JUNE2010 JMSMA

VOL. LI No. 6

June 2010

Timothy J. Alford, MD 2010-2011 MSMA President

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JUne 2010 VolUMe 51 nUMber 6

Scientific ArticleS

Domestic Violence Screening in a Military Setting: Provider Screening

and Attitudes 155Monica Lutgendorf, MD, MC, USN; Jeanne Busch, MD, DO;

Everett F. Magann, MD, MC, USN and John C. Morrison, MD

SPeciAl Article

An interview with timothy J. Alford, MD

2010-2011 MSMA President 158

PreSiDent’S PAge

i Wish You Hearts that race, Minds that Dream… 168Randy Easterling, MD; MSMA President

eDitoriAl

if only We Knew 170D. Stanley Hartness, MD; Associate Editor

relAteD orgAnizAtionS

Mississippi State Department of Health 164

DePArtMentS

new Members 165

images in Mississippi Medicine 171

Poetry in Medicine 172

the Uncommon thread 173

Placement/classified 174

Una Voce 175

AboUt tHe coVer: tiMotHY J. AlforD, MD; 2010-11 MSMA PreSiDent - During our

MSMA’s 142nd Annual Session, held June 3-6 at the Natchez Convention Center,

Dr. Tim Alford of Kosciusko was installed as the 143rd president of the

association. Dr. Alford is board-certified by the American Academy of Family

Physicians and is a Past President of the Mississippi Academy of Family

Physicians. He is in the private practice of family medicine with Kosciusko

Medical Clinic, a division of Premier Medical Group of Mississippi. You will

also find an interview with Dr. Alford in this issue of the JMSMA. r


2010June

VOL. LI No. 6


2010June

VOL. LI No. 6

Official Publication

of the MSMA Since 1959

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Copyright© 2010, Mississippi State Medical Association.

Lucius M. Lampton, MDEditor

D. Stanley Hartness, MDMichael O’Dell, MDAssociAtE Editors

Karen A. EversMAnAging Editor

PublicAtions coMMittEE

Dwalia S. South, MDChair

Philip T. Merideth, MD, JDMartin M. Pomphrey, MD

Leslie E. England, MD, Ex-OfficioMyron W. Lockey, MD, Ex-Officio

and the Editors

thE AssociAtion

Randy Easterling, MDPresident

Tim J. Alford, MDPresident-Elect

J. Clay Hays, Jr., MDSecretary-Treasurer

Lee Giffin, MDSpeaker

Geri Lee Weiland, MDVice Speaker

Charmain KanoskyExecutive Director

june 2010 jOuRnAL MSMA 153

As a physician, you ask more of an Academic Medical Center.

You ask us to invent new ways to diagnose and treat disease.

To lead the medical research that can give us all better lives.

You ask more of University of Mississippi Health Care.

You ask us to offer the highest level of medical care to our mutual patients, every day.

To push the boundaries of what is possible.

This is University of Mississippi Health Care.Your Academic Medical Center.

Expect more.

Talk doctor-to-doctor at 866.UMC.DOCS or learn more at umhc.com.

An Academic Medical Center Is Not Like

An Ordinary Hospital.

154 jOuRnAL MSMA june 2010

Domestic violence is an important healthcare problem, and it

appears more prevalent in military patient populations although no one

has demonstrated the cause behind this phenomenon. The purpose of

this observational study was to assess data regarding domestic violence

screening from practitioners at one military training center. This study

used an anonymous questionnaire for physicians, nurses and nurse mid-

wives, which surveyed current methods, attitudes toward screening,

and barriers for such assessment. Fifty-seven surveys were distributed,

and 26 were returned for a response rate of 45.6%. Only about a third

(38.5%) of the practitioners screened all obstetric patients while the re-

mainder screened selected patients for domestic violence. Even less

(19%) screened gynecology patients routinely, whereas 69% reported

they screened selected women with chronic or somatic complaints. A

history of prior abuse in the respondents led practitioners to try to iden-

tify such patients within their practice. Lack of education or training

was the most common barrier to universal screening followed by time

constraints and frustration about not being able to address adequately

the problem when noted. These results emphasized the importance of

an educational program to increase domestic violence awareness and

routine screening.

KeY WorDS: DOmEsTic viOLEncE, scrEEning,

prOviDEr ATTiTuDEs

introDUction

Domestic violence has important healthcare implications in-

cluding injuries, mental illness, and complications during pregnancy.1

The incidence of domestic violence is estimated to be between 2-23%

annually2 with its victims reporting a poorer overall health status and

more frequent use of health care services.3 such women seek care for

a variety of somatic and psychological complaints including gyneco-

logic, gastrointestinal, chronic pain, and psychiatric complaints.4 The

healthcare costs related to domestic violence are significant. in 2003,

the centers for Disease control and prevention’s national center for

injury prevention and control reported an estimated $5.8 billion spent

per year for the direct and indirect costs of domestic violence in the

u.s.5 in fact, these costs are likely an underestimate as domestic vio-

lence is often unrecognized and underreported. many professional or-

ganizations including the American college of Obstetricians and

gynecologists (AcOg), the American Academy of Family physicians

(AAFp), and the Joint commission on Accreditation of Health care

Organizations (JcAHO) recommend routine screening for domestic vi-

olence.6

The military healthcare setting presents a unique situation with

respect to domestic violence. previous work has shown that stress

within the military and lack of control in various military occupations

may lead to adverse pregnancy outcome.7 Additonally, dependents of

military personnel have increased stress due to long separation and

often times to hazadous duty assignments of their spouses.8 it is not

surprising then that the incidence of spousal abuse in the military is

higher than the civilian sector with estimates of one third of military

spouses experiencing abuse during their marriage.9 military personnel

and their families also have ready access to healthcare resources and the

unique Family Advocacy program (FAp) that provides social support

to families struggling with domestic violence.

The purpose of this study was to examine clinicians’ screening

profile for domestic violence in a military healthcare setting and to

identify barriers to such screening.

MAteriAlS AnD MetHoDS

With approval from the naval medical center portsmouth in-

stitutional review Board, all practitioners (nurses, midwives, and doc-

tors) in the obstetrics and gynecology clinic at naval medical center

portsmouth were anonymously surveyed regarding their current meth-

• SCienTiFiC ARTiCLeS •

Domestic Violence Screening in a Military Setting:Provider Screening and Attitudes

Monica Lutgendorf, MD, MC, USN; Jeanne Busch, MD, DO;

Everett F. Magann, MD, MC, USN and John C. Morrison, MD

AbStrAct

AUtHor inforMAtion: Drs. lutgendorf, busch and Magann are in the Departments of

Obstetrics and Gynecology at the naval Medical Center in Portsmouth, VA. Dr. Morrison

is in the Department of Obstetrics and Gynecology at the university of Mississippi

Medical Center in jackson, MS.

correSPonDing AUtHor: john C. Morrison, MD, Department of Obstetrics and

Gynecology; university of Mississippi Medical Center; 2500 north State Street;

jackson, MS 39216-4505; Telephone: (601) 984-5300; Facsimile: (601) 815-4096; e-Mail:

[email protected]



ods of screening patients for domestic violence as well as their atti-

tudes toward screening. participants were also questioned regarding 19

potential barriers to screening. Written permission was obtained from

the author to use the questionnaire previously published by parsons in

a nationwide survey of AcOg fellows10 which used a series of closed

ended questions.

The first part of the survey contained questions regarding current

screening practices. practitioners were asked (1) is it part of your rou-

tine obstetric history to screen all patients for abuse? (2) Do you screen

selected patients for abuse? (3) is it part of your routine to screen pa-

tients for abuse at their annual gynecologic visit? (4) is it part of your

routine history taken on women with chronic somatic complaints, sex-

ual problems, or chronic pelvic pain to ask about abuse?

One question was designed to assess past training on abuse/do-

mestic violence with instructions to include all prior sources of train-

ing including no training, formal continuing education course, local

hospital, county family services, other local agency, residency program,

battered women’s shelter and the AcOg Educational Bulletin.6

The second part of the survey addressed 19 potential barriers to

screening using a 5-point Leikert scale. responses were designed to as-

sess time constraints as a barrier, education/training, deficiencies, pa-

tient type, fear of offending the patient, frustration at inability to help

the patient, a personal history of abuse, inability to verify the abuse,

intention to screen but not yet initiated, and the belief that abuse is not

a medical problem.

reSUltS

A total of 57 surveys were distributed to clinicians in our prac-

tice area. surveys were anonymously collected over the following

month. Twenty-six surveys were returned with a response rate of

45.6%. respondants were 34.6% male, and 65.4% female with 10

(38.5%) aged 20-40 years, 6 (23%) 41-50 years, and 10 (38.5%) > 50

years old. Fourteen (56%) respondents were physicians (mD/DO) with

the remainder being rn’s or nurse midwives. Thirteen (68.4%) com-

pleted residency (or are still in training) from 1991-present, and 6

(31.6%) completed residency from 1971-1991.

Only 38.5% providers reported that they screened all obstetric

patients for domestic violence while 58.3% screened selected obstetric

patients for abuse. Only 31% of physicians screened all obstetric pa-

tients for abuse, compared to 60% of nurses. Additionally, 62% of

physicians screened selected obstetric patients for abuse while a simi-

lar percentage (60%) of nurses employed selective screening among

obstetric patients. Even less (19%) of respondents screened all gyne-

cology patients at routine annual exams while 69% reported that they

assessed only women with chronic pelvic pain, sexual problems or

chronic somatic complaints. When stratified by provider, 14% of

physicians surveyed and reported that they screened gynecology pa-

tients at annual visits compared to 29% of nurses surveyed. Of those

who used selective screening, 80% of physicians and 71% of nurses

questioned women with chronic pelvic pain, sexual problems or

chronic somatic complaints for domestic violence.

When questioned about a personal history of abuse, 67% of

physicians and 27% of nurses reported no history of abuse. conversely,

27% of physicians and 73% of nurses reported that their own exposure

to abuse led them to try to identify victims of abuse within this patient

population. Lack of education or training was one of the most common

barriers (53.8%) to screening with 47% of physicians and 64% of

nurses reporting that they felt inadequate in dealing with abuse because

of a lack of training. On a personal level 67% of physicians and 50%

of nurses felt more qualified to deal with physical problems than psy-

chosocial issues. Time constraints, cited as a barrier by a third (33%)

of physicians and nearly two-thirds (64%) of nurses, prevented ade-

quate screening and consultation with such patients. One half (53%)

of physicians and 18% of nurses responded that they felt frustrated that

they could not do anything about such problems even if they could

identify them. no one responded that “such contact is normal in a re-

lationship” or that “women bring this on themselves.”

Only 40% of physicians and 27% of nurses followed all four

American medical Association (AmA) screening guidelines whereas

13% of physicians and 18% of nurses followed the six AcOg screen-

ing guidelines. When questioned regarding what outcome they would

take if a patient responded with a history of abuse, 100% of physicians

and 91% of nurses said they would obtain a more detailed history while

most physicians (93%) and nurses (64%) would record it in the pa-

tient’s chart. in addition, 80% of physicians and 73% of nurses would

provide patients with emergency numbers whereas 53% of physicians

and 64% of nurses would provide information on referral sources.

About half of the physicians (47%) and nurses (46%) would inquire

about child abuse. Fifty-three percent of physicians and a greater num-

ber of nurses (73%) would advise counseling.

DiScUSSion

Our departmental policy is to screen all pregnant women for do-

mestic violence at their initial visit by a question on the standard intake

form. The American college of Obstetricians and gynecologists rec-

ommends screening for domestic violence at routine annual exams, at

preconceptual counseling, once each trimester in pregnancy and post-

partum.6 if nothing else, we have highlighted how we did so poorly in

screening for abuse in this high risk population. Therefore, while a

limited response rate at one military base may hamper geralization, the

results would seem compatiable with other military installations and

in other branches of the service. indeed, the majority of providers do

not routinely screen women health patients for domestic violence.

providers are more likely to screen selected obstetric and gynecology

patients with chronic pain/chronic somatic complaints or at certain

times rather than follow the routine screening guidelines for all pa-

tients. Lack of education or training was the most commonly cited bar-

rier to screening. The second most common complaint was time

constraints since military physicans have to see more and more patients

per unit of time because of overseas deployment of other practitioners.

This is compounded by the lack of time and reasons to deal effectively

with such cases when they are identified.

The small numbers in this study preclude drawing general con-

clusions regarding screening within the military as a whole. However,

physicians as well as their patients represented geographic areas from

all over the country and patients from all branches of military service.

These results underscore the importance of educational programs to in-

crease domestic violence awareness and routine screening. ideally such

There’s a lot going on in organized medicine so it’s easy to miss something if you’re on the go. To help you stay in touch no matter where you are, MSMA is now communicating via “Twitter.”In about three minutes, you can set up a free Twitter account for yourself. Simply visit www.twitter.com and submit your name, email address and mobile phone number (optional, standard text messaging rates apply). Once you’re signed up with Twitter, you can add MSMA by going to the following web page http://twitter.com/MSMA1 and clicking “Follow” next to the MSMA icon.MSMA1

For a bird’s eye view on medicine follow MSMA on!

There’s a lot going on in organized medicine so it’s easy to miss something if you’re on the go. To help you stay in touch no matter where you are, MSMA is now communicating via “Twitter.”In about three minutes, you can set up a free Twitter account for yourself. Simply visit www.twitter.com and submit your name, email address and mobile phone number (optional, standard text messaging rates apply). Once you’re signed up with Twitter, you can add MSMA by going to the following web page http://twitter.com/MSMA1 and clicking “Follow” next to the MSMA icon.

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!


programs should focus on the unique situation of the military with its

reporting requirements and the Department of Defense’s Family Ad-

vocacy program designed to provide support for victims of domestic vi-

olence. All physicians and providers should be familiar with the

available resources within their community and appropriate channels

for referral. Finally, active duty women support routine screening in the

military: a recent survey of 474 active duty women deomonstrated that

57% supported routine screening, 87% supported mandatory screen-

ing, and 48% felt that abuse should be reported to the commanding of-

ficer.11

AcKnoWleDgeMent:

The authors wish to acknowledge the practitioners and patients

of the Department of Obstetric and Gynecology Naval Medical Center,

Portsmouth VA and Keesler Air Force Base Medical Center, Biloxi, MS.

The views expressed in this article are those of the author(s) and

do not necessarily reflect the official policy or position of the Depart-

ment of the Navy, Department of Defense, or the United States Gov-

ernment.

The Chief, Navy Bureau of Medicine and Surgery, Washington,

DC, Clinical Investigation Program sponsored this study (CIP #P05-

091E).

This work was prepared as part of the official duties of a mili-

tary service member. Title 17 U.S.C. 105 provides that ‘Copyright pro-

tection under this title is not available for any work of the United States

Government.’ Title 17 U.S.C. 101 defines a United States Government

work as a work prepared by a military service member or employee of

the United States Government as part of that person’s official duties.

referenceS

1. ramsay J, richardson J, carter YH, Davidson LL, Feder g. should healthprofessionals screen women for domestic violence? systematic review. Br

Med J 2002;325:314-318.2. Laumbach sg. Detecting Domestic violence: To screen or not to screen?

The Female Patient 2004;29:47-57.3. campbell Jc. Health consequences of intimate partner violence. Lancet

2002;359(9314):1331-1336.4. Eisenstat sA, Bancroft L, Domestic violence. N Engl J Med 1999;341

(12):886-892.5. centers for Disease control. Costs of Intimate Partner Violence Against

Women in the United States. Atlanta, gA: u.s. Department of Health andHuman services, cDc, national center for injury prevention and control,2003.

6. American college of Obstetricians and gynecologists. The Battered

Woman. ACOG Educational Bulletin Number 257. Washington Dc:AcOg; 1999.

7. magann EF, Winchester mi, carter Dp, martin Jn Jr., Bass JD, morrisonJc. Factors adversly affecting pregnancy outcome in the military. Am J

Perinatol 1995;12:462-6.8. Haas Dm, pazdernik LA. partner deployment and stress in pregnant

women. J Reprod Med 2007;52:901-6.9. Brannen sJ, Bradshaw rD, Hamlin Er, Fogarty Jp, colligan TW. spouse

Abuse: physician guidelines to identification, Diagnosis and managementin the uniformed services, Mil Med 1999;164(1):30-36.

10. parsons LH, Zaccaro D, Wells B, stovall Tg. methods of and attitudestoward screening obstetrics and gynecology patients for domestic violence.Am J Obstet Gynecol 1995;173:381-386.

11. gielen Ac, campbell J, garza mA, O’campo p, Dinemann J, Kub J, JonesAs, Lloyd DW. Domestic violence in the military: Women’s policypreferences and Beliefs concerning routine screening and mandatoryreporting, Mil Med 2006;171(8):729-735.


• SPeCiAL ARTiCLe •

An Interview with Timothy J. Alford, MD2010-2011 MSMA President

Karen A. Evers, Managing Editor

tiMotHY JoHnStone AlforD, tHe YoUngeSt of foUr

cHilDren… After my mother, virginia small Alford, reared us, she

renewed her career as a registered dietitian and went to work for Dr.

John Bower’s Kidney care. Like so many registered dietitians, she

was a marvelous resource and, by golly, she made sure that we ate

our fresh fruits and vegetables! my eldest brother, John, lives in

macon, georgia, with his family and is a dentist there. Helen, my

sister, met her husband at southwestern (rhodes) college in

memphis. she is a teacher of choral music in the Jackson,

Tennessee; public schools and her students continue to top the

charts in Tennessee. Helen has a knack for getting the best from

young people. Brother peter, is an intensivist in statesville, north

carolina. peter attended Davidson college, and we could never get

the carolina out of him.

my dad, John Alford, mD was a tough taskmaster and

expected excellence from all of us regardless of what we were

doing. He had a strong work ethic and was a very principled

physician. Dad never purchased a dime’s worth of medical

malpractice insurance and insisted that such contracts violated the

sacred patient-physician trust. Fortunately he was never sued.

However, this stand abbreviated his tenure on the medical staff at

greenwood-Leflore Hospital. mike carter, mD, former msmA

president, once told me that Dad was right about many such “cries

in the wilderness.” Dad grieved over medicine succumbing to

corporate America and the inherent erosive effect that profiteering

had on the doctor-patient relationship. He openly admitted that he

was not programmed for organized medicine and on one occasion

was convinced by Dr. Ed Hill to rejoin the Association after a three

to four year hiatus.

DeciSion to becoMe A Doctor…i would say that not only my father’s influence but also the collaborative influences of a congenial group of physicians in a

small Delta town along with outstanding high school science teachers were what motivated me toward medicine.

going to MeD ScHool…my class at the university of mississippi school of medicine was one of the last of the mega-classes – 140 plus before it

dropped to 100. it is a good thing, too, because i probably would not have gotten into a smaller class and that is the truth! The

sTEp exams are much more rigorous i believe than the FLEX. We have a steady stream of m-3’s and m-4’s rotating through our

[Each June the JMSMA interviews the incoming president. Here we go behind the scenes. Due to space limitations, the answered questions

do the speaking for this interview.] —Ed.


(Kosciusko) clinic doing their Family medicine blocks. To me these students are extremely bright and even better rounded than

we were.

MArrYing forMer StAte HeAltH officer Dr.Alton cobb’S DAUgHter, MArY Al…

i met mary Al at millsaps during my freshman year

there. she was a year ahead of me and was my orientation

advisor. We did not date until her senior year, though.

Our wedding was held the saturday after my graduation

from millsaps. mary Al was fortunate enough to land a

job in governor Winter’s administration and worked at the

governor’s mansion during my medical school days.

As for my father-in-law Alton and mother-in-law

mary cobb, i am not sure there are two better public health

servants in mississippi than these two. mary worked as a

public health nurse at the high risk clinic at umc. she

took on many exceedingly challenging patients, babies, and

home environments with intense devotion. As for Alton, i

spent many a sunday afternoon at his beloved home place

in camden, mississippi. This log home built in 1832 is the

oldest residence in madison county. i have been well

schooled in the critical matters of public health along with

the best way to grow pine trees. in my opinion, Alton is

mississippi’s foremost health analyst and genuinely

attempts to look at issues on balance.

becoMing inVolVeD in MSMA…my entry into msmA began in the early years of the Young physicians’ section. Dr. stanley Hartness, my partner at Attala

medical clinic, offered much encouragement in my involvement with msmA. i owe my service on the Board of Trustees to Dr.

Dwalia south who convinced me to run for the Board position.

on SerVing AS MSMA PreSiDent…i cannot say that being msmA president has been a life-long pursuit, but i am humbled by the fact that my colleagues

would see fit to elect me to this position and i am committed

to doing the best i possibly can to serve organized medicine in

mississippi.

orgAnizeD MeDicine iSSUeS iMPortAnt to YoU…

• At the practicing level, bringing greater efficiency

and “value” to our practice. This translates into

better health care for our patients and is a never-

ending, labor-intensive process.

• At the policy level, laying the groundwork for the

eventual rolling out of the patient centered medical

Home statewide. HB 1192 signed into law and

drawn up collaboratively by mAFp and msmA

empowers our state Health Department to assist

physicians statewide in adopting this new model of

care. most of us are on the “lower limb ” of the

learning curve with regards to this revolutionary

approach of caring for our patients. The good news

is that physicians will lead the team in this plan of

care.

FiRST ROw: MArY brUce AlforD, MArY Al AlforD, leAH HenDrix,

tAl HenDrix, MArY cobb; SeCOnD ROw: tiMotHY AlforD, JoHn PAUl

AlforD, tiM AlforD, Alton b. cobb

tiM AnD MArY Al AlforD

“What they say about him...”

Tim Alford is just a great guy. As a new physician gettinginvolved in organized Family medicine he allowed me toparticipate, excel, make mistakes and learn from them, and thenchallenge me to move on. i am grateful for his guidance, histhoughtfulness, and his leadership. Tim, i wish you the bestduring your year as president of msmA. Thanks for all of yourhard work to make mississippi a better place! —Jason B. Dees,DO, FAAFP, New Albany

Tim and i go way back, mostly connected through our yearswith the mississippi Academy of Family physicians and throughsome American Academy of Family physician activities. Timwas, at one time, chair of the American Academy of Familyphysicians council on Legislation. it was in that capacity that heoften invited me to attend several other national meetings.remember, i was a guest, there only to learn from Tim andothers. Like most medical meetings, they all began early in themorning (around 7:00 a.m. and concluded by noon). Havingsome measure of OcD, i was dutifully at each meeting by 7:00a.m. sharp, often times employing toothpicks to hold my eyesopen. Each morning, Dr. Alford’s absence was conspicuouslyobvious. Then around 11:00-11:30 a.m., you could set yourwatch by it, in would saunter Dr. Alford. After several mornings,i asked him, “Where in the hell have you been?” “Well,” hewould say, “i slept until 7:00, took a leisurely jaunt, and thenwent to the hotel masseuse for a massage.” Beware, if Dr. Alfordis late for any meetings this year, he may well be found runningaround the block or getting a “butt rub” from the local masseuse.This association is in for a treat. Tim will do a great job. —Randy Easterling, MD; MSMA Immediate Past President,Vicksburg

i knew that Tim was destined for great things when he beatme out several years ago as winner of the relay for LifeWomanless Beauty pageant. must have been his heightadvantage…and five o’clock shadow! —Stanley Hartness, MD;MSMA Past-President, JMSMA Associate Editor, Jackson

For many years Tim Alford has done a really great jobworking for our mississippi Academy of Family physicians. ithink he will represent us well and do an equally impressive jobas president of msmA. no one else can carry a “Torch” likeTim can!! He can carry my “Torch” anywhere-anytime! —JoeJohnston, MD, Mount Olive

i see Tim Alford as the moses of mississippi medicine. Heis one of the most visionary leaders that i have ever met, and hecan see the promised Land for our patients and our profession.He recognized critical medical and public health issues wellbefore the rest of our professional community. He also hasextraordinary skills as bridge builder. He doesn’t lead by runningover people; he leads by rallying the troops and showing the wayto go. Too often, we forget what’s really most important in ourleaders. Yes, they need intellect and competence, but at the coreof great leadership are kindness, grace, vision, and integrity.Tim’s got all of those traits, and we docs need them in ourleadership at this difficult transitional period in medicine.

Few know that Tim was one of the state’s best swimmers inhis earlier days and coached Hanging moss country club swimTeam, one of the perennial champions in the Jackson swimAssociation. The discipline of an athlete is a basic component ofhis character. He knows about working hard and training todayin preparation for success in the future. Also, being a swim teamcoach brings you into contact with a bunch of often loony anddemanding parents. This, too, has prepared him for what he doestoday. He’s affable and gracious in all of his interactions,whether you are on his side or against him, and he’ll lead in thatsame manner. He’s also wildly funny and his self-effacinghumor will warm many a msmA member’s heart. One finalthing: Don’t ever underestimate Tim Alford. His kindness andgood humor may be what you see first, but his intellect is keenand complex, and he’s one of the medical profession’s bestwarriors in our state. —Lucius M. “Luke” Lampton, MD,

Editor, JMSMA; Chairman, Mississippi State Board of Health,Magnolia

i can remember Tim saying after attending his first Youngphysicians’ section meeting of the AmA, “i think this thing isbigger than i am!” As history has unfolded, i think he’s provenhe’s quite big enough to be a superb representative and leader inorganized medicine for all of us! —George McGee, MD;

MSMA Past-President, Hattiesburg

Dr. Alford has worked with iQH through his leadership toassist our physicians with quality improvement activities in ourstate. He has also been a leader and an advocate for healthinformation technology within our state. —James McIlwain,MD; President, Information and Quality Healthcare, Jackson

i have heard a lot of great things about Dr. Alford, but idon’t think he ever got to be the official “pageant Doctor” for themiss mississippi contest, did he? —anonymous


AMericAn cAncer SocietY relAY for life fUnDrAiSer— in The

SPiRiT OF SuPPORTinG A wORThy CAuSe, DR. STAnLey hARTneSS AnD

DR. TiM ALFORD weRe PARTiCiPAnTS in A "wOMAnLeSS BeAuTy

PAGeAnT" BeneFiT heLD SeVeRAL yeARS AGO. The ACS ReLAy FOR

LiFe RePReSenTS The hOPe ThAT ThOSe LOST TO CAnCeR wiLL neVeR

Be FORGOTTen, ThAT ThOSe whO FACe CAnCeR wiLL Be SuPPORTeD

AnD ThAT One DAy CAnCeR wiLL Be eLiMinATeD. See DR. hARTneSS'S

COMMenT.

controlling HeAltH cAre coSt…We should acknowledge that more tests and procedures do not

necessarily equal better care. Although increasing overhead and

inflationary costs are real to our practices, again i believe that the

pcmH approach puts patients in the appropriate care setting and

keeps them out of the emergency rooms and hospitals which will

alleviate much of the increasing costs in health care.

AffiliAtion AS A PASt-PreSiDent of tHe MiSSiSSiPPi

AcADeMY of fAMilY PHYSiciAnS… There is a rich heritage of family physician involvement in

msmA. This organization has managed to tap talent from most all

specialties over the years. not so long ago family physicians were

at risk of being another shelf item for the smithsonian. now we are

an integral part of the solution to the health care challenge. stay

tuned; this may be the cinderella story of medicine over the next

decade.

concernS oVer HeAltH SYSteM reforM…Well, we know that healthcare reform evolved quickly into health insurance reform much to the insurance industry’s

chagrin. There is concern that the insurance companies will learn new ways to game the system, but i am hopeful that many of

our patients who are uninsured or underinsured will get relief. it is worth noting that at least 25% of citizens in mississippi 19-64

years of age fall into this un/underinsured category. This inadequacy has kept a foot firmly planted into the back of further

economic development. After the dust settles and this all unfolds over the next decade, i do wonder whether enough substance

will be left to heal a broken system. Will physicians have the high fortitude to lay aside their differences and be part of the

solution?

PreSiDentiAl PlAtforM…From my vantage point, the patient centered medical

Home (pcmH) model of health care delivery springs from the

Future of Family medicine project. The concept, first spun by

the American Academy of pediatrics and now the American

Academy of Family physicians, the American Osteopathic

Association, and the American college of physicians, has

emerged with joint principles. These principles include:

A. personal physician relationship

B. comprehensive care

c. Enhanced accessibility

many would say that they are already accomplishing

these goals but i would question any ambulatory clinic in

mississippi that thinks they have finally arrived in this regard.

The piloted clinics that have really “done the patient medical

home deal” report better patient and physician satisfaction,

improvement outcomes and considerable cost savings to the system. The specialists like it, too!

ADVocAcY iSSUeS… • We are one supreme court justice away from losing everything we have gained with our very strong tort reform laws.

pressure from trial lawyers legislatively may become a challenge again.

• scope of practice concerns can best be managed if we position ourselves early on as head of the medical home

household, but we have to be vigilant in this regard.


nePhew, conner AlforD; BROTheR, Dr. JoHn AlforD; tiM AlforD;

SOn-in-LAw, tAl HenDrix

JoHn PAUl AnD tiM

on being An olYMPic torcHbeArer… it was a humbling and gratifying experience that i

considered to be a high honor. it was especially rewarding to

meet fellow torchbearers from the united states who, while in

their teen years, are doing amazing things for their fellow

citizens.

AnYtHing i HAVen’t ASKeD YoU WoUlD liKe MeMberS

to KnoW? Just that the health care debate and legislation was a huge

distraction for our Association and threatened its very existence.

i believe we are even stronger now, and it is time to gather our

wits and help this state produce a better health report card. r

BlueCross BlueShieldof Mississippi

Committed to a Healthier Mississippi.


Dr. tiMotHY AlforD; Dr. JAMeS PiVArniK, PReSiDenT OF The AMeRiCAn

COLLeGe OF SPORTS MeDiCine; Dr. JUDitH PAlfreY, PReSiDenT OF The

AMeRiCAn ACADeMy OF PeDiATRiCS; JeSSie PAVlinAc, PReSiDenT OF The

AMeRiCAn DieTeTiC ASSOCiATiOn; Dr. elizAbetH nAbel, DiReCTOR OF

The nATiOnAL heART, LunG, AnD BLOOD inSTiTuTe

2010 olYMPic torcH beArer; StrAtHMore, cAlgArY—DR. ALFORD

wAS SeLeCTeD FOR The ReLAy when The MAFP SuBMiTTeD An

eSSAy On hOw he heLPS OTheRS LiVe POSiTiVeLy By STAyinG ACTiVe

AnD PhySiCALLy FiT, wORkinG TO MAke GOOD ThinGS hAPPen in

The COMMuniTy, AnD heLPinG The PLAneT By ReCyCLinG OR

DOnATinG TiMe TO A ReCyCLinG PROGRAM.

About Tim...

You're most likely to see me around at: the Kosciusko

Medical clinic

On the weekends I love to: ride the tractor

The high school, college or pro sports teams I root for

are: Kosciusko Whippets, go Majors! (Millsaps), st. louis

cardinals – i love me some tony larussa.

If I'm watching a movie or listening to music, it's probably: the Kosciusko Movie theater

doubles as a bingo parlor so my movie going is a bit limited. i like all kinds of music. Music has

always been a very important part of my life, with the exception of rap.

Ipod or Stereo? both

My favorite book is: “huck Finn”

Latest splurge: the stealth, our electric all-terrain cart for the

cabin

I am passionate about: My family

Something about me not everyone knows: i hate beavers and

their offspring.

Do you like to go out or stay in? depends on the weather!

Perfect meal: Vegetables, fresh out of the garden with crispy cornbread

– can’t beat that!

Perfect day: cool, crisp, late fall day of quail hunting

Favorite color: green

Cologne: no

Text, email or cell phone: text

Pets: A moccasin killing boykin spaniel (buddy); English setters - 3

(sugar, Yock and Kate); one digging cairn terrier (bela); one adopted

something dog found on the natchez trace (o.d. – other dog) and a

huge 15 pound white cat leah brought home from senior play practice (Van)

MSMA Member since: 1986 i believe

cHriStMAS 2009 - TAL henDRix,

TiMOThy ALFORD, LeAh

henDRix, MARy BRuCe ALFORD,

MARy AL ALFORD, TiM ALFORD,

jOhn PAuL ALFORD

tiM AnD JerrY

tiM AnD “neW blUe” At bUcKSnort fArMS


• MSDh •

* Totals include reports from Department of Corrections and those not reported from a specific district

NA - Not available (temporarily)

for the most current MMr figures, visit the Mississippi State Department of Health web site: www.HealthyMS.com

Mississippi Reportable Disease Statistics

May 2009



• new MeMBeRS •

AMOS, HEATHER, Biloxi; Born

10/4/1978 Hollywood, Florida; grad-

uated DO southeastern college of Os-

teopathic medicine, miami 2005;

specialty: Family medicine; cedar

Lake Family practice.

CUMBEST, MIMI C., Hattiesburg;

Born 4/28/1958 pascagoula, ms;

graduated DO university of Health

sciences, Kansas city 1992; spe-

cialty: Anesthesiology; southern

Bone & Joint specialists, pA.

HAQUE, NIAZ M., gulfport; Born

11/10/1976; graduated mD st.

christopher’s college of medicine,

senagal 2006; specialty: internal

medicine; memorial Hospital-gulf-

port.

HOPKINS, ERICA, gulfport; Born

1/9/1977 south Korea; graduated

mD Temple university school of

medicine, philadelphia 2003; spe-

cialty: nephrology; south mississippi

nephrology.

HUGHES, VERNON THOMAS,

clarksdale; Born 7/2/1952; graduated

DO West virginia school of Osteo-

pathic medicine, Lewisburg 1992;

specialty: Family medicine; v

Tommy Hughes, DO.

JOINER, SARAH, grand Bay;

Born 8/26/1979 Biloxi, ms; gradu-

ated mD university of south Ala-

bama college of medicine, mobile

2005; specialty: internal medicine;

grand Bay medical center.

KERBY, SEAN C., gulfport; Born

5/28/1971; graduated mD university

of south Alabama college of medi-

cine, mobile 1997; specialty: Family

medicine; southern coast Family

medical.

LEATHERBURY, CLIFTON T.,

gulfport; Born 3/3/1979 mobile, AL;

graduated mD university of south

Alabama college of medicine, mo-

bile 2008; specialty: radiology; smB

radiology, pA.

MCCALOP, LAURA E., Jackson;

Born 5/4/1968 Bolivar county; grad-

uated mD university of Health sci-

ences, Kansas city 2002; specialty:

Ophthalmology.

MUSICK, STAN, Jackson; Born

6/27/1955; graduated mD Baylor

college of medicine, Houston 1982;

specialty: Anesthesiology; university

physicians, pA.

NAMAN, MICHELLE K., grand

Bay; Born 12/30/1974 mobile, AL;

graduated mD university of south

Alabama college of medicine, mo-

bile 2001; specialty: pediatrics;

grand Bay medical center.

NEILL, JAMES S. A., Jackson;

Born 8/25/1953 Jackson, ms; gradu-

ated m.D. university of mississippi

of school of medicine, Jackson 1978;

specialty: Anatomic pathology;

Ameripath mississippi, inc.

PATTERSON, SCOTT B., Jackson;

Born 8/2/1971 Jackson, ms; gradu-

ated DO pikeville college, Kentucky

2003; specialty: general surgery;

Lakeland surgical clinic, pLLc.

RUBELOWSKY, JOSEPH JOHN,

Hattiesburg; Born 5/18/1961 Brook-

lyn, nY; graduated mD university of

medicine & Dentistry of new Jersey,

new Jersey 1987; specialty: Thoracic

surgery; Wesley physician services.

SEALS, SCOTT R., gulfport; Born

11/4/1976; graduated mD ross uni-

versity, school of medicine, Do-

minica 2005; specialty: internal

medicine; Hospitalist services mHg.

SHEPHERD, JINNA M., Jackson;

Born 10/29/1968 Jackson, ms; grad-

uated mD university of mississippi

of school of medicine, Jackson 1994;

specialty: internal medicine; DcA

mississipppi, LLc.

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• PReSiDenT’S PAGe •

I Wish YouHearts that Race,

Minds that Dream…

As i pen my last presidents page, it is 5:30 a.m. sunday may 9th,

mother’s Day. Janie is still asleep (as are most sane folk) and i find

myself in a reflective mood.

mother’s Day is one of those times that many of us are flooded with mixed

emotions. To sum it up, human nature dictates that we rarely appreciate something or

someone until a defining event occurs. What i would give to be able to spend today

with my mother! (she passed away 11 years ago.) But the natural progression of our

lives will allow me the next best thing - a day with the mother of my children. god is

good! Along those lines of not appreciating something until it is gone (or almost

gone), indulge me a moment as i reflect on this past year.

it seems only yesterday that we donned our blue jeans, cowboy hats and boots, and i took the oath as mississippi state medical

Association’s 142nd president in Oxford, mississippi. As i settled into what was to be a quiet and uneventful year, June 16, 2009, descended on

us all like a mississippi thunderstorm. it was on this day, 16 days after assuming the mantle of leadership of our association, that president

Barack Obama stared down the American medical Association House of Delegates as he presented his plan to reshape, redefine, and reconstruct

a health care system that we have all grown to know and love. needless to say, the ensuing 11 months have been all things but uneventful.

i will not bore you by recanting the last year in detail. i have made every effort through the president’s page, components society talks,

television, newspaper, and radio to enunciate the concerns of our membership over the Democratic plan for health system reform. i say

Democratic plan because this was the first time in our nation’s history that a piece of legislation of this magnitude has been signed into law by

either of the two bodies in the united states congress without a single yea vote from the minority party. pretty impressive, huh!

While i have spent the last decade immersed in the goings on of the mississippi state medical Association, it was not until this past year

that i have grown to appreciate fully our association and what it does for the physicians of mississippi (whether they are members or not), but

more importantly for our patients.

The past 12 months of heated debate and dialogue have brought out the best in most of us and the worst in a few of us. The AmA support

for Hr 3200 and subsequent backing of Hr 3590 sent shock waves through our membership. The very existence and livelihood of our

association were threatened (remember we were the only unified state left standing one year ago). in October 2009, in a rarely called special

session of the mississippi state medical Association House of Delegates, your elected representatives spoke loud and clear. seven months later

you no longer have to be a member of the AmA in order to be a member of the mississippi state medical Association. in hindsight, that was a

defining moment for our association.

Be it good or bad, right or wrong, to date AmA membership in mississippi has plummeted by over 3,000 members. At the same time,

msmA membership appears to have increased by anywhere from 200 to 400 members (final tally is pending) for 2009/2010. This speaks

volumes.

in my opinion, the aforementioned numbers are not only a reflection of mississippi physicians’ disapproval of the AmA but equally as

much a barometer of the affection and support that our members hold for msmA. We should all be proud of that!

rAnDY eASterling, MD

2009-10 MSMA PreSiDent


As i complete my year as president, i can say without reservation that your mississippi state medical Association is ready, willing, and

able to meet whatever challenges come her way. none of the events of the past decade (Tort reform Bill of 2002, revolutionary Tort reform

Bill of 2004, reshaping the mississippi state Board of Health (law requires the chairman be a physician), Fully funding medicaid, Limiting the

scope of those who want to practice medicine without the benefit of medical school, Electing fair-minded judges to the mississippi state

supreme court, Electing a fellow msmA member president of the American medical Association, the rural physicians scholarship program,

Effective and respected mississippi political Action committee, Tobacco Tax, etc., etc., etc. . .) happened by accident. it took untold hours of

planning, scheming, and down right hard work by a dedicated Board of Trustees, an engaged membership, and a cadre of mississippi state

medical Association employees whose devotion and labor are second to none. We have served our patients well. For that you should all be

proud!

A word about your staff. regardless of how engaged we may be with msmA issues, the association takes a back seat to our patients,

practices, communities, and families, as it should. in order to be effective, physicians must be herded in the right direction by knowledgeable,

skilled, and caring staff. To chairman, neely, steve, Karen, and the others who make this train run on time: thank you from the bottom of my

heart for your support this past year. more importantly, for what you do day in and day out to make the mississippi state medical Association

such a bright and shining star, you will forever have my undying appreciation and deepest gratitude.

To our members: You have honored me by allowing me to serve as your president. For that alone, but more importantly for your

support, friendship, and prayers, i will forever be grateful. You have touched me in a manner way beyond what i deserve. god bless you all!

in closing, you have heard me say from the coast to corinth, from vicksburg to meridian, your msmA is about the business everyday of

earning your membership dollar. Do what you want with AmA, that is a personal decision.

i, along with your entire board of trustees, have decided for now to stay with the AmA. But for the sake of your practices and more

importantly your patients, for god’s sake don’t leave the mississippi state medical Association. We need you and your patients!

Because you choose to practice medicine in mississippi, each

morning you will get up earlier than most, stay up later than most, work

harder than most, do more paperwork than most, hold more hands than

most, and care more deeply about the well being of your patients than

most. Each morning when you go to work your patients will be sicker

than most and poorer than most. Your patients will have less education

than most, have less access to quality care than most. Your patients will

eat less nutritious food than most. They will be fatter than most and

exercise less than most. They will have the highest rate of diabetes,

hypertension, and coronary artery disease than most. Each day when you

enter that exam room, hospital room, and or operating room, you carry

with you a more awesome responsibility than anyone other than another

physician can begin to comprehend.

To that end, i wish all of you “HEArTs THAT rAcE, minDs

THAT DrEAm, AnD cLOcKs THAT HAvE nO HOur HAnD.”

Your partner in making mississippi healthier,

Randy Easterling, MD

President, Mississippi State Medical Association


• eDiTORiAL •

If Only We Knew

As it turned out, it really was a chance of a lifetime.

since retiring and moving to Jackson (i even recently attended my first central medical society meeting!), Beth and i make occasional

runs back to Kosciusko in attempts to tie up those proverbial “loose ends.” On our most recent pilgrimage, my partially empty gas tank

provided a reasonable excuse to patronize one of my favorite local businesses, Town pump—service station / corner coffee shop combo. After

settling up inside and treating myself to a cup of the always fresh brew, i was headed back to my car when an imposing black pickup truck

wheeled in and jerked to a stop.

To my surprise, out sprang diminutive sue sartain, retired registered nurse with whom i had worked at montfort Jones memorial

Hospital. Whatever her age, she looked at least twenty years younger! sue had always been the consummate professional: her appearance neat

as a pin, her judgment “spot on,” her knowledge current, and her energy boundless. The fact that she always seemed to “get” my attempts at

humor (no matter how corny or obtuse) made the two of us kindred spirits.

A warm hug followed by the exchange of pleasantries made time disappear as if we’d never been apart. she was especially excited to tell

me that she and her sister had once again attended our church’s passion play the previous week. Then, almost as an afterthought, she asked

offhandedly, “You knew that i had a big heart attack last month?” Well, no, i hadn’t known. “But i didn’t have to have any surgery or stents,

and the doctor says i’m doing fine.” Hopping back into the truck, she leaned out the open window and, sort of like santa claus, exclaimed as

she drove out of sight, “i love you, Dr. Hartness.” “i love you, too, mrs. sartain,” i echoed.

And just like that, she was gone.

Two mornings later as i was downing my granola with fat free vanilla yogurt and skimming the Clarion-Ledger, there it

was…Obituaries…sue sartain…retired registered nurse…age 75…needless to say, i’m glad i was sitting down. A quick call home revealed

that on the very evening of our chance encounter, mrs. sartain had suffered a massive heart attack and had been airlifted to Jackson where she

underwent emergency bypass surgery but never made it off the ventilator.

And just like that, she was gone.

Had our earlier meeting been only chance? Who knows? Had our earlier meeting been a chance of a lifetime? You betcha! if only we

had the luxury of knowing the finality of such chance contacts…overdue gratitudes that have been taken for granted could be expressed,

damaged fences that have eaten at the soul mended, relationships that have been idling thrown into high gear. At the risk of sounding like a

sermonizer, i offer that we have the opportunity to make some of those “chances” happen. it has been my personal experience that the power of

a handwritten note…of thanks…of congratulations…of condolence…of apology…can never be underestimated…or imagined!

Take that chance!

—D. Stanley Hartness, MD

Associate Editor

The Pen is Mightier than the Sword!Express your opinion in the JMSMA through a letter to the editor or guest editorial. The Journal MSMA welcomes letters to the editor. Letters for publication shouldbe less than 300 words. guest editorials or comments may be longer, with an average of 600 words. All letters are subject to editing for length and clarity. if you arewriting in response to a particular article, please mention the headline and issue date in your letter. Also include your contact information. While we do not publishstreet addresses, e-mail addresses or telephone numbers, we do verify authorship, as well as try to clear up ambiguities, to protect our letter-writers.

You can submit your letter via email to [email protected] or mail to the Journal office at msmA headquarters: p.O. Box 2548,ridgeland, ms 39158-2548.


• iMAGeS in MiSSiSSiPPi MeDiCine •

COLLEGE PHYSICIAN, ALCORN A & M, 1925-6— This photo is of Miles A. Jones, MD, College Physician of Alcorn

Agricultural and Mechanical College in 1925-6. Jones had graduated with a B.S. from Alcorn and had obtained his M. D.

from Meharry Medical College. I have been unable to find little else about him. He operated out of the original hospital for

students at Alcorn A. and M. College which was featured in last month’s Images and which was one of the earliest hospitals

for African Americans in the state. Located in Claiborne County, four miles south of Port Gibson near the Jefferson County

line, Alcorn State University was founded in 1871 as one of the nation’s first state-supported colleges for African American

students. In 1974 Alcorn Agricultural and Mechanical College became Alcorn State University. This photograph is from

the first volume of “The Alcornite” which was published by the Alcorn senior class of 1926. The Alcorn Ode in that same

pioneer annual reads: “Beneath the shade of giant trees, Fanned by a balmy Southern breeze, Thy classic walls have dared

to stand, A giant thou in learning’s band.” For those interested in a history of Alcorn, “Against Great Odds” by Josephine

McCann Posey, published in 1994 by the University of Mississippi Press, is a quality resource. Anyone with additional

information on Dr. Jones is asked to contact Dr. Lampton. If you have an old or even somewhat recent photograph which

would be of interest to Mississippi physicians, please contact the JMSMA or me at [email protected].

—Lucius Lampton, MD, Editor


Miles A. Jones

B.s., Alcorn college

m.D., meharry medical

college

College Physician

Alcorn A & m college

• POeTRy in MeDiCine •

[This month, we print the poetry of Richard D. deShazo, MD, Chairman and Professor, Department of Medicine, Professor of Pediatrics, and

Billy S. Guyton Distinguished Professor at the University of Mississippi School of Medicine. He is board certified in the medical specialties of

internal medicine, allergy-immunology, rheumatology and geriatrics. He is also known to the listeners of Mississippi Public Radio as the host

of “Southern Remedy,” a vibrant weekly program where his passion for serving his patients is clearly evident. While he has no pretentions as

a poet, he has found joy in poetic expression and notes he has always been encouraged to “be poetic.” He explains: “For instance, my sixth

grade auditorium teacher encouraged me to enter the city poetry reading contest. She was a short, animated, thin lady we called ‘Miss

Maude.’ She always smelled like a tobacco factory. She had a private bathroom off the property room in the back of the auditorium. She

smoked like a chimney in there. Miss Maude made me read ‘The Village Blacksmith’ by Henry Wadsworth Longfellow in the city-wide contest.

Later, some of the other boys in my class questioned my sexual identity because of the poetry thing. To protect myself from further

humiliation, I abstained from further poetry reading contests. By the freshman year of high school, I had figured out I was heterosexual and

another school teacher, ‘Miss Frances,’ forced our class to submit poems to the National Poetry Anthology. Like Miss Maude, she was short,

and had a distinct odor. She weighed about 325 pounds and had one of the worse cases of body odor I have ever experienced. My poem was

accepted to the National Anthology, and I had to ride with her to a ceremony to get my certificate. Being with her in a closed space induced

my first migraine.” About the poem below, Gratitude, deShazo adds: “Speaking of migraines, the patient I describe in my poem gave me one

too. So many of my patients want to lose weight. She had come to clinic on multiple occasions complaining about weight gain and

peripheral edema. I had tried to explain basic metabolism to her but she claimed to ‘eat like a bird’ despite having tell-tale evidence of

calorie excess on the person more often than not. I wrote ‘Gratitude’ out of exasperation one night after clinic when she opened her very

large purse to check the dose of her oral hypoglycemic, only to reveal a treasure trove of junk food.” Any physician with Mississippi ties is

invited to submit poems for publication in the JMSMA, attention: Dr. Lampton or email to him at [email protected].] —ED.

Gratitude

she eats like a bird, but still is fatTwinkies are in her purse,And a coke is on her lap.

portion control is fully explainedshe thanks me for my time,

But has to rush and will not be detained.

Are good deeds remembered or to the contrary,Am i correct to conclude thatAll gratitude is temporary?

— Richard D. deShazo, MD

Jackson


• The unCOMMOn ThReAD •

it’s June and i will have just run for president of our msmA and will either have won or lost. Well, i guess i could have tied, but theywould have probably had a runoff or something, so i guess it would come out one way or the other anyway. now. i could just pretendthat wasn’t the case and write about something else entirely, but who could pass up such a delicious opportunity. i get to engage in

unbridled speculation, which, i will admit, is my favorite type.

First, let me say that it doesn’t matter a bit who won. Tom Joiner is a good man and i’ve worked with him on the board for years and ireally respect him. There is no one i know that i’d rather see as president at this point in time, unless it was i. so, whoever it turns out to be, ithink everything is going to be just fine. Either one of us who is elected is going to try and do as good a job as possible to deal with whatever itis that shows up down the road and needs to be dealt with. Who can predict what it’s going to be? not i; that’s for sure. god never gave me acrystal ball.

One thing i’m sure of, being president isn’t such a big deal as you think it is going to be when you get on this medical politics merry-go-round. it’s a chance to keep on working and trying to do a good job for another three years as you work your way through president-elect,president, and then past president. Then you get thrown off the ride and your ticket’s punched. Enjoy the grass out in the pasture. so the onlymeaningful thing you can do to make a difference is to try and reflect the will of all the folks out there who aren’t president.

if i’m president, then i’m asking you to keep your eyes peeled, watch what i’m doing and don’t hold off telling me if you don’t like it.The editor of the Journal should be keeping an eye on me too, and he should write about any bad stuff that i do just so you know what i’m up to.i’ll try not to embezzle all of the association’s money, run off with any of the staff, or embarrass the association in any way i can avoid.

if i’m not president, then i’m really happy for Tom. i’ll do whatever i can to help out with either the AmA delegation or anything else hecan think of for me to do.

some of you may have noticed that Dr. south has returned and is writing away. she will resume her role as the author of the “una voce”section. i’ve been asked to move to a new column, this one, which is called, “The uncommon Thread.” One of the complaints received duringmy time writing “una voce” was that i tended to run a bit long. so i’ll try to keep this one to a page (a page and a half, tops, unless…) To showhow hard i’m trying to fit in, i’m going to wind this up.

no matter how this election thing turns out, i’m just happy to be here and writing. i look forward to seeing where we can go with thisnew column. if you like it, let me know, if you hate it, let me know that too. see ya next time.

— R. Scott Anderson, MD

Meridian

r. Scott Anderson, MD

The ManchurianCandidate


R. Scott Anderson, MD, a radiation oncologist, is medical director of the Anderson Regional Cancer Center in

Meridian and vice chair of the MSMA Board of Trustees. Additionally, he is an accomplished oil-painter and

dabbles in the motion-picture industry as a screen-writer, helping form P-32, an entertainment funding entity.

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• unA VOCe •

Culture and Sensitivity: Part 1“Adventures with

Juan and Bud”

By a recent conservative estimate there are over 12 million illegal aliens (primarily Hispanics) living in America today. There are

some days when it almost seems believable that half that number is living in northeast mississippi and a great percentage of

them are patients in my office on any given day. When i make the mistake of perusing my daily slate of patients and note that the

four final patients scheduled for the day have distinctly Hispanic names, i make unpleasant groaning sounds in the direction of the clinic

receptionist. she can’t seem to fathom that i cannot adequately care for the complex problem presented by a non-English speaking patient in the

reprehensible 10 minute time slots which comprise my day. it is certainly not because of any racial prejudice or dislike of our Hispanic patients

that i have this mournful knee-jerk response. On the contrary, interactions with my mexican patients are almost universally pleasant and

mutually beneficial learning experiences. i try not to allow one of them to leave without teaching me a new word or phrase. my dread comes

from knowing that it will take at least four times as long to diagnose and treat these patients as it would even the most obtuse geriatric patient

with 17 different prescriptions in their meds bag. And, so many times when a visit with one of my Hispanic patients comes to a close, i cannot

shake the uncertainty of whether we have truly understood each other or that i have done “the right thing.”

i would speculate at least 75% of my Hispanic patients “have no English” and many of them rely on their grade school children to serve

as interpreters in the clinic. This proves a sticky wicket when mom complains of something like a bacterial vaginosis, pelvic pain or dysparunia,

and her 6-year-old son is there to translate. There are simply no words for the frustration of these experiences.

i am fairly certain that i got my message across to two of my pre-med shadowing students recently. i had told this semester’s students

that they did not need to leave Blue mountain college without some spanish courses under their belts. They saw this first hand as we mutually

struggled with non-English speaking patients simply to understand what the chief complaint was, not to mention outlining a proper diagnosis

and treatment plan. The students gave me a very appropriate parting gift at the end of their school year recently…a book and accompanying

cDs called “spanish for the Health care professional.” i laugh out loud when i remember my own pre-med days when my advisor

recommended with all seriousness that i would be wise to study either german or French before applying to med school. i have yet to run across

one Frenchman in Tippah county!

One hot summer day, perhaps 15 years ago, i had my first experience with a totally non-English speaking patient in my office. This was

about the time that the local furniture and timber mill industries began recruiting large numbers of Hispanics into their workforce. “Juan” was

approximately 35-years-old and, though our initial interaction of greeting was pleasant, there was an undercurrent of pain and fear in his dark

brown eyes (obviously, the names have been changed to avoid HippA violation). He was accompanied by one of his supervisors, “Bud,” a local

good ol’ boy who had absolutely no knowledge of spanish. Luckily, i am, however, fluent in my native redneck tongue so here was our starting

point. The two worked at the big sawmill east of town that was at that time producing vast quantities of cross ties for the railroad industry. Even

with modern mechanization, many parts of that production process are back-breakingly laborious.

Juan’s supervisor said, “The feller that usually does his talkin’ for him had to go to memphis with the boss man today. m’am, i really

don’t know why they sent me ‘cause i don’t know a word of that mexican lingo.”

Then i asked the inevitable opening question “What problem brings Juan to the office today?”

Bud offered, “All’s i know, miss south, is that boss says to bring him here because he was hurtin’ pretty bad and something is wrong with

his ass.”

i thought about this a moment and began making inquiring gestures toward Juan’s derriere. something about his agonized expression


Dwalia South-bitter, MD


gave me the brilliant insight that because Juan’s job was stacking cross ties we perhaps would be treating hemorrhoids. i gestured for him to

remove his jeans and lie on his side on my exam table. This being unclear, i then pantomimed exactly what i intended him to do for my exam.

i quickly learned that Juan knew only one English word, “Ho-Kay,” which was his sole response to my every instruction. Juan dutifully

assumed a lateral recumbent position. i donned exam gloves and walked around to face him, demonstrated the K-Y jelly and mimed that i was

about to examine his behind.

Juan said, “Ho-Kay.”

Then, after several minutes of positioning and repositioning Juan in preparation for his rectal inspection and exam, i placed my hand on

Juan’s hip and tried to calmly reassure him that my exam would not hurt. “no dolor!” i promised, using perhaps the only spanish word i knew

besides ‘taco.’

Juan said, “Ho-Kay.”

Bud did not help matters. sitting facing Juan and grimacing he murmured, “Oh, hell, doc, do i have to stay in here for this?”

i walked back to the business end of the patient, and quietly told him i was about to begin if he was ready. And Juan said timidly, “Ho-

Kay….”

As gingerly as i could, i inspected Juan’s problem area and touched the hot, floridly engorged hemorrhoidal flesh while calculating what

my next move would have to be. And Juan yelled, “HOOO-KAAAAY!!!!”

For whatever it was worth, i uttered, “La hemorrhoida thrombosa,” a

pronouncement which added nothing to the solution of the problem.

collecting my thoughts, i told Bud that Juan’s treatment was going to

require a minor surgical procedure which would involve his understanding and

consent, the use of a knife, not to mention pain, a good deal of blood, and

some time off from work. i explained that i would not, could not do this

procedure today in the office, and that he would need to come back in a few

days with a real interpreter and hopefully also bring a family member.

Bud whined, “The boss man ain’t gonna like this. He is our best hand.”

i simply shrugged in reply.

Then i sat Juan up on the table and put my hand on his shoulder and he

smiled at me slowly for the first time, relieved for the moment that his ordeal

was past. i wrote him a prescription for hemorrhoidal cream, wrote out my

verbal instructions on a script for his treatment for the next few days

(including time off from work) and crossed my fingers that these things would

be accomplished.

And Juan said to me, “gracias, doctora, gracias!” For this, i had no need

of an interpreter.

read more in next month’s “una voce.”

—Dwalia South-Bitter, MD

Ripley

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