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!

Doctors Are From Another Planet

Jupiter and Venus aligned recently in what was called a Bethlehem Star event. The next time the two planets appear this close together will be in 2023. The rarity of planetary conversions reminded me of the 1993 bestseller from PhD counselor Dr. John Gray, titled Men Are from Mars, Women Are from Venus. If you haven’t read it, apparently there are more than 50 million copies floating around.

The basic premise of the book is that men and women are naturally different in the way they think and communicate. We all know that an underlying lack of communication in a relationship keeps that relationship from maturing or even kills it. The success of the book is rooted in the knowledge it imparts (in very humorous ways) about how our spouses think and, therefore, how we need to relate to one another.

Communication among doctors is equally important, but what may die in this physician-physician communication desert is you, the patient.

Everyone knows the phrase from the 1967 Paul Newman movie, Cool Hand Luke, “What we have here is a failure to communicate.” A scholarly article in the Journal of the American Medical Association in 2007 noted that direct communication between inpatient physicians and primary care physicians happened in less than 1 in 5 hospitalizations. It is just as bad inside our hospitals.

Physicians are notorious for expecting others to communicate for them. Part of that is time crunch, but mostly it is laziness. It is easier to write an order for a nurse to contact another physician to see a patient rather than to make the call yourself. Although, with cumbersome electronic medical records and CPOE – computerized physician order entry – it is getting easier again just to pick up the phone and call.

Consulting physicians are busy, too, and getting one on the phone can be a challenge. But if I am asking another physician see my patient, I’m the one who knows best why I am making that request and what I want from that consultant. I shouldn’t delegate critical communication to others. That gets back to one of my golden rules: take the time and do what’s right.

What’s more, patients are demanding better communication among their healthcare team, and rating hospitals and physicians on whether or not they measure up. A 2011 National Academy of Medicine discussion paper noted, “Consistent and effective communication between patient and clinician has been associated in studies not only with improved patient satisfaction and safety, but also ultimately with better health outcomes, and often with lower costs.” In addition, “Breakdowns of communication, or disregard for patient understanding, context, and preferences, have been cited as contributors to health care disparities and other counterproductive variations in health care utilization rates.” In other words, when we don’t communicate, extra tests may get done and patients can get hurt.

However, communication is a two way street. You, the patient, need to know at a minimum your own medical and surgical history, what medications you are taking (and what doses), and what you are allergic to. Medical records are not perfect, and as with any electronic media, if garbage goes in, garbage comes out. If you don’t give your physician or the hospital accurate and complete information, that’s just garbage in. Can’t remember everything? Write it all down and bring in a copy.

Communication is a skill, and skill development requires practice. Yes, some physicians (and patients) need more practice than others. Let’s work together to align our communication stars and usher in a new era of patient safety, better outcomes, lower costs, and greater satisfaction.

Doing the Right Thing, One Day at a Time

As I write this column, it is Saturday morning of Memorial Day weekend. I have been at my office several hours working on patient charts and mapping out cancer treatment plans. This type of work cannot be done in the midst of a busy clinic day. Once I am done today, my radiation physicist will compute these patient plans. Then I will come back out later today or tomorrow to review and approve them so treatment can start next week.

Such is a typical Saturday morning for me. This is the tedious, mental work that requires me to be alert, focused, and very careful. Modern radiation treatment is highly precise, and the treatment is only as good as the planning process. If I don’t accurately target the cancer, it doesn’t get treated. And if I don’t carefully protect surrounding normal tissues, side effects can be worse. All of this takes dedicated, uninterrupted time. So, I am here at my office this lovely Saturday morning because, well, it is the right thing to do.

What does it mean to “do the right thing”?

A number of guiding principles come to mind. For me, the most important one is to take my time. Doing the tedious work on a Saturday morning or weekday evening. Spending adequate time with my patients. When I rush or get careless, I make mistakes. And by the way, we should acknowledge our mistakes and learn from them.

A second principle is: don’t do either more or less than required. Medically speaking. What I mean is physicians shouldn’t do procedures that are unnecessary just to pad their pocketbook. The flip side is also true: physicians should provide needed care even if they do not expect to be paid for it. Yes, there are times when this is not possible, but the concept and practice of providing charity care is part of who we are and what we profess to be as physicians.

Third, don’t be afraid to ask for help. I can provide most radiation-related cancer treatment in Lufkin, Texas, thanks to the fantastic equipment and personnel at CHI St. Luke’s Health Memorial. But there are rare or unusual cases where I don’t mind asking colleagues for assistance. It’s OK to pick up the phone and call my Houston colleagues if needed. In a similar vein, I tell my patients that I am not offended if they decide to seek treatment elsewhere. Patients need to be comfortable getting their care from me, and almost all are. Some physicians get all bent out of shape and act offended when someone wants to go elsewhere for care. They need to get over it and realize it is not about them. We are to serve our patients, not the other way around.

Fourth, treat everyone the same. What I mean by that is, each person has value, and that value is not based on their insurance plan. We shouldn’t let money dominate our decision-making.

Reimbursement for one’s work is important, but physician compensation comes with an obligation that an ever growing, younger crop of physicians seems unwilling to meet. We “old school” physicians often lament that younger doctors don’t view medicine as a profession. New medical school graduates view medicine as a job, with an employee, get-in-and-get-out, do-the-minimum mentality. Yet, they expect high salaries off the bat. What a shame! Sometimes the best payment is the heartfelt gratitude of a needy patient.

Each of us should strive to do the right thing, one day at a time, no matter what our profession or job.

A New Era of Cancer Survivorship

We are surviving cancer in greater numbers than ever!

The American Medical Association's new oncology journal, JAMA Oncology, presented encouraging statistics in their inaugural issue on how many of us survive cancer. Some cancers have seen a lot of progress over the last 20 years. For example, patients aged 50 to 64 years and diagnosed with colorectal, breast, liver, and prostate cancer from 2005 to 2009 were 39% to 68% more likely to survive than similar patients diagnosed between 1990 and 1994. The article also pointed out that certain subgroups - the elderly, and African Americans - are not seeing as much improvement. Disparities in healthcare remain one of our greatest challenges in the United States. I have addressed this previously, but for today, I want to focus on the survivors.

According to the American Cancer Society, nearly 14.5 million Americans with a history of cancer were alive on January 1, 2014, not including carcinoma in situ (non-invasive cancer) of any site except urinary bladder, and not including basal cell and squamous cell skin cancers. It is estimated that by January 1, 2024, the population of cancer survivors will increase to almost 19 million: 9.3 million males and 9.6 million females.

I recently spoke at the Polk County Relay for Life Survivor's Dinner, and this weekend will speak at one for Crockett/Houston County. American Cancer Society Relayers are passionate about the fight to end cancer and remembering loved ones lost to cancer, but they are equally passionate about recognizing and honoring survivors. If nothing else, these dinners remind me that survivors are the everyman. And as such, survivors want nothing more than to live their lives with cancer in their past, not with side effects or debilities that are constant reminders of what they have been through to get where they are.

For the field of oncology - the study of cancer and how to treat it - this new focus on what happens when we cure cancer is both refreshing and eye-opening.

What does it mean to survive? Surely it means more than just to live, more than just to carry on despite the hardship or trauma of cancer. Today, when you can buy survival guides for anything from zombies and global warming to ballroom dancing and Disney queue lines, we very much risk cheapening the word. And how about the "take no prisoners" approach of the reality television Survivor series? Being the last man or woman standing is not the goal, either. Cancer survivorship is about all of us reaching the goal!

I believe that successful cancer survivorship has much to do with attitude. I see it all the time. Patients with a positive mindset suffer less! Negative patients can talk themselves into any side effect and can let the burden of cancer treatment weigh so heavily on them that they simply can't function. Having strong support systems in place can help; surviving cancer is a cooperative effort which ideally should include not only the patient and the medical team, but the family, friends, caregivers, support groups as well.

We have entered an era where it is no longer good enough to cure cancer. We must cure with the least toxicity possible, all the while staying concerned with the cost of cancer treatment both for the patient and for society. And, we must ensure that these advances are available to all patients, regardless of race, ethnicity, income.

Are you or is someone you love going through cancer treatment? Get involved in Relay for Life! Survive? Thrive! Find an event near you at relay.acsevents.org.

New Cancer Fighting Technology in Lufkin

Last week, the Temple Cancer Center treated the first patients on our new Elekta Synergy linear accelerator, the first major investment of Memorial since the CHI acquisition. To say, "We got a new piece of equipment" understates the multi-year project of visiting other cancer centers, evaluating manufacturers, specking options, removing an older treatment machine and renovating the vault that houses the linear accelerator, and determining what other hardware and software is required to make this new piece of incredible technology work to treat cancer. No small task!

All told, this project, which also included a Toshiba large bore CT scanner, Vision RT image guided radiation alignment technology and other accessories, topped out at $4.5 million. It is a recognition of the importance of exceptional cancer treatment to our region and a signal that Memorial will remain the regional hub for cancer care in deep East Texas.

So, what does this new technology bring to our deep East Texas region? For our many patients currently being treated with IMRT - intensity modulated radiation therapy - we will be able to deliver their treatment in a fraction of the time it has taken up until now, often less than five minutes per treatment! Standard treatments can go even faster. And, these treatments are often even more precise with less dose to surrounding normal tissues, which will translate to even fewer side effects.

In addition, we will be able to implement a totally new procedure to the region called SBRT - stereotactic body radiosurgery. SBRT delivers high doses or radiation over very short courses - three to five sessions, typically - and requires much finer tuning and more rapid treatment delivery than we were previously able to do. We will start using this technology for small lung cancers first, but I anticipate over time treating cancers in other locations as well. The utility of the technology for lung cancer cannot be overstated. Lung cancer is almost always related to smoking, and heavy smokers often cannot undergo surgery, because they do not have enough normal lung function to survive removal of even a small part of a lung. However, these same patients can often be cured with SBRT. With low-dose CT lung cancer screening, we anticipate finding more early lung cancer; now we have the ability to treat them even if they cannot have surgery, with equal results and less morbidity.

Another site where we plan to implement stereotactic radiosurgery technology is in the brain, where small tumors can be ablated with radiation without having to be removed neurosurgically. Treating tumors such as these in an outpatient setting without having to resort to major chest or brain surgery is a remarkable benefit of this new technology. We will not start using this new technology immediately, however, because any new procedure requires establishment of appropriate protocols, quality assurance procedures, and training, all of which will be implemented over the coming months.

The Temple Cancer Center is also excited that our social worker, Appolonia Ellis, recently completed the Harold P. Freeman Patient Navigation Program, where she learned how to better assist our patients in accessing available services and programs so that they can successfully complete treatment. Patient navigation is fairly new to cancer programs, and we are excited to have the only navigator in the area.

At a time when other industries have announced plans to cut hundreds of jobs or move out of the area altogether, CHI's long term commitment to Lufkin and the Memorial system is reassuring. They are putting their money where there mouth is, so to speak. For that, I am grateful.

A Spoonful of Sugar

I don't think I'm unique in having a family that discusses medical issues at the dinner table. But in a family with a doctor, sometimes discussions – to the dismay of my children – are more colorful than they would like. I have learned (mostly) to keep discussions from veering off track. For my family’s part, they know there is a cardinal rule that must be obeyed: you are not allowed to mention Google or Reader’s Digest when discussing medical facts. That rule was recently broken by my wife, Catherine, but in an interesting and forgivable way. Here's the story.

My wife takes a potassium pill – a common supplement – once a day. As anyone who takes this pill knows, it is a big tablet. A horse pill, some would say. And because of that, she wasn't taking it reliably. Some days she could swallow it without too much difficulty, and other days she just couldn't get it down. If she tried a couple of times without success, she just let it go. That’s where Google comes in. In a worthy attempt to educate herself, she went online, researched the medicine, and found out why she needed it. Now, she is much more compliant... to a point. She won't take it if she is alone, because she doesn't want to choke on it.

When she told this story at the dinner table, she concluded, "Isn't that interesting?" To which I replied, "What is interesting is that you didn't trust that because the doctor prescribed it for you, you needed to take it." My daughter then remarked, "That's because a lot of doctors are quacks." So much for respecting the medical profession these days.

Of course, as a doctor's wife, Catherine very much respects the profession of medicine, and I had a twinkle in my eye when I "accused" her otherwise. My daughter's sarcastic analysis, however, did sting a little. Long gone is the era of paternalistic medicine, where TV doctor Marcus Welby, MD simply told his patients what was best and they complied without question. Now patients come to our offices telling us what is best and expecting us to comply. And front line primary care doctors are so strapped for time and paid so little for each office visit that sometimes it is easier just to acquiesce. 

Physicians must resist that temptation. Historically, perhaps it was appropriate for the family doctor to be paternalistic when he knew his patient so well – both inside and outside the office – and when he took care of the medical needs of the entire family. Too often today, the primary care physician is seen simply as the source of a referral to a specialist. The gatekeeper moniker was a kind way of referring to the physician whose true role was (as far as the insurance companies were concerned) to prevent specialist referrals rather than facilitate them. That is a far cry from the position of a genuine coordinator of care who manages the various specialists’ recommendations and knows all the medications that have been prescribed. Such coordination takes a great deal of communication not only among healthcare professionals but between the primary physician and the patient as well.

All physicians – not just primary care physicians – must work harder to earn the respect and trust of their patients. We must take the time to explain the interventions we recommend and the medicines we prescribe. Those horse pills will go down a lot easier with a little sweet talk and education along the way. And our patients will be happier and healthier as a result. Now, that's good medicine!

Cancer is a Global Problem

Tomorrow is World Cancer Day. We think we have a cancer problem in the US, and we do. But other countries, especially the poorer ones, are truly suffering. Two publications by the American Cancer Society - Cancer Atlas and The Global Economic Cost of Cancer (which I quote extensively) - soberingly detail the scope of the problem.

For example, 6 out of 10 cancer patients would benefit from radiation therapy (my specialty) in the course of their cancer treatment. However, about 20 countries in Africa do not have a single radiation treatment facility. And even when radiation facilities are available, as is the case in several countries in Africa and Asia, coverage is woefully inadequate. Ethiopia, a country of around 90 million people, is served by a single radiation treatment center located in the capital city.

Similarly, although morphine to treat cancer pain is plentiful, safe, and easy to use, millions of terminally ill cancer patients in Africa and Asia die in pain because of regulatory restrictions, cultural misperceptions about pain, and concerns about addiction. Eighty-five percent of the global population lives in low- and middle-income countries, but consumes just 7% of the medicinal opioids, like morphine.          

For the first time, research has shown that cancer has the most devastating economic impact of any disease in the world. The total economic impact of premature death and disability from cancer worldwide was $895 billion in 2008, nearly 19 percent higher than heart disease. And, that figure does not include direct medical costs.

Cancers of the lung, bronchus, and trachea account for the largest drain - nearly $180 billion - on the global economy. That's not surprising, given that smokers die an average of 15 years earlier than nonsmokers. Tobacco is predicted to kill seven million people annually by 2020 and eight million per year by 2030, with more than 80 percent of the deaths taking place in low- to middle-income countries. One-third of those deaths are the result of cancers. This is almost entirely preventable.

And it isn't just lung cancer. Despite the fact that most cases of cervical cancer can be prevented or treated effectively, 274,000 women die from the disease yearly. Approximately 241,000 of these deaths are among women in low- and middle-income nations. And then there's breast cancer, colorectal cancer, and on and on.

It seems like all we hear about on the global stage is HIV/AIDS and malaria (and, more recently, Ebola) - the so-called communicable diseases. But the economic loss from HIV/AIDS ($193.3 billion) TB (45.4 $billion) and malaria ($24.8 billion) combined is not even 30 percent of the economic loss of cancer.

Why should you care?

Put simply, the global cancer epidemic is huge and is set to rise, according to World Cancer Day planners. Cancer treatment and pain management for those dying of cancer are not political issues. They are global health issues which we in the United States, with our expertise and yes, wealth, can tackle better than any other country. They are also the type of moral issues which donors and politicians of every stripe can come together to address. 

This will require effort on the part of organizations like the American Cancer Society and other NGOs, but it will to an even larger degree depend on the leadership of the United States in organizations like the United Nations and the World Health Organization, whatever you think of them. And it will depend on you. Support the American Cancer Society and ACS CAN - the American Cancer Society Cancer Action Network - so that we can create a world with less cancer and more birthdays.