By Dr. Vinh Chung
Carlos was the last patient on my schedule for the day. He was coming in because of a skin cancer on the right side of his nose. I was seeing him at a Vanguard dermatology clinic located an hour away from the main dermatology clinic located in Colorado Springs, where I live.
We had opened this dermatology office to serve the rural population in southern Colorado, where patients must drive for hours to see a dermatologist. It was the end of the day, I was exhausted, and I was ready to go home. I was a bit irritated when I saw that he was added to the end of my day. If it weren’t for him, I would have left early enough to beat rush hour traffic.
I have a loyal patient base at the Colorado Springs dermatology offices closer to my home, so it did not make any business sense to continue commuting and serving this rural population. I was getting grumpy just thinking about it. I was already imagining that he would show up late or not even show up at all. Fortunately, I was wrong about all my assumptions.
Carlos showed up on time. He was soft spoken, mild mannered and exceptionally courteous. The strength and depth of his character were palpable. I was humbled by this incredible man. After we spent a few minutes to discuss Mohs surgery to treat the skin cancer, I continued the conversation to learn more about his fascinating life story.
Carlos had immigrated from Mexico in his 20s, not speaking a word of English. He had settled in southern Colorado where he works on a large commercial farm. He works 12-hour days, 6-7 days a week, and was able to take this rare day off to drive three hours so he can see me. I felt embarrassed for having been irritated earlier.
Married and with three kids, Carlos has dreams of sending his children to college so they could have a better future. His family is the epitome of what it means to live the American Dream. The more I learned about Carlos and his family the more grateful I became for having the privilege of being his dermatologist.
I was expecting an inconvenient add-on problem to fix. Instead, I found a deep human connection. Carlos’s life reminds me of my own personal journey to become a dermatologist and Mohs surgeon. My family had immigrated from Vietnam as refugees. It was only because of the kindness and generosity of others – teachers, mentors, and coaches – that allowed me to be where I am today.
These individuals spent extra time with me, did not make poor assumptions about me, and they believed the very best in me. A reminder of my personal journey through this patient allowed me to feel such profound joy and gratitude in a long and hectic day. I have been inspired by Carlos and I believe my life is a bit richer for having cared for him. I have received more than anything I could have given him.
In any major city, if I personally could not care for a dermatology patient, there would be dozens of other dermatologists who could. This is especially true for patients with commercial insurance or who have cosmetic needs. For patients from rural areas, getting dermatology care is almost impossible. That is why I continue traveling to multiple dermatology offices in these rural communities, an hour from my Colorado Springs home. I do this not only to serve an unmet need but also to feed my own soul. I do not enjoy the long commute just like anyone else. With four children, I have the same financial and time pressures just like anyone else. But I realize that even more important than time and money, I need inspiration. I need a sense of purpose for what I do, so that I can experience joy and gratitude in my work.
With the epidemic burnout among physicians, finding joy and gratitude through intimate human connections is the ultimate solution. I do not need improved efficiency. I do not need more metrics. I do not need coping mechanisms, so that I can work harder or to be more resilient. I just need to know that what I do matters. That my work matters to another human being. That what I am doing serves a greater purpose.
With the ever-changing landscape of health care, physicians must fight hard to remove any obstacle that may prevent us from having authentic human connections with our patients. This is our lifeblood, reminding us that our work is a calling.
When physicians choose to go into medicine, we want to connect with patients so that we can uniquely serve their needs. Over time and with all the administrative demands of practicing medicine, we become occupied with just fixing problems.
Sometimes, we need to pause and take a little extra time so our hearts can be reminded about “Why” we chose to go into medicine in the first place. Like any important thing in life, we find meaning and fulfillment when our hearts can flourish.
Vinh Chung, MD is a board-certified dermatologist and a fellowship trained Mohs surgeon. He specializes in the diagnosis and treatment of skin cancer at Vanguard Skin Specialists. Dr. Chung sees patients in Colorado Springs, Canon City, Pueblo and Woodland Park.
He has a passion for finding meaning and purpose in medicine. He can be contacted at [email protected].
There has been recent considerable discussion regarding local-only membership allowance. Pueblo County Medical Society, El Paso County Medical Society, and Denver Medical Society each have local-only memberships as an option. Each of these local-only society memberships currently represent less than 10 percent of total membership, meaning over 90 percent of the other members are members of both the local component and the Colorado Medical Society (CMS).
Some CMS members have viewed this as competing and not “unified” and have advocated for eliminating any local-only memberships. They have expressed a fear that if local-only options were available that this would result in state CMS membership competing with local society only membership and they hope to avoid this conflict.
However, although local-only members make up only a small portion of the total membership for each society, with the loss of the financial stream to these societies, they would no longer be able to function in the capacity that they have. I believe that truly “all politics is local” and losing the ability to do what we have done on a local level would be a substantial loss. I believe that local-only memberships do not compete with CMS membership but compliment it and provide a bridge to broader involvement, giving members who would like to be involved an easy place to start and then as they see the benefit, move into more statewide efforts from there.
It is my hope that CMS will see the unity and benefit that come from not only having but using the local-only option as a bridge to CMS membership. I believe it would be of benefit to write an email or letter to Bryan Campbell and CMS staff expressing concern regarding the loss of the local-only option and would invite you do so. His email is [email protected]. As Mr. Campbell is new, I think he has only heard one side of the issue and has not heard the reasonable concerns. To be clear, it is ultimately not his decision but the board’s; however, I believe that helping him see the other side would be of benefit.
As it currently stands, an amendment was passed at the CMS Board of Directors meeting in which this will not be voted on by CMS BOD until all affected component societies have a chance to present to the CMS BOD. This is to happen on or prior to the March 2021 board meeting.
The Centers for Disease Control and Prevention has issued a warning about certain hand sanitizers.
Most commercially available alcohol-based hand sanitizers or rubs (ABHSR) contain either ethanol or isopropanol as active ingredients. On June 19, 2020, the U.S. Food and Drug Administration (FDA) advised consumers not to use any hand sanitizer manufactured by “Eskbiochem SA de CV” in Mexico, due to the potential presence of methanol, a “toxic alcohol”, as an active ingredient, which can cause blindness and/or death when absorbed through the skin or when swallowed. Since then, FDA has identified additional ABHSR products that contain methanol and is working with manufacturers and distributors on a voluntary recall of these products (https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitzers-methanol).
Clinicians and public health officials should advise the public to:
- Seek immediate medical attention and contact their poison center (1-800-222-1222) for advice if they have swallowed an ABHSR product or are experiencing symptoms from repeated use of these products that are on the “FDA’s testing and manufacturer’s recalls” list (https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand-sanitzers-methanol),
- Stop using any ABHSR that are on the “FDA’s testing and manufacturer’s recalls” list because using these methanol-containing products may result in serious adverse health events (e.g., blindness and death), and
- NEVER swallow ABHSR and only use them for their intended purpose. Clinicians should be highly suspicious of methanol poisoning when a patient presents with a history of ABHSR ingestion, compatible signs and symptoms, and laboratory findings.
The myriad of benefits breastfeeding has to offer has landed it a spotlight in five objectives in the Heathy People 2020 initiatives. According to the Centers for Disease Control and Prevention (CDC), breastfeeding decreases risk of obesity, asthma, ear infections and sudden infant death syndrome for infants as well as decreases risk of high blood pressure, Type 2 diabetes and ovarian and breast cancer for the mother. While the benefits can be clear, what is often not clear is how to help a breastfeeding mother and infant when they are experiencing complications.
The Special Supplemental Nutrition program for Women, Infants and Children (WIC) of Pueblo county is here to help. The Pueblo WIC office has multiple assets to help breastfeeding mothers and infants. On staff is one International Board-Certified Lactation Consultant (IBCLC) and seven Certified Lactation Counselors (CLC) (one bilingual in sign language and one bilingual in Spanish).
The office is home to the Breastfeeding Peer Counselor Program where clients can text questions and concerns regarding breastfeeding and receive help from moms, just like them, who received special training. The pump loan program, through the WIC office, loans high quality, hospital grade pumps to moms on a priority basis. Each mom is assessed by a CLC to offer interventions and education as well as instructions how to effectively use the pump.
Every year, the Pueblo WIC office celebrates our community’s breastfeeding families as part of the Global Latch On. This year, among other events, the Global Latch On will look very different. Our normal gathering of vendors and activities will be shortened to providing a drive-through version of information and incentives accompanied by a virtual latch at 10:30 am on Aug. 1, 2020. The focus this year is “Every Drop Makes a Difference,” specifically noting the benefits breastfeeding has for a healthy environment, healthy mind, healthy body and healthy community. For more information regarding the event please visit: https://www.facebook.com/pueblowicprogram.
Refer families to WIC at: www.coloradowicsignup.org
Call for more information: 719.583.4518 or 719.583.4399
Chelsea Hollowell MS, RD, CLC
Pueblo WIC Program Manager
By Brad Roberts, MD
Emergency medicine physician
PCMS representative on the CMS Board of Directors
Recently I was asked to speak as a panelist during a Colorado Medical Society webinar on smoking and COVID-19. As part of the preparation I read lay news articles from outlets such as Yahoo News, VICE, CNN, and other online sources found through a Google search. I also read multiple articles from peer reviewed journals from a PubMed search.
My biggest takeaway surprised me: It became very clear that as physicians we need to make sure we are looking at true peer reviewed research and look at it with the critical eye we were taught to use at journal clubs during residency. While physicians must understand what the public is seeing, we need to be able to see through much of the popular press and be able to have an understanding of what is true evidence-based medicine compared with what is written as a quick article to entice readership.
Ultimately the peer reviewed studies suggested that more research was needed to further look into why there were possibly fewer smokers admitted to certain hospitals than would have been expected. The researchers acknowledged small sample sizes and confounders that may be present, suggesting only an interesting finding that may benefit from further research. They were careful to state that patients should still be encouraged to stop smoking. The popular press, however, took this to state smoking was protective from COVID-19, which was not what the researchers had even implied.
It also was clear from my reading of the peer reviewed research that smokers with COVID-19 were 2.4 times more likely to go to the ICU, be intubated, or die with complications from COVID-19 than non-smokers. Clearly, now more than ever, patients should be encouraged to make healthy lifestyle choices such as stopping smoking. Implying smoking was protective from COVID-19 was not only premature and likely incorrect but also harmful. Smoking is the leading cause of preventable death in the U.S. and the world and causes far more morbidity and mortality than COVID-19. I have seen these same misleading popular press articles in the cannabis discussion as well.
It is imperative that we as physicians are able to understand and interpret scientific literature through the appropriate lens of the education we were able to receive.
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