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LMS President’s Message – January 2021

LMS President’s Message, January 2021: Acceptance for Lexington Medical Society Presidency

By James Borders, MD

Thank you for the opportunity to represent you, the physicians of Lexington through the Lexington Medical Society.  I want to thank Dr. Mamata Majmundar for her excellent leadership this past year and for her truly history-making term, as she brings many “firsts” to the position.  She will soon be relocating to Louisville, and we wish her every success in practice and in their local medical leadership.

I have remarks about the now ever-present medical topic of the pandemic, but, before discussing that, I want to address a preceding and following issue of great personal interest and importance to me.

In America, there is an unnatural lack of acceptance of the inevitability of death, at least to see it early enough to avoid an overly “medicalized” approach to it.  You have seen the statistics comparing our healthcare expenditures mirroring other developed countries until near end of life when we vastly outspend everyone else.  While the American general public hungers for and deserves to receive healthcare advice from the physicians they know and trust, they are especially needful of it as the end of life approaches.   Our patients are subject to the terrors and discomforts of a modern hospitalization where care is now often delivered by inpatient providers who enter their lives as strangers.  The skill set of the outpatient internist or family practice physician and the hospitalist have diverged so much that the outpatient primary care provider must transfer care to the inpatient primary care provider to assure that patients have access to the latest medical knowledge. 

What’s lost in this exchange is continuity of care- not just in the knowledge of one’s health history but also an awareness and understanding of a patient’s character, beliefs, attitude, and desires.  Patients with a background of medical complexity and frequent hospital admissions whose approaching demise should be obvious to any observant medical professional more often than not arrive at the hospital with no advance directives or Medical Orders for Scope of Treatment (MOST) form completion.  A MOST form is generally applicable when a patient’s prognosis for survival is six months or less and is a voluntary end-of-life planning tool designed to give those who are seriously ill or medically frail the opportunity to make their healthcare wishes known in the event that they are unable to speak for themselves.  Like a DNR order but added to it, it offers details that can help a patient’s family feel more secure in arriving at decisions about such things as feeding tubes and antibiotics.  It is signed by the patient (or surrogate) and the physician and goes with the patient providing more specific instructions of a patient’s wishes.

The new inpatient medical providers- strangers intruding when a patient is most vulnerable- are greatly disadvantaged in broaching a subject of limiting the scope of care as they seek to gain the trust of a new patient.  Time and time again, inpatient physicians are faced with patients whose healthcare trajectory should have been obvious enough for the outpatient primary care providers to have taken the time and effort to consider what is likely to face their patients.  Perhaps the most profound and comforting truth many family members discover by a sensitive and thoughtful healthcare professional is the permission- legal, ethical, and moral- to set limits on the scope of care.  No patient or family member is likely to ask what can be avoided, and our silence on the subject is often interpreted as a moral mandate to act. 

Let’s agree to be a voice, perhaps the public voice of Lexington’s physicians to be a beacon of hope, light, encouragement, safety, and peace to a very vulnerable and often confused public- a shepherd of sorts that stands guard especially toward end of life.  Let’s be a shepherd that will assure that all of modern medicine is brought to bear to reduce suffering but is used with reverent restraint, ever mindful that it can be an instrument of suffering if indiscriminately applied. 

LMS is the one local organization that offers the promise of providing a public voice for all area physicians, whether you work as an employee of a healthcare organization or practice independently, and even for area physicians who are not members of the Society.  That may be a presumptuous statement but one with which few- whether inside the local realm of healthcare or not- would disagree.  It is a sober responsibility and one desperately needed in a day and time in which many voices compete for our trust and attention.  Recent months have forced laymen to their computers and television screens looking for advice and direction, looking for a familiar face, listening for a respected voice.  They are thirsty for your caring counsel that is born out of a very personal relationship that takes time to develop.  Strained by technical barriers that have sprung up in response to a damnable pandemic, our patients need your personal attention.  They need the reassurance best delivered by the physicians who know them best.  Even before the pandemic, questionnaires have revealed that the public has a skeptical view of the character of physicians in general, but most of these same skeptics –nearly 90%- also say that their personal physician is an exception.  When given a chance, your sincere concern and professional skills will win the confidence of your patients.  The Lexington Medical Society wants to add its collective chorus of voices to assure the anxious and confused public that we physicians, their personal physicians who have been in their lives these many years, are still here for them and quickly making sense of a new disease that threatens so many in the widest sense possible.

The pandemic has exposed to a medically naïve public the fact that science must approach an unknown disease entity with an open mind that remains public and transparent in its deliberations.  Although the speed with which American healthcare has responded to this new challenge is truly remarkable, the public has been subject to an ever changing and developing standard of care- both in prevention and treatment with political overtones.  Messaging to wear a facemask that involves neither an investment of time nor money has nevertheless proven perhaps to be most difficult in this country, a country populated by so many people refusing to wear them and whose only excuse for their defiance is an unwillingness to be told what to do.  One could argue that this attitude is uniquely American, one that even distinguishes us from our allies in western Europe.  Yet, from all appearances, the most effective and safe vaccines have all been created either in the United States or with the involvement of American companies overseas.  How many of us believed the promised timeframe for success by the end of 2020 in Operation Warpspeed when it was first announced?  Now we are faced with the challenge of convincing a wary public of the safety and effectiveness of available vaccines. 

In my opinion, the most urgent task of the LMS at this hour is to add familiar and trusted voices to encourage our patients and the public to take the vaccines.  LMS has sent the first of many messages for physicians and their staffs to get the vaccine, so please stay aware of alert messages from LMS.  We have also sent a message seeking volunteers to help with Lexington-Fayette County Health Department administer the COVID-19 vaccine to our retired physicians with a valid KBML license.  I want to encourage LMS members to make a short video of themselves when they take the vaccine and say, “I am taking the COVID-19 vaccine because it is safe and helps protect Lexington.”  Please forward those to Chris Hickey for use on our social media to encourage fellow citizens to take the vaccine. 

Many of you do not know that LMS has a highly successful physician wellness program offering counseling services without fees to LMS active physicians and UK College of Medicine residents, fellows, postdoctoral fellows, and medical students throughout Kentucky. 

The Lexington Medical Society will continue virtual programming until group meetings are considered safe again, possibly in the fall of this year.  In the meantime, we will use every technology available to stay connected and to ensure that our members stay informed on the latest COVID-19 updates and alerts.  The LMS has already sent out over 80 COVID-19 messages to our members from the beginning of the pandemic addressing the shutdown, reopening, federal financial assistance programs, and now the vaccine.  Our May LMS Meeting will most likely be virtual but hope our October and November meetings and other programming are in person.

The KMA is going to have an Advocacy in Action Month throughout February with a virtual kickoff brief on Feb. 1 at 7pm ET. Registration is now open. The Advocacy in Action Month will replace “Physicians’ Day at the Capitol,” the in-person KMA advocacy event held in Frankfort each year, out of concern for the health and safety of Kentucky’s physicians during the pandemic.

Finally, I want to commend our physicians who have risen to the occasion, have represented our profession at a time of the greatest personal risk in modern times, and will continue to educate and reassure the public that we will remain active in their behalf. 

                                                                                James Borders, M.D.