What If We Don’t Flatten the COVID-19 Curve?

On April 5, 2020, US Surgeon General Jerome Adams said, “The next week is going to be our Pearl Harbor moment. It’s going to be our 9/11 moment.” The same day Dr. Anthony Fauci, arguably our most trusted spokesperson during this coronavirus crisis, said, “We’ve got to get through this week that is coming up because it is going to be a bad week.” One oft-cited set of projections showed deaths from COVID-19, the illness caused by the novel coronavirus, and resource use (including ICU beds and ventilators) were expected to peak this weekend. That all of this is happening during Easter and Passover only adds to the sorrow.

For those of us in Texas, the wait to peak is a bit longer. Estimates a week ago were for peak resource use on May 6, 2020, but that prediction has now moved up to April 22, with peak in daily deaths on April 24. Texas appears to be flattening the curve. In Angelina County, we have 16 confirmed cases of COVID-19 as of April 9, but only 283 people have been tested so far. We can only hope that the wise and early decisions by our local elected officials, including the Stay Home – Stay Safe order, will have flattened our curve enough to avoid the healthcare crisis experienced in New York, New Orleans, and other cities.

But what if our hopes are unfounded? What if we get a surge of COVID-19 cases beyond what our healthcare system can handle? In New York City, some COVID-19 victims could be temporarily buried in mass graves in a park, as morgues don’t have the capacity to handle the mounting casualties.

Thankfully, doctors across the nation have been giving much thought to this grim prospect. After the 2003 SARS outbreak, North Texas physicians came together to answer that very question: What would they do if a really big pandemic hits and hospitals are overwhelmed? The result was the formation of the North Texas Mass Critical Care Council. The council established that during a time of crisis, the ethical, moral, and medical approach should be that “access to treatment would be based upon the patient’s ability to benefit from it, using objective physiologic criteria.” In other words, medical evidence – rather than insurance status, social standing, what have you – would guide decision-making about which patients are most likely to benefit from ICU interventions when there are not enough ICU beds or ventilators for every patient. The goal – as it should be in any medical crisis – is to save “as many lives as possible.”

In a similar fashion, CommonSpirit Health, the Catholic health system that is the second-largest nonprofit hospital chain in the US (and the parent of CHI St. Luke’s Health Memorial Lufkin), developed Crisis Response Guidelines for Hospital and ICU Triage Allocation. These guidelines are not based on opinion or guesswork. The many criteria used to prioritize who would benefit from ICU and ventilator support are validated in the medical literature and have been compiled to arrive at a robust sequential organ failure assessment (SOFA) score, based on the degree of dysfunction or failure of the heart, lungs, liver, kidneys, brain, and blood system. This SOFA assessment, well known to emergency and intensive care specialists, is used routinely to predict mortality in any critically ill patient.

Based on SOFA scores and other medical criteria, doctors might determine that an elderly patient with COVID-19 whose organs are functioning well is more likely to recover using a hospital ventilator than a young patient with multiple organs shutting down from the virus, but the decision would be based entirely on whether the treatment is likely to help the patient recover. Doctors are expressly prohibited from considering social status, money or other nonmedical criteria when making these decisions. The last thing doctors want to be accused of is indiscriminately playing God.

A recent Wall Street Journal opinion implied that merely considering apocalyptic scenarios would lead to legalizing euthanasia, and that not having guidelines (and thereby wasting resources on those that would not benefit) was morally superior to sound medical decision making. Texas Health and Safety Code §166.009 acknowledges that sometimes difficult choices have to be made and states that provision of life-sustaining treatment is not required if it “cannot be provided to a patient without denying the same treatment to another patient.” There is a larger problem of futile care in this country that did not start with the coronavirus pandemic and it won’t end once this virus is under control.

Crisis guidelines are not written to decide who lives and who dies; they help direct the most aggressive care to those who are most likely to benefit so that the most lives can be saved. Regardless, all patients are to be treated with dignity and receive appropriate and compassionate care. If I, as a physician and community leader, have little to no chance of survival if placed on a ventilator – based on solid medical criteria – but an illegal immigrant (for example) has a good chance of survival, guess who gets the ventilator? Not me. And that is the way it should be.

We must continue to follow the social distancing recommendations of our city, county, and health district leaders in order to minimize the impact of the coronavirus locally. We can do this – we ARE doing this. As the Lufkin/Angelina County Chamber of Commerce is encouraging us, we are #BetterTogether and #AngelinaStrong.

A Health Problem We Can’t Ignore

On Thursday, the Chamber of Commerce hosted the 11th annual Salute to Healthcare Banquet, where we recognized the importance of the healthcare sector and its role in the local economy as well as celebrated four great individuals for their contributions to our local healthcare community.

Amber Warner received the Nurse of the Year award for her work as a certified hospice and palliative nurse at Hospice in the Pines and her volunteer work in the community; Pat Todd was honored as Individual of Merit for her advocacy for suicide awareness and prevention; Sharon Shaw got the Healthcare Professional of the Year nod for her tireless work on behalf of the uninsured and underinsured at the Angelina County & Cities Health District; and Dr. Tom Willis was honored with the Lifetime Achievement Award for 30-plus years as an internist in Lufkin as well as his civic and charitable contributions. It was a wonderful night of celebration.

It was also a night of sober education about the poor state of health in our schools and our community at large. Dr. Jeremy Lyon, a retired Frisco ISD superintendent who has a passion for healthy kids and schools, presented a compelling talk titled, “Strong Kids in Healthy Communities: Creating Our Future.”
Angelina County is not healthy. That unfortunate fact is supported by data used to rank counties nationwide and compiled by the Robert Wood Johnson Foundation. These rankings are available for anyone to review at http://www.countyhealthrankings.org.

In Texas, Angelina County is in the lowest 20% for the state for Health Outcomes. Sadly, for Health Behaviors we rank dead last. Eighteen percent of adults smoke, compared with 14% for the state at large (and may states smoke much less than that). One-third of Angelina County residents are physically inactive. And fully 40% of Angelina County citizens are obese! On average in Texas, 28% are obese, with some counties as low as 21% - nearly half of where we are in Angelina County. Finally, life expectancy in Angelina County is almost 2 years and 9 months shorter than for the US as a whole.

All of these factors can be traced back to habits and behaviors we pick up as kids. In 1982, The Dallas-based Cooper Institute launched FitnessGram, a health-related fitness assessment used annually in tens of thousands of schools, reaching over 10 million children across the United States. But even with FitnessGram assessments in our schools, we are not changing behaviors.

Dr. Lyon presented factors in our culture that contribute to negative youth health outcomes as well as barriers and opportunities to improve youth health outcomes within schools and communities. One model - the Center for Disease Control’s (CDC) Whole School, Whole Community, Whole Child (WSCC) model, developed in cooperation with the Association for Supervision and Curriculum Development (ASCD) - is designed to improve learning and health in our nation’s schools. That model starts with the premise that every child in every school deserves to be healthy, safe, engaged, supported, and challenged. The CDC and ASCD understand that health and learning are inextricably intertwined.

The Texas Forest Country Partnership, the Chamber, the Angelina County & Cities Health District, Angelina College, LISD, and hospital and community leaders have already had an information-gathering meeting with Dr. Lyon to consider what steps we may take in Angelina County to improve our county health rankings. Goodness knows, they can’t get much worse. This will require a long-term, coordinated, multi-institutional approach to health and wellness with the entire community providing support.

Together, we can - we must - move the needle toward a healthier Angelina County. Literally, our children’s lives depend on it.

History and Medicine in Angelina County

I recently came into possession of Angelina County Medical Society meeting minutes dating back 80 years, from 1936 to 1954. These archives were kept by Dr. W. D. Thames. A walk down medical memory lane with these records is remarkable. Some facts are simply mundane. For example, dues in 1936 were $10.50 per member - $488 in today’s dollar. That makes our current County Medical Society dues of $100 seem like a bargain.

More fascinating to me is that even though the practice of medicine has changed profoundly over the last 80 years, little of the economics and politics of being a physician has changed. For example, charity care issues were documented back in 1937. We struggle with that today. The physician-patient relationship – what today would be assessed by patient satisfaction scores – was the topic of lectures in 1938.

The broad legislative issues on the table today are hardly different than those in 1938 when a Legislative Committee was appointed. Scope of practice issues with optometrists and chiropractors were discussed way back in 1941. In 1953, Dr. Arnett “encouraged members of our society to join the American Association of Physicians and surgeons, which is a political organization of doctors. Its purpose is to stop socialized medicine.” (What would they say now?)

Some issues from the past seem frankly quaint today. In 1952, Dr. Arnett was to appoint a committee to investigate a physician who took out an ad in the Lufkin Daily News, apparently quite the no-no at the time. The next month’s minutes document how that physician “apologized and said it wouldn’t happen again”. The Society even had a secret ballot to vote whether he was guilty or not guilty of advertising. He was acquitted on a 9 to 2 vote.

Admirably, the Angelina County Medical Society minutes also contain notable evidence of community involvement and civic leadership. In January, 1940, the Society was holding joint meetings with city and county officials and the Chamber of Commerce directors to discuss a federal aid program for the building of a county hospital. It was these very discussions that spurred local industry leaders to join together to build a new hospital. The legend we pass down is that in 1941, Arthur Temple, Sr., President of Southern Pine Lumber Company, W.C. Trout, President of Lufkin Foundry & Machine Company, E.L. Kurth, President of Southland Paper Mills, and Col. Cal C. Chambers, President of Texas Foundries, along with ten other businesses and industries, joined resources, refused federal funds, and raised one million dollars to build the non-profit Memorial Hospital (now CHI St. Luke’s Health Memorial). But we have forgotten the groundwork was laid the previous year by the healthcare community, the city and county leaders, and the Chamber of Commerce, all working together. Such cooperation and leadership can still take place today.

Another more poignant event occurred in February, 1954. Then President Dr. Gail Medford “read a letter from the Negro Chamber of Commerce wanting help from the Angelina County Medical Society in their plan to improve sanitary conditions in the colored community. Drs. Taylor and Spivey, City and County health officers, were appointed to work with the colored organization.” We cringe now, thinking about Jim Crow segregation and disparities in neighborhood services and conditions. But do we recognize similar disparities in healthcare today? Are we addressing the needs of the indigent, uninsured and underserved populations among us? Is the medical community as approachable today as it apparently was in the segregated 1950s?

Technology has revolutionized healthcare over the last eighty years. But technology cannot replace the heart. Let us not forget our calling, our oath, and our love for the patient. The practice of medicine should never be just a job. It is a profession.

I invite everyone to the Salute to Healthcare banquet on Thursday, November 10, 2016. Help us recognize and honor those in our community who set the standard in healthcare and who are true to the calling – the profession – of medicine. Call the Chamber at 634-6644 for ticket information.

Doctors Must Reinstill Sense of Duty

This article was originally published at Houston Chronicle http://www.houstonchronicle.com/opinion/outlook/article/Doctors-must-reinstill-sense-of-duty-6733668.php?t=d4a64f80cb&cmpid=email-premium and is reprinted here with permission from the author (me).

I am a physician. Being a doctor defines me. Whether I am seeing patients in my Cancer Center or dining at a restaurant, I am Dr. Roberts. I have expectations of myself in my role of physician, certainly. But the broader community has expectations of me, as well - expectations of competence, compassion and especially availability. Surveys and patient satisfaction scores, however, show that physicians are not meeting those expectations.

I see two broad reasons for this disconnect. One is related to how we practice medicine in the 21st century (in front of a computer rather than in front of our patients). The other has to do with what we see our role to be as physicians.

As a member of my hospital's Performance Improvement Committee, patient safety is our primary concern. Too often, though, we get bogged down in an ever-increasing slough of statistics. Some data we need to track (mortality rates, infection rates, etc.) but other data (such as whether patients think the bathroom is clean enough) are, to put it mildly, distracting.

Chasing data has become the focus of American medicine, and the individual patient has been lost in the process. On top of this is the stress and frustration of working with a bloated and perversely incentivized health-care bureaucracy that views every failure to dot an "i" or cross a "t" as fraud and abuse. Not surprisingly, not only has patient satisfaction declined, but physician satisfaction with the practice of medicine has tanked as well.

It isn't simply about computers and bureaucracy. Since I started practice in 1991, the percentage of physicians in private practice has dropped dramatically. "The New England Journal of Medicine's" CareerCenter website posted that physicians coming out of residency are increasingly gravitating toward contracted rather than private practice positions. Anecdotal reports put the desire to be employed as high as 80 percent. Various reasons are given, including the uncertain direction of health-care reform, declining reimbursement and rising overhead costs. Increasingly, physicians just want to show up at work, practice medicine (without having to deal with administrative and insurance issues), and then go home. They believe that employed positions offer a more predictable work schedule than private practice.

This growing employment model, not just among millennials, coincides with a major shift in attitude among physicians about their role - dare I say duty? - when it comes to patient care. "Becker's Hospital Review," an industry magazine, noted that physicians increasingly expect their affiliated hospitals to provide compensation for on-call coverage, which used to be an expectation of all physicians who had hospital privileges. By 2001, nearly two-thirds of health care organizations provided call pay to at least some physicians.

In our hospital committee meetings, we - the self-selected 10-percenters who are involved in medical staff leadership - bemoan the loss of a sense of citizenship among physicians. We opine on the privilege of being on a medical staff, and that there are responsibilities that come with those staff privileges. Ultimately, we just want our fellow physicians to "do what is right." That simple ethical imperative is the heart and soul of the practice of medicine. Not just doing what is expedient. Certainly not just doing what you hope (or demand) to get paid for.

I fear this is where we are in medicine today. Being a physician is no longer a profession - a calling, a responsibility - it is simply a job. The art and practice of medicine has been reduced to a series of individual transactions, each separately identified in an ever-complex system of billing codes, rather than an ongoing relationship not just between doctor and patient, but between doctor and community.

How can we recover the profession? How do we reinstill a sense of duty? Of moral obligation?

Medical schools have the initial obligation to provide a strong ethical foundation for the practice of medicine. But organizations that provide ongoing training and continuing medical education are responsible as well. The Texas Medical Board requires two ethics and/or professional responsibility CME credits every 24 months as part of a total of 48 credits required.

The Texas Medical Association, which has more than 48,000 physician and medical student members, offers 62 ethics-related CME courses ranging from communication skills and dealing with difficult patients to stress and burnout and HIPAA compliance. However, there is not a single course on basic ethical principles, which have guided the practice of medicine in Western civilization for centuries. Maybe that is because an ethical imperative to "do what is right" presupposes we know (and are willing to agree on) what "right" is.

The United States Conference of Catholic Bishops produced a document - Ethical and Religious Directives for Catholic Health Care Services - which guides all Catholic healthcare institutions, including CHI St. Luke's Health hospitals. Physicians of all faiths would be well served to read and abide by these directives, which first and foremost stem from a sacred view of human dignity. If nothing else, physicians should re-read the Hippocratic Oath, which for centuries has united physicians in a common, patient-centered cause.

Finally, we should look to physician role models around us. The Lufkin/Angelina County Chamber of Commerce hosts an annual Salute to Healthcare banquet where they honor a Healthcare Professional of the Year, Nurse of the Year, Individual of Merit, and a Lifetime Achievement Award winner. In November, I had the honor again of emceeing the event. As I announced the Lifetime Achievement award recipient, I emphasized the award is not just about showing up at work for 40 years and then retiring. That's just doing your job. What we honor each year is the extra - the above and beyond - that exemplifies a career marked by service not just to patients but to society. I hope that by honoring those who set a great example of leadership, compassion, and generosity over and above medical skill, younger physicians will be inspired to follow these examples of care beyond the dollar.

I challenge my physician colleagues, young and old alike, to "do what is right" by all patients. This is your profession, if you will still claim it.

Feeding the Hungry this Holiday Season

Our series of articles titled Business is Everyone’s Business has focused so far on various employers, both large and small, and their economic or employment impact in the region. In this season of Thanksgiving and Christmas, we must also remember that our local non-profits are everyone’s business as well.

The Thanksgiving holidays saw a great outpouring of giving through the Community Food Drive, originally started by our own “saint” Rev. Bettie Kennedy and now ably overseen by Bruce Love. On November 21, 2015, two thousand boxes of food were quickly packed and distributed throughout the community. Hundreds of volunteers, young and old, black and white, rich and poor came together for a common purpose and in one accord. That singular, annual event has great impact. Do you ever wonder how that need is met throughout the year?

The Christian Information & Service Center is an amazing organization that provides food for our hungry day in and day out. CISC, a 501 (c)(3) organization led by the indomitable Yulonda Richard, has a mission to be a Christian witness and minister to those in need specifically by feeding the hungry within Angelina County. It is a volunteer-supported organization that exists because of donations given in love by individuals and local churches. These donations allow CISC to operate locally in Lufkin to provide food out of the East Texas Food Bank in Tyler.

The need is significant. One in seven Americans will visit a food bank this year. 465,000 East Texans are at risk of hunger. Every year, CISC hands out over 2M pounds of food to around 200,000 people on a budget of $347,000. Though the primary assistance to the community is free food for low-income residents within Angelina County, CISC also offers various programs throughout the year, such as the "BackPack Buddies" after-school feeding program, the "Senior Food Box" senior citizen program which feeds over 2,600 seniors per year, and the "21-Day Meal Program," which aims at feeding children who are on summer vacation. There is also an avenue for assistance with gas vouchers, sleeping bags, bus tickets or utility assistance.

According to Yulonda Richard, the recent layoffs in Angelina County have led to an increase in the number of clients seeking help at CISC. Previous statistics showed that forty-nine percent of the households served have at least one employed adult, and the rest are mostly children and seniors on fixed incomes. It is, to a large extent, the working poor who really need a helping hand.

If you have ever driven by CISC in the morning, you know there are people there at 6:30 AM waiting, even though the doors don’t open until 9:30 AM. Fresh fruits, vegetables, meats, dairy, bread, everything you find in the grocery store CISC delivers. The majority of the donations come from right here in Angelina County: money, food, church support.

How can you help? Come to the Believe in Christmas! musical this Sunday, December 6, 2015 at 6 PM at Lufkin’s First Baptist Church. First Baptist and New Beginnings Baptist are uniting for the second year to celebrate unity, worship together, and support CISC. Admission is free, but bring canned goods or even a monetary donation for CISC when you come. As Yulonda Richard says, “It doesn’t matter what we give, God always expands it. As long as you are giving from the heart, God will increase it.”

CISC may not be the most glamorous non-profit in town, but they just might be the most impactful. As we move through this holiday season, remember that supporting local non-profits like CISC is everyone’s business.

PineCrest has Far-reaching Economic Impact

Mayor Bob Brown, City Manager Keith Wright, Chamber CEO Jim Johnson and other local government and business leaders recently launched a series titled Business is Everyone’s Business. The purpose of this initiative is to highlight local businesses and remind us not only of their economic impact but also the importance of our community support.

I recently asked the Texas Comptroller of Public Accounts office to provide me with updated statistics on the contribution of the healthcare sector to our local economy, and I was startled at the findings. Employment in the healthcare industry in Angelina County grew from 7,091 FTEs in 2005 to 8,411 in 2014. In 2014, 23 percent of all jobs in Angelina County were in the healthcare industry (up from 20 percent in 2013). In 2013, the healthcare industry accounted for $401,447,145 or 13 percent of the gross regional product in Angelina County. Angelina County truly is the healthcare hub of our deep East Texas region.

Within the healthcare industry, there are the major employers we all know about, like CHI St. Luke’s Health Memorial (1200 employees), Woodland Heights Medical Center (580 employees) and the Burke Center (400 employees throughout East Texas). There are myriad small businesses providing pharmacy, home health, hospice, and various diagnostic and therapeutic services to our region. We also have a number of nursing, rehabilitation and long term care facilities, one of which I want to feature today.

PineCrest, part of Methodist Retirement Communities, is a not-for-profit continuing care retirement community offering independent living, assisted living, memory support, skilled nursing and home health. Open since 1992 and located on 55 acres, PineCrest employs 220 people with an annual payroll of $6 million (mostly to Angelina County residents) and an additional spend of $3 million going to physical plant operations, utilities, contractors, and others.

Much more than a nursing home, PineCrest has 82 residential apartments, 36 patio homes, 21 assisted living apartments, 40 memory care units, and 51 skilled nursing units with 19 of those dedicated to transitional rehab. PineCrest also has on-site banking, full-service dining, a bistro, grocery store, library, chapel, beauty salons, a wellness center, and even a large auditorium to hold banquets, seminars, or private parties.

According to Amy Thomas, Executive Director at PineCrest, they currently serve around 237 residents, which include those with spouses. PineCrest is constantly reinvesting in our local community with ongoing renovations. PineCrest residents also contribute to the local economy as any of our county residents would, whether dining out, going to the grocery store, shopping, buying gas, attending Angelina Arts Alliance and Pines Theater shows, as well as with expected healthcare-related visits (hospitals, doctors, pharmacies, etc.).

PineCrest supports our broader economy in other, unexpected ways. For example, they partner with SFA as an intern site for social workers and as a clinical site for nursing students in SFA’s Bachelors nursing program. In addition, PineCrest is an intern site for SFA’s hospitality program. PineCrest also partners with Angelina College with AC’s LVN, RN, and CNA programs. These affiliations have led to numerous full time healthcare positions not only at PineCrest but at other facilities in our community.

PineCrest residents serve as volunteers at CHI St. Luke’s Health Memorial and at AC’s Adult Learning Center. And local high school students are working with PineCrest residents in a program called Wisdom for Youth with Senior Expertise (WYSE), which promotes inter-generational learning through shared experiences. An Alzheimer’s support group is also facilitated at PineCrest. Though these programs may not have a direct economic impact, their quality of life impact is significant.

PineCrest is a true community within our community, and one that is far from insular or isolated. I’m grateful for PineCrest’s economic impact as well as their influence far beyond simple employment statistics. PineCrest demonstrates that Business is Everyone’s Business!

A New Generation of Leaders

A new generation of leadership is emerging in Lufkin.

For those of us who have volunteered for various organizations over the years, there has been a hunger to see young adults step into volunteer leadership roles in the community as well as a desire to see our churches, schools, and governmental organizations mentor and raise up a new generation of leaders.

In recent years, there has been an oft-repeated lament that we've lost a generation of leaders - the Kurth, Temple, Trout and Henderson families jump to mind, among others - individuals who could pick up the phone and make a call and things got done. Though there certainly were instances where that was true, I think nostalgia glosses over the very real hard work and elbow grease that often went on behind the scenes. And the problem with that type of nostalgia is that it discourages current and future leaders from jumping in and getting their feet wet. "Oh, we can never accomplish what those guys did," we surmise. But we can.

Bettie Kennedy, whose life was celebrated this last weekend, didn't just pick up a phone to get something done; she got in the trenches and worked hard. Day after day, year after year. Rev. Kennedy proved you can have influence through servant leadership. Lufkin is a better place and a stronger community because of her.

My church, First Baptist, has been without a full-time pastor and music minister for some time now, and the church (which is the people, after all) has had to step up and be the church they were meant to be. This is the church fulfilling its mission.

In the same way, our community - especially our young adult population - is demonstrating we can step up and be the community we want and need to be! Each generation must reach the point where they take that mantle and lead. It is incumbant on both the current leadership to pass that mantle down and the next generation to take up that mantle and lead us forward.

I had the privilege over the last several months of serving on two different search committees for the Angelina County area and region. The first committee was to recommend a new president for Angelina College. The second was to select a new President and CEO of the Lufkin/Angelina County Chamber of Commerce. Both committees engaged search firms and conducted nationwide searches. Several things were remarkable about each process. Both committees were intent on seeking the input of a broad range of our community, as these were community leadership positions. And both committees were willing to consider, and in the end choose, young leaders.

Starting this month, Angelina College is under the leadership of Michael Simon, and the Lufkin/Angelina County Chamber of Commerce will be led by Jim Johnson. Both leaders come from a younger generation than their predecessors and symbolize the passing of the mantle I already mentioned. At Jim Johnson's press conference announcing his hiring, he was accompanied by his wife, Jasmine, and preschool son, William, who played with his toy car, cheerfully oblivious to the importance of the occasion. How refreshing!

And look at just some of the young leaders we already have! People like Trent Ashby, Mark Hicks, Tara Watson-Watkins, Hall Henderson, Martha Hernandez, Hilary Haglund Walker, Monique Nunn, They are accomplishing amazing things! There are many more in those ranks just starting to get involved.

I am proud of Lufkin and Angelina County. We have always demonstrated a greater degree of leadership, volunteerism and charity than any other place I know. My unsolicited advice to potential young leaders is this: Take the servant approach. Give of your time and talent first and foremost. As you have treasure to give, do so in a generous fashion. Lead by example, like Bettie Kennedy. You will gain credibility which will open doors and allow you to accomplish far more than you can imagine. But the first step of leadership is to step out of your office and get involved. You'll never regret it!

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.”

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.

Shop Local, Get Well Local

I have the privilege this year of serving as Chairman of the Board for the Lufkin/Angelina County Chamber of Commerce. The Chamber, along with the City of Lufkin and the Economic Development Partnership, commissioned a retail study that will help us in recruiting even more business to the area. Do you support our local economy by shopping local?

Even more important to our economy, where do you go for your healthcare?

As a physician community leader, I have a unique perspective on the healthcare sector. Across the state level and nationally, healthcare accounts for 11%-12% of a local economy. In the Lufkin area, it is nearly double that at 20%. Over the last 11 years, all other sectors of the economy combined have shown miniscule growth (0.5%). The healthcare sector grew by 36.3% during that same period. 7,424 Lufkin area jobs are directly linked to the healthcare sector, with a direct tie-in of $193.26 million in annual disposable income. It is not an understatement to say that the healthcare sector is a strong driver of Lufkin’s economic growth.

Of course, everyone is a bit nervous about the recent changes at Lufkin Industries and Temple-Inland. In my role with the Chamber, I am grateful for the recent outreach from new leadership from both GE/Lufkin Industries and Georgia Pacific. I urge both companies to continue the legacy left to them of strong involvement with the Chamber, the United Way, and the many other organizations that contribute to our quality of life. But, each of us has a responsibility to our community. Now – more than ever – how we act as individuals will drive our local economy.

We love to tout how much we love Lufkin, then we turn around and head to Houston for healthcare… when our local facilities and personnel are top notch. Those of us who are blessed with jobs and insurance have a responsibility to our community to direct our healthcare dollars locally as much as possible.

Why? Your community non-profit hospital, Memorial Health System of East Texas, has a mission to care for all – even those who do not have insurance or means to pay. For example, the Arthur Temple Sr. Regional Cancer Center has never turned a patient away due to inability to pay. Those Houston hospitals aren’t going to care for our indigent or uninsured, but they are more than happy to take our insurance. MD Anderson, for example, has a history of not even giving appointments without proof of payment up front. When you leave for healthcare services that can be delivered locally, you are diverting resources away that can not only help support local care for all, but improve our local economy. In these times of ever-increasing bureaucracy and ever-tightening reimbursement, we need to consciously support what we have here… or it may go away.

Ah, but then the argument turns to perceived quality of care. A couple of years ago, I looked at our cancer patient population to determine the #1 cause of delay in starting treatment. It was not income level or lack of insurance. It was seeking a second opinion out of town. Ironic, isn’t it, that thinking you need to go somewhere else for treatment might actually hurt you in the long run! Your local healthcare providers are perfectly capable of making the decision of what needs to be treated in the big city, and it is far less than what most people think.

To tweak an expression: “What stays in Lufkin is good for Lufkin.” Shop local? You bet. Stay local for healthcare? Absolutely.