation, and many other individual, family, and foundation donors, the ACS regional office building was constructed. This office also houses the Susan R. Mathis Resource Center and the Louise Maxwell Patient Service Suite, where Jean Ann learned about hair loss, makeup, and tried on wigs through the Look Good Feel Better program.

You see, all those contributions ten years ago are still bearing much fruit today. Thousands of patients have benefited from these and other services, such as patient navigation, clinical trials information, help with finding transportation and lodging, the online Cancer Survivors Network, and I Can Cope support groups. Whether in person at the ACS office on Gene Samford Drive or through their 24/7 1-800-ACS-2345 phone number, the American Cancer Society is there to help.

I want to publicly thank once again all who contributed to the American Cancer Society ten years ago for this wonderful community resource. But the fight isn't over! Support Relay for Life by putting together a team, walking, or contributing in some way. Come to the Pineywoods Cattle Barons Gala on October 25th at Winston 8 Ranch! Call 936-634-2940 for more information about these events. And, thank you!

Being There for Those Who Suffer

Two articles appeared recently in major newspapers discussing how we can be more helpful to those who are suffering. The New York Times article by David Brooks (The Art of Presence) looks at helping those who are experiencing tragedy, while The Wall Street Journal column by Elizabeth Bernstein (To Be a Friend In a Time of Need, Talk Less, Listen More) specifically addresses helping those with depression. The lessons of each apply equally well to anyone who is grieving or suffering. To me, Brooks sums up our mission with one word: presence.

What does presence look like? Better yet, what does presence sound like?

First and foremost, silence. That means shut up. When I am sick or grieving, I don't want or need your advice unless I ask for it. Don't tell me I should go see XYZ doctor just because you or your Aunt Melba did. I can make my own decisions, thank you very much. But do let me vent sometimes, without thinking you have to fix it for me. Just be there for me; that is comfort. The Latin root of comfort means to come along side with strength. The Holy Spirit is also called the Comforter. Isn't that a beautiful image?

As friends, we don't feel very strong, though, so we try to overcompensate. Why do we always feel we have to solve someone's problems, rather than quietly comforting? Bernstein notes how we can comfort others with our notes and cards. Brooks agrees it is often simple non-verbal expressions like bringing soup that mean so much. Both emphasize: listen.

When I was in college, one of my best friends was very ill in the hospital from juvenile rheumatoid arthritis. She nearly died. She was a baby Christian, and I tried to "be there" for her. Unfortunately, there were others who told her that her faith was not strong enough or she wouldn't be sick. Not only is that terrible theology - Job, anyone? - it is devastating psychology.

Often, what presence boils down to is time. I remember conversation I had recently where I delivered some devastating news to a patient and her caregiver. It was near the end of a long day, and it would have been so easy to say some platitudes and "give hope" when what was really needed was simple truth delivered with compassion and grace. When the visit was over, the caregiver followed me out into the hall and said, "I know you are busy..." That's when I stopped in my tracks, paused, and replied, "You are the most important thing right now."

She asked some particular questions that made me realize we needed to have a much deeper conversation, and that the "truth" I delivered needed a little more "presence". So, we went back into the room and had the unrushed conversation we should have had all along. We talked much more about prognosis, treatment options, and whether or not to continue with plans to see another specialist and get more tests done.

Ultimately, I recommended hospice care - end of life care focused on comfort rather than prolongation of life. I wasn't sure if the patient would agree. But this lovely woman – who couldn't speak from a prior stroke, but who could understand fully the intricacies of the conversation – looked at me and gave me the most peaceful smile I have ever seen, along with her faltering, "Yes."

At the end of a busy day, that smile meant the world to me. The gift of presence, returned with a smile.

My Bar Code Diet

In December 2013, I wrote a column about my brother's heart attack and my wakeup call to lose weight. I promised to report back on my progress. I just didn't think it would take this long!

The reason you haven't heard from me earlier is because the first several months were spent researching weight loss techniques and plans rather than actually doing anything about it. As a matter of fact, I gained an additional eight pounds while contemplating dieting, which proves that just thinking about food adds weight!

We love to talk about losing weight. Actually doing it is much harder. It takes commitment. And, we only commit to something we truly think will work. I am happy to report now that not only did I lose the weight I gained, I lost an additional eleven pounds. So, I am now 19 pounds down from my max!

How did I do it? Wait for it...

Diet and exercise! I used to joke that bulimia was better than exercise. Bad joke. I did not go that route. I opted for the simple math: calories in < calories out.

It was not as difficult as I thought it was going to be, once I made some key decisions. First, I had to stop eating hospital food. I just didn't know how many calories I was eating! More importantly, I had to track how much I was eating.

Hence, my Bar Code Diet. If I couldn't scan it into my phone, I didn't put it in my mouth, with rare exceptions. There are iPhone and android apps (like Lose It or My Fitness Pal) which will help you set a goal for weight loss. You enter your starting weight, your target weight, and how much you want to lose per week. Generally, 1-2# is typical. The apps then tells you how many calories per day you can eat and how long it will take you to get to your goal, assuming you are compliant with the diet. You scan the bar code with your smart phone and it tracks how many calories you eat. You can even track calories burned with exercise. These apps have many chain restaurant menus on file, so it is possible to eat out and still track your calories. I don’t recommend it, though, because portion sizes in restaurants are generally huge and it is hard to stop mid meal.

Every day starts with breakfast. Even if it is only a latte, you need to consume some calories (including some carbohydrates) within 30 minutes of waking up to reset your hormone and blood sugar levels.

My favorite meals to take with me are Hormel Compleats (not frozen, but need to be microwaved) or Zone bars (taste great and are easy to grab and go). And in the evening at home, often an Atkins frozen meal is quite satisfying, plus it limits carbs in the evening, which can keep you from getting hungry in the middle of the night (or from waking up starving). Of course, our metabolism slows as we age, so exercise (including some strength training) is essential. Even walking can be a great start if you haven’t done any exercise at all.

This isn’t fad dieting. It is simply counting calories. Anyone can do that nowadays. Not only did I lose nineteen pounds, I also dropped my cholesterol 40 points. I don't have acid reflux anymore. I sleep well at night. I feel better. And I know that my risk of both heart disease and cancer will be less as a result.

Prostate Cancer: How Should We Treat It?

Prostate cancer screening and treatment may be the most divisive issue in oncology today. Oh, we argue about breast cancer, and whether or not women in their 40s should get a mammogram (they should), and how often they should get one (every year). But prostate cancer is even more controversial. That's because prostate cancer is not a single disease with just one way to treat it.

We divide prostate cancer patients into three risk categories: low, intermediate, and high risk. Risk of what? Risk of spreading and killing you, basically.

We place patients in these risk categories based primarily on how high the prostate specific antigen (PSA) blood test is, and how aggressive the prostate cancer biopsy specimen looks under the microscope (the so-called Gleason score). Low risk patients (PSA less than 10, Gleason score 6 or less) have a 90% survival rate at 10 years, which is fantastic. High risk patients on the other hand (mainly those with PSAs greater than 20 or Gleason 8-10) have aggressive cancers and only a 50% survival rate. Finding a prostate cancer when the PSA is lower and the cancer is less aggressive is better. But...

The problem is, we are now finding some cancers so early that they don't even act like a cancer; they will never spread or cause a problem. The conundrum is determining which cancers those are, because we still live with fear of the word "cancer" and assume that something must be done whenever it is diagnosed. Even more problematic, we too often assume that we must have surgery and "cut it out", when that may not be what is best, much less what is needed at all.

Yes, we over-diagnose and over-treat prostate cancer. Now, I am not a hardliner who says we shouldn't be screening for prostate cancer. Far from it. The American Cancer Society recommends that "men make an informed decision with their doctor about whether to be tested for prostate cancer." How old are you? What health problems do you have?

"Starting at age 50, men should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. If they are African American or have a father or brother who had prostate cancer before age 65, men should have this talk with a doctor starting at age 45."

Remember, however, that even if you learn you have prostate cancer, you do not necessarily need treatment! Certainly, don't jump in and have major surgery without checking out all your options, including that of observation. On of the oldest statements in medicine is primum non nocere - first, do no harm. That holds true today as much as it did when that ethical concept was included in Hippocratic Oath in the 5th century BC.

If treatment is recommended, we are fortunate at CHI Memorial to offer a very precise form of radiation treatment called Intensity Modulated Radiation Treatment (IMRT) for prostate cancer. This pinpoint, outpatient treatment is every bit as effective as surgery with few side effects. It also does not have the risk of long-term incontinence that comes with surgery.If you or a loved one you know gets diagnosed with prostate cancer, or even just has an elevated PSA, please do not rush to surgery. Certainly, we have skilled surgeons in East Texas, but take your time and get a second opinion to determine 1) whether treatment is the best option, and 2) whether surgery or radiation is a better option for you.

Memorial and Catholic Health Initiatives

In my January column, I wrote that we have an ongoing obligation to provide non-profit care locally so that Memorial’s mission of compassion, established in 1949 by our community forefathers, can continue. I am thrilled that Memorial has strengthened its ability to deliver on that mission by becoming part of Catholic Health Initiatives (CHI), effective June 1. CHI operates 89 hospitals in 18 states, with more on the way.

Much has been written about the transfer of ownership already, so I thought I’d comment on what this transaction is not:

It is not a takeover of physician practice. CHI has committed to preserve existing physician relationships in the community and build new ones. CHI’s relationship model with physicians is very much dependent on the region of the country they are in. Ultimately, improved coordination of care and better patient outcomes have to happen. Quality, efficient care is the focus, not whether or not physicians are independent or employed.

It is not a transfer of care to Houston. In fact, CHI wants to see Memorial become an even stronger hub for healthcare in the region. Of course, we will have increased access to highly sophisticated care through closer ties to CHI St. Luke’s Health in Houston and its affiliations with Baylor College of Medicine and Texas Heart® Institute. That will only strengthen our position in the region and improve the quality of care we deliver locally so that even more health care can remain local. Over the next two to three years, it is CHI’s intent that Memorial will become a part of CHI St. Luke’s Health. In my own area of cancer care, this can only enhance my options for my patients, including improved access to clinical trials.

It is not a drain of money from the local economy. The fact is, Memorial’s board recognized that the landscape of healthcare had so fundamentally changed that maintaining mission in a fiscally responsible way was becoming increasingly challenging without the resources and expertise of a well-capitalized, national partner. Over the next 5 years, CHI will invest more than $1 billion to expand and enhance the southeast Texas region’s health care infrastructure. Memorial, for its part, is guaranteed to see significant capital improvements over the next 6 years.

It is not a change of mission. Having read the Ethical and Religious Directives for Catholic Health Care Services – the guiding document for ethical behavior in health care for Catholic institutions – I can tell you that CHI’s mission and Memorial’s mission mesh beautifully. Both Memorial and CHI share a commitment to putting the health of the people and communities we serve at the center of everything we do. CHI intends to maintain the core health care services and charity care currently provided by Memorial in the East Texas community, which will continue to be overseen by a local board of community and physician leaders. I have the privilege of serving on that board, and I can state with confidence that Memorial’s strong commitment to charity care will continue.

It is not an end of an era. In 1949, our community forefathers got together to establish Memorial Hospital to take care of the people here in deep East Texas. They were compassionate, innovative, and forward-thinking. Their descendants – some in name and all in spirit – have led this health system to maintain that mission for sixty five years. Today, with no less compassion and thought for the future, we have taken a bold step to preserve and advance non-profit care for our region. Here’s to the next 65 years!

The Profession of Medicine

Physicians today rarely encourage students to consider becoming a doctor. There are quicker ways to start earning a good living. (Petroleum Engineering and Investment Banking come to mind.) But beyond the financial aspect, being a doctor just isn’t the same as it once was. Increasingly, patients don’t trust doctors, much less respect them or care whether or not they are happy.

A recent online Daily Beast article suggests the public should have more empathy for doctors. The author notes that 300 physicians will commit suicide this year, making it #2 on the list of the 19 jobs where you are most likely to kill yourself, according to Business Insider.

Why? She believes well-intentioned people working to solve the healthcare crisis have come up with answers that are “driving up costs and driving out doctors.” A simple example: “Just processing the insurance forms costs $58 for every patient encounter.” She also quotes noted writer Malcolm Gladwell, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

Insurance claims, bureaucratic red tape, “quality” metrics (that are often more about trying to successfully report than actual quality) – all of these take away from face time with patients and chip away at the joy of what is increasingly becoming an unrewarding profession, not only monetarily, but emotionally.

In other words, practicing medicine has become a demeaning, demoralizing, punitive, bureaucratic nightmare for many physicians.

Don’t get me wrong. Most physicians make a good (or even great) living. I do, and I am not ashamed of it. As an honor graduate from Rice University with a medical degree from Baylor College of Medicine, followed by an additional four year residency, I am proud of my training and feel I have worked hard to get where I am. But with position comes responsibility.

Unfortunately, physicians have, for decades now, not paid attention to the cost of prescribing the latest and greatest drug when an older, cheaper generic is just as effective. Likewise, we put expensive imaging and treatment equipment in our offices and refused to acknowledge that there may be a conflict of interest, when studies show we order more tests and do more procedures as a result.

On top of that, I fear there is a growing contingency of younger physicians who see the practice of medicine as a job only, with a corresponding (and alarming) callousness toward the poor and uninsured.

There is hope. We have many physicians in Lufkin who have earned our respect, and I am honored to call them colleagues. Since 2008, Drs. Ravinder Bachireddy, George Fidone, and Kay Carter (and Mrs. Demetress Harrell) have each been recognized as Healthcare Professional of the Year at the Lufkin/Angelina County Chamber of Commerce Salute to Healthcare banquet. The Chamber has also honored Drs. WD Thames, Anna Beth Connell, George Thannisch, Dan Spivey, and Jacob Thomas with Lifetime Achievement Awards. Young physicians, who may not have gone into medicine for the “right’ reasons – indeed, all of us – would do well to follow their example.

Emily Shelton, the wife of my long-time partner, Dr. Bill Shelton, gave me sage, simple advice when I first moved to Lufkin in 1992: “Just do what’s right.” A sense of duty, compassion for the poor, cooperation with the healthcare team, communication with patients and families, collegiality with fellow physicians, and, of course, excellence of care are hallmarks of a great physician. That’s what being a doctor is all about. It can still be a rewarding, respected profession if we “just do what’s right.”

What’s Coming in Healthcare Reform in 2014?

My middle daughter is a graduate student in opera at Eastman School of Music. After October 1, if I go to hear her sing in an opera and get injured while there, a specific code must be used if my healthcare is to get paid. That code is Y92.253: “Opera house as the place of occurrence of the external cause.”

Perhaps I will be at Ellen Trout Zoo and get “Bitten by turtle, initial encounter” (W5921XA). And if, for some reason, I am stupid enough to get injured again by said turtle, there is a code for that, too:  “Struck by turtle, subsequent encounter” (W5922XD). But the current favorite new code among pundits has to be V9027XA: “Drowning and submersion due to falling or jumping from burning water
-skis, initial encounter.” Really? Who comes up with this? Is this a sick joke?

Our current system of coding for clinical encounters in healthcare is ICD-9, which has been in use since 1979. ICD-9 contains around 13,000 diagnosis and 3,000 procedure codes, arguably more than we need already. But get ready, because ICD-10 jumps to 68,000 diagnosis and 72,000 procedure codes, including the ridiculous ones noted above.

The change to ICD-10 illustrates the problem of government involvement in healthcare. First, complexity increases exponentially while usefulness – what I call the common sense factor – plummets. Then, the government tightens the rule belt, so that if you do not code correctly (how did I know you were bitten by a turtle before!), you do not get paid. Not only that – and this is what really galls me – if you don’t do it correctly, as narrowly and obscurely defined as only the federal government can do it, it is labeled fraud and abuse.

Someone asked me, as I explained this to them, “How will the government know if you didn’t do it correctly?”

Simple. They contract out to firms that employ high school-educated workers to go out and look for “fraud and abuse”. These firms get paid for what they find – whether or not what they find is really accurate – and then the government takes back those “fraud and abuse” payments from the provider (the doctor or the hospital, for example). Then, the provider has to fight multiple levels of appeal in order to get their money back, if they can afford the appeal process.

This is how our federal government is “saving money” with healthcare reform: make the hoops impossible to jump through; only pay you if you manage to make it through the hoop; then take back what they pay you because someone else with an unfair incentive claims you didn’t really make it through the hoop after all.

Our healthcare system truly needs to be reformed, but so far, very little is happening that gives me hope that we are headed the right direction. I foresee an explosion of job opportunities starting October 1, and anyone with expertise with how to code under ICD-10 will be golden. Orthopedic surgery, for example, will see one code under ICD-9 – 821.01 Fracture of femur, shaft, closed – expand into at least twenty four possible codes under ICD-10, depending on laterality, displaced or non-displaced, location, fracture type (greenstick, comminuted, transverse), type of healing (routine, delayed, non-healing), malunion, nonunion, open or closed, and encounter type (initial or subsequent). Those who can play the game successfully will survive.

At a time when payment for healthcare services needs simplification, we are taking a major step in the wrong direction. Now, is that step left, or right? There’s probably a code for that.

Winning the War on Cancer

“I have cancer.” What is your first reaction when someone tells you that? Not the same as when you hear, “I have diabetes,” or, “I high blood pressure.” Something about cancer scares the bejesus out of us. But, should it?

Twenty-plus years ago, when I first started practice, I would quote that we cured around fifty percent of patients. People didn’t believe me then, and you may not think we cure that many today. In fact, we now cure fully two-thirds of cancer patients! We have made remarkable progress in the war on cancer, thanks in no small part to the work of the American Cancer Society. In lung cancer alone, there has been a 20% decline in cancer death, largely due to decreased rates of cigarette smoking.

We just celebrated the fiftieth anniversary of the Surgeon General’s report on smoking and health. This major report, relying on research conducted by the American Cancer Society, exposed the lies of the tobacco industry and laid to rest any doubt that smoking causes lung cancer. We still don’t cure very many lung cancers today – about 15 out of 100 – but we can prevent the vast majority of cases. Since the Surgeon General’s report, eight million lives have been saved, and almost 20 years of life have been added to those lives saved!

Unfortunately, lung cancer is a global problem. There were six trillion cigarettes consumed in 2009! Last century, tobacco killed 100 million people worldwide. This century, tobacco is projected to kill 1 billion people, mostly in the developing world.

Decreasing lung cancer death rates in the United States is just one success story. Over the last nearly 40 years, breast cancer cure rates have increased from 75% to 90%, colon and rectal cancer cure rates have risen from around 50% to two-thirds, and prostate cancer 5-year survival has gone from 68% to 100%. How did we do it?

Better yet, how did YOU do it? You got your mammograms, Pap smears, PSA blood tests, and colonoscopies. You prevented cervical cancer by taking care of precancerous lesions found on Pap smear, or by getting your HPV vaccine. You prevented colorectal cancer by having precancerous polyps removed. You caught your breast cancer or your prostate cancer early by getting a mammogram or a PSA blood test. You noticed a mole changing and had it removed. YOU took charge of your health!

But there is a new danger lurking: obesity. Predictions are, obesity will surpass tobacco as the leading cause of death in the next two decades. Like with tobacco, both cancer and heart disease risk are increased with obesity. Fighting obesity is a lifestyle change, for sure. To change up an old phrase, “An ounce of prevention… is a TON or work!” And, unlike screening tests, you have to work at the diet and exercise continually. (Funny how I preach to myself in these columns!)

Anyway, next time you hear someone say, “I have cancer,” know that they are quite likely going to beat it. The war on cancer isn’t over. We still need to support research, provide prevention and detection programs, work for access to quality healthcare programs, and advocate for smoke-free public places. Walk in Relay for Life on Friday, May 2, 2014 at 6:00 PM at Lufkin Middle School! Support the Cattle Barons Gala, which will be October 25th! The American Cancer Society is the backbone in the fight against cancer. Finally, be a friend and encourager to those with cancer. It’s all about more birthdays, after all!

A New Paradigm of Volunteerism

Last week, I had the privilege of speaking at the annual Chamber banquet as outgoing Chair. This was my charge to the 700-plus in attendance, and my hope for Lufkin and Angelina County.

I have a passion for Lufkin – for her growth, her people, her churches and volunteer organizations. We live in a city and county that lives philanthropy. We have inherited a community built and sustained by many visionary leaders who made things happen, often, so the legend goes, by simply picking up the phone. And because of that legend, we run the risk of becoming complacent.

We are guilty of two things, as I see it, and I am intentionally using hyperbole to make a point. First, we are guilty of a reductionist view that thinks all advancement centered around Arthur Temple and that circle of leaders, as influential as it was. Second, we are guilty of a pessimistic view that no one is left who can make the big things happen. Now, of course, neither is true, but we shouldn’t allow ourselves to simplify and excuse away the need for hard work.

There are four keys to our continued success, as I see it.

First, COMMUNICATION.

When I was in medical school, one of the hardest lessons for me to learn was to pick up the phone and call someone for advice when I didn’t know the answer. There are experts out there in all fields. Maybe the Arthur Temples and Murphy Georges, the George Hendersons and Bubba Shands, the Rufus Duncans and Joe Denmans – I could go on – maybe it just seemed like they could just pick up the phone and call one another and get things done. We can, too, but we have to communicate. We are all in this together, and all have the same goal, whether city, county, Chamber, public or private sector, for-profit or non-profit. Let’s communicate!

Second, COOPERATION.

This actually dovetails with communication. Not only do we need to talk to each other, we need to work together. And we are! One thing I do believe is different today from the previous generation, perhaps, and that is rules and regulations are just more complicated. But everyone has to play by the rules, so let’s all get in there and do the work… together, and across organizational lines.

Third, CREATIVITY.

Partly because the rules of the game have changed, we need to get more creative with our solutions. I think of the discussions community leaders have had regarding Economic Development and how both the City and the Chamber have an interest, and how at an Economic Development Partnership meeting we were able to identify common interests as well as areas where either the City or the Chamber should take the lead (for example, bringing in manufacturing jobs versus business retention and retail initiatives). Let’s embrace our different approaches and creatively structure our relationships for maximum effectiveness.

Finally, CONTINUED INVOLVEMENT.

Last month, we buried Lizzie Wallace, a courageous teenager who died from a rare liver cancer. Her two-year fight with cancer didn’t stop her from working to make a difference. “Be the change you want to see” was her motto. As Lizzie saw it, we all have a responsibility to continue to use our influence in a positive way, even if – as in her case – we are near the end of our journey.

Whether you bring youth and energy to the table or the connections and influence that come with age and experience, you are needed. Get involved; stay involved! Together, we can make our dreams for Lufkin and Angelina County come true.

What a Hospital Should Be

Healthcare reform may be the most polarizing issue today. Depending on your point of view, you are either eagerly anticipating or just dreading the changes that are happening. Either way, we can all agree there is profound upheaval in the system. We are in the middle of an earthquake waiting for the ground to stop shaking.

While the focus on Obamacare has been on the individual’s access to healthcare, we need to remember that our hospitals are feeling the earth move underneath them as well. When hospitals are merely trying to survive may not the best time to consider what a hospital is and does, but I believe it is exactly when we need to take a step back and focus on mission.

A hospital is, first and foremost, an institution to take care of the sick. The Latin root for hospital is the same root for hospice and hospitality. Hospices in the Middle Ages were way stations for pilgrims who needed a place to rest/ Today, hospices are known for end-of-life care for those on their final journey. And the word hospitality denotes kindness and generosity. What a great family or words! Hospitals should provide comfort for travelers on a journey – a journey from illness to wellness. And that hospitality should be extended to all.

We, as a country, have decided that healthcare is not a universal right, in that not everyone (even under Obamacare) will have free care. Yet, we can’t seem to decide what level of individual responsibility (either in terms of healthy lifestyle choices, like smoking, for example, or huge deductibles which the average person cannot afford) goes along with whatever care we do receive. That leaves us with a broken system of inflated billing and inadequate reimbursement that continues to leave a good number of our sick not only without resources but with outrageous bills.

And, unfortunately, the government is placing more and more burden on the hospital to make sure that patients not only receive high quality care in the hospital, but are taking their medicine and seeing their doctor once they are back at home. The hospital is now supposed to be Big Brother. If a patient is readmitted to the hospital too soon after being discharged, the hospital does not get paid for that stay, even if it was because the patient was noncompliant with their own care outside the hospital. One can argue the fairness of regulations such as this, but all hospitals are required to play the same game now, and some will be better at it than others.

I would argue, some will have better results than others in the new quality outcomes paradigm because they “cherry pick” their patients based on ability to pay. That brings me to my main point: We must not let a divided system of care (non-profit versus for-profit) keep the sick from accessing care.

As a non-profit institution, Memorial has a mission to provide care for all, regardless of ability to pay. In an era of declining reimbursement, for-profit institutions – who report to investors – are increasingly turning away those without insurance (except in emergency situations, where federal law requires care to be administered to stabilize a patient). All hospitals operate on a tight margin, and non-profit hospitals (especially those outside of metropolitan markets) are increasingly feeling the pinch. We in Lufkin have an ongoing obligation to provide non-profit care locally so that OUR mission of compassion in Lufkin can continue. It is what our community forefathers established. It is what hospitality demands.