September 2010 JMSMA

VOL. LI No. 9

September 2010

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SEPTEMBER 2010 VOLUME 51 NUMBER 9

SCIENTIFIC ARTICLESCan the Delta Stop Singing the Blues? 242Jessica Harpole Bailey, PhD; Tracilia “Drew” Beacham, RN,MSN; Katie Weeks, MA,

CCC-SLP; C. Cory Smith, RN, BSN;Michelle Horn, MD and Vincent E. Herrin, MD

Surgical Management of Eyelid and Periocular Cancers 247Milam S. Cotten, MD

PRESIDENT’S PAGEPromise and Hope for Healthy Schools 253Tim J. Alford, MD; MSMA President

SPECIAL ARTICLEMississippi Women in Medicine Leading the Way 258Karen A. Evers, Managing Editor

EDITORIALSacred Spaces and Higher Ground 255Richard D. deShazo, MD; Associate Editor

Let’s Not Go Down Without A Fight 257Thomas E. Joiner, MD; MSMA President-Elect

RELATED ORGANIZATIONSMississippi State Department of Health 250

University of Mississippi Medical Center 272

MSMA Alliance 275

DEPARTMENTSLegalease 273

Images in Mississippi Medicine 276

Poetry In Medicine 277

The Uncommon Thread 278

Placement/Classified 279

ABOUT THE COVER:“HOPE PREVAILS”- William F. Pontius, MD took this photograph while visitingwith a family member at St. Dominic’s Cancer Center on September 11, 2009. The

picture was taken while awaiting the results of the latest CT scan and a consultation

with an oncologist. The photo was made from the mezzanine floor as the composition

was impressive from this perspective. The flag is flown at half-staff to honor the

innocent Americans and people from around the world who lost their lives as a result

of the terrorist attacks of September 11, 2001. Dr. Pontius is retired from nine years

as a family practitioner and 25 years as a diagnostic radiologist. He resides in

Ocean Springs with his wife, Mollie.�

2010September

VOL. LI No. 9

Official Publicationof the MSMASince 1959

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The views expressed in this publication reflectthe opinions of the authors and do not necessarilystate the opinions or policies of the Mississippi StateMedical Association.

Copyright© 2010,Mississippi State Medical Association.

Lucius M. Lampton,MDEDITOR

D. Stanley Hartness,MDRichard D. deShazo,MD

ASSOCIATE 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

Tim J. Alford,MDPresident

Thomas E. Joiner,MDPresident-Elect

J. Clay Hays, Jr.,MDSecretary-Treasurer

Lee Giffin,MDSpeaker

Geri Lee Weiland,MDVice Speaker

Charmain KanoskyExecutive Director

SEPTEMBER 2010 JOURNAL MSMA 240

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.

241 JOURNAL MSMA SEPTEMBER 2010

This article was written to describe a collaborative effort be-tween the University of Mississippi Medical Center and the DeltaHealth Alliance to increase primary care providers in the 18 countiesdesignated as the Mississippi Delta. Journals compiled by traineeswere analyzed to reveal issues significant to practicing in a rural areafrom the perspective of medical students and residents who participatedin the program. Patient noncompliance, provider sensitivity to cost,continuity of care, and quality of the doctor-patient relationship wereall identified as significant issues by the trainees.

KEY WORDS: PRIMARY CARE PROVIDERS,RURAL HEALTHCARE, MISSISSIPPI DELTA

INTRODUCTIONOn the dawn of our nation’s healthcare reform initiative, much

discussion has been focused on the predicted shortage of primary careproviders. However, in Mississippi, we don’t have to wait for this pre-dicted shortage, as we are already experiencing it. Nowhere is this re-alization more prevalent than in the Mississippi Delta. Classified asan underserved area, the Delta population suffers from health dispari-ties unequaled in other regions of rural America.¹

The Mississippi Delta is classified as the fourth most rural lo-cality in the United States. All 18 of the designated Delta counties ex-perience poverty rates above the national average, according to the

2004 US Census data.² Delta residents represent a very vulnerable pop-ulation in the most underserved counties in our nation. Although healthstatus and life expectancy have improved for most US citizens in recentyears, this is not true for the Delta, where the burden of chronic diseaseis exacerbated by the impact of crushing poverty. Access to healthcarefor chronic morbidities and access to preventive medicine is quite lim-ited.¹ In order forAmerica to make progress in national health reform,underserved regions like the Mississippi Delta must be addressed.

No one will claim that the supply of health professionals in ruralareas of our country is sufficient. Research provides evidence that ruralareas have fewer primary healthcare providers than the US as a whole.³Rural practitioners are predominantly primary care providers, a spe-cialty whose supply has been in a steady decline in recent years. Tocomplicate matters even more, 20% of Americans live in rural areasand only 9% of medical doctors choose to practice in rural areas. A2010 publication by Chen, Fordyce,Andes, and Hart 4 indicates that theUniversity of Mississippi Medical Center is third among the nation’smedical schools producing the highest percentages of graduates prac-ticing in rural areas, coming in just underWest Virginia University andthe University of Minnesota-Duluth. However, despite continued ef-forts to increase the number of healthcare providers in rural areas, dis-parities between supply and demand persist.

In most rural areas of the country there are about 170 physiciansper 100,000 people. In Mississippi, however, there are only 26.62 pri-mary care physicians per 100,000 people.¹ Fifty-six percent of Mis-sissippi’s physicians are practicing in four urban areas, and themetropolitan area of Jackson is home to 28% of the state’s primary carephysicians.6

A collaborative project between the University of MississippiSchool of Medicine and the Delta HealthAlliance has been initiated tocombat the shortage of primary care physicians in the Delta. The pro-gram, originally designed by Dr. Rick deShazo of the Department ofMedicine at the University of Mississippi Medical Center, is called theDelta Health Scholars Program (DHSP) and is in its second year of op-eration. This project partners rural primary care healthcare providerswith fourth year medical students and residents. The rural providers

• SCIENTIFIC ARTICLES •

Can the Delta Stop Singing the Blues?Jessica Harpole Bailey, PhD; Tracilia “Drew” Beacham, RN, MSN; Katie Weeks, MA, CCC-SLP;

C. Cory Smith, RN, BSN; Michelle Horn, MD and Vincent Herrin, MD

ABSTRACT

AUTHOR INFORMATION: Dr. Bailey is the director of educational programs for the Schoolof Medicine at the University of Mississippi Medical Center. She serves as primaryinvestigator for the Delta Health Scholars Program (DHSP) and has had oversight ofthe DHSP project for the past two years. Mrs. Beacham is an assistant professor anddirector of multicultural affairs at the University of Mississippi School of Nursing. Herresearch interests include reducing health disparities by increasing the number of ethnicminority healthcare professionals. Ms. Elkins is an instructor in speech languagepathology at the University of Mississippi Medical Center. Mr. Smith is a clinical nursein the Department of Oral-Maxilofacial Surgery and Pathology. Dr. Horn is theclerkship director for the Department of Medicine and supervises all third and fourthyear medical student clinical activities with internal medicine.Dr. Herrin is the programdirector for the internal medicine residency program. He oversees all clinical rotationsfor the internal medicine residents.

CORRESPONDING AUTHOR: Dr. Jessica Bailey, Director of Educational Programs, Schoolof Medicine – UMMC Graduate Medical Education Office, 2500 North State Street,Jackson, MS 39216. Phone: 601-984-5530, Email: [email protected].



serve as preceptors for a month long clinical rotation to expose the stu-dents and residents to life as a primary care provider in a rural healthclinic. Delta Health Alliance (DHA) is a tax-exempt, non-profit or-ganization, located in Stoneville, Mississippi, whose mission is to im-prove the health of the individuals who make the Delta their home.DHA provides funding for the participating preceptors, funding to re-imburse trainees for expenses incurred during the rotation, and finan-cial support for administration of the program. Fourth year medicalstudents enroll in a course for a rural clinical experience and receive ac-ademic credit for the month they spend with the preceptor. Residentsmay choose the DHSP experience as a monthly rotation in their annualclinical schedule. Participants in the program are expected to demon-strate an identified interest in practicing medicine in a rural location.

The DHSPwas created in an attempt to expose future physiciansto life in a rural setting and increase awareness of practice opportuni-ties in small community clinics. Design of the program was based uponthe premise that these individuals in training need an early exposure torural medicine practice in order to make well-informed career choices.Naturally, if they attend medical school in a metropolitan area and re-main in the same geographic location for clinical training, they will notknow what rural practice entails and may not fully realize the positiveaspects of a primary care physician’s life-style in a rural community.

The program currently has ten primary care clinic locations withInternal Medicine and Family Medicine preceptors who welcome thetrainees and are committed to providing a positive learning experience.Additional Family Medicine sites are being added in the fall and thereare tentative plans to extend the program beyond internal medicine andfamily medicine and begin including pediatrics and obstetrics/gyne-cology preceptors as optional training sites for interested trainees. Thequality of the preceptors ensures academic enrichment and outstandingphysician role modeling for the trainees. Each trainee’s experience inthe program is monitored through an evaluation system with the Uni-versity of Mississippi School of Medicine.

The trainees experience four weeks of the daily schedule of arural primary care practitioner. A day may begin with treating some-thing as simple as rhinitis in a 3-year-old and progress to treating an 86-year-old with uncontrolled diabetes, congestive heart failure, chronicobstructive pulmonary disease, and a skin rash. Trainees are expectedto participate in a community service project while on site and are re-quired to keep a journal of their daily activities. The intent of the jour-nal is to capture a glimpse of the trainees’ reflections during thisexperience. Each trainee was instructed not only to document clinicaldiagnoses of patients seen but also to record the impact of the patientinteraction on their experience in the Delta.

METHODOLOGYThe journals, serving as a main source of data, revealed issues

that are important to the practice of medicine in a rural area from thetrainee’s perspective. Midway through the second year of the project24 trainees (18 fourth year medical students and 6 residents) have takenpart in this program and have been required to keep a journal of theiractivities during the experience. The journals have been analyzed usingqualitative methodology. Embedded in the journal entries are commonthemes recorded by the participants.

According to an article published in The Journal of RuralHealth, a similar program established in Minnesota recognized thatqualitative data was essential to capture the richest descriptions of theRural Physician Associate Program (RPAP) experience.7 In compari-son, the qualitative data gathered from the Delta Health Scholars Pro-gram best exemplifies the uniqueness of being a primary care physicianin the Delta. Our data collection and analysis process closely followedthat employed by the Minnesota RPAP study.

We used an interpretive approach to investigate the learners’per-spectives of their rural rotation. Interpretive practice is dependent uponthe premise that meaning is constructed through contextually situatedevents and these events become meaningful through reflection and dis-course. Included from the onset, as an integral component of this learn-ing experience, the students and residents were instructed to recorddaily events and reflect on their interactions with both patients and ruralpreceptors. This provided our data collection mechanism.

Analysis of data began with reading and re-reading of the jour-nal entries, line by line, capturing commonalities among participants’words and phrases. A constant comparative method of analysis wasinitiated with the process of open coding. Descriptive themes began toemerge as we first identified and labeled concepts by jotting marginalnotes on journal entries. These concepts were then sorted into cate-gories through axial coding. In the final step of analysis we identifiedpatterns in the categorized data and arranged them into explanatorythemes.

We divided into two sections to perform a test of inter-rater re-liability using the initial codes developed and refined during axial cod-ing. After an acceptable level of inter-rater reliability was achieved,we worked together as a team to identify the most representative quo-tations from the journal entries to best explain the themes that emergedfrom the data. Thematic findings are described below.

FINDINGSContinuity of Care

Continuity of care emerged as a constant theme by nearly all ofthe participating trainees. This idea incorporated not only caring forthe same patient on multiple visits but also caring for patients across theage continuum – infants to geriatric patients. One student commented,“Rural clinics serve a vital role not only as healthcare providers butalso as friends and neighbors.”

The importance of continuity of care, particularly in FamilyMedicine, is valued internationally. A 2009 study by Beaulieu et al. (p.e17) noted family medicine residents viewed their specialty as a “pro-fession of relationships.” 8 Students from UMMC echoed this idea asthey described seeing patients for their initial visit and following upwith that patient on subsequent visits to see if their treatment plan hadworked. It was both rewarding and challenging for students as this as-pect of medicine is often absent from their training in an academichealthcare center. Regarding this component of care, one student noted:

“It is nice that I have been here for a while, because I amnow seeing some patients that I saw earlier in the month. It’snice to have a little continuity of care. That is something thatyou don’t get much of in med school. ”


A resident described one day of his rotation as “‘bittersweet.’We admitted someone to hospice. I didn’t know the patient but Dr. Xhad been taking care of the patient for 20 plus years. He informed mehe definitely had covered end of life issues with her. Her family ap-peared to be at peace about things.”

The opportunity for continuity of care provided by practicing ina rural area was a positive and valued aspect of the rural health rotationnoted by almost all trainees and offered a change from the academicworld of medicine.

Sensitivity to CostParticipating in primary care in a rural area required students not

only to select the best treatment plan for the patient but also to con-sider the cost of that treatment plan. Resources were limited both fi-nancially and with regards to availability. As such, students wererequired to carefully select medications and treatments, tests, and otherdiagnostic tools. The limited availability of tests was a stark contrastcompared to the availability of tests at an academic medical center.One of the trainees describes this below:

“It was very interesting participating in a community-based hospital like this where the resources were much morelimited than they are at the large university hospital I am usedto. We had to think carefully about the tests that we were order-ing due to practical and financial constraints.”

Considering financial resources also taught the trainees to askcontinuously their patients about medication compliance. One studentcommented, “We have patients who sometimes cannot afford $4 amonth prescriptions.”

Learning to consider financial resources encouraged the traineesto carefully consider tests ordered and treatment plans, including accessto medications. This will prove to be an ever important skill in caringfor their patients and in promoting patient compliance.

NoncomplianceNoncompliance is defined as the inadvertent or willful failure

to adhere to medication regimens, provider instructions, scheduled ap-pointments, or any prescribed course of therapy.9,10 Reasons for non-compliance are multifaceted and are many times inter-related. Theyinclude psychological factors, behavioral factors, treatment factors, andhealthcare provider-patient interactions.

Additionally, consequences of noncompliance can be costly, se-rious and even fatal. For example, a missed dose of antibiotics could re-sult in the emergence of a more resistant strain of the invadingmicroorganism. Noncompliance with provider orders can also lead tohospitalizations and nursing home admissions.9

Donavan and Blake (1992)10 assert that one-third to one-half ofall patients are noncompliant. Heszen-Klemens (1987)11 found non-compliance to be a major source of provider frustration. Frustration re-sulting from noncompliance was also evident in this study. A fourthyear medical student noted in her journal that “approximately twentypercent of the doctor’s patients do not keep their appointments.”

While an internal medicine resident was completing his rural ro-tation, he encountered an “extremely noncompliant” patient diagnosed

with type II diabetes mellitus. He described the patient as having an el-evated hemoglobin A1C level (12%), peripheral neuropathy, impend-ing kidney failure, and retinal damage. When the patient was askedwhy he doesn’t take insulin as prescribed, the patient responded, “I justdon’t feel like it.”

One of the medical students who participated in the programdescribed his encounter with a noncompliant patient. “I saw a patientthis morning that had two chief complaints. One was that he couldn’tsee and couldn’t afford glasses. The second complaint was that hewanted a motorized wheelchair because he cannot get around becausehe gets short of breath. I told him if he didn’t spend $5 per day smok-ing cigarettes, he could afford glasses and would not need the motor-ized chair because his breathing would improve. He opted to keepsmoking.”

Another observation providing an example of the insidious na-ture of noncompliance is described below:

“I saw a patient today who had a lot of classic findingsassociated with diabetes….was noncompliant with her meds, herblood pressure was through the roof, and she complained ofheadache, blurry vision, and dizziness. She also has asthma andher breath sounds were audible from across the room. Althoughshe is diabetic, she does not regularly check her blood glucoselevels. …..Other signs and symptoms expressed by the patientwere those of diabetic neuropathy. She was admitted from theclinic to the hospital. Instead of adhering to her medication andappointment regimens, she will have a ‘tune-up’ for a few daysin the hospital.”

Doctor-Patient RelationshipAnother positive theme that emerged from the journals was the

feeling of being needed by the community. Lavanchy et al (2004)12

found one determinant of rural physicians’ life and job satisfaction isfeeling needed by the community. Berk, Felder, Schur, and Gupta(2009)13 suggest that while there are numerous areas of dissatisfactionassociated with rural practice, the quality of doctor-patient relation-ships is not one of them. In a survey of rural physicians regarding as-pects of rural life and practice, 73% indicated they were not satisfiedwith access to cultural activities, 65% of respondents stated they weredissatisfied with the amount of personal time away from work, 50%were not satisfied with earnings from their practice, but only 14% ofphysicians indicated dissatisfaction with the quality of doctor-patientrelationships.

One journal entry revealed the depth of this type of doctor-pa-tient relationship when a student wrote about her preceptor attending apatient’s funeral as a pallbearer. “It is not very often that you see thedoctor as the patient’s pallbearer. Dr. X had the death certificate in hispocket when he left the clinic for the funeral.”

These relationships were obviously meaningful to students andresidents as many of them wrote about this aspect of primary care in arural clinic setting. One student shared, “Just in my short time in thistown, the doctor has seen some of the same patients multiple times.He knows their families. He knows about their jobs. He knows exactlyhow to talk to them and to motivate them to comply with preventivescreenings and medication instructions. Watching him in this role only


serves to remind me of how much I desire continuity of care in mypractice. I want to know the people I am treating.”

DISCUSSION“When I was young, my ambition was to be one of the people

who made a difference in this world. My hope is to leave the world alittle better for having been there.”14 Awell-knownMississippi Deltanby the name of Jim Henson once made this profound statement. Hen-son’s quote could be claimed by the medical students and residents thatparticipate in the Delta Health Scholars Program. The purpose of theprogram is for the future doctors of Mississippi to leave this clinicalrotation experience in the Delta with a sense of wanting to return tomake it a better and healthier place. Now we must ask ourselves whysolving the Delta’s access to healthcare is relevant to Mississippi’shealthcare dilemma and, furthermore, America’s healthcare issues. Ifthe state of Mississippi can improve the access to healthcare in one ofthe nation’s poorest and most underserved regions, we can have a senseof hope for a healthier Mississippi and ultimately a healthier nation.

The healthcare needs of the Delta are not simply a matter of cor-recting a proportionate physician-to-patient-ratio. The needs are deeperthan that on the state and national levels. An adequate number of physi-cians is not only needed for the treatment of disease but to prevent dis-ease. In order to address the healthcare needs of the state, andspecifically the Delta, a multi-disciplinary approach is needed, withprimary care physicians who are committed to coordinating care forthis population. It is common knowledge that Mississippians, andspecifically the Delta population, have a high morbidity and mortalityassociated with preventable diseases, such as, diabetes, heart disease,and obesity. These conditions could potentially be prevented in certaininstances or managed more appropriately with regular access to pri-mary care physicians. If we neglect the importance of prevention andwait until the late-onset of symptoms, we have done a disservice to ourpatient population. Moreover, there is a financial irresponsibility thatmust be considered by waiting until late stages of an illness to emergebefore a patient will seek out a specialist for advanced treatment of thedisease process.

One resounding theme mentioned throughout the trainees’ jour-nals was the issue of noncompliance. The role of the primary carephysician in patient education could have a much needed impact oncompliance issues. With an adequate number of primary care physi-cians in the Delta, more emphasis could be placed on health promo-tion and wellness as well as improving access to much neededhealthcare.

The theme of sensitivity to healthcare cost factors was some-thing that even medical students with very minimal experience in theclinical setting noticed in this underserved population. Sensitivity tocost is most appropriate at this time, given the current economical hard-ships that many patients are facing. In an area where poverty is a com-monly shared element of life, trainees had their eyes opened to thereality of patients’ inability to afford medications that could signifi-cantly improve their lives.

Continuity of care emerged as a theme that trainees experiencedand relished. Journal entries reflected excitement as patients were seenrepeated times in the clinic during the month-long rotation and even

recognized in social settings in the community. Students were sur-prised to have the opportunity to see patients more than once and pro-vide follow-up to initial treatment given and to be able to monitorprogress.

One of the most encouraging themes that the trainees mentionedin their journals was the quality of doctor-patient relationships that theyobserved between the preceptors and their patient population. The ideaof establishing a lasting relationship with patients was one of thebiggest rewards that being a primary care physician in a rural commu-nity could offer.

CONCLUSIONFinding and executing a solution to the healthcare needs of the

Delta will be an arduous task. Even with the rich history and cultureof the Mississippi Delta, the residents of the Delta have overcome ob-stacles in a way like no other. This type of resiliency can be heard inthe lyrics and music of the well known Delta Blues. It is suggested thatthe blues serve as a cathartic response to the hardship of what the Deltaresidents have faced for years. Mississippians must seek the inspira-tion from their own region that has birthed and nourished these talentedminds of the past and present and use this inspiration to develop andimplement creative solutions for Mississippi’s healthcare needs. More-over, it is important for us as a state to continue to identify barriers thatprevent primary care providers from choosing to practice in the Deltaand find ways to overcome disincentives.

As Mississippians, we are proud of our cultural heritage and therich historical context that has led to advances in literature, art, musicand the practice of medicine. It is important that the blues traditionstill be heard from the Delta’s history, but we need to cure the bluesassociated with inadequate access to healthcare and associated health-care disparities in the Delta region and our state.

ACKNOWLEDGEMENTNone of this work would have been possible without the tireless

efforts of Ms. Becky Yates who has served as education administratorof the DHSP project from its inception. Ms. Yates coordinates all op-erational activities of the program between UMMC, the rural precep-tors, and trainees.

REFERENCES1. Mississippi Center for Health Workforce. (2010, January). Listening

to Mississippi’s needs: Assessing our health workforce. http://www.nemsahec.msstate.edu/publications/whitepaper/pdf%20of%20com-plete%20assessment.pdf. Retrieved April 8, 2010.

2. United States Census Bureau. American community survey. Missis-sippi: Selected economic characteristics:2004. http://fact finder.cen-sus.gov/servlet/ADPTable?_bm=y&-context=adp&-qr_name=ACS_2004_EST_G00_DP3&-ds_name=&-tree_id=304&-redoLog=false&-all_geo_types=N&-geo_id= 04000US28&-format=&-_lang=en.Retrieved April 8, 2010.

3. Fordyce M, Chen F, Doescher M, Hart L. 2005 physician supplyand distribution in rural areas of the United States. Final Report#116. Seattle, WA: WWAMI Rural Health Research Center, Univer-sity of Washington; 2007.

4. Chen F, Fordyce M, Andes S, Hart G. Which medical schools pro-duce rural physicians? A 15 year update. Academic Medicine.2010;85(4):594-598.

5. American Academy of Rural Physicians (2002).Keeping physiciansin rural practice. http://www.aafp.org/online/etc;medialib;aaft_org/documents /about/rhe/keepin-rural.Par.0001.File.tmp/ ru-ralrr/pdf. Retrieved April 27, 2010.

6. Cossman J, Ritchie J, James W. Mississippi’s physician labor force:A look at primary care physicians.http://www/healthpolicy.msstate.edu/publications/healthmaps/primcarephy.pdf. Retrieved April 29,2010.

7. Zink T, Halass G, Finstad D, Brooks K. The rural physician associ-ate program: The value of immersion learning for third year med-ical students. Journal of Rural Health. 2008;24(4):353-359.

8. Beaulieu M, Dory V, Pestiaux D, et al. What does it mean to be afamily physician? Exploratory study with family medicine residentsfrom three countries. Canadian Family Physician. 2009; 55:e14-20.

9. Department of Health and Human Services.Medication regimens:Causes of noncompliance; 2005. http://oig.hhs.gov/oei/ reports/oei-04-89-89121.pdf. Retrieved April 7, 2010.

10. Donovan J, Blake L. Patient non-compliance: Deviance or reasoneddecision-making? Social Science and Medicine. 1992;34(5):507-513.

11. Heszens-Klemens I. Patients’ noncompliance and how doctors man-age this. Social Science and Medicine. 1987;24(5):409-416.

12. Lavanchy M, Connelly I, Grzybowski S, Michalos A, Berkowitz J,Thommasen H. Determinants of rural physicians’ life and job satis-faction. Social Indicators Research. 2004; 63:93-101.

13. Berk M, Feldman J, Schur C, Gupta J. Satisfaction with practiceand decision to relocate: An examination of rural physicians.Bethesda, MD: Rural Health and Policy Centers (Final Report, May2009).

14. Henson J. It’s not easy being green: And other things to consider.New York, NY: Hyperion; 2005.


MRI’s in flexion and extensionpositions offer the most accurate diagnosis of

herniated disc .

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Our media focuses so much on homicides (317) in 2008while 25% more people die from suicides (398).

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Therapeutic surgical management goals require the achievementof 4 features to cure the patient of eyelid/periocular cancer:

1. complete removal of the cancer;2. preservation of eyelid function;3. pain free state after healing;4. pleasing cosmetic appearance.

KEY WORDS: EYELID CANCER; EYELID CANCER

TREATMENT OPTIONS OF SURGERY OR

RADIATION; CURE RATE EXPECTATIONS

INTRODUCTIONThe principle and concept of evidence based frozen section con-

trol has been published.1This article presents a 4 year period of the

management of eyelid/periocular cancers that has been successful inthe vast majority of such cases using the frozen section control for 30+years.

RISK FACTORSAttempts to recognize predisposing causal/protective factors to

eyelid/periocular cancers have received worldwide attention includingbut not limited to duration of exposure to solar radiation, gender, age,race, genetics, and latitudinal locations.

PATIENT HISTORYThis retrospective review illustrates the nature of the eyelid/pe-

riocular cancers including clinical manifestations, appearance, loca-tions, size, demographics, examinational findings, natural history,tissue diagnosis, expectations, complications, treatment options [sur-gical or radiation therapy], post-op care, and follow-up exams for ev-idence of recurrence. Patients usually present with a persistent growth,

bump, or knot located on the eyelid or periocular areas. The patientswere aged from 31 to 90 with average age of 66 and did not have acommonality of occupations. Twenty-four patients were referred to mewhile 11 presented without referral.

NATURAL HISTORYUntreated basal cell eyelid/periocular cancer usually does not

metastasize but can cause extensive anatomical destruction of the su-perficial and deep tissues interfering with essential functional, protec-tive, and cosmetic attributes. Squamous cell carcinoma of the eyelidsand periocular region is a potentially lethal tumor.1 I have not observeda fatal case of eyelid/periocular cancer.

DIAGNOSIS AND MANAGEMENTUsually an office-based diagnostic biopsy is performed to de-

termine the type of cancer. Identifying the type of cancer assists inplanning appropriate treatment options with the patient and family.When appropriate, the patient is presented at a hospital-based tumorconference. This allows the patient and family to consider the best treat-ment consensus by surgeons, radiologists, oncologists, pathologists,and support personnel. Daily and situational matters considering fi-nances, time, safety, travel, number of procedures or treatments, mor-bidity, quality of life, and assistance requirements are also veryimportant in the management of cancer.

CANCER LOCATIONSThis series of 35 Caucasian patients [22 males, 13 females] in-

cluded locations of the lower eyelid [21], upper eyelid [8], inner can-thus, [2] and outer canthus [4]. The size was usually less than 1 cmlength of the lid margin cancers and up to 2.5 cm length of the perioc-ular skin cancers.

EXCISIONAL SURGICAL TREATMENTThirty-four patients [1 patient cancelled surgery] underwent sur-

gical excision of the cancer using frozen section control in the operat-ing room with sedation and local anesthesia. By clinical judgment, thetissue is surgically excised and examined immediately by the patholo-gist for “tumor-free” margins. Such an exam takes 20-25 minutes dur-

Surgical Managementof Eyelid and Periocular Cancers

Milam S. Cotten, MD

• SCIENTIFIC •

ABSTRACT

AUTHOR INFORMATION: Milam S. Cotten, MD; University of Mississippi School ofMedicine, 1959; Medical officer aboard a nuclear-powered guided missile cruiser; smalltown general practice; University of Tennessee ophthalmology residency; practicedophthalmology in Hattiesburg since 1970 at Forrest General Hospital and WesleyMedical Center. His practice is now limited to eyelid/periocular disorders and strabismussurgery.

CORRESPONDING AUTHOR: Milam S. Cotten, MD; Southern Eye Center, 1420 South 28thAvenue, Hattiesburg, MS 39402; Telephone: 601-705-0079 (office), Fax: 601-264-5930,E-mail: [email protected].


ing which time the patient and operating room team awaits the results.If margins are clear, the reconstruction phase is performed. If marginsare not clear, more tissue is removed before reconstruction is performed.

RECONSTRUCTION AND FOLLOW-UPRepair of the surgical defect is performed by the appropriate

technique: a. pedicle rotational flap [21]; b. full thickness donor skingraft [6]; or c. primary excision of cancer with direct reconstruction [5].Large benign lesions [2] were excised with direct reconstruction. Theusual surgery time was 40-90 minutes. Site is not patched.An antibioticdrop or ointment is used locally 2 times a day until the operative site ishealed. Mild analgesics usually control any post-op pain. The patient is

contacted by telephone the following day and seen 1 week post-op forexam. Sutures are removed at 7 to 14 days. Post-operatively patientsare seen at 8 weeks and 1 year.

POST-OP REFLECTIONSPatients report a pleasing comfort level during surgery with se-

dation and local anesthesia. Operative complications included 1 sameday return to surgery to control bleeding that did not respond to localpressure at home. There were 2 late complications (post-op greater than1 year) requiring surgery to repair cicatricial ectropions by lid recon-struction with full thickness skin grafts. One case of basal cell carci-noma recurred in this series. Incomplete primary resection of an eyelidskin cancer is the main risk for recurrence.2 At the final post-op visit,the patients stated that they were pleased with their decision for sur-gical management of their cancer.

MICROSCOPIC TISSUE ANALYSISFinal diagnoses included 28 basal cell carcinoma; 5 squamous

cell carcinoma, and 2 benign lesions [size required operating room].32 were surgically cured while 2 were referred for radiation therapy.Successful surgical management of eyelid/ periocular cancers is en-hanced by evidence-based frozen section control surgical excisionduring “real time on the operating table.” The final evidence of exci-sion is confirmed by a permanent paraffin section microscopic tissueexam by the pathologist.

PROFESSIONAL RESOURCESIt is reassuring that eyelid/periocular cancers can be treated

successfully by several modalities. Since my personal experience isconfined to the surgical diagnosis and treatment of eyelid/adnexal le-sions, it is a particular advantage to have available in our medicalcommunity highly credentialed colleagues for the non-surgical treat-ment of eyelid/periocular cancers when it is in the best interest of thepatient. It is imperative that physicians select the matrix of treatmentfor the patient— rather than subject the treatment to the patient.

PHOTOGRAPHIC EXAMPLESSurgical excisional techniques illustrate the frozen section con-

trol (later permanent paraffin sections to verify the complete excisionof the cancer) and surgical reconstructive techniques. (Figures 1-8)

ACKNOWLEDGEMENTFor their contributing expertise in the treatment of these can-

cers, I thank the staff at Southern Eye Center, the hospital-basedpathologists, the Departments of Surgery of Forrest General Hospi-tal and Wesley Medical Center, and the medical librarian of ForrestGeneral Hospital.

REFERENCES1. Cook BE Jr, Bartley GB. Treatment options and future prospects for themanagement of eyelid malignancies: an evidence-based update. Ophthal-mology 2001;108:2088-2098.

2. Nemet AY, Dechel Y, Martin PA, et al. Management of periocular basaland squamous cell carcinoma: a series of 485 cases. Am J Ophthalmol.2006;142:293-297.


Fig 1. Eyelid location of cancers

Fig 2. Clinical presentation of cancer

Fig 3. Frozen section control of excision. Skin margin (black ink)lower left and mucosal margin lower right, showing tumor freemargins

��


Fig 6. Reconstruction by full-thickness skingraft using skin from theinfraclavicular area asthe donor site

Fig 4. Reconstruction by pedicle flap

Fig 5. 1 month post op pedicle flap

��

Fig 8. The infraclaviculararea as the donor site(bottom right)

Fig 7. Suture graft inposition (bottom left)


• MSDH •

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

* Totals include reports from Department of Corrections and those not reported from a specific districtNA - Not available (temporarily)

Mississippi Reportable Disease Statistics

June 2010

• MSDH •

Thad F. Waites, MD, of Hattiesburg, has been sworn in as a member of theMississippi State Board of Health. He was appointed to the Board by Gov-ernor Haley Barbour, along with re-appointed member Sammie Ruth Rea,

RN, of Jackson. Mississippi State Board of Health Chairman Dr. Luke Lampton looks forward to

working with both new members. “Governor Barbour has made two outstanding appoint-ments to the Board. Both recognize the serious problems facing public health in our stateand are committed to making a difference. On behalf of our Board, I welcome them withmuch excitement.”

Dr. Waites is a graduate of the University of Mississippi School of Medicine. Hecompleted an internship in the Emory University program at Grady Memorial Hospital inAtlanta, Georgia, and his medicine residency at the University of Colorado. Following atenure on the medical staff at Ochsner Clinic, he served as Chief Resident and as a fellowin cardiology at Emory University Hospital in Atlanta, Georgia. Waites has been practic-ing cardiology at the Hattiesburg Clinic in Hattiesburg since 1987.

“I am honored to have this opportunity to serve on the State Board of Health. I lookforward to using my passion for cardiology to help this Board continue to improve publichealth in Mississippi,” said Dr. Waites.

Dr. Waites presently serves on the American College of Cardiology (ACC) Board ofGovernors as Governor for the state of Mississippi and as Chairman-Elect of the Board. He has served as President of the Southeast and Missis-sippi Affiliates of the American Heart Association and was inducted into the Forrest General Hospital Hall of Fame in 2009.

Both Dr. Waites’ and Mrs. Rea’s terms will expire on June 30, 2016. �

THAD F. WAITES, MD

MSMA Member Appointed to the Mississippi State Board of Health



The Mississippi State Department of Health (MSDH)recognizes and applauds the following cities forprotecting the health of their citizens with the

passage of comprehensive smokefree air ordinances:

“The smokefree policies implemented by these cities willprotect citizens from the harmful effects of secondhand smoke.Everyone deserves to breathe smokefree air,” said State HealthOfficer Dr. Mary Currier. “There is no safe level of exposure tosecondhand smoke.”

Secondhand smoke causes premature death and disease inchildren and adults who do not smoke. Even brief exposure tosecondhand smoke is harmful.

Exposure to secondhand smoke causes respiratorysymptoms and slows lung growth in children. Because childrenbreathe faster, they are twice as likely to be affected by secondhandsmoke. They are at an increased risk for sudden infant deathsyndrome, ear problems and more severe asthma.

Exposure of adults to secondhand smoke has immediateadverse effects on the cardiovascular system and causes heartdisease and lung cancer. Each year, an estimated 550Mississippians die from exposure to secondhand smoke. �

Health DepartmentCommends

Smokefree Cities

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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• PRESIDENT’S PAGE •

Promise and Hope for Healthy Schools

The school breakfast program was the last thing on my mind as I joined Mr.Simpson on the track for an early jog the other morning. I consider Mr.Simpson a hero and value his opinion. He is the retired principal of our

middle elementary school. We share an appreciation for the sanctuary of the KosciuskoHigh School track, a secluded place surrounded by old woods and inhabited by familiesof bluebirds, redheaded woodpeckers, and rabbits. The huge bank of mimosa trees on thebackstretch provides built-in aromatherapy in the early summer for those who use thisfacility. Mr. Simpson is a burly, handsome man with a bottlebrush mustache. He carrieshis arms like Popeye and has a voice that is pitched such that when he tells a story youthink he may break out into song any minute. His marvelous sense of humor is well-known. On one occasion he placed a bumper sticker on the back of an overly serious fel-low principal’s van that stated, “When this van starts rockin,’ don’t come a knockin!”

On this particular morning, Mr. Simpson was poking fun at me because he is now retired. I mused to him that sometimes I feel as though I havebeen taken to the principal’s office by some of my patients. Usually these are patients we know too well, and they usually have many chronic prob-lems – a recurring cough related to tobacco use or uncontrolled diabetes with the theme of non-compliance or an intractable backache. Often thesedifficult problems are age-related and/or immune based, but sometimes the problems are self-inflicted and preventable. These patients come in often.There is a shared frustration between doctor and patient with a reckoning that holds the doctor accountable. With all the tricks in the little blackbag used, all second opinions exhausted, the sense of futility conjures that helpless feeling of visiting the principal’s office.

The other day on the way around the track with the real principal, I was enlightened. Mr. Simpson is one of those rare educators that de-manded the best from his teachers and had each child feeling as though he or she was the most important citizen in Mississippi. He was deployedduring Desert Storm, 1990-1991, and upon his return received a welcome home greeting at his school by all the second and third graders wavingtheir little American flags. He hugged each child as he progressed down the breezeway leading to the school. Tears flowed from parents, teach-ers, and children, and yes – even Mr. Simpson. He stopped to embrace one child in particular whose middle name must have been “trouble” andthey BOTH cried like third graders.

My question to Mr. Simpson that morning was how the budget cuts were going to affect our schools. “Well, we are gonna lose our schoolnurse and special education will be thrown into disarray and these students will have to be mainstreamed. That’s not good. Our teachers will haveto manage larger classes and we will lose several teacher aides this year. Next year will be far worse.” I seized the opportunity to ask him aboutthe USDA school breakfast program. This is the one where school districts and independent non-profit schools can choose to take part in cash sub-sidies for each meal that they serve. The diet must meet dietary guidelines for children so that no more than 30% of an individual’s calories comefrom fat and 10% from saturated fat. In addition, one quarter of the daily allowance of protein, calcium, iron, vitamin A, and vitamin C should bepresent in each meal. Sounds good, doesn’t it? Not according to Mr. Simpson. He says, “Okay, you mean the pancake on a stick? We hate it!”This was consistent with the comments one of his third grade teachers made to me earlier in the year as she wished for whole grain cereals andberries for the children in the morning. Instead, the children are given the human equivalent of rocket fuel – pancakes and syrup – and burst forthlike a skyrocket only to fizzle out mid-morning. In the meantime, teachers contend with stomachaches and frequent trips to the bathroom. Nev-ertheless, our school district, like so many others, is addicted to the federal pay of $1.20 per meal and does not want to upset the apple cart becauseit needs the dollars.

Formerly thought to occur only in people over the age of 40 (adult onset diabetes), now one-half of all cases of diabetes mellitus in childrenare the Type II variety. As blood pressures rise, waistlines expand, and lipid profiles deteriorate, metabolic syndrome is far too commonplace. Thereis no refuge at home as fast foods, three to four hours of television, and inactivity are now routine. As a consequence, for the first time in the his-

TIM J. ALFORD, MD2010-11 MSMA PRESIDENT


tory of the United States, children will live sicker and die younger than previous generations. Although this grim reality is more apparent amongnon-Caucasian populations, no ethnicity is exempt.

There are those of us who would like to hide behind the cultural curtain doctrine that says our population is too steeped in its own traditionsand habits to change. We are well aware of what is served in most households in Mississippi, if they are lucky enough to get a prepared meal. Mostpeople’s idea of breakfast is a sausage and egg biscuit. Potluck at church dinners offers up a long tradition of heavy casseroles and is seldom seenwithout a big platter of fried chicken. I have even heard our own office staff bribe a child’s unruly behavior with the reassurance of a trip to Mc-Donald’s.

We claim our children as our most precious resource. We rock them, stroll them, counsel them, console them, bankroll them, and sing themto sleep all in the name of love. If this is so, and knowing what we know of the reality of obesity, then why don’t we behave differently as pro-fessionals? There is evidence that physicians are uncomfortable managing obesity and frequently fail to do so. One study found that patients areless likely to receive weight management advice from their primary care physicians than from their spouse, family, or friend. It follows, then, thatwe physicians avoid engaging a parent about their overweight child.

Not far up the road, Amory Middle School was selected one of the ten healthiest schools nationwide by Health magazine. Amory schooladministrators successfully challenged the USDA’s breakfast program by offering healthy whole grain cereals and fruit to the children. This menuis reinforced in the classroom by age appropriate curriculum that makes the whole approach lots of fun for the children. The Food Services staffinteracts with the children, discusses their food preferences, and encourages healthy choices. There is a school fitness center and a mission to getand keep kids moving. By doing these things and the other elements of the CDC’s eight-component program, within one year Amory MiddleSchool’s reading comprehension scores have soared to a new height. Both Amory and Corinth have fully embraced the 2007 Healthy Schools Lawthat calls for Health Councils in every school district. These districts have watched Body Mass Index readings in their students stabilize and beginto decrease. Shane McNeill, Director of the Office of Healthy Schools, has many such success stories to share from around Mississippi. He en-courages physicians to take the initiative to organize Health Councils within their local school communities. (A word of thanks to the Bower Foun-dation for assistance in the initial funding of the Office of Healthy Schools) These Councils are comprised of allied health professionals, teachers,parents, ministers and other concerned community volunteers. There is a chef resource that can be called upon by any school district for assistancein improvements to school meal choices. Most districts have abandoned the sweet soda machines, but many still hold onto their deep fat fryers.

By the way, our own MSMA Alliance has committed to purchase three industrial grade fruit and vegetable slicing machines to donate toschool districts that show a worthy interest in improvements to their menu options. Louise Lampton, Alliance President, will lead Alliance effortsto promote healthy choices amongst students in our schools.

As our children enter school this fall, they will do so with much promise and hope. Unfortunately, we must acknowledge that they are lit-tle metabolic syndromes waiting to happen. The Office of Healthy Schools has won the first round fending off the naysayers who continue to preachthat you cannot swim against the Southern cultural mainstream.

This time my visit to the principal’s office was not with that nostalgic sense of foreboding but, rather, with a sense of renewal. For eventhough I have not put my life on the line for our country as Mr. Simpson did, I am sure that we can do a better job of fighting for our children righthere at home.

Ask List:• Lead a Health Council in your school district.• Contact your school superintendent or principal concerning compliance with the Healthy Students Act within your

school district.• Add BMI to your patients’ vital signs.• Volunteer your time to visit elementary schools and speak to children about healthy habits. • Become a President’s Challenge Program Advocate by promoting and supporting an active lifestyle. Visit

http://www.presidentschallenge.org/ to learn more about how you can help promote physical fitness. • Reward your young patients who participate in regular physical activity or exhibit other healthy habits. Consider

recognition in your waiting room or another acknowledgement.• Donate to the MSMA Foundation (to help fund MSMA Alliance public health projects that benefit Mississippi children).

References:Tham M, Young D. The Role of the General Practitioner in Weight Management in Primary Care – a Cross Sectional Study in General Practice.

BMC Family Practice 2008. 9:66.Robinson TN. Reduing children’s television viewing to prevent obesity: A randomized controlled trial. JAMA 1999;282(16):1561-1567.Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD. Breakfast habits, nutritional status, body weight, and academic performance in

children and adolescents. J Am Diet Assoc. 205;105(5):743-760. Mississippi Office of Healthy Schools: www.healthyschoolsms.org.2007 Healthy Students Act Senate Bill 2369 as amended.



• EDITORIAL •

Sacred Spaces and Higher Ground

Over the years, I have received the admonition to “seek higher ground” on many occasions. I found that ambiguous advice untilour family lived in New Orleans. We sought higher ground there in the literal sense on a number of occasions. While in NewOrleans, I began to understand what my advisors meant. They weren’t talking about keeping my feet dry. They were talking

about finding fulfillment in knowing you are doing the best you can in your work and doing it with integrity. The physicians I know who havefound higher ground have done so, at least in part, by time regularly spent in “sacred spaces.” I realize this term is even more ambiguous than“higher ground.” Please give me a chance to explain.

What are sacred spaces? They are events in life that lift us up from where we are to our highest calling. These spaces are always sharedwith someone else. They are not quiet times of reflection spent listening to new age music. They include relationships with family, faithpartners, and small groups of friends who know our shortcomings but care about us anyway. Not least of these are the relationships we areprivileged to have with our patients. Those are among my most valued sacred spaces.

Years ago when I was a moonlighting medical student at a private hospital in Birmingham, I crossed paths with an older surgeon. Lateone night, he took me aside and began to ramble on about the “magic” he regularly experienced when he was one-on-one with a patient. He toldme that he considered each patient interaction a “sacred space,” not just another scheduled encounter. He said that, prior to entering an examroom, he prepared for each interaction by trying to find at least one thing he could say that would “lift the patient up” and “then magichappened.” It might have been as simple as a compliment, a healing touch, or as complex as assurance that the doctor would be there to helpeven though there was bad news to hear. I thought he was loony until I began to think back to the Sunday afternoons I had spent with my uncleas a boy.

My uncle was an elderly general practitioner in a rural area of Jefferson County, Alabama. He worked 24-7. His wife was a regularchurch-goer; he was not. On Sundays after hospital rounds, he went alone to see those patients who were dying of one disease or another in themining camps around the area. On occasion, I would ask to go. We would drive up to a modest wooden house on a dirt road in the woods.Family members were usually hanging around in little groups on the porch, in the yard, or in the house.

My uncle, whom everyone called “Doctor,” an imposing former full-back with a shock of white hair and an acne-pocked face, would nodto the family and go directly to the patient’s bedroom, sit down at the bedside and “visit.” After a while he would do a brief physical exam andthen proceed to give the patient something, a bottle of Gevrabon (80% alcohol with B-complex vitamins), a narcotic if they were in pain or hisfamous D50-multivitamin IV infusion. Whatever, it always seemed to help. It was a “sacred moment” for the patient, the family, him, and evenfor me, a pre-teen.

It seems that each generation of physicians must rediscover the transformation that comes in sacred spaces. This year, the discovery ishighlighted for physicians and the public in Dr. Abraham Verghese’s new novel, Cutting for Stone (Vintage Books, 2010), a title taken from theHippocratic oath. In this book, since each person deserves to be cared for, the physician is the Samaritan healer and the healing is mutual.

I am convinced that the sacred spaces we share with our patients are mutually therapeutic. They provide the emotional energy to stay onhigher ground. As we move forward in the evolution of our healthcare system, we must find a way to preserve and improve opportunities formeaningful interactions with patients and families. We may well have to buck the system, make less money, look to other practice models, anddo things in very different ways. Assembly line medicine driven primarily by productivity and medicine that treats patients and doctors ascommodities, erodes healing relationships and turns our profession into a trade. If we focus on what is best for us in healthcare, we will haveachieved tradesman status. There won’t be many sacred spaces or higher ground then.

How do we move forward? One place to start is to more fully engage with our colleagues as patient advocates, something we have notdone well in the past. Our new MSMA president, Dr. Tim Alford, has good ideas to move us in that direction. He deserves our support… andwe need his leadership and passion. He knows how to find higher ground.

—Richard D. deShazo, MDAssociate Editor

Medical Assurance Company of Mississippi

“

“Diane Beebe, MD

Family Medicine Jackson, Mississippi

My position on the American Board of Family Medicine’s credentials committee gives me new insight and appreciation for the critical role that MACM plays in the lives of our state physicians. MACM’s involvement with its insureds — from risk management to liability and scope of practice issues — has their best interest, and that of the public they serve, at heart.

Particularly at the level of the Risk Management Committee, many of these issues are handled constructively and effectively to improve and ensure quality care for patients, while guiding physicians from potential hazards. In many states, without the commitment of an organization like MACM, physicians and patients are far less protected and similar issues result in adverse actions that often result in licensure and practice restrictions.

All insureds of MACM should be grateful for the role MACM and their experts in Risk Management play in keeping us (physicians and patients) safe.

For over 30 years, Mississippi physicians have looked to Medical Assurance Company of Mississippi for their professional liability needs. Today, MACM is an integral part of the health care community through its dedica-tion to risk management services for our insureds.

A dedicated sta and physician involvement at every level guarantees that the interests of our policyholders remain the top priority. This, combined with the many years of loyalty and support from our insureds, is what allows us to be the carrier of choice in Mississippi.

Please call on us to assist with your professional liability needs.

1.800.325.417 www.macm.net

An outside perspective and appreciation of MACM

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Let’s Not Go Down Without A Fight

• EDITORIAL •

There is a problem in healthcare and I guess we have been identified as it. It seems healthcare is too costly. It is out of control andthis has to be stopped. They say, if the pay for fees and services to doctors is cut, this should solve the problem. After all, theaverage family practice MD makes over $200,000 a year, according to an internet source called StudentDoc.com. Therein lies the

problem. Our reimbursement is becoming more and more dependent on the decisions of parties who have little or nothing to do with the actualdelivery of care. As I sit here in my office writing, I’m distracted by a failed air-conditioner that is going to cost $2,000 to fix. My x-raymachine needs a $7,000 repair. I have to cover payroll, monthly expenses and all other costs to run an office; but, this is what “docs” do (or Ithought we did). Doctors deliver healthcare and charge enough to live on and take care of their families, just as other business owners do –ordid.

As friends and fellow physicians have all turned to other financial arrangements to make a living, I have tried to hang on here in my southJackson clinic I built 13 years ago to better serve patients after I entered private practice in 1985. Perhaps it is my stubborn pride and ego,which have led to the distasteful decisions I am forced to make in the near future. Reimbursement has dwindled to the point I question whether Ican afford to continue providing for my patients. I wonder if it pays to practice medicine as I know it.

Hospitals can employ “providers” at a loss if their admissions are fed and they have a continuous source of revenue. They can pay theiremployees $200,000 and support their outpatient facilities with the revenue stream it creates. We dinosaurs, on the other hand, have no way toadjust our fees to cover the costs and expenses of running a primary care stand-alone clinic. If expenses increase from inflation, taxes,maintenance costs or other factors, we are not allowed to adjust accordingly. The “policy makers” know better than we practitioners what weneed. After all, we all make $200,000. Why would they want to let us raise our rates to cover expenses?

This is the nail in the coffin for us in solo practice. I perceive it as an attack on doctors’ freedom to deliver the care our patients want anddeserve and our aspiration to keep the doctor patient relationship as the most important service we can offer. I do not think our patients realizehow important this freedom is and will not until a crisis occurs. That is how it sneaks up and becomes acceptable. The “policy makers” are notconcerned with this relationship, only that they be perceived as providing the populace with something favorable. They are flooding the countrywith money for healthcare mandates that have nothing to do with the actual delivery of care. Millions! None of it going toward coveringantibiotics for sore throats and infections, surgery, blood pressure control, or chemotherapy for cancer treatment.

So, where is the real cost of healthcare? I know that I am preaching to the choir. You and I both know the most efficient way to deliverhealthcare is for the doctor actually to see the patient. It is this basic freedom that I am dedicated to fighting for –for myself and my family, youand your family, and our patients. I have told many that we are being shot at from all sides, and I am determined not to go out without a fight!We may not win the war, but we can win some battles! Please let me know how you feel.

—Thomas E. Joiner, MDMSMA President-ElectJackson

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.



What a difference a generation can make. Just a fewdecades ago women, like my mother, interested inmedicine were encouraged to become a nurse. Even

in today’s liberated society, it’s shocking many women’s magazinespublish articles on “hot careers for women in the 21st century” listingevery health-related job under the sun still failing to mention“physician” as a good career choice. Despite such, Mississippi womenare choosing medicine as a profession in record numbers.

Our Mississippi State Medical Association (MSMA) hassupported a “Women in Medicine” program since the AmericanMedical Association (AMA) established it in 1979, when womencomprised fewer than 12% of all U.S. physicians. Thirty-one yearslater, with women at almost 20% of the physician workforce, femalephysicians continue to lead the way, creatingtheir own opportunities by founding newprograms and focusing on issues that in thepast had received little attention.

Historically, in the late 1800s the U.S.led the world in training women physicians.However, in 1910 when Abraham Flexnerreviewed the medical education systemleading to the subsequent closing of almost50 medical schools, women lost their accessto med school acceptance and becamescarce in American medical schools.Interestingly, a note scribbled on an AMAmeeting program by a MSMA delegaterelates there were “more female physiciansin 1890 then there were in 1950.” Ageneration later brought the feministmovement and affirmative action, and onceagain, women returned to America’smedical school classrooms.

Globally, the number of women in medicine has beenincreasing steadily over the last decade. Today, women comprisenearly a third of all U.S. physicians and half of all U.S. medicalstudents. Figures from the Mississippi State Board of MedicalLicensure (MSBML) support this trend showing a steady increase inthe number of female licensees over the past several years (Table 1).

When asked about the minimal increase, MSBML Director Dr.H. Vann Craig said, “The main problem I see with the femalephysician is reentry to practice after an absence for family matters(birth, parent care, home management). They do not keep theirlicense active. I personally do not see the $200 renewal fee as adeterrent to maintaining their license but I guess it is in the globalhome costs.”

...CONTINUED PAGE 260...

Mississippi Women in Medicine Leading the Way

• SPECIAL ARTICLE •

Karen A. Evers, Managing Editor

FIRST WOMEN PRESIDENTS OF THE MISSISSIPPI STATE MEDICAL ASSOCIATION— Women who

have held the highest office of MSMA president are: Helen R. Turner, MD, PhD (2005-

06) (left), second woman president; Dwalia S. South-Bitter, MD (2006-07) (center),

third female president; and Candace Keller, MD, MPH (2000-01) (right), the very first

woman elected MSMA president.

[Each September is designated Women in Medicine Month by the AMA to recognize and celebrate the growing number andinfluence of women physicians. Here, the JMSMA commemorates the occurrence by highlighting some of Mississippi’s femalephysicians who are leading the way. Due to time constraints and space limitation, this article is far from inclusive. If you wouldlike to be involved in Women in Medicine Month next year e-mail [email protected] and we may feature your story inthe JMSMA. To all female doctors: Congratulations, you’ve come a long way, baby!] —ED.


Table I. Physicians Licensed by the Mississippi State Board of Medical Licensure Year Gender In Mississippi Out of State All Licensees % Women 2009 Male 4,498 2,841 7,339

Female 1,108 556 1,664 22.6% 2008 Male 4,461 2,723 7,184

Female 1,063 537 1,600 22.2% 2007 Male 4,431 2,644 7,075 Female 1,016 522 1,538 21.7% 2006 Male 4,405 2,602 7,007 Female 981 482 1,463 20.8% 2005 Male 4,432 2,521 6,953 Female 989 423 1,412 20.3% 2004 Male 4,349 2,595 6,944 Female 956 449 1,405 20.2% 2003 Male 4,766 2,039 6,805 Female 999 354 1,353 19.8% 2002 Male 4,732 2,057 6,789 Female 951 347 1,298 19.1% Source: Mississippi State Board of Medical Licensure Statistical Data website: http://www.msbml.state.ms.us/statisticalreports.htm. Accessed August 2, 2010

r. Nell Ryan was the first woman to graduate from Mississippi’s new four-year School of Medicine. The new medical

school enrolled its first students when the University of Mississippi Medical Center opened in 1955. The first class

graduated in 1957.

A 1950 graduate of Millsaps College, she took her internship in pediatrics at

Vanderbilt University Hospital in 1958. She did a rotating internship at the University of

Oklahoma Medical Center and completed a pediatrics residency at UMMC in 1960.

Dr. Ryan completed a postdoctoral fellowship in pediatric cardiology at Oklahoma in

1961 and a residency in pediatric neurology at the Medical Center in 1977. She joined the

Medical Center faculty as an instructor in pediatrics in 1961. In 1964, she became an

assistant professor of pediatrics and then became an associate professor of pediatrics in

1969. She also served as an assistant professor of neurology from 1980-1983.

While at the Medical Center, Dr. Ryan served as medical director of the Birth

Defects Clinic in the Department of Pediatrics from 1961-1983, director of the Pediatric

Outpatient Department from 1964-1975 and medical director of the infant care area from

1980-1983. A Vicksburg native, Dr. Ryan left the Medical Center in 1983 to join the faculty

at the Louisiana State University Medical Center at Shreveport where she served as

associate professor of neurology and associate professor of pediatrics. She was

appointed representative for women in medicine to the Association of American Medical

Colleges and director of the Neonatal Comprehensive Care Clinic.

In 1994, she was named professor emeritus of pediatrics at Louisiana State

University Medical Center at Shreveport.

Dr. Nell Ryan

Female Medical Pioneer

First woman to graduate from

Mississippi’s New Four-Year

School of Medicine in 1957

...CONTNUED FROM PAGE 258...

“To help in proving clinical competency, the licensure boardwill now accept Board recertification in lieu of going to some placelike the Center for Personalized Education for Physicians (CPEP) inDenver, Colorado. This is cheaper and gets two birds as it shows theircompetency and gets them recertified, something most hospitals arerequiring for privileges,” Dr. Craig added.

While maintaining an active license is one obstacle womenface when they take time out for other phases of life like motherhood,there are other significant hurdles female physicians face also. Insummary, data from a 2008 survey of members of the AMA WomenPhysicians Congress revealed the following key findings:

• Achieving a work/life balance is a key issue;women physicians feel it is difficult to maintainobligations with their families as well as patients.

• Some women physicians work part-time to helpattain this balance.

• Popular notions about the frequency of part-time work for women physicians are not supported bythe data. In fact, most women physicians do not work-part time, including younger women physicians.

• Women may choose lower-paying specialtiesthat more likely accommodate part-time physicians,possibly causing them to sacrifice advancementopportunities in the process; pay disparities result.

• Sex discrimination may also account for paydisparities. Women physicians believe they are not paidthe same as men, and cite specific examples.

• Discrimination is often defined in terms ofsexual harassment. Women physicians often do not feellike they get fair treatment and the respect they deservein terms of equal pay or inappropriate behavior in theworkplace.

September “Women in Medicine” month honors the livesand achievements of female doctors. Here we take alook at a few of our state’s women physicians who have

excelled in many diverse medical careers. The JMSMA asked themabout overcoming obstacles as a woman doctor… how they havemade a difference, work-life balance, words of wisdom frommentors, mentoring roles, and how their careers have evolved. On thenext few pages you’ll meet some of Mississippi’s top femalephysicians, see how vital they are in our health care community andhow they help make our state a healthier one.

Proudest accomplishment as a woman in medicine:Simply being accepted into medical school andbecoming a doctor. When I was in high school with

aspirations of medical school, colleagues of my dad’s told him,“Good luck to her, but, they really don’t admit women to medicalschool.” My medical school class had about 10 women out of 150.

Leadership: I have been very fortunate to be involved locally,in the state, and nationally. I served on the ACGME ResidencyReview Committee for Family Medicine for nearly eight years, andwas chair of that committee for four. I am still on the RRC-FMappeals board. I served on the AAFP Future of Family Medicineeducation task force and just completed serving for six years as anacademic council member for a national residency leadershipdevelopment fellowship. I am now on the board of the AmericanBoard of Family Medicine and serve as the chair of thecommunications committee, as well as serving on the credentials andbylaws committees. I’ve been active in our Mississippi Academy ofFamily Physicians (MAFP) for years as an ex-officio board memberand am on the executive committee and board of the MississippiPhysicians Rural Scholars Program. At UMMC, I serve as chair ofthe Department of Family Medicine and serve on numerouscommittees. Until recently, I was the only female chair of adepartment, as was my predecessor.

Role models: My role models were both men and women inmy profession nationally and locally. These people believed in myskills and me and encouraged me to continue to get involved andapply for various positions. I currently have several close womenfriends and colleagues nationally in leadership roles who serve as rolemodels and a support system.

Mentoring others:Yes, I certainly hope that I mentor others,both men and women, but, specifically, many of the women


DIANE K. BEEBE, MD CHAIR, DEPARTMENT OF FAMILY MEDICINE, UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

Jones, Verina Morton Harris

Fearn, Anne Walter

Wiss, Rosa Douglas

Jones, May Farinholt

Procter, Georgia A.

Bonner, Daisy Estelle Brown

Caraway, Margaret Roe

Wells, Josie English

Mattingly, Maria Dees

Dean, Sara and Frances Giles

Ferebee, Dorothy Boulding

Magiera Estelle Antoinette

Bass, B. Mary Elizabeth

Meloan, Eva Linn

Alexander-Nickens, Myrna

Batson, Margaret B.

Gay, Emma von Greyerz

Moss, Emma Sadler

Ryan, Nell J.

Herrington, Walterine (Bell)

Goetz, Catherine

Hawkins, Mary Elizabeth

Dowdy, Elizabeth

Barnes, Helen B.

Mauney, Jessie

Blount, June

Blissard, Thomasina

Wells, Peggy Jean Johnson

Moy, Ruby

Aseme, Kate N.

Moffitt, Nina G.

First Black Female Physician in Mississippi

Holly Springs Native Founded First Co-Ed Medical School in China

First Female Licensed to Practice Medicine in Mississippi

First Female Member of the Mississippi State Medical Association

First Black Female Physician in Vicksburg

First Black Female from Mississippi to Earn M.D.

First Graduate from a Mississippi Medical School

First Woman to Teach at Meharry Med. College

First Woman Accepted to School of Medicine UMMC

First Female Graduates 2-Year Medical School Ole Miss

First Director Mississippi Health Project

First Female Psychiatrist to Practice in Mississippi

First Female Officer of the Southern Medical Association

First Woman Physician Health Officer in Mississippi

First Black Female Cardiologist in Mississippi

First Female Faculty Dept. of Pediatrics UMMC

First Woman Member, Mississippi State Medical Association 50-Year-Club

First Female President American Society of Clinical Pathology

First Female Medical Student and Graduate, School of Medicine UMMC

First Female Medical Student Recipient of Leathers Medal UMMC

First Female Faculty Dept. of Pathology UMMC

First Woman Resident Ob/Gyn UMMC

First Female Faculty UMMC Dept. of Anesthesiolgy

First Black Female Obstetrician in Mississippi

Blue Mountain College First Alumna of the Year

First Female Faculty Dept. Radiology UMMC

First Female Psychoanalyst in Mississippi

First Black Female Graduate School of Medicine UMMC

First Female Asian Graduate School of Medicine UMMC

First Black Female Surgeon in Mississippi

Founder of the Caduceus Club (Mississippi Professionals Health Program)

1888

1890s

1895

1901

1903

1907

1910

1915

1917

1920

1934

1937

1939

1941

1955

1955

1955

1955

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1958

1959

1963

1964

1968

1969

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1974

1974

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1978

MISSISSIPPI’S FIRST WOMEN AS MEDICAL DOCTORS, 1888-2010


Acknowledgement: Special thanks to the Rowland Medical Library, University of Mississippi Medical Center, for access to and use of theirarchive and history collection “Mississippi Women in the Health Professions, 1888-1977” developed by David Juergens and Virginia Hughson.It is a challenging endeavor to identify the numerous “firsts’ for women in health professions from Mississippi beginning in the 19th century topresent. While Mr. Juergens is an extraordinary archivist and librarian, we do not claim complete accuracy for this listing compiled from theaforementioned exhibit and other sources. For the purpose of this JMSMA feature, only a limited number of medical doctors are included fromthe list of health professionals. If you know of other “firsts” among Mississippi women in medicine contact Head of Collection Development andArchives Manager David Juergans: (601)981-1830, [email protected], or Karen Evers: [email protected].

Acknowledgement: Special thanks to the Rowland Medical Library, University of Mississippi Medical Center, for access to and use of theirarchive and history collection “Mississippi Women in the Health Professions, 1888-1977” developed by David Juergens and Virginia Hughson.It is a challenging endeavor to identify the numerous “firsts’ for women in health professions from Mississippi beginning in the 19th century topresent. While Mr. Juergens is an extraordinary archivist and librarian, we do not claim complete accuracy for this listing compiled from theaforementioned exhibit and other sources. For the purpose of this JMSMA feature, only a limited number of medical doctors are included fromthe list of health professionals. If you know of other “firsts” among Mississippi women in medicine contact Head of Collection Development andArchives Manager David Juergans: (601)981-1830, [email protected], or Karen Evers: [email protected].

Spruill Davidson, Faye

Tolbert, Virginia Stansel

Eakins, Maxine

Hyde-Rowan, Maxine

Graeber, Angela Dickson

Phillips, D. Melessa

Manley, Audrey Forbes

Fredricks, Ruth K.

Pullen, Jeanette

Currier, Mary

Tatum, Nancy O’Neal

Lockard, Blanche

Gibson-McKee, Lisa Tijuana

Travelstead, Meredith Montgomery

Keller, Candace E.

Coney, Ponjola

Turner, Helen

Malpass, Aimee Sparkman

Bush, Freda McKissic

Douglas, Sharon

Poe, Katrina Nichelle

Chaney, Geraldine

South Bitter, Dwalia

Currier, Mary

Woodward, LouAnn

Bush, Freda McKissic

Woodward, LouAnn

Schlessinger, Shirley D.

Mississippi’s First Medical Examiner

First Woman Elected to Mississippi State Medical Association Board

First Female Urologist Dept. of Surgery UMMC

First Black Female Neurosurgeon

First Female Recipient Waller S. Leathers Award

First Female Dept. Chair (Family Medicine) UMMC

First Black Female Appt. Asst. Sec. Pub. Heal. Ser.

First Female Neuro-Oncologist in Mississippi

First Female Recient Barnard/Guyton Dist. Prof.

First Female State Epidemiologist for Mississippi

Established UMMC Formal Ethics Program

First Woman Faculty Dept. Ob/Gyn UMMC

First Black Female Resident Dept. Ob/Gyn UMMC

First Female Recipient of the Carl G. Evers, MD Award

First Female President of the Mississippi State Medical Association

First Female Grad. Dean of School of Medicine UMMC

First Female Associate Vice Chancellor Academic Affairs UMMC

First Female Recipient of the Wallace Conerly, MD Award

First Female Chair of Central Medical Society

First Mississippi Female on AMA Council on Ethical And Judicial Affairs

2005 Country Doctor of the Year Award

First Black Female President, Jackson Medical Society

First Grandmother, Third Female President of the MSMA

First Female State Health Officer for Mississippi

First Female Interim Dean, School of Medicine UMMC

First Mississippi Female Chair, Federation of State Medical Boards

Vice Dean, Associate Vice Chancellor Health Affairs, School of Medicine UMMC

First Female (interim) Chair, Dept. of Medicine UMMC

1979

1982

1983

1985

1986

1986

1987

1992

1993

1993

1993

1995

1996

1997

2001

2002

2003

2004

2005

2005

2005

2006

2007

2009

2009

2010

2010

2010

Acknowledgement: Special thanks to the Rowland Medical Library, University of Mississippi Medical Center, for access to and use of theirarchive and history collection "Mississippi Women in the Health Professions, 1888-1977" developed by David Juergens and Virginia Hughson.It is a challenging endeavor to identify the numerous "firsts" for women in health professions from Mississippi beginning in the 19th century topresent. While Mr. Juergens is an extraordinary archivist and librarian, we do not claim complete accuracy for this listing compiled from theaforementioned exhibit and other sources. For the purpose of this JMSMA feature, only a limited number of medical doctors are included fromthe list of health professionals. If you know of other "firsts" among Mississippi women in medicine contact Head of Collection Development andArchives Manager David Juergens: (601)981-1830, [email protected], or Karen Evers: (601)853-6733, [email protected].



participants in our national fellowship program for program directorshave become mentees. We actually talk openly during the fellowshipabout roles in medicine and personal and professional balance – forall, not just the women. In addition, my Mississippi Rural PhysiciansScholar mentee is a young woman, now in medical school. I hopethat over the years I have also mentored young faculty, many of themwomen.

Balancing professional and family responsibilities: Clearly,this balance is important for both men and women, and I believe menare becoming more sensitive to the challenges that women,particularly with children, face in the workplace. There are stillbarriers for child care for working mothers, more of an expectationthat the mother stay home to care for sick children but with nodifferential of time to do this. The responsibilities are not just relatedto children. The role of caring for elderly parents is an issue as well,since much of that responsibility as well traditionally falls to thedaughters and wives. Even without young children or elder parents,it is challenging to keep up a home, with all of the cooking, shopping,and cleaning responsibilities, while working fulltime. In addition tothe daily responsibilities, things like gift shopping, party organizing,holiday decorating, card and letter writing, and so much more, falls,at least in my household, to the woman of the house. After hourwork commitments increase this challenge with less time toaccomplish the personal responsibilities, or just to spend time withspouse and children. Overcoming these challenges is all aboutsetting priorities, being able to multi-task and being extremelyorganized. It’s also about having a spouse who understands andhelps tremendously. You have to block time out to do the things thatare important in your life and you have to make time for vacationsand time together as a family.

Thoughts about childbearing/rearing issues in training andpractice: In training, there are time issues related to childbearingsuch as the maximum time allowed away from the training program.At least our Board of Family Medicine is generous with exceptionswhen pregnancy and childcare issues affect this. Hopefully mosttraining programs and employers are becoming more equal to providepaternal time for leave and childcare as well. I think our youngergeneration of physicians, both male and female, are more interestedin balance with their careers and their families. We see this in the jobopportunities they seek. Many of our male residents have wives whoare also professionals, so the non-professional responsibilities areshared. Much of this is also supported by increasingly stringent dutyhours during training.

Preparing for more women in the profession: It’shappening now. I think we have to be realistic in looking at theworkforce. As above, expectations are changing among many ofthose entering medical school and practice. I think we have to realizethat many of our new generation of doctors are not going to practicelike many of those who came before us, or even like us. We have tobe more flexible with hours so that parents can attend schoolprograms and recitals and appreciate the value of part-time positions.We need to use more effectively our colleagues in nursing, pharmacy,

psychology and other professions to render care to our patients thatthe physician does not absolutely have to render, thus utilizing thephysician’s time with their patients fully. This is, by the way, part ofthe concept of the Medical Home as well to utilize more teamwork inpatient care.

Proudest accomplishment as a woman in medicine:To have graduated from Michigan State UniversityCollege of Osteopathic Medicine at the age of 44 .

Leadership: 1987- Hosted and testified before the U.S. Houseof Representatives Select Committee on Hunger and Infant Mortality;1989- Testimony presented at the Lower Mississippi DeltaCommission; 1996-Testified before the Mississippi Senate and HouseHMO Oversight Committee; 2000-2002 first female Chief of StaffNorthwest Mississippi Regional Medical Center; 2003- Participated atthe Health Care Policy Round Table (Wye River Health Foundation);2005- Panelist at the AMA Foundation "Pride in the Profession"Award ; 2008-current Member of the Advisory Board of WilliamCarey University College of Osteopathic Medicine in Hattiesburg.

Mentor: John Upledger, DO challenged me by giving mepower over my health and insisting that I could become a physician

Mentoring others:As instructor/ preceptor at the TutwilerClinic for student physicians and nurse practitioners on familypractice/rural practice rotations for the past 27 years.

Balancing professional and family responsibilities: AtMichigan State University College of Osteopathic medicine therewas a spiral curriculum, allowing students to take time off forseveral months or (even a year) to handle family matters or moreintensive instruction if they wished and then plug back into thecurriculum where they left off.

Changes needed to attract more women to the profession?Flexible hours, particularly call schedules.

An admirable woman in medicine:Mel Bouldin, MD, adelightful woman dedicated to good health, constantly inspiring,teaching, collaborating, challenging her colleagues to jump into thefray and help people become more healthy!

DIANE K. BEEBE, MD CONTINUED...

SISTER ANNE BROOKS, DO (right) with Dr. Narayan Bhetwal,MD, (left) who joined her at the TUTWILER CLINIC in 2007.


Proudest accom-plishment as awoman in

medicine: Returning to myhome of Rankin County toprovide medical care in a typi-cal family medicine clinic.

Leadership: CurrentlyCentral Medical Society(CMS) President-elect,previously CMS secretary andRankin County Vice-President,served on a local hospital’smedical executive committeeas secretary, also served aschair of ethics committee,chair of pharmacy andtherapeutics committee, andchair of MR/UR committee.

Role model:My uncle,Dr. Tom Joiner, who is also afamily physician andpresident-elect of MSMA. Hehas encouraged me to remainactive in both the field offamily medicine and medicinein general including MSMA and Central Medical Society. I have hadmany other mentors along the way.

Mentoring others: I have had many female medical studentsrotate through my clinic as 3rd year medical students.

Preparing for more women in the profession: Great strideshave been made towards overcoming obstacles for women inmedicine.

An admirable woman in medicine: Dr. Helen Turner becauseshe is an excellent physician and past-president of MSMA. She is agreat leader and well-respected physician and gives all femaleMississippi physicians someone to look up to.

Additional comments: Women in medicine have come a longway since the early days. There may be some discrepancies betweenmen and women, however, I feel the gap is closing. I have feltsupported in my decision to balance my career with family life, and Ihave not felt any hindrance to being involved in professional medicalorganizations or medicine in general.

Proudest ac-complishmentas a woman in

medicine: Co-authoring thebook, Hooked, New Scienceon How Casual Sex is Affect-ing Our Children with Dr. Joe

McIlhaney, Founder of the Medical Institute for Sexual Health. Ihave been working for years in my practice and in the culture to in-fluence strategically young women to raise the standard of their sex-ual behavior. This book brought the science into the discussion in apractical way that would inform and empower them to do just that.No longer was the discussion just on the physical effect of sex likesexually transmitted infections and unplanned pregnancy but on thelarger more pervasive impact on the emotions and the effect on thebrain chemistry which drives the thinking and thus the behavior.Women listen to women. As a woman in medicine, I was proud to usebe able to use the science in a practical way to help women and thusfamilies and the larger community.

Leadership: April 2010, I was installed as the chair of theFederation of State Medical Boards of the United States. This was thesecond time a Mississippian has held this honor. The first was Dr R.N. Whitfield in 1948. I served for 12 years on the Mississippi StateBoard of Medical Licensure (MSBML) and did a two-year stint aspresident and as chair of the Joint Practice Committee between theMSBML and the Mississippi Board of Nursing. In 1995, I waselected as the first female and first African American to serve asPresident of Central Medical Society. I saw these leadershipopportunities as preparation for the national positions.

Role models: My principle role model is my mother. Shepursued her dream of becoming a teacher by going to school throughthe years and graduated from college two weeks before the birth ofthe 9th child. When I began medical school, it was with threechildren and had a fourth while in med school. I was confident Icould do it because my mother did.

Beverly McMillan, MD, FACOG was a mentor for me as wellas my senior partner in practice. Dr. McMillan, founder of the firstabortion clinic in Mississippi,who as a Christian has become a strongPro-Life advocate. She demonstrated how you could have principlesof conviction that may not be popular or politically correct and stillhave a successful practice.

Mentoring others: This past school year, I served as a mentorfor an M3 through a mentoring program with the UMMC

JENNIFER BRYAN, MDFAMILY MEDICINE PHYSICIANUNIVERSITY PHYSICIANS, GRANTS FERRY CLINIC

FLOWOOD

FREDA MCKISSIC BUSH, MDOBSTETRICIAN-GYNECOLOGIST,

PRIVATE PRACTICE,EAST LAKELANDOB-GYN ASSOCIATES,

JACKSON


Multicultural Affairs Division. There were many hours of shadowingand discussion about studying, career choices, and attention to familymatters. For several years, I have served as the coordinator for theDepartment of Family Practice residents rotating through mypractice. This has afforded me the opportunity to spend quality timewith the women as they have spent time with us. Some of thoserelationships continue today. Through the years, I have spent timewith young women on the telephone, emailing and at dinner not inany official capacity but who just wanted to seek my opinion oradvice.

Balancing professional and family responsibilities:Balancing professional and family responsibilities was and is achallenge. My mantra is to provide quality and quantity time to myfamily. When I am present with my family, I try to be totally presentand give them my undivided attention. My husband and I got anunderstanding of what would be required to be successful in marriageand in medicine and periodically would sit and talk with the childrenabout “why mama is not home a lot of time.” We planned a 24-hourschedule for me and posted it on the refrigerator, changing it asneeded. If a sacrifice is to be made, we share as much as possible butknowing I would be the one ultimately to do so.

At the end of my career and my life, it is family that willmatter most to me. I consider it more important to invest in the livesof my children. Therefore, when I was pursuing my education andlater in practice, I limited external community and professionalactivities until the children were older. When I could, I took thechildren with me to the hospital, office and to various meetings.

Thoughts about childbearing/rearing issues in training andpractices: I viewed childbearing as one of my primary privileges asa woman. I was also to “live my life.” Even though I viewed mycareer in medicine as a privilege, I did not see the two privileges incompetition but complementary-- Not “either or” but “both and.”Therefore, my husband and I sought to develop a good supportsystem through family and friends and nurtured relationship with agood housekeeper/babysitter. For about eight years when I began inprivate practice, my husband served as the primary parent in thehome allowing me to establish myself in practice.

Gender-related organizational barriers: These were facedthrough women’s networking groups that were official in someorganizations, unofficial in others. Women helping women with “bestpractices” and working through the system in other areas helpedovercome obstacles.

Preparing for more women in the profession: First, I wouldlike women to recognize they are not men. The differences arenatural and not less than. They do not have to act like men to beprofessionals. The profession needs to acknowledge also, there aregender differences in thinking and problem solving and thedifferences are okay.

Flexible work schedules and “shared” positions arearrangements I have heard work well for women, especially withsmall children.

Admirable women in medicine: I admire several women inparticular. Regina Benjamin, MD, MBA is the new Surgeon Generalof the United States. However, more than that, she was the only

family doctor in a small shrimping town in AL for years. NancyDickey, MD was the first woman president of the AMA; HelenBarnes, MD, FACOG was the first in a number of areas as anAfrican-American and as a woman.

Additional comments: I have been married to Lee Bush for41 years. We have four children and seven grandchildren. He hasbeen my friend and biggest supporter. I also consider my career inmedicine a calling from God who has guided me from the beginning.In addition to Lee, my faith in God has sustained me.

Proudest ac-complish-ment as a

woman in medicine: I thinkmy proudest accomplish-ment is having both a serv-ice career that I love, doingsomething I think is useful

and of benefit to the public, and having a family that is so wonderful.That balance has been difficult and has required thought and dedica-tion from the whole family. I don’t think the kids (now perfectlyspectacular adults, not that I’m biased or anything), have sufferedfrom the example I’ve set, and my relationship with my husband [Dr.Currier is married to pediatric ophthalmologist Dr. Robert A. Mal-lette. —ED.] is better for my having a purpose in the outside world.

Leadership: I was the State Epidemiologist with theMississippi State Department of Health (MSDH) for many years(about 13), coordinating activities around disease surveillance andresponse. For example, disease surveillance allows us to recognizefoodborne outbreaks, to investigate the cause, interrupt transmission,and prevent future transmission. I’m now the State Health Officerwith MSDH and oversee all health department activities, as well asrelating to outside entities such as the Legislature. It is certainly achallenge but also such a great opportunity to have an effect on healthin the state.

Role models:Well, of course, my parents. My Dad was theChairman of the Department of Neurology for many years, and myMom taught English before I was born. Both made it easy for me tobelieve I could do whatever I wanted, and medicine was such animportant part of my growing up years, I suppose it was inevitable.The first time I really thought about epidemiology was when ourfamily went to Ireland for 6 months in 1972, and Dad interviewedtwins discordant for multiple sclerosis, then created on graph paper (!)lovely charts and figures comparing the risk factors between twins.These graphs were all over our dining room for the time we werethere, and they fascinated me. My parents always believed in me andencouraged me and loved that I was interested in epidemiology,public health, and prevention.

MARY CURRIER, MD, MPHSTATE HEALTH OFFICERMISSISSIPPI STATE

DEPARTMENT OF HEALTH


Dr. Tom Brooks, professor and chairman emeritus of theDepartment of Preventive Medicine at UMMC, played a huge part inmy career. I loved his preventive medicine course in medical school,and he worked with us at MSDH for many years as the editor of theMississippi Morbidity Report. His wisdom and advice helped me seethe possibilities in my life and work.

Dr. Ed Thompson also encouraged me and provided supportfor the epidemiologic activities that we undertook for so many years.He was so knowledgeable and so solid; he always “had our backs.”Without him and his belief in me, I would not be doing what I amtoday.

Mentoring others: I spent time working with the Educationprogram within the Department of Medicine at UMMC and had anopportunity to get to know several female medical students duringthat time. This was not a formal program, but I tried to be availableto talk about whatever they wanted. At MSDH, we’ve also hadmedical students, both female and male, for summer work or arotation, whom I have taken time to get to know and hope to havebeen a positive example.

Balancing professional and family responsibilities:Certainly, there are obstacles wherever you go that make it difficult tobalance a family and a career. I think those can be overcome throughcareful thought, understanding marital relationships, and a systemthat is supportive. Something that would have been very useful andwould have decreased the stress level in our family would have beenchildcare that was close and dependable and connected to my or myhusband’s work. If residency programs would/could support mothers(and fathers) by providing healthy and happy day childcare onsite, Ithink it would benefit the parents and the program.

Thoughts about childbearing/rearing issues in training andpractices:With great difficulty and much family discussion! Myhusband and I talked about everything relating to our career choices.We also took turns in our training, which made for interesting jobsbetween training opportunities! It is just not easy, but it is so worthit.

Preparing for more women in the profession: I used tothink that we (humans) were blank slates at birth, but my childrentaught me different. You just can’t get around the genetics of beingmale or female, and moms are women. I think that the business ofmedicine will have to become more flexible and moreaccommodating to alternative schedules for moms and to less formaloffice atmospheres as children become more common in theworkplace. I think it will take open minds as we think of new waysto accommodate moms. I also think it will make us more empatheticto our patients and their needs as we increase our own flexibility.

Admirable women in medicine: I think of Helen Turner, MD,PhD, Associate Vice Chancellor for Academic Affairs at UMMC,who is truly an example of someone who has achieved with herequanimity and femininity intact.

I also think of Helen Barnes, MD, who is a female AfricanAmerican obstetrician and taught at UMMC, who led the way.

Additional comments: I know I’m lucky. I’m grateful for allthe opportunities I’ve had and for all the folks in my life who’ve putup with me. I hope they continue to do so.


woman in medicine: Beingthe first woman in my fam-ily to graduate from medical

school and having my sweet, wonderful mother be there to see it andenjoy it.

Role models: Dr. Mary Clarr, a pioneer woman pediatrician inHattiesburg. While I admired her from afar, I also got a wonderfulhandwritten note from her once. Mentors are not gender specific,there were also men doctors at medical school and elsewhere whowere influential.

Mentoring others:Yes, with the pediatric medical studentsand loved it.

Balancing professional and family responsibilities: Yes,there have certainly been times when I felt torn between family andcareer desires. Unfortunately, your family definitely suffers.

Gender-bias in the workforce: Not much. You can overcomethese.

Thoughts about childbearing/rearing issues in training andpractices: Marry a wonderful husband like mine. I would never behere without him.

An admirable woman in medicine: Dr. Nancy Tatum – akind and wonderful family practitioner who unfortunately died andleft us early. Dr. Tatum once said a lot of us “never forget the divineprivilege God has granted us in the opportunity to care for ourpatients.” (A great teacher and lecturer.) She was a wonderful friend.Dr. Tatum is also remembered as a pioneer in treating HIV/AIDSpatients in the Hattiesburg area when others were so fearful.

Additional comments: Things I tell young people in pre-med– women or men:

1. Be persistent in striving for your dreams. Oneturn down by an admission committee is not the end unlessyou decide it is. Apply again, but improve your applicationand skills. Apply more than one place. Take that MCAT over!

2. The one person who will keep you frombecoming a doctor for sure is yourself. If you believe it’s “nouse” and you can’t do it – you are right. If you know you canand you keep trying – you’re right! You just have to convinceothers.

3. Sir Oliver Wendell Holmes (Dr. Holmes) said,“To save life on occasion - to relieve suffering often – tocomfort always.”

CAROLYN F. GERALD, MDEMERGENCY MEDICINE

PHYSICIANHATTIESBURG


woman in medicine: I hadno idea that I wanted to goto medical school when Ifinished college. After ayear of working, I decidedthat I really would love tobe a doctor. Since I lackedsome of the pre-requisites, I had to go back to school and take 16hours of chemistry and 8 hours of physics, while continuing to workfulltime. My medical school class consisted of 20 women andaround 100 men initially. On graduation day, I was one of only 10women in my class that had completed the four years of medicalschool. Today I have the privilege of practicing medicine... this is myproudest accomplishment.

Leadership:While I have been a doctor, I have been presidentof my group, Anesthesia Consultants, a member of the MedicalExecutive Committees at River Oaks Hospital and Surgicare ofJackson, a member of the MMPAC Board, and chair of one of theClaims Committees at MACM. Presently, I serve on the Board ofMACM, Board of Preferred Health Services, and the MississippiProfessional Health Program Committee.

Role models: I guess if I had to say that I had a mentor in myearly anesthesia days, it would be Dr. Marion Parker. Dr. Parker wasan anesthesiologist in my group who was devoted to pediatricanesthesia. He practiced in the days before there was the drug, Versed,which today is given to sedate children pre-operatively. He knew howto talk to children and their parents and put them at ease. He showedme how to hold a baby in my arms while slowly putting him to sleep.He taught me how to start an I.V. on a seven-pound infant while stillholding a mask on his face. I learned so much from Dr. Parker aboutpediatric anesthesia. I will be eternally grateful to him.

Mentoring others: I have mentored several women who havewanted to become anesthesiologists. Some have been in high school,others in college or medical school. It thrills me to see theirenthusiasm, and I try to teach them a little about being a woman inmedicine and how great the specialty of anesthesia is for a woman.

Balancing work/life: I personally think that women makegreat doctors. Therefore, I am glad that there are more womengraduating from medical school.

Gender-bias in the profession: I have not seen any gender-bias in anesthesia nor income inequalities. In my group, you ‘eatwhat you kill’, so to speak; therefore, my income is based on howmuch I am willing to work.

Admirable women in medicine:When I think of women inmedicine, I think of Dr. Helen Barnes and Dr. Gerry Ann Houston.Both have given so much of their lives to their particular specialties.I admire both of them and am proud to have known them.


woman in medicine: Myproudest accomplishment asa woman in medicine was

being named the first woman Chair of a clinical department (FamilyMedicine) at UMMC in 1987. I was humbled to be recognized in2008 by UMMC as a Local Legend in the Changing Face of Medi-cine National Library of Medicine program [See p. 270-71].

Leadership: I was fortunate enough to serve as the chair ofthe Department of Family Medicine for 19 years until my retirementfrom UMMC in 2006. I was also fortunate to be chosen forleadership positions over the years in the national Society of Teachersof Family Medicine organization. In 1990, I was named one of 50Kellogg Fellows by the Kellogg National Fellowship Program and in1999 received the American Academy of Family Physicians ThomasJohnson Award for Career Contributions to Family Medicine.

Role models: I was one of eight women in a medical schoolclass of 164 at Tulane Medical School from 1969-73. There wereonly a very few women on the faculty then –the most memorablebeing Dr. Hannah Woody, a pediatrician. I can’t say that she gave usany encouragement outside of expecting all of us, men and women,to do our job on the pediatric service. When I came to UMMC in1973 to enter the Family Medicine residency, I was the only womanresident in the program, and there were no women faculty. By 2006,half of the departmental faculty was women.

Mentoring others: I hope that I served as a mentor to womenmedical students during my years at UMMC. I know that I talked tohundreds of them about medicine in general and career choices inparticular.

Gender differences and the complexity of balancingprofessional and family responsibilities: Although there are nowmore women medical students, residents, faculty members, and deansat American medical schools and more women in the nationalphysician workforce, men still dominate medicine in positions ofpower. CEOs and CMOs of managed care organizations, third partyinsurance companies, medical licensure boards, hospital staffs,national specialty and practice organizations, state and local medicalsocieties, and the editorships of major medical journals are stillalmost exclusively male. Strong stereotypes, borne out by multiplestudies, exist that women cannot manage family and a career orleadership positions in medicine simultaneously –women withchildren have less successful academic progress than their malecolleagues. Women are still paid less in private practice for the samework as men, even when adjustments are made for years of training


D. MELESSA PHILLIPS, MD RETIRED

PAST CHAIR, DEPARTMENTOF FAMILY MEDICINE,

UNIVERSITY OF MISSISSIPPISCHOOL OF MEDICINE

JACKSON

CAMILLE J. JEFFCOAT, MDANESTHESIOLOGIST

JACKSON


and hours worked. I don’t believe that these issues are exclusively“women’s issues” but societal issues. Gender equality is stillcharacteristic of our culture – men’s careers in all areas are morehighly valued than women’s.

Thoughts about childbearing/rearing issues in training andpractices: I greatly admire the women physicians I know who jugglechildcare responsibilities and practice. While women always havehad and always will have primary responsibility for raising children,medicine and parenthood are not incompatible. It’s the hardest jobin the world, and most woman doctors I know make concessions totheir careers in order to care for their families.

Preparing for more women in the profession: Theinfrastructure of academic, research, and private practice medicineneeds to change in order to create a woman physician friendlyatmosphere. The “male model” fulltime-dedicated first to career-example will not work for tomorrow’s male or female doctors.

When I think of women in medicine: I think of my eightwomen colleagues in medical school. We were a tight knit groupbecause we really only had each other to depend on to understand our“women’s issues”–there simply were no women faculty members andvery few women residents for us to talk to.


woman in medicine: Beingable to raise two wonderfulgirls while working fulltime in a job that I love. Mylife is full of children –bothothers’ as patients and mine.

Leadership: I havechaired the Women’sCaucus, MSMA YoungPhysicians Section (YPS),and the Rules andRegulations Committee. Ihave served on Reference

Committees and represented Mississippi at AMA annual and interimmeetings. I have served on the Medicaid Committee. I have been aninvited guest to the Board of Trustees meetings for several years. Ihave also served as the Mississippi Chapter of the AmericanAcademy of Pediatrics as vice-president. Locally, I have been onevery committee in our hospital, including the MedicalAdministrative Committee, and served as the chair of pediatrics forseveral years.

Role models: Dr. Helen Turner at UMMC was alwaysinvolved in organized medicine. I enjoyed getting to know her atmeetings on and off-campus. She also had an important family lifeand reassured me I could have both a good job as a physician and besuccessful as a mother.

I really appreciated Dr. Sharon Douglas sharing her home witha small group of females for a Bible study while I was at UMMC. Welearned a lot from each other during that time and it was nice to see afemale physician on “the other side.”

I have met many wonderful female physicians at the MSMAAnnual Session through the years, two of whom are Dr. Dwaila Southand Dr. Mary Gayle Armstrong. Missing the convention for the pasttwo years due to family commitments was hard because I enjoytalking with these women, and this is the main time that I see themface-to-face. I have e-mailed Mary Gayle several times aboutdifferent issues and am glad that I met her through MSMA. I wouldencourage everyone to attend the Annual Session and the YPS CME.They are both great avenues to meet wonderful physicians fromacross the state. The Women’s Caucus at the Annual Session isespecially fun and a good way to meet other female physicians.

Mentoring others: I have had several medical students dopediatric rotations with me. I try to discuss “life” with these students,as well as teaching them the fundamentals of pediatrics.

Gender differences in the profession: In the health system inwhich I am employed, I feel the income is equal between men andwomen based on our specialties. However, I also feel that I have hadsome resistance being “heard” by administrators when I personallyor our pediatrics department has a hospital/health system problem.

Sometimes, I have to get my Dad (also a pediatrician in mygroup) to call and help plead our case, which is ridiculous. Beingconfrontational and demanding is not in my nature. I don’t know ofmany females whose nature it is. I do believe that this is a factorsometimes in not being taken seriously by our hospitaladministration. I am learning to be a little more aggressive withoutbeing rude, and as the saying goes, “The squeaky wheel gets thegrease.” Persistence definitely pays off.

On gender equality with patients: I am still called a nurse,or “Miss Price” very frequently by parents, grandparents, andpatients. I have never heard this mistake made with my male partners.

Gender-bias in the profession: When I was put on bed rest at28 weeks with my second daughter, I knew that it caused a strain onmy partners and I felt really guilty about that. I tried every way that Icould think of to work part-time to “make up” for it but keptcontracting and finally had to sit strictly in bed, which is totallyagainst my nature. Looking back, I was probably depressed duringthat time, but I made it through with a healthy baby! I did, because ofguilt, rush back to work when she was 5-weeks-old and managedsomehow to nurse her for the first year of her life. Again, I had asupportive husband who could sometimes bring her to me at theoffice or come by and pick up pumped milk. Those were very tiringdays but we made it through as a team. I can see howchildbearing/rearing could scare many females from working full-time, especially if their husbands work full-time. There are manydays when I still feel inadequate (and tired!).

DEANNA I. PRICE, MD, FAAP(DEEDEE)PEDIATRICIANEAST MISSISSIPPI


When my partner had a baby and took eight weeks off, it wasstressful for the rest of us, especially since I had two young childrenat that time. However, having been through that myself, I encouragedher to take as long as she needed and tried not to complain!

We have given our male partners two weeks of “paternityleave” when their wives have had children. I think this is important tothem, especially if their wives have had C-sections. I’m sure that wewould have agreed to more if they had requested it. We try to be veryfamily-oriented at our clinic.

Of course, my dad, being older, is not eligible for paternityleave, so we give him every Friday off. He’s happy with that. Overall,within our clinic, I don’t think we have gender-related issues betweenour physicians.

Balancing professional and family responsibilities: I thinkthat balancing family responsibilities well would be impossiblewithout a supportive spouse. I am blessed with Chris. He even stayedhome for several months with each of our daughters after birth. Nowthat they are older, it is nice to be able to “Tag Team” them. Extendedfamily is also important. We love having both sets of grandparentshere in Meridian!

A New England Journal of Medicine study concludes that itis possible for women to combine motherhood with a fulfillingcareer in academic medicine, but it is difficult, and most suchwomen believe that motherhood slows the progress of theircareers (N Engl J Med. 1989;321:1511–7). Thoughts aboutchildbearing/rearing issues in training and practices: I am notemployed in academic medicine, so I cannot comment directly to thatstudy. However, I would have liked to do a fellowship in pediatricemergency medicine because that is the area I most enjoy. If I hadcompleted that training, I most likely would have been tied to amedical center. However, three more years of living in poverty andstress was not conducive to my plans to have a family before I wasconsidered to be “advanced maternal age.” I delayed having my firstchild until I was 28 because of medical school/residency. Myhusband and I had been married six years at that time. So, I guessbeing a female did keep me from ever entering the academic world.

Preparing for more women in the profession: I read thatmany practices across the country are using job-sharing as a way toaccommodate females. I don’t think anyone can adequately preparefor what life will be like after residency, but rotations through clinicswhere job sharing, maternity and paternity leave, and otheraccommodations are used as well as just talking to physicians whohave “been there” would be helpful.

When I think of women in medicine: I think of myfriends/mentors from UMMC and my female partner because it is asmall group from which I gain a great deal of support. I don’tpersonally know many other “women in medicine.” Even thoughthere are several other female physicians in Meridian, I guess ourindividual schedules have kept us from being better acquainted,which is a shame because we could all probably learn from/supporteach other. �

DEANNA PRICE, MD CONTINUED...

Women in Leadershipat the

University of Mississippi Medical Center School of Medicine

by Richard D. deShazo, MD; JMSMA Associate Editor

Since the University of Mississippi School

of Medicine was founded on the Oxford

campus, Mississippi women have

continued to grow in their leadership roles. We all

know these individuals as recently represented by Dr.

Helen Turner, MD, PhD, associate vice chancellor for

academic affairs and MSMA past-president, and

LouAnn Woodward, MD, vice dean of the School of

Medicine and associate vice chancellor for health

affairs. Most recently, Shirley Schlessinger, MD,

associate dean for graduate medical education who

also serves as medical director for the Mississippi

Organ Recovery Agency (MORA), has become the

interim chair of the Department of Medicine, the first

woman in the school’s history to serve in that role.

Now that the medical school class is about half and

half male and female, it is encouraging to see the

Shirley Schlessinger, MD

Interim Chair of the Department of Medicine

University of Mississippi School of Medicine


growth of women in leadership roles in our medical

school where role modeling is so important to long

term career choices and practice styles. Dr.

Schlessinger joins Dr. Diane Beebe, MD, chair of

the Department of Family Medicine, and her

predecessor Dr. Lessa Phillips, as the third female

chair among the primary care departments.

Dr. Schlessinger brings the very best in

professionalism, clinical skills, and leadership to this

role. She established the renal transplantation

program at University Medical Center and is a

passionate advocate for individuals with chronic

disease. However, she is an equally passionate

advocate for the selection of medical students and

house staff who are empathetic, caring, principled,

and altruistic individuals open to meeting the needs

of the communities from which they come. Since

she now chairs the largest department in the

medical center, it is comforting to know that a

woman of her integrity has assumed this important

role. It will be good for Mississippi. �

Mississippi Women Physicians Recognized as "Local Legends"

Ascholarly history and archive collection “MississippiWomen in the Health Professions, 1888-1977” in theUniversity of Mississippi School of Medicine Rowland

Medical Library is dedicated to the state’s women healthprofessionals. The following Mississippi women physicians arerecognized as local legends:• Dr. Helen Barnes, of Jackson, earned the MD in 1958at Howard University in Washington, D.C., and completedresidency training in obstetrics and gynecology at Kings CountyHospital in Brooklyn, N.Y. Her commitment to improving healthcare for the economically disadvantaged and for women was thehallmark of her career. She was on the faculty of the Universityof Mississippi Medical Center from 1969-2003. • Dr. Lessa Phillips, of Madison, the first female chairof a department in the School of Medicine at UMMC, earned theMD in 1973 at Tulane University School of Medicine andcompleted an internal medicine internship and family medicineresidency at UMMC, where she led the Department of FamilyMedicine from 1987-2006. • Dr. Jeanette Pullen, of Jackson, professor emeritus inthe Department of Pediatrics at UMMC, earned the MD at Tulanein 1961 and completed pediatric residency training in the TulaneDepartment of Pediatrics at Charity Hospital in New Orleans.She later completed a postdoctoral fellowship in pediatrichematology-oncology at the University of Tennessee HealthSciences Center. She joined the UMMC faculty in 1969 and wasinstrumental in the creation of Mississippi’s Children’s CancerClinic. • Dr. Nell Ryan, of Vicksburg, the first woman tograduate from Mississippi’s new four-year School of Medicine in1957, completed an internship in pediatrics at VanderbiltUniversity Hospital in Nashville, a pediatrics residency at theMedical Center, a postdoctoral fellowship in pediatric cardiologyin Oklahoma and a residency in pediatric neurology at theUMMC, where she served in leadership roles during her time onthe faculty from 1961-1983. She then served on the faculty atLouisiana State University, where she was named professoremeritus of pediatrics at LSU at Shreveport. • Dr. Helen Turner, of Jackson, associate vicechancellor for academic affairs and senior associate dean foracademic affairs at UMMC, is professor of medicine and on staffat the Department of Veterans Affairs Medical Center. She wasthe second faculty member at UMMC to be named president ofthe Mississippi State Medical Association. She earned the PhD inmicrobiology at UMMC in 1975 and the MD in 1979. She tookher internship and residency in internal medicine and afellowship in infectious diseases at UMMC.


MISSISSIPPI WOMEN PHYSICIANS RECOGNIZED AS LOCAL LEGENDS— The contributions of women to the profession ofmedicine served as the backdrop for the grand opening of the National Library of Medicine’s traveling exhibit “Changingthe Face of Medicine: Celebrating America’s Women Physicians.” Mississippi’s five “local legends” were the luminaries ofthe program held March 6, 2008, at the Jackson Medical Mall. The exhibition included a special display of “first” womenphysicians in Mississippi, part of the archive and history collection “Mississippi Women in the Health Professions, 1888-1977,” developed by David Juergens and Virginia Hughson with the University of Mississippi School of Medicine RowlandMedical Library. The “Mississippi Women in the Health Professions, 1888-1977” collection contains information on about350 of the state’s female health professionals. The criteria for the collection include women who were either born inMississippi or spent much of their professional career in our state. Two large displays highlighted 50 women of the 64 firstphysicians from this collection. The following Mississippi local legends’ names were added to a national list of womenphysicians:

Dr. Tenley Albright, second from left, general surgeon and director of Collaborative Initiatives at MIT, stands with the‘Mississippi Legends - Women in Medicine” recipients including, from left, Dr. Helen Barnes of Jackson, professor emeritusof obstetrics and gynecology, Dr. Nell Ryan of Vicksburg, first female graduate of the School of Medicine, Dr. Helen Turnerof Jackson, associate vice chancellor for academic affairs, and Dr. Jeanette Pullen of Jackson, professor emeritus ofpediatrics. Dr. Lessa Phillips of Madison,(not pictured) the fifth honoree, was unable to attend.

Local Legends Recognized in "Changing the Face of Medicine" Exhibit

• UMMC •


Jackson Heart Study to Mark 10th Anniversary with Conference

To celebrate the Jackson Heart Study’s 10th anniversary, organizers plan a scientificconference that will both mark progress in understanding disease disparities amongAfrican-Americans and help shape the study in the coming years.

The conference, September 23 and 24 to be held at the Jackson Convention Complex, willinclude speakers from Harvard University, Johns Hopkins University, the National Institutes ofHealth, Duke University and other prominent research institutions.

The Jackson Heart Study (JHS) is a population study by three longstandingJackson institutions – The University of Mississippi Medical Center, Jackson StateUniversity and Tougaloo College – to characterize risks for cardiovascular diseasein African-Americans. It is funded by the National Heart, Lung and Blood Instituteand the National Center on Minority Health and Health Disparities.

Through numerous medical tests, scans, exams and interviews, JHS hasfollowed 5,300 African-Americans in Jackson. It also analyzes lifestyle factors such as diet and community and church involvement. The studyhas served as a springboard for community health outreach and given training opportunities to dozens of undergraduate students interested inscience, medical and public-health careers.

In the mid 1990s African-Americans suffered cardiovascular disease at astounding rates. For example, 40-year-old black women had alikelihood of dying of cardiovascular disease four and a half times higher than the national average.

“You had these obscenely skewed statistics that needed investigation,” JHS Principal Investigator Dr. Herman Taylor said. “In the late1990s African Americans represented, unfortunately, a worst-case scenario for cardiovascular disease.”

Through its first decade the study amassed an impressive collection of achievements including doubling the number of publications everyyear for the last three years.

This year also marked the founding of a support group for the study, Friends of the Jackson Heart Study. Organized under President RitaWray, the non-profit group is raising private funds.

“Through Friends of the Jackson Heart Study, we providematerial support, such as books, supplies and equipment, for studentresearchers, travel expenses for young faculty dedicated to the JHSmission, community outreach and coverage of other related costs,”Wray said. For more information on giving to the Friends group, contactthe UMMC Office of Development staff, at (601) 984-2300 orhttp://giveto.umc.edu.

The anniversary also includes a pre-conference symposium forjunior investigators using JHS data scheduled for September 22 and agala reception at the Jackson Medical Mall on September 24.

A complete Jackson Heart Study 10th Anniversary Conferenceschedule is available on the study’s website, www.jsums.edu/jhs.

DR. HERMAN A. TAYLOR, JR., MD, MPH, FACC, FAHASHIRLEY PROFESSOR FOR THE STUDY OF HEALTH DISPARITIES

PRINCIPAL INVESTIGATOR, JACKSON HEART STUDYUNIVERSITY OF MISSISSIPPI MEDICAL CENTER

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• LEGALEASE •

Talking to Lawyers about Patients: When is it really Okay?

When facing a malpractice claim, a physician knowsto hire a lawyer and then not talk to anyone aboutthe patient’s care except as specifically instructed

by his or her lawyer. Nevertheless, how do you handle the situationwhen malpractice is not the issue, but a lawyer wants to discuss apatient’s care with you? Take, for example, a pharmaceutical productliability case. You prescribed a drug to your patient, and your patientbelieves he was injured by that drug and sues the manufacturer. Youget a call from the manufacturer’s lawyer, and she wants to talk withyou about your patient. Assuming Mississippi law and rules governthe situation, can you talk to her alone without the patient and/or hislawyer being present? The answer is generally no. Have you everwondered why? Below is a series of questions and answers to helpyou understand why and to help you properly deal with such requests.

Q:What exactly is the physician-patient privilege andwhat does it cover?

A: In a lawsuit, “discovery” is the term for allowing lawyers tolearn about the facts of a case. This includes learning facts about theplaintiff’s medical condition. Discovery is allowed only of relevant,non-privileged information. Certain medical information sharedbetween a physician and a patient is deemed to be “privileged.”Privileged information, even if relevant, is not discoverable. Basedon privilege, a patient can refuse to disclose and prevent others (i.e.,his physicians) from disclosing: 1) knowledge derived by the treaterby virtue of his professional relationship with the patient; and 2)confidential communications made for the purpose of diagnosis ortreatment of his physical, mental, or emotional condition.Knowledge derived by the treater has been held to include even suchthings as test names, not to mention results. A “confidentialcommunication” is any communication that was not intended to bedisclosed to a third person except to facilitate treatment. Theprivilege applies to communications with licensed physicians treatingphysical, mental, or emotional conditions, as well as licensed orcertified psychologists. There is also authority to argue that theprivilege applies to communications with osteopaths, dentists,hospital personnel, nurses, pharmacists, podiatrists, optometrists, andchiropractors. The privilege arguably also applies to communicationswith any person a patient reasonably believes to be such a treatereven if that person actually is not a treater. The privilege does notapply to communications with licensed social workers.

Q:Whose privilege is it and who can waive it?A: The privilege belongs to the patient. It can be claimed by a

living patient, by a living patient’s guardian or conservator, or by thepersonal representative of a deceased patient. A treater may assert theprivilege but only on behalf of the patient. Except as noted below,because the privilege belongs to the patient, only the patient canwaive it to allow disclosure.

Q:Are there any instances when no privilege exists orwhen the privilege is deemed to be waived?

A: Yes. Examples are: 1) commitment proceedings; 2) court-ordered physical or mental examinations; 3) medical malpracticelawsuits; and 4) the release of medical information needed to complywith certain public health regulations (e.g., reporting ofcommunicable diseases). Before making any disclosures, a physicianshould ask a lawyer if the situation permits disclosure without thepatient’s permission.

Q:What actions by a patient can waive the privilege?A: A patient waives the privilege when he places any aspect of

his physical, mental or emotional condition at issue (such as by filinga lawsuit against the manufacturer and requesting damages). Waiverof the privilege, however, is limited and conditional in both personalinjury actions and medical malpractice actions. The party is deemedto have waived the privilege only to the extent he places his conditionat issue. Only information relevant to that specific condition is nowmade discoverable by the waiver. Any aspect of the patient’scondition that is not placed at issue in his pleadings remainsprivileged. Statements about non-medical issues, (e.g., the cause ofan accident) also remain privileged.

Q:What is an “ex parte” communication?A: Ex parte is lawyer talk for speaking with one side only

(e.g., just the manufacturer without the patient/plaintiff present). Thisis what is generally not allowed.

Q: If the privilege is waived by the filing of a lawsuit,why can’t I talk ex parte to the lawyer who wants to talk tome?

A: The Mississippi Supreme Court has reasoned that since thepatient is the holder of the privilege and gets to decide when to waive

Stephanie M. Rippee, Esq.


it, allowing a physician to speak ex parte with opposing counselplaces the physician, rather than the patient, in control of determiningwhat information is or is not privileged and thus, is or is not able tobe disclosed. To protect the patient’s privilege, the Court has held itnecessary for a patient to be given notice of any ex parte contactswith his physicians and the right to prevent them. The Court hasfurther held that the medical information gathered by ex parte contactwill not be admissible at trial. If the information obtained isinadmissible, it is effectively useless to the party who obtained it.

Q:Can a patient authorize his physician to have exparte communications with an attorney?

A: Yes, so it never hurts to ask. But practically speaking, apatient’s lawyer (that is who you will have to ask) has no incentive tosay yes and likely never will. This is why the opposing party’slawyer generally asks to take your deposition instead of asking just totalk to you alone. A deposition is a proceeding where both sides arepresent and allowed to ask you questions under oath. A court reporteris present to swear you in as a witness and to record your answersword for word. Busy treaters are often reluctant to give depositionsbecause they can be inconvenient. But generally, the attorney whoneeds to learn the details of your treatment of the patient cannot learnthat information any other way. A physician’s testimony can often beinstrumental in getting rid of a weak or frivolous claim. Thus, theattorney asking to depose you should try to accommodate yourschedule if possible.

Q: If I agree to allow an attorney to depose me, why am Istill served with a subpoena commanding me to appear?

A: This is a legal step designed to protect both you and theopposing party. If you appear for a deposition because you weresubpoenaed, you do not seem to your patient to be voluntarilycooperating with the opposing party. In addition, if for some reasonyou elect not to appear, the opposing party cannot be sanctioned (i.e.,required to pay the other side’s costs associated with coming to thedeposition). Understand that you must comply with a subpoena oryou can be held in contempt of court.

For further information on the issues discussed, please contactStephanie M. Rippee, Shareholder at Baker, Donelson, Bearman,Caldwell & Berkowitz at 601-351-8943 [email protected]. �

This article is written for a non-lawyer audience and isdesigned to provide general information on the issues addressed asgoverned by Mississippi law and the applicable state court rules.Thus, the legal citations that support the information provided havebeen omitted. For a more in depth legal analysis of the issuesdiscussed, including an analysis of the somewhat conflicting rulesand statutes that govern these issues, please see the related legalarticle written by the author entitled "Don’t Ask The Doctor: TheProhibition on Ex Parte Communications with Non-Party TreatingPhysicians." This article can be found athttp://www.bakerdonelson.com/stephanie-m-rippee/.

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Where did you grow up? I grew up in a very small town(about 5,000 people) called Gate City, Virginia. I am anonly child of only children, so I have no aunts, uncles or first

cousins. My dad used to say we could have a family reunion in a closet. GateCity is right at the state line of Tennessee, so many people think I am fromTennessee. We had to travel five miles to go out of state when going to themall, movie, hospital and almost any restaurant. I did attend college at theUniversity of Tennessee where I became happily anonymous among 25,000students!

How did you meet your physician spouse? I met Mark at ErlangerMedical Center in Chattanooga, Tennessee. He was a resident at the time andI was selling pharmaceuticals with Merck. He deployed to Desert Storm 6months before he completed his Internal Medicine residency and while hewas gone I left Merck and became the Infection Control Coordinator atErlanger. When he returned, we started dating and became engaged within ayear. We married on the beaches of Seaside, Florida, (we were engaged theretoo) on October 17, 1992. As they say, the rest is history.

What are the names and ages of your children? We have boy-girltwins, Kiser and Sabine, who are 11. They were born December 3, 1998.Then, as a surprise, we had Fletcher on March 1, 2005. He is five.

How do you spend your free time? My first response is “What freetime?” The license plate on my car says NVRHOME (never home) and thatis fairly accurate. I wake up most mornings before sunrise and work out. I doa little of everything – weight training, cardio machines and I love to run,when I am not injured. I enjoy reading, traveling and do lots of volunteer andchurch work in Laurel. I also scrapbook and get great pleasure watching mychildren look through all their scrapbooks and talk about their favoritememories.

How did you come to join the Alliance? I distinctly rememberreceiving a couple of cards in the mail from the Jones County MedicalAlliance members, after Mark and I were engaged, and before I moved toLaurel. After I moved, I received a phone call and was personally invited to ameeting. I think one of the members even picked me up and took me to themeeting. I immediately felt welcome.

What is your favorite Alliance memory? I recall being asked bysome JCMA members who were serving on the state level and were activenationally to write a Health Alliance Project (HAP) entry for our Women’sLife Conference held annually in Laurel. I read the directions for applying,

wrote up the project, and we won! I was invited to present the project (thiswas the first year they had award winners do this) in Chicago at the AMAAAnnual Meeting. At this point, I don’t think I had even attended a statemeeting, much less a national meeting. I recall going to Chicago, walkinginto the lobby of the Drake and thinking “Wow, this is quite a place.” Afterchecking in, I walked around and explored the hotel. I saw a sign that said“Gold Coast Room” and I recognized that as the room I was to speak in thenext day. When I opened the door, I was blown away by the magnificence ofthe room. I still am! They had it set up for the event the next day, so I walkedup on stage and looked out over the room. Public speaking has neverbothered me, but the grandeur of the room left me speechless. Being in therealone was a special moment, and of the dozens of times I have walked intothat room, I still recall that magical first time. Needless to say, I left Chicagobeing quite impressed with the Alliance.

What are the highlights of your presidential year? There are two: 1) Finding out in October that I was 17 weeks pregnant! I had delayed

accepting the presidency position until my twins were in first grade, going toschool all day, and fairly independent. Shock doesn’t even do it justice when Irealized that not only was I going to have a baby sometime between thewinter board meeting and our state convention, but I had managed to getpregnant the month I took office! Some people ask me how a doctor and anurse could not figure out I was pregnant ’til half way through thepregnancy…well, we needed lots of help to get pregnant the first time andwere told it wouldn’t be possible again. As they say, the rest is history,

2) The second highlight of my tenure was being able, as an Alliance,to give Barbara Shelton a diamond cross necklace. I usually wore crossnecklaces, and she always commented on them. When the money wasapproved, I immediately knew what would be the perfect gift. Every time Isee her with it on, it still brings back thoughts of a memorable year.

Do you have any advice for fellow physician spouses? Stick together and nurture our friendships. Nobody else understands the

trials, tribulations, joys and frustrations of being married to a physician. I amalways proud of my husband and what he does but I am often frustrated becausewhile he is “practicing,” I am often a single parent, attending events solo, andspending weekends wishing we could do something other than listen to thephone and beeper sing. However, I wouldn’t have it any other way. Only myphysician spouse friends understand and appreciate this crazy lifestyle. �

• ALLIANCE SPOTLIGHT •

Past President’s SpotlightDanita Horne, 2004-05, Laurel

DISCO FEVER— SABINE, MARK, KISER, DANITA

AND FLETCHER IN COSTUME.

FAR RIGHT: DR. & MRS. MARK W. HORNE


• IMAGES IN MISSISSIPPI MEDICINE •

JACKSON SANATORIUM, 1902-1916 —These two old postcards are of the important Jackson Sanatoriumwhich was a large private hospital established in Jackson by Dr. Julius Crisler in 1902. Located in the capital cityon West Street just behind the current downtown main office of Trustmark Bank, the hospital operated from 1902to 1916, with many Jackson doctors caring for patients there. Dorland’s Medical Dictionary defines "sanatorium"(also “sanitarium”), derived from the Latin “sanitas” (which means health), as an “institution for treatment ofsick persons, especially a private hospital for convalescents or patients with chronic diseases or mentaldisorders.” Dr. Crisler, a prominent Jackson physician, delivered my father-in-law Louis Lyell on September 15,1925, at his parents’ house on Bellevue. Family tradition notes that the day was one of the hottest ever in midSeptember, 104 degrees, and Dr. Crisler performed admirably despite the heat! After the Sanatorium closed, theWest Street site was used by the YWCA, and later the Catholic Rectory was built there in 1922. Also after itclosed, the Jackson Infirmary on the corner of President and Amite Streets became the major Jackson hospital fora period. If you have an old or even somewhat recent photograph which would be of interest to Mississippiphysicians, please contact the Journal or me at [email protected].

—Lucius Lampton, MD, Editor

• POETRY IN MEDICINE •[This month, we print a poem by John D. McEachin, MD, a Meridian pediatrician. This poem, written recently, represents “afaithful account”of events surrounding the surgical removal of a basal cell skin cancer from his wife’s nose. Dr. McEachinexplains: “The results of the procedure, itself, were aesthetically excellent and without complication. Nevertheless, there arelessons to be learned from the total experience, many of which can perhaps remind us of our need to be on guard for styleand substance in the delivery of principled and considerate care to our patients.” The prolific Dr. McEachin holds a specialplace at the Journal as our unofficial poet laureate. For more of Dr. McEachin’s poetry, see past JMSMAs and look for morein coming months. Any physician is invited to submit poems for publication in the Journal, attention: Dr. Lampton or emailhim at [email protected].] —ED.

“Just a Little Xylocaine”

My wife was referred for a procedure called MohsTo treat cancer on the tip of her nose.

A specialist was called in a city one state away;This would be surgery in the office —same day!Delighted with the prospect of a neat little trip,We soon discovered we were in for a flip!

On providing a medical history to the new Doc’s aide,Came a terse response, “Hospital surgery, I’m afraid!”Xylocaine allergy, confirmed with positive skin test,

Too risky— hospital setting would be best.(If Marcaine could be used, office would be fine.

Marcaine was acceptable —wouldn’t change her mind!)Four times I gave the Xylocaine info for tagging her chart;

Aides all recorded it —they did their part.Wife was “screened” by an M.D. for routine physical;Brevity was the game, and indeed a bit quizzical.

Seems the Doc had for his exam table no clean sheet,Worse, the used pillow case was stained, and sticky sweet!

Ordered to leave our motel next A.M. at sunrise,We were to encounter yet another little surprise.

Seems scheduled for 9:30 means “all patients for that day;”But 1:30 after lunch was when things really got under way.The Derm specialist dropped by to greet my wife and me;

He was in quite a hurry, a brief visitor was he!A Plastic associate checked the nasal lesion, tooTo assess the kind of graft he would plan to do.Then came the male nurse for an I.V. insertion;

He kindly invited me to render tactful observation.A filled syringe was ready and he was set to begin,

When my curiosity dared me ask, “What fluid is that within?”His casual answer brought blood to my face!

Remember the reason we were here in the first place?Didn’t take long, you knew without a quiver;

Xylocaine, for S.Q. prick was the item they planned to deliver.I calmly reminded the nice young man,

“Glance at her chart if you think you can!”Once that was ironed out and all seemed straight,

Mohs surgery proceeded with the Derm and Plastic mate.The work completed about 4:30, same day,

We got Rx for pain and got back on the highway.Follow-up appointment was set for noon, seven days hence;Surely a more normal visit! I should have had better sense!

Well, back to the big city for post-op evaluation,Hoping, anyway to avoid further aggravation.

Assistant came in quietly, took the dressing off the face;Nurse then removed sutures at a steady pace.A third attendant now entered, camera in hand;

The sequential activity was surreal, part of a plan so grand.We waited for the Derm or Plastic man to come assess;

Perhaps to peek, opine, advise, or simply bless!Sitting there several more minutes expecting this type of event,The ambient office quietude should have given us a hint.

Finally, in came another aide, appearing somewhat bemused.“I thought you’d gone!” Again were we shocked, confused!Won’t the Derm or Plastic man surprise us and appear?

“Nope! Return to your local Doc in three months or next year.”Thus ended a saga of blunders –attention, concern, and welfare;

We had visited a “mill” which only postured “care.” As a physician, myself, I have taken this encounter to heart—I hope all this was aberrant misadventure, not the state of our art!

— John D. McEachin, MDMeridian


• THE UNCOMMON THREAD •

Boils and Goiters


Howdy boils and goiters. Wait a minute. That’s wrong.Oh, I know why. I guess I’m thinking about what it waslike to practice in what the press likes to call “third

world” countries. I don’t really know what “third world” means. MostlyI guess they’re financial deprivation zones. The people don’t have squat,and one of the things that they have the least of is access to medical care.

You start to understand that when you wake up at first light in some collection of tin and plywood shacks in the middle of a desert orsome jungle clearing and find a line of people a half-mile long waiting to see you. And you’re deployed on what’s supposed to be a covertoperation, but they heard a doctor was there, so they came with the small hope that you would take the time to look at them, or their children, ortheir mother. That’s why terrorists in conflict areas frequently kill medical aid workers. Nothing’s more valuable to any local population thanthe care of them and their families. Mothers will walk miles carrying their children just for a bit of your time and a few antibiotics to treat arampant impetigo.

You should do it sometime. If you don’t believe me, ask folks like Danny Edney who went down to help the folks in Haiti…not once buttwice. I would have gone, but my linear accelerator wouldn’t fit in my suitcase. It’s always easy to find reasons not to do the right thing. Thetruth is that radiation treatments aren’t what’s needed anyway. Their needs are much more basic: a sharp blade to lance a boil so a father canwork to feed his family, some iodine to abate a goiter that’s grown so large it’s compressing the airway of young woman being carried on astretcher by her neighbors.

Okay, okay! You’ve rambled enough. Now get to the point. The point is…well, that is the point! There really are areas of such medicaldeprivation that it is simply unimaginable, and Mississippi could end up being one of them. Our state was economically deprived before theeconomy took a big downturn. Now even fifty out of fifty in the USA isn’t southern Honduras or the middle of the Sahara, but it isn’t all thatgreat either. We have a whole lot of patients that are dependent on public assistance to have any real access to the medical care they need. Ourgovernors have used a lot of different methods to try and improve that access, but it has always been a difficult problem to address in the face oflimited resources. Of course, we have federal programs that help, but they remain significantly flawed as well.

I started thinking about all of this when I was asked if we as a state medical association should sign on to a letter pushing for expansion ofthe rights of physicians to contract privately. The more I thought about it, the more problems I had with it. I’m all for making money, but if therecent banking and real estate collapses showed us anything, it’s that rampant greed and lack of regulation are generally not a good thing foranyone in the long run.

What happens to the poor folks in Mississippi if the access to health care that they are currently being provided goes away? That’sexactly what happens if the right to contract privately is unregulated. Let’s be perfectly honest. The right to contract privately is about theability to ask for more. Not just to ask for more, but to demand more from those who would receive the care. What we’re asking for is theability to agree to accept this patient because he can pay more and reject that patient because he can’t. “Cherry-picking,” in other words.

The right to contract privately is meaningless in the context of private insurance. You’re able to do that already. It’s meaningless in thecontext of the uninsured, as they are being gouged into insolvency by the requirements of the federal bureaucracy which allows them no powerin limiting what they’re charged for the care they receive. So they’re charged four or eight times as much as the insured for, at best, the samelevel of health care.

R. Scott Anderson, MD

• PLACEMENT/CLASSIFIED •

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The right to contract privately is aimed only at patientscovered by publically provided health care insurance, Medicare andpossibly Medicaid. The Balance Budget Act of 1997 already givesMedicare patients and their physicians the right to contract privatelyfor health care services outside of the Medicare system. Physicianswho want to opt out of Medicare participation to contract privatelywith their patients are already allowed to do so. They just can’t do iton a case-by-case or patient-by-patient basis. This is done to preventthe “cherry-picking” problem we already mentioned. I know, I know.None of us would ever do that, but somebody would. It happens inevery market of every state every day with uninsured patientpopulation. That’s why you have to choose if you’re in or you’re outfor a two-year period.

We don’t have to provide care for any group of patients at all.There’s no requirement to provide that care. It’s all a matter ofchoice. But is it? Let me ask you, “What am I supposed to do aboutcancer patients who aren’t able to pay for any extra out-of-pocketexpenses?” Boot ‘em out the door of the cancer center? Sure, Imight be allowed to do it legally. But the whole idea of it kind ofreminds me of Lou Reed’s suggestion in his song “Dirty Boulevard”:

“Give me your hungry, your tired, your poor. I’ll piss on ’em”That’s what the statue of bigotry says.

“Your poor huddled masses, let’s club ‘em to deathAnd get it over with.”

Of course, he meant it only as social satire. We’re talkingabout doing it for real. What happened to “Whatever houses I mayvisit, I will come for the benefit of the sick”?

I have bunches of patients who can’t afford anything—notfood, not medicine, not gas, not Boost or Sustacal—nothing. That’swhy we started the Cancer Patient’s Benevolence Fund so we cangive them some of that stuff. Cancer patients aren’t the only onesthough. You all have them, the same kinds of patients, in your ownpractices. We need to think about them before we, as a state medicalassociation, go off signing letters in magazines supporting the right tocontract privately.

What we should be about is our patients, and a lot of ourpatients don’t have the resources that you and I do—and they neverwill. Doing things that will further deny them access to the care thatthey need is unconscionable. We need to aggressively push the stateand federal governments to provide fair reimbursement for theservices we provide and not place that burden on those who can leastafford it.

R. Scott Anderson, MD, a radiation oncologist, is medical director of the Anderson Regional Cancer Center in Meridian and past vice chair ofthe 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.

If you use a knife to take money from someone against hiswill, it’s criminal. If you use a knife for the good of a person andare fairly paid for it, it’s noble. We should embrace nobility in allthat we do.

You’re welcome to believe what you want about all of this.Just make sure you think about it some before you’re too sureabout what you believe.

—R. Scott Anderson, MDMeridian

Locum Tenens Pathologist NeededLocum Tenens Pathologist NeededSurgical Pathologist with Mississippi licenseneeded to fill in at small practice in North Miss.Proficient in GI biopsies, routine surgicals andnon-gyn cytology. Oxford Pathology, Inc.

E-mail: [email protected]

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Documents

September 2010 JMSMA