Words Matter

I don’t think anyone would argue we are living in a different world than then one we were living in just a few months ago. It has been amazing to see how technology and the pandemic has fostered innovations both in how we take care of patients and how we interact with each other. We have seen telehealth be rapidly adopted within our health systems and have tried to be good stewards of who needs to be seen in the office and who needs to have surgery. We have seen meetings across the country and world be cancelled due to the pandemic. Locally, we have converted so many meetings to telephone I feel I am becoming a connoisseur of virtual meeting platforms having used four or five in the past few months.

While there is no substitute for being able to meet and network in person, organizations have been able to pivot to virtual learning. The Florida Chapter of the American College of Surgeons was scheduled to have its in-person annual meeting in Orlando on May 2nd, 2020. We were excited about the chance to meet in person and to be a part of the program which Dr. Jay Redan had put together regarding the Surgeon of 2030. He had even arranged for a behind the scenes tour of Animal Kingdom at Disney World for Sunday afternoon.

The Florida Chapter, under both Dr. Redan and president Dr. John Armstrong’s guidance, was able to change to a digital platform which still met the morning of May 2nd. While the program was abbreviated it still provided a great opportunity for education and interaction with surgeons chatting virtually during the presentations.

The meeting started with Dr. John Weigelt, current First Vice-President of the American College of Surgeons discussing what CME may look like in 2030. It was an interesting presentation that went through the history of CME and how CME may evolve to a more curated surgeon specific program moderated by artificial intelligence.

We then moved on to the Edward M. Copeland III, MD, FACS Resident Abstract presentations and heard from the top Basic Science and top Clinical Science abstracts. The other abstracts are available here. The top basic science article was “Myeloid Cell Differentiation Signaling of Portal Venous Blood Circulating Tumor Cells of Pancreatic Ductal Adenocarcinoma Patients” by Dr. Joseph Reza of AdventHealth Orlando and the top Clinical Science Abstract was “Chronic Critical Illness after Surgical Sepsis is Associated with Worsening Frailty: Induced Frailty” by Dr. Michael Cox at the University of Florida.

There were then three abstracts presents as a part of the annual Commission on Cancer Competition and the winner was “the Significance of Hispanic Ethnicity with Subgroup Analysis-Disparities in Clinical Outcomes with Pancreatic Ductal Adenocarcinoma” by Dr. Andrea Riner at the University of Florida. The final competition was the Spectacularly Challenging Case Competition and the winner was “A Rare Case of IVC Filter Penetration into the Duodenum” by Dr. Olivia D’Angelo at Jackson Memorial Hospital.

The final presentation of the morning was by Dr. V. Suzanne Klimberg on “The Past, Present, and Future of Women in Surgery” and was an excellent presentation on the history of women in surgery, the history of women in leadership roles in surgery and provided some thoughts on how to continue to encourage and support women in leadership roles locally and nationally.

We then proceeded to our annual business meeting and Dr. Redan took to virtual gavel via appropriate social distance and became the president for 2020-2021. I am looking forward to having meetings resume because I miss person to person interaction and networking with colleagues and friends. However, this was an excellent blueprint on how to continue to network and provide education while adhering to social distance.

Keep your head up

And try to listen to your heart

Be kind always no matter

Dave Matthews Band “Drunken Soldier“

We have spent the last few months hearing about COVID-19 and social distancing. For many Americans, this has been a huge upheaval in their personal and professional lives. There were over 16 million people who filed for unemployment in just 3 weeks. Many have cancelled family events including weddings and birthdays and there have even been virtual funerals held during this time. All of this was done to flatten the curve to minimize resource utilization in hospitals and to lessen the mortality from the novel coronavirus. While social distancing has worked to mitigate the effects of the pandemic, the social distancing at times feels like social isolation.

People are not visiting their family members who may be older or who are at higher risk of a bad outcome from contracting COVID 19 due to preexisting medical conditions. This has led to a sense of social isolation which is really not who we are as people. There was a meme when this started about how social distancing and limited contact was perfect for introverts. I laughed when I read it, but now, two months later, I miss in person meetings and interacting with people on a more personal level. The work of the hospital and medical group is still getting done but with virtual meetings–it is just not the same.

Even though the work has changed, at least I still get to go out and go to the hospital and office and interact with staff and patients. My wife and kids have pretty much been home for two months. While my kids get to see their grandparents, they have not gotten to hug or touch them in two months. We worry about what would happen if my parents or my in-laws got COVID-19. The pandemic has really changed how we are living.

With so many people unemployed and so many physician practices struggling due to decreased volumes, I do not take for granted how fortunate I am to work for BayCare Medical Group and how they have led the Tampa Bay area in their response to the pandemic. I am proud that BayCare has focused first on taking care of the community and patients but also taking care of team members and worked hard to find roles for team members who may not be able do their normal jobs.

With so much bad news and uncertainty in the world I feel like there are ways to share even if social distancing is required.

1. Share a kind word via text, email, or phone call. I have tried to do this more than I normally would because people are more anxious and I want to put more joy out in the world.
2. If you are able, donate to a food bank or other foundation. There are a lot of people who despite working may have a harder time financially even with the CARES act. For those that are able, this is a great time to give what you can.
3. Be kind to those around you. If you are at the grocery store or at work, now is the time for more grace.
4. If you are out walking or running (while social distancing) take the opportunity to wave at those who are also out.
5. Be kind to yourself. Sure, somewhere, someone is using this time to be productive, but if you are not–that’s ok. This is a time to be kind and that starts with being kind with yourself.
6. It’s not the same without hugs, but a ZOOM birthday party can be fun. My 6 year old seemed to enjoy his.

I started listening to the Dave Matthews Band during college about the time I was learning to play the guitar. One of the main draws was the acoustic guitar playing such a heavy role in the band. I also love the horn section and the role the violin has played in the band. I started attending shows in 2002. We recently have attended shows 31 and 32 in West Palm Beach, FL. These shows are always unique and while looking at previous sets may give you a clue as to what is going to be played you just never know what is going to be played. When you go to two shows back to back in the same venue, you are going to get two completely different shows and may not even hear one repeat song performance.

One of the other fun things about attending these shows are the posters. When they first started doing posters they would often repeat the design during the tour but for a while now, they have unique posters at each show. There is a community which has developed around this where people collect different posters. For the most part, we just collect posters for shows we’ve been to (and like) but on occasion we pick up a poster that is not a show we’ve been to because we like it.

We have over twenty posters at this point. Not all them are hanging up, but we do have some of them hanging around the house. Here are some of our favorite posters from the shows we’ve seen:

These posters are the earliest posters I have. I have been going to shows since 2002, but I didn’t really get into collecting the posters until later. In fact, I only recently got these posters because I loved these shows and I love how they work together for one scene.

This was the poster from Virginia Beach in 2013 when we attended. This poster is by Chuck Sperry and is a pretty in demand poster.

This poster is by Miles Tsang. This is one of the posters from a show we did not actually attend. This is from a show that took place in Tampa just about the time we moved back to Florida. Because of all of the Florida references, we felt like it needed to be in our collection, so this is one of the few posters we have from a show we did not actually attend.

Finally this poster is by M.I.D. Goods. We got this during our trip to Nashville in 2017 to see Dave Matthews and Tim Reynolds and was such a great representation of the city and our trip to Nashville that we just adore this poster.

The last few months have caused me to reflect on advocacy and being an advocate. I have spent my entire life watching politics and simply not understanding why people would want to enter that realm. However, since January I have gone to Tallahassee to talk to legislators with the Florida Chapter of the American College of Surgeons and to Washington DC to speak to legislator’s offices with the American College of Surgeons. I have also become engaged with the Florida Medical Association and am a proud graduate of the Karl Altenburger Leadership Academy in 2018.

What changed to push me into these pursuits? I think there are two reasons:

1. Everyone has likely heard some version of ‘If you are not at the table, you are on the menu.’ I think this is true. If you are not providing a voice to any particular problem or issue the people in Tallahassee or Washington, DC are going to make the policy based on the information they have. Sharing our insights as professionals is invaluable in helping to shape public policy. Part of it, for me, is never wanting to feel like I did not do my part. We may not get what we want, but at least it is not because I did not attempt contribute my part.
2. Almost everyone has benefited from advocacy or having an advocate at the local level. I have had people advocating for me at every step of my career. In particular when I got into practice, one of the more senior surgeons took a special interest in me as a person and helped me develop my career in the operating room, in my office, and helped guide me into leadership positions within the hospital and our medical group. This is one way I feel like I can help to pay back the people that advocated on my behalf is to help try to advocate for surgeons everywhere.

There are a lot of ways to get involved with advocacy. For surgeons, you should leverage your local chapter and the national chapter. Save the dates, March 28-31, 2020 for next year.

For physicians in Florida, consider being a part of the FMA.

It is only appropriate that I use this space today to say Happy Mother’s Day!

• From my grandmother, Honey, I learned to pray at night before bed.
• From my other grandmother, Maw-maw, I learned the importance of being a life-long learner and it pained me to see Alzheimer’s take that away from her
• From my mother (now Mimi) I learned how to be responsible because I was the oldest of her five children and learned how to help take care of the others.
• From my mother in law (now Nanny), I learned how to make someone feel special as she accepted me into her family with no hesitation
• From my wife, Mary Beth, I have gotten to watch the pure joy of being a mother and I am so blessed to share my life with her.

This week I have had some major fear of missing out (FOMO). There were three national meetings that I would love to have attended, but unfortunately it was my turn to take call so they were not to be.

The first meeting was the American Society of Breast Surgeons (ASBrS) Annual Meeting taking place in Dallas, Texas. This is always an exceptionally good meeting where there is quality content for the entire meeting. I always enjoy the meeting and networking at this meeting. Since I now primarily take care of breast cancer and breast diseases, it is extremely high yield for my practice. My partners and I take turns going to this meeting and because I attended last year, I was not able to attend this year. Fortunately, there are a lot of attendees who tweet from this meeting, so at least I have been able to follow along from afar.

The second meeting took place earlier this week and is the Surgeons as Leaders Course put on by the American College of Surgeons in Durham, NC. I wanted to apply for this meeting this year, but as it is taking place almost at the same time as the ASBrS meeting, I knew I would not be able to attend. Every participant I have known who has attended has nothing but positive things to say about this meeting. I believe surgeons make really good leaders and should take the mantle of leadership, so as long as the dates work out, I am planning to apply to attend the meeting next year.

In addition to surgical leadership, the American Association of Physician Leaders annual meeting is taking place this weekend in Washington, DC. I have not had the opportunity to attend one of these meetings in person, but I would like to in the future. I was able to get my MBA through this organization, so I would like to attend a meeting in the future.

The truth is I always have FOMO related to national and regional meetings. I wish I could attend all of them but time and finances keep that from happening. I have long said that if I could figure out how to make a living going to these meetings and learning I would do it. There are so many good meetings that I could probably attend a meeting of some sort every week of the year. At least I have Twitter so I can follow along with the meetings I can not attend in person.

Law XIII: The delivery of medical care is to do as much nothing as possible.

Samuel Shem, The House of God

I reread The House of God recently. It is an irreverent look at medical care written in 1978. It is about a young intern, Dr. Roy Basch who is being mentored by a senior resident and learning about delivering care in the hospital, affectionately called The House of God. In this book, there are numerous rules about taking care of patients. Some of them are actually extremely useful even if I would never model my behaviors by anything else in this book. For example, Law III: At a cardiac arrest, the first procedure is to take your own pulse. I actually find this is great advice, because sometimes the first thing to do is to take a big breath before a high anxiety situation. There is also Law IV: The patient is the one with the disease. At the end of the day the deliver of healthcare really needs to be patient-centric.

In my most recent reading of the book, I really took notice of Law XIII: The delivery of medical care is to do as much nothing as possible. It’s hard to see how this is happening when we spend 17.9% of the Gross Domestic Product on healthcare. In the book, this rule came about when some of the young doctors were actually making patients worse by performing procedures and doing diagnostic tests on patients. This should not come as a surprise as most us become doctors to help people and we always want to do something. The key is doing the right something.

Around the time I was reading this book, I read Ending Medical Reversals by Vinayak K. Prasad and Adam S. Cifu. This is an interesting book about how many times in medicine we have started going procedures and they turn out to not having compelling data behind them and when we get new data we ultimately start to recommend something completely new.

One place in medicine where I have found us to be extremely successful in limiting treatment to treatments that work is in the treatment of breast cancer. We have seen surgery go from radical mastectomy (removing the entire breast) to doing lumpectomies (removing the cancer with a small amount of normal tissue around it with an emphasis on preserving the look of the breast). In addition, we have gone from routine axillary lymph node dissections (removal of all of the lymph nodes) to sentinel lymph node mapping (removing certain lymph nodes) to in some cases not recommending the sampling of the lymph nodes at all. We have seen the number of days of radiation decrease in certain situations. Finally, we have seen the proliferation of tests which analyze an individual’s tumor to see wether they would benefit from chemotherapy or can be spared from chemotherapy because it will not provide them a benefit.

I think this is what Dr. Basch and the The House of God was trying to emphasize. Instead of applying every treatment to every patient we are increasingly able to provide personalized care to spare medical and surgical therapies on patients that are not going to specifically benefit that patient.