MARCH/APRIL 2020 - LYRIC THEATER OF OKLAHOMA - Oklahoma County Medical Society
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B U L L E T I N
OKLAHOMA COUNTY MEDICAL SOCIETY M A R C H /A P R I L 2 0 2 0
LY R I C T H E AT E R O F O K L A H O M A
Save the Date for
Medicine Day
2020
Legislative Reception
Presented by the Oklahoma State Medical Association
Wednesday, March 25
Meet Your Legislators: Oklahoma State Capitol, Time 2 p.m.
Legislator Reception: OSMA, 313 N.E. 50th Street, OKC, 5 to 6:30 p.m.
Sponsored by
THE BULLETIN
March/April Volume 93 Number 2
Six Annual Publications • Circulation 1500
313 North East 50th Street, Suite 2
Oklahoma City, OK 73105-1830 TABLE OF CONTENTS
phone: 405-702-0500 fax: 405-702-0501 Medicine Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC
email: ocms@okcountymed.org About the Cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
www.okcountymed.org President’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Ideas and opinions expressed in editorials and feature articles are Physicians’ News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
those of their authors and do not necessarily express the official
Dean’s Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
opinion of the Oklahoma County Medical Society.
In Memoriam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
OFFICERS The Pearl: Genetic Obesity . . . . . . . . . . . . . . . . . . . . . . . 12
Lisa J. Wasemiller-Smith, MD . . . . . . . . . . . . . . . . . . . . President Welcome New Members . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Basel S. Hassoun, MD . . . . . . . . . . . . . . . . . . . . . . President-Elect Law & Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Savannah D. Stumph, DO . . . . . . . . . . . . . . . . . . . . Vice-President
Leprechauns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Sumit K. Nanda, MD . . . . . . . . . . . . . . . . . . . Secretary-Treasurer
OCMS Events and Updates . . . . . . . . . . . . . . . . . . . . . . . 23
BOARD OF DIRECTORS Love Also Dies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Michael S. Cookson, MD R. Kevin Moore, MD Director’s Dialogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Jeffrey B. Cruzan, MD Thy K. Nguyen, MD The Great Masquerader . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Morris R. Gessouroun, MD Michelle L.E. Powers, MD
120th Inaugural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Matthew J. Jared, MD Chad M. Smith, MD
Christopher Jordan, MD Nathan I. Valentine, MD CME Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Amanda K. Levine, MD Jeremy R. White, MD Professional Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Bradley K. Margo, MD
BOARD OF CENSORS THANK YOU TO OUR 2020 SPONSORS!
Sam S. Dahr, MD
GOLD Oklahoma Blood Institute
David L. Holden, MD
R. Kevin Moore, MD
BRONZE First Liberty Bank
EXECUTIVE OFFICE McBride Orthopedic Hospital
Jana Timberlake . . . . . . . . . . . . . . . . . . . . . . . . Executive Director OU Medicine
Alison Fink . . . . . . . . . . . . . . . . . . . . . . . . . . . . Associate Director,
PLICO
Managing Editor of The Bulletin
Quail Creek Bank
Rebecca Carr . . . . . . . . . . . . . . . . . . . . . . Membership Coordinator
Variety Care
EDITORIAL BOARD
William P. Truels, MD THANK YOU TO OUR ADVERTISERS!
Editor
Commerce Bank
S.S. Sanbar, MD, PhD, JD
Assistant Editor Epworth Villa
Anureet K. Bajaj, MD Hanna A. Saadah, MD INTEGRIS Hospice
Mark F. Kowalski, MD Christopher Jordan, MD Oklahoma City Ballet
H. K. Kurkjian, MD Pooja Singhal, MD
Betsy Nolan, MD Michael Taylor, MD
OK Allergy & Asthma Clinic
Tomás P. Owens, MD Elizabeth Wickersham, MD OSMA Health
Janet G. Rodgers, MD
2020March/April | The Bulletin 1
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2 The Bulletin | 2020 March/April
Lyric Theatre of Oklahoma will present the world premiere of the Native
American Musical Distant Thunder this spring as part of the organization’s
New Works Initiative. The production will be staged at Lyric at the Plaza,
1725 NW 16 St., March 25 through April 11. Sponsorship opportunities, as
well as single and season tickets, are now available.
D
istant Thunder centers on
Darrell Waters, a successful
young attorney, who returns
to his childhood home in Montana to
broker a deal that can benefit his tribe,
the impoverished Blackfeet Nation.
He soon faces his reclusive father
about their painful past and grapples
with the paradigm of what it means of our condition, the culture of our
to be Native American in the United time and adds to the canon of musical Founded in 1963, Lyric Theatre
States. Cultures collide and unite theatre. I am proud to have Distant of Oklahoma is the state’s leading
through music, dance, stories and Thunder premiere at Lyric Theatre, professional theatre company. Lyric
faith as we witness the dawning of a where Native American tribes are an produces classic and contemporary
Distant Thunder. integral part of the state of Oklahoma. musicals, new works, and plays
The book is written by famed This new American musical educates featuring artists from Oklahoma
director/choreographer Lynne audiences and promotes Native peoples
and around the nation. Shows are
Taylor-Corbett and her actor/writer and artists to the world through a
presented at two Oklahoma City
son, Shaun Taylor-Corbett. Distant powerful, heartfelt and inspiring story.”
venues — the intimate Plaza Theatre
Thunder features music and lyrics by This marks the sixth production in
Chris Wiseman and Shaun Taylor- Lyric’s New Works Initiative, which and in the summer at the grand Civic
Corbett, with additional music and began with the world premiere of Center Music Hall. Lyric’s Thelma
lyrics from Robert Lindsey-Nassif Triangle (2014), Bernice Bobs Her Gaylord Academy is the premier
and Michael Moricz. The production Hair (2015) and Mann… And Wife professional theatre training ground,
will be directed by Lynne Taylor- (2016) and When We’re Gone (2018) offering classes in all aspects of the
Corbett and feature scenic and – all staged at the Plaza Theatre. Lyric performing arts. Lyric is a nonprofit
lighting designs by Shawn Irish and unveiled a new production of Disney’s member theatre of the National
costume design by E.B. Brooks. When You Wish during the 2017 Alliance for Musical Theatre and
Music direction will be provided Summer at the Civic Center season. Allied Arts. For more information,
by Michael Morris with stage Lyric received a Production Grant, visit www.LyricTheatreOKC.org.
management by Laurena Sherrill. part of the Frank Young Fund for New
“Bringing new works to Lyric Musicals, from the National Alliance
Theatre’s stage creates relevant and for Musical Theatre (NAMT) to assist
meaningful experiences and provides with the production of Distant Thunder.
a rare opportunity to engage with the Single tickets start at just
future of musical theatre,” said Lyric $25. For more information, visit
Producing Artistic Director Michael LyricTheatreOKC.org or call Lyric’s
Baron. “Each new work tells the story box office at (405) 524-9312.
2020March/April | The Bulletin 3
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4 The Bulletin | 2020 March/April
PRESIDENT’S PAGE
Lisa J. Wasemiller, MD
Physician burnout. Depression. Anxiety.
No Longer a Silent Epidemic.
Y
ou may not be aware that September is Physicians often learn to ignore signs and
designated as National Suicide Awareness symptoms of burnout, depression and suicidality. Thus,
month. September 10th is National Suicide the medical profession sustains a dangerous “culture of
prevention Day; ironically, that is also my silence. This should no longer be the case.
son’s birthday. I recently learned about this dealing For many doctors, the strains of medical school
with my son’s personal encounter with anxiety marked the beginning of mental health conditions. In
and depression. In conjunction with the monthly 2016, an analysis found at 27.2% of medical students
recognition, September 17th is designated as National were depressed or had symptoms of depression
Physician Suicide Awareness Day. but only 15% of the students who were depressed
It is never too early to create awareness and reached out for psychiatric care. Unfortunately, these
strength in the fight against suicide. Messages numbers only increase during residency rising to a
concerning work and life balance, mental health proximately 29% according to report in 2015. And
awareness, overall physical wellness flood our additional reports indicate that this only continues to
culture. As healers, physicians diagnose and manage worsen with time.
these issues regularly in providing patient care. The American Foundation of Suicide Prevention
Despite extensive training, physicians often struggle estimates that 300-400 physicians commit suicide
to identify depression and other mental illnesses— in each year in the US; approximately one per day. That’s
colleagues and themselves. Frequently, physicians approximately the size of 2 medical school classes per
themselves defer seeking treatment, finding it year lost to the decision to “die by suicide”. Through
difficult to seek help for their own healing due to of a process of education, we can make a difference in
fear of embarrassment and possible loss of respect this trend. Stigma reduction is a core component in a
from family, friends, and colleagues. successful wellness and suicide prevention program.
The culture of medicine also plays a role in this It is important that programs and hospitals provide
phenomenon. Stoic training environments normalize opportunities for those experiencing distress to follow
stress and distress as inherent or even necessary up with mental health professionals without fear of
components of physician identity. Physicians often punitive consequences.
feel they are capable of handling their own treatment Physicians may also fear of seeking treatment
because they are so knowledgeable about medicine. because of potential future impact on hospital
Continues on page 6 …
2020March/April | The Bulletin 5
PRESIDENT’S PAGE Continued from page 5 …
privileges, state licensure and insurance credentialing. As a reminder, the PWP, is TOTALLY FREE
Many physicians say they know they are in crisis for up to eight sessions per year provided by the
but refuse to seek help for fear of potential negative generosity of the Oklahoma County Medical
impacts to their careers. Questions on medical Society and by generous donations from its
licensure applications about past and current mental members. The entire process is 100% confidential
health conditions also discourage physicians from with NO REPORTING to alleviate concerns about
seeking help due to fears about licensing and credentialing or licensure restrictions. Appointments
discrimination in hospital credentialing, and therefore are made through direct contact from the physician
loss of the ability to practice their profession. This to the therapist, avoiding going through an
results in a loss of income as well as consequences answering service or through a secretary receptionist
pertaining to personal and liability insurance due to for scheduling privacy. Immediate same-day
disclosure of mental health diagnoses. appointments are available. Counseling is done by
Therefore, we, as physicians, need to address competent vetted therapists in established practice.
the manner in which some licensure boards ask Sessions occur in a private offsite location with times
about physician’s current mental health, previous scheduled to meet the needs of the physician.
mental health conditions, and or any history of Please consider supporting your Oklahoma County
hospitalization or impairment from a mental health Medical Society physician wellness counseling
condition. This line of questioning on forms leads program with a tax-deductible donation. Support is
some physicians to self-medicate, self-prescribe, also available through fundraising via the sale of
seek prescription assistance from a colleague just physician suicide awareness prevention Rustic Cuff
to be able answer NO to these questions. This is the bracelets. Donate and see the bracelets available
time to realize the adage “Physician heal thyself” is online at okcountymed.org/news.
NOT appropriate. There is currently no evidence to
suggest that a physician’s mental health diagnosis and
treatment per se imply impairment or increased risk
We can make a difference.
of harm to patients. We can all help prevent suicide.
The Oklahoma County Medical Society Spread the word
recognized the need in this area and moved forward
to implement a program to assist in maintaining
Ask
appropriate mental health for our physician Members. Listen
The program has now been in place for over a Offer hope
couple of years and has provided for more than
80+ visits by Physician members. The program is “Place your hand over your heart. Can you feel it?
open to resident members and medical students in That is called Purpose.
Oklahoma City.
The Oklahoma County Medical Society You are alive for a reason, so don’t ever give up”.
recognized that the other county medical societies Anonymous
could benefit from this program as well and have
reached out to Tulsa County and Rural County If you are experiencing thoughts of suicide, please
medical societies to inform them of this program call 1-800-273-8255. Help is available. To access the
and potential expansion into those medical Physician Wellness Program, please visit okcountymed.
societies as well. org/pwp. Same-day appointments are available.
6 The Bulletin | 2020 March/April
2020March/April | The Bulletin 7
PHYSICIANS’ NEWS
Crawford Cookson Landrum Moxley Saadah
The University of Oklahoma Michael Cookson, MD, current Gynecologic oncologist Katherine
College of Medicine named OCMS board member, was Moxley, MD, is one of only 10
family medicine physician recently elected president of the physician-scientists to receive
Steven Crawford, MD, as senior Society of Urologic Oncology. a leadership award from the
associate dean and director of the He currently sees urologic cancer National Cancer Institute. The NCI
newly formed Office of Healthcare patients at Stephenson Cancer Cancer Clinical Investigator Team
Innovation and Policy. The Office Center at OU Medicine. He was Leadership Award recognizes
of Healthcare Innovation and installed in his new role December Moxley’s efforts to improve the
Policy was launched to harness 3rd in Washington and will sever a lives of people with cancer through
resources within the college and one-year term. leading NCI-funded clinical trials.
across the academic healthcare The award acknowledges her
enterprise to address the social Gynecologic oncologist Lisa leadership efforts at Stephenson
determinants of health - the Landrum, MD, PhD, has Cancer Center as well as with
social factors that significantly been honored for her national clinical trail collaborates
impact health conditions among advocacy work on behalf of throughout the United States. The
Oklahomans. Crawford has been her patients with gynecological award comes with a monetary
serving as chair of the Department cancers. Landrum was presented prized that she will use to develop a
of Family and Preventive the Ambassador Wared for the comprehensive precision medicine
Medicine for 20 years and brings Society of Gynecologic Oncology. program.
a background and dedication to As one of the two winners across
helping people achieve better the United States, Landrum Hanna Saadah, MD, will be
health in their own communities. was recognized for educating honored at the OU Alumni Reunion
Oklahoma’s congressional Day on May 1st with the Friend of
delegations about several issues of Medicine Award.
great importance to women who
are fighting gynecologic cancers
and the physicians to treat them.
8 The Bulletin | 2020 March/AprilDEAN’S PAGE
John P. Zubialde, MD
Executive Dean and Professor,
Family and Preventive Medicine
University of Oklahoma College of Medicine
A
s part of an academic healthcare leave the doctor’s office or hospital, they must
system, the mission of the OU College manage their conditions, and we want to work
of Medicine involves taking our work with communities and health systems to find
beyond the boundaries of our campus and innovative solutions to address the things that
across Oklahoma, where physicians and patients most impact their health and wellbeing.
manage health conditions in their home and For example, in Healthy Hearts for Oklahoma
community settings. (H2O), our team led a project that assisted
To more fully work toward that mission, I was approximately 300 primary care clinics across
pleased last month to announce the creation of the the state in incorporating and standardizing
Office of Healthcare Innovation and Policy and guidelines known to decrease the risk of
its director, Dr. Steven Crawford. Many of you cardiovascular disease. By embedding a person
know Dr. Crawford as the longtime chair of the known as a practice facilitator into each practice,
Department of Family and Preventive Medicine and we were able to work in-depth with both clinicians
for his advocacy with numerous state organizations. and office staff to leverage their electronic
We are delighted that he is joining the Executive health records for the project. Rural practices
Dean’s Office, where he will also serve as Senior are especially strapped for time and resources to
Associate Dean. conduct quality improvement initiatives, but with
The Office of Healthcare Innovation and assistance in using their EHR to its full potential,
Policy will serve as an umbrella for resources they saw several positive outcomes. Overall,
within the College of Medicine and across practices saw an increase in documentation of
the OU Health Sciences Center. Our faculty aspirin use when appropriate, an improvement
members are leading many exciting programs of blood pressure control, and more consistent
across the state, and the role of this office verification of a person’s tobacco use and referral
is to coalesce these efforts in a strategically to treatment. The three-year project was funded by
aligned fashion. The medical care we deliver the Agency for Healthcare Research and Quality.
is important, but equally so are the resources The success of that program led to a similar
for our patients in the communities where they program called Do No Harm, a pain and opioid
live. Approximately 75% of the care we provide management effort in conjunction with the
is for people with chronic illness. Once they Oklahoma Department of Mental Health and
Continues on page 10 …
2020March/April | The Bulletin 9DEAN’S PAGE Continued from page 9 …
Substance Abuse Services. We recently increased to Innovation and Policy dovetails with that of the OU
100 primary care practices across the state where Hudson College of Public Health, whose work focuses
our practice facilitators work with physicians and on improving the health of an entire population rather
staff to standardize their approach to consenting a than treating acute illnesses as they arise.
patient for opioid treatment, discussing it with them The OU College of Medicine also has launched an
and checking the Prescription Monitoring Program innovative program called the PARTNER Council,
as required by law. a clinician and patient advocate advisory board to
The Oklahoma Department of Mental Health and the Oklahoma Primary Healthcare Improvement
Substance Abuse Services also asked the OU College Cooperative (OPHIC). Created in 2015, OPHIC is a
of Medicine to collaborate on another project called statewide collaborative effort aimed at strengthening
SBIRT – Screening, Behavioral Intervention and the state’s primary care delivery system, using an
Referral for Treatment. By implementing a process approach similar to cooperative extension methods.
to screen patients for depression, suicide risk and During our second PARTNER think tank last fall,
substance use disorder, physicians can intervene and we welcomed 85 participants from around the state to
either treat the patient or refer for treatment. The talk about how we can better integrate social care into
project also raises awareness about less-prescribed health care.
medications such as those that can help people As physicians, we may successfully treat a
decrease alcohol use. patient who has been in the hospital, but if we send
There are many other initiatives in the planning them home with a prescription that they never fill
or early stages, including a partnership with the – perhaps because they couldn’t afford it or they
Oklahoma State Department of Health to focus on didn’t have transportation to the pharmacy – then
diabetes prevention, particularly in high-risk areas they are likely to be readmitted to the hospital,
of the state. Other projects involve helping primary increasing the cost for all of us. The PARTNER
care clinics standardize vaccine practices, as well as Council provides insight and engagement about how
screening for dementia. to “move healthcare upstream” to address the social
As important as these medical interventions are, determinants of health.
at least 40% of our population’s total health outcomes In order to improve the health of Oklahomans, we
are shaped by upstream factors before people ever see must rethink the way we deliver healthcare and find
a physician. Medicine must do better at understanding innovative solutions to support our patients both inside
and recognizing the social determinants of health and and outside of their healthcare appointments. This is a
adverse childhood experiences, and the effect they can challenging yet exciting time for academic medicine,
have on people’s physical and mental health throughout and we are eager to partner with you to improve health
their lives. The work of the Office of Healthcare and quality of life for people throughout our state. THE
BULLETIN
IN MEMORIAM
Roy Barton Carl, MD
1929-2019
John M. Brown, MD
1922-2020
10 The Bulletin | 2020 March/April2020March/April | The Bulletin 11
The Skinny
on Genetic Obesity
Ryan T. Morgan, DO, FACOI, Dipl ABOM, Dipl ABCL
W
hen it comes to the medical community, Genetics is one area that is overattributed by
few topics are as divisive as obesity. That patients, but also underappreciated by physicians as
might seem counterintuitive because we a significant cause of weight gain. In medical school
know that excess weight is associated with most of us learned rare genetic disorders that have
a myriad of medical conditions; but, consider this: obesity as a prominent feature, like Alström syndrome,
IAEDP, or the International Association for Eating Albright Hereditary Osteodystrophy, and Bardet-
Disorders Professionals, encourages physicians and Biedl Disease. Another, Prader-Willi, is the largest
health care providers to practice Health at Every Size syndromic cause of obesity. There are several others
(HAES). HAES rejects pathologizing specific weights that are less well-known such as leptin deficiency,
and teaches people to eat to pleasure. Those that leptin receptor deficiency, POMC (Pom C) deficiency,
support HAES claim that weight stigmatization and PCSK1 and 3 deficiencies, BDNF deficiency, TrkB
weight cycling cause obesity and disordered eating, deficiency, and SIM1 deficiency. MC4R.org.uk suspects
unlike the unrestricted mindful eating that HAES 1% of the adult UK population with severe obesity
promotes. On the flip side, the government’s Let’s has the melanocortin 4 Receptor (MC4R) mutation. If
Move campaign focuses on increasing healthy foods applicable, the 7.7% of the US population with extreme
and physical activity, believing that poor compliance (severe) obesity would equate to more than 250,000
in these areas are the root of the obesity epidemic. Americans. This number may be even higher with
A third perspective absent from HAES and Let’s some researchers estimating 2.5% of those having
Move, is treating obesity as a disease, a core stance of severe obesity also have MC4R deficiency, making it
the American Medical Association and the Obesity the largest monogenic cause of obesity.
Medicine Association. As of now, there are over 100 known genetic
The reality lies somewhere in the intersecting markers discovered to be associated with obesity.
middle ground of a Venn diagram of all these While we are certainly learning more about these
approaches. We know that a complex cocktail of markers and their association/correlation, consider
mental health, media, social pressures, socioeconomic the following. Similar to the way diet and lifestyle
status, exercise, food accessibility, energy density, sleep can affect the phenotypic expression of lipids in
quality, sleep duration, and leisure time all play a role genetically susceptible patients with familial combined
in the rising obesity epidemic. In addition, less known hyperlipidemia, obesity too may be increased in
factors such as endocrine disrupters, epigenetics, and patients who have a confluence of weight-promoting
antibiotic exposure may also play a role. genes plus weight-promoting lifestyles.
12 The Bulletin | 2020 March/AprilWithin the past 30 years, scientific research into
genetic causes of obesity has shed more light onto the
pathophysiology of weight regulation. We know that
there are over ten peripherally circulating hormones
that cross the blood-brain barrier and act on the
hypothalamus. These hormones act on 1st order nuclei,
namely NPY/AgRP and POMC/CART, which then go
on to act on each other and downstream on to 2nd and
3rd order nuclei. This process is tightly regulated with
feedback loops to keep the body in homeostasis. It’s
the understanding of genetic obesity, with mutations
or deficiencies somewhere along the pathway, that
have helped scientists to understand that obesity is
also a disease. Yes, poor diet and lifestyle absolutely
contribute to weight gain, but how the body responds
to hypothalamic dysfunction caused by obesity is why
obesity is a disease.
Most of us are familiar with insulin resistance,
wherein our body does not have a problem producing
insulin, but rather sensitizing to insulin. Similarly,
leptin which is produced from adipocytes acts on the
hypothalamus to turn on pathways that promote weight
loss. When individuals have excess adiposity, especially
central adiposity, the excess leptin is unable to have
the same affect on the brain, tipping the scale in favor
of the orexigenic and weight-promoting NPY/ Agouti-
related protein pathway.
Continues on page 14 …
THE
PEARL
2020March/April | The Bulletin 13GENETIC OBESITY Continued from page 13 …
While there are some medications in the activation. Together, these increase the anorexic
development pipeline, it is true no medication pathway and decrease the orexigenic pathway in the
currently exists solely to treat genetic causes of obesity. brain, promoting increased energy expenditure and
Anecdotally, many of those who treat patients with decreased energy intake.
obesity report that by simply finding a diagnosis, We know behavioral changes such as mindfulness
patients are more likely to lose weight. This makes can improve calorie consumption, we know increased
sense when considering the parent of a child with activity and decreased energy density can also
Prader Willi and the feelings of guilt that can ensue improve weight. One unfairly chastised component
when the child is begging for food. A parent knowing of treatment is medication. Our goal in treatment
that he or she is showing love, rather than cruelty, by is not for patients to rely solely on medication, but
locking cabinets and refrigerators without giving in to medication can be a useful adjunct to the treatment
the child can make a world of difference. of obesity. Anti-obesity medication is no different
Currently, there are 10 FDA approved medications than medication for hypertension or diabetes, which
for weight loss and an additional 8 medications that can also be improved with diet and lifestyle. To
can be used off-label for weight loss. Despite no ignore this fact is to allow societal views that patients
FDA-indicated medication for genetic obesity, we can with obesity are weak and lazy to cloud our medical
use current medications available to help augment judgment and knowledge of the facts. By considering
the abnormal pathologic pathway for obesity in the genetic causes of obesity, we can shed some of the
brain. For example, we can use bupropion to stimulate stigma we might hold on patients, and by doing so,
POMC and naltrexone to block the MOP receptor, improve a relationship that can foster change.
which would normally decrease the efficacy of POMC THE
BULLETIN
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2020March/April | The Bulletin 15Heather R. Burks, MD Summer Jatala, MD is a board-certified family
is a board-certified medicine phyisican with Variety Care in Oklahoma City.
fertility and reproductive She received her medical degree from St. Matthew’s
endocrinologist with OU University and completed her residency at the University
Physicians. She completed of Oklahoma.
medical school at the Michael Edward Johnson,
Vanderbilt University MD is a Board-Certified
School of Medicine, pediatrician who pursued his
residency at the University medical training at The
of Oklahoma College of University of Oklahoma
Medicine, and fellowship in reproductive College of Medicine and his
endocrinology and infertility at the University pediatric residency training at
of Southern California Los Angeles. Cincinnati Children’s Hospital
Medical Center. He began
Tommy Ibrahim, MD is working at The Children’s Center Rehabilitation Hospital
Executive Vice President, as a hospitalist in 2013 and then joined the team full time
Chief Physician Executive in 2015 as medical director of inpatient services. Dr. John-
of INTEGRIS. He serves son was named vice president of medical services/medical
as the physician executive director in 2016 and chief medical officer in 2020.
in charge of leading the
strategic direction for clini- Jennifer Morris, MD
cal services throughout the completed medical school at the
health system, including all University of Oklahoma, and
clinical excellence, quality then undertook internship and
and patient safety objectives. Dr. Ibrahim received his residency in psychiatry at
Bachelor of Medical Science degree and his Doctor Griffin Memorial Hospital. Dr.
of Medicine degree from St. Christopher’s College Morris completed her board cer-
of Medicine in Cambridge, England, and holds a tification in 2004. After working
Master of Science degree in Health Administration in private practice for 6 years,
from Seton Hall University in South Orange, New Dr. Morris launched the Transcranial Institute of
Jersey. He is a practicing hospitalist and boarded in Oklahoma in 2009, and shortly afterwards founded
internal medicine and hospital medicine. Edmond Psychiatric Associates, LLC. Dr. Morris
practices general psychiatry, with special focuses on
treatment resistant depression, depression associated
with comorbid medical illnesses (including polycystic
ovarian syndrome), attention deficit disorder, suboxone
management (opiate detox), and transcranial magnetic
stimulation (TMS) treatment and management.
16 The Bulletin | 2020 March/AprilWELCOME Gretchen Wienecke, MD
is an associate professor of
NEW MEMBERS anesthesiology specializing
in pain medicine at the
University of Oklahoma
Health Sciences Center and
Jeffrey L. Sabine, MD is a board-certified family has been a faculty member
medicine physician with Mercy Clinic Primary Care since 2001. She is the medical
in Bethany. He completed medical school at the director of the OU Physicians
University of Texas and residency at Shasta General Pain Medicine clinic and
Hospital in Family Medicine. also program director of the pain medicine fellowship.
Dr. Wienecke received her medical degree at the Uni-
Laura Shamblin, MD received her medical education versity of Oklahoma Health Sciences Center.
at the University of Oklahoma College of Medicine, Her internal medicine internship was completed at
graduating in 2005. She did her residency training at St. Mary’s Hospital in San Francisco, followed by
Children’s Hospital of Oklahoma, finishing in 2008. anesthesiology residency at Tufts Medical Center in
After residency, Dr. Shamblin worked full time from Boston. She completed her fellowship in pain manage-
2008-2012 for The Children’s Center in Bethany, OK, a ment at the OU Health Sciences Center. She is board
long-term care hospital for children with special needs. certified in anesthesiology and pain medicine. THE
BULLETIN
Chittur A. Sivaram, MD
is a board-certified
cardiologist with OU
Physicians Cardiovascular
Institute. He’s sub-specialty
certified in cardiovascular
disease and echocardiogra-
phy. He completed medical
school at Kerala University;
fellowship and residency at the University of Alberta.
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2020March/April | The Bulletin 17LAW AND MEDICINE
OLDER DRIVER
PART 1
SAFETY
MEDICAL & ETHICAL ASPECTS
S. Sandy Sanbar, MD, PhD, JD, FCLM*
T
here are both ethical and legal issues that relate to identifying impaired older drivers,
balancing the patient’s desire to continue to drive with public safety, reporting by
clinician of impaired older drivers to state agencies, and ensuring that the patient
has indeed stopped driving. Part 1 of this article presents the medical and ethical
issues. Part 2 will cover the legal aspects of older driver safety.
More than 40 million older drivers are licensed to drive in America. Between 2007 and
2016, the number of older drivers increased 34 percent. On average, driver involvement
in fatal crashes increases significantly after age 75 for women and after age 80 for men.
The total number of traffic fatalities among the older population, who were 65 and
above, increased by 13 percent – 20 percent in males and 4 percent in females. There is
a significantly greater involvement in fatal crashes among male drivers in any age group
from 65 to over 85, compared to female drivers. Most automobile crashes involving older
adults occur during the daytime and on weekdays and involve other vehicles.
In 2002, a study compared the average life expectancy and maximum driving age for
people older than 70 years old. The results showed that the majority of older drivers in
the United States will outlive their ability to drive by about 7 to 10 years.1 Driving safely
requires the ability to move, think, and see, all at the same time. A good number of older
people have challenges with one or more of the three requirements for safe driving.
Clinical risk factors for impaired driving2 include:
1. Physical problems, such as history of falls, impaired ambulation, hearing,
vision or function – for example, slow response to visual or auditory cues,
impaired, inability to use the gas or brake pedals, or decreased range of motion
in head and neck making it difficult to turn the head to fully visualize an area.
Cognitive impairment such as decreased short-term memory, easily
distracted, decreased way-finding, and difficulty learning new
information quickly or recognizing unsafe
conditions or situations.
*Executive Director, Diplomate and Past Chairman, American Board of Legal Medicine; Vice President and
Director of CME, Western Institute of Legal Medicine, California; Fellow and Past President, American
College of Legal Medicine; and Adjunct Professor, Medical Education, OUHSC.
18 The Bulletin | 2020 March/AprilPhysicians should
use their best
judgment when
determining
when to report
impairments
that could limit a
patient’s ability to
drive safely.
Continues on page 20 …
2020March/April | The Bulletin 19LAW AND MEDICINE, Continued from page 19 …
You take exceptional care of your
Ethical approaches to managing older drivers
patients. Let us help you take
Driving cessation can lead to depression, reduced
exceptional care of your practice.
quality of life, and social isolation. Elderly non-
drivers are more likely than those who drive to be
institutionalized in long-term care facilities. Caregivers
are also negatively affected if a patient stops driving.
They are expected to arrange or provide alternative
transportation. There are three approaches to managing
older drivers:
1. The principle approach focuses on autonomy,
beneficence, nonmaleficence and justice. Clinicians
working with older drivers must balance the four
ethical principles.
• The older driver who chooses to continue driving
is exercising autonomy.
• Beneficence may allow the clinician to
recommend driving cessation in order to reduce
the risks for car crashes and associated injuries.
• Driving cessation may harm the patient and
violate the principle of nonmaleficence (first, do
no harm).
2. The utilitarian approach optimizes outcomes of
ethically driven decisions to produce the best results
or the greatest amount of good.
• An act utilitarian considers only the
consequences of a single act. For example, it is
Call now and schedule a consultation alright for an elderly patient with dementia to
with a Healthcare Banking Specialist. continue driving despite the increased risk of
accidents because that is the best for that person.
• A “rule utilitarian” considers all the consequences
resulting from following a rule of conduct. For
example, permitting older people to drive for as
long as possible produces the greatest good (1) for
the older person, (2) for the people who will have to
Michael Levine, SVP drive that person around, and (3) for society which
Healthcare Banking Division Manager will not have to bear the costs of transportation
mlevine@myfirstliberty.com alternatives like para-transport services.
405-608-1048 3. The professional approach includes the special
Lynn Blankenship, VP fiduciary and confidential obligations clinicians have
Healthcare Banking Relationship Manager to their patients. Professionals should do what is best
lblankenship@myfirstliberty.com for the patient and put the best interests of the patient
405-252-4476 ahead of the professionals. Healthcare professionals
are also obligated to honor the principle of
9601 N. May Ave. Oklahoma City, OK 73120
myfirstliberty.com confidentiality and to not disclose patient information
to family without the patient’s permission.
20 The Bulletin | 2020 March/AprilEthically, whether the clinician applies a principle, recommendation is made for his/her safety. Encourage
utilitarian, or professional approach, older people the patient to devise a transportation plan to include
should stop driving when the risks of continued alternative transportation methods, support system, and
driving outweigh the benefits to the patient, family, and potential barriers.
society. This is in keeping with The American Medical Finally, the patient should return for follow up after
Association Code of Ethics which states: 1 month, and as needed subsequently, to evaluate for
“Physicians should use their best judgment when signs of depression, social isolation, and worsening
determining when to report impairments that could mental or physical health. Inquire about transportation
limit a patient’s ability to drive safely. In situations resources and how the patient is managing without
where clear evidence of substantial driving impairment driving. Educate the family/caregivers on signs of
implies a strong threat to patient and public safety, and depression and self-neglect, and inquire about their
where the physician’s advice to discontinue driving concerns. Some patients may find comfort talking to
privileges is ignored, it is desirable and ethical to their trusted friends, clergy or personal attorney.
notify the department of motor vehicles.” THE
BULLETIN
Evaluation of driving ability and documentation
First, the clinician should assess the patient’s 1
Foley DJ, Heimovitz HK, Guralnik JM, et al. Driving life expectancy of
perception of his/her driving ability and inquire about persons aged 70 years and older in the United States. Am J Public Health.
2002; 92:1284-1289.
any social pressures that affect driving behavior. 2
American Geriatrics Society and National Highway Traffic Safety
Determine if the patient has family members or Administration. Clinician’s Guide to Assessing and Counseling Older
caregivers who can support the mobility transition, Drivers. 3rd ed. https://geriatricscareonline.org/ProductAbstract/
clinician’s-guide-to-assessing-and-counseling-older-drivers/B022.
and whether they disagree among themselves about Published 2015. Accessed December 1, 2017.
the patient’s driving ability or need for support. If Note – 4th edition of the Clinicians Guide, is in progress and expected to
be released in 2019
indicated, consult or refer the patient to a neurologist,
an occupational therapist, a social worker, or a geriatric
care manager. Social, medical and legal aspects of human sexual behavior
Next, ask the patient to give permission to
have family/caregiver present when explaining the
assessment results. Describe in detail the patient’s
level of dysfunction and why this is important when
considering safe driving. State the potential risks of
driving, for example injury, public safety, and financial
liability. Conclude with either a recommendation to
stop driving or for the specific driving restriction such
as driving short distances in daytime only.
It is essential to document the discussion in writing
and give a copy to the patient and/or to a family
member or caregiver if the patient lacks decision-
making capacity.
Communicating with the elderly patient
Ask the patient open-ended questions such as,
“Kindly tell me about your concerns regarding the
assessment results and recommendations.” The patient Physicians may order eBook directly
may be anxious, upset or angry. That should be by email: sandysanbar@gmail.com
acknowledged without engaging in long discussions or
disagreement. The clinician should not vacillate and
$8.50 - available through Kindle, Amazon
make sure the patient understands that the safe driving
2020March/April | The Bulletin 21LEPRECHAUNS
Philip Maguire, MD
L
eprechauns are very small Sprites related Brogan. They are quite visible to us and dressed
to Elves and are peculiar to Ireland. They brightly in green with red Caps and small leather
take the form of old men, very short and aprons. But it is the noise of their hammering
stout in stature, rather tiny. They are known that will betray them to their seekers. When
to be solitary and not at all friendly by nature. found working on the shoe they usually have a
They live alone in remote places like wine purse, but it never contains more than a shilling.
cellars. Sometimes in old farmhouses and such, When they finish their work, they have wild
spending their time in solitude. feasts called Cluricauns and become slightly
They may aid humans, perform small tasks drunk. Then they can be seen riding wildly
for them. Sometimes they ask for supplies for across the moonlight on the backs of dogs.
which they trade objects that bring luck and Each Leprechaun was thought to have hidden
good fortune. at the foot of a Rainbow a pot of pure gold. If
They spend most of their time making shoes. captured and threatened with bodily harm the
Some say only shoes for elves. They will always hiding place would be revealed but only if the
be seen working on only one shoe. Thus, the captor did not glance away. If the Leprechaun
name Leprechaun is thought to be derived could trick the captor into glancing away the
from the Irish: Leith - half and Brog - shoe or leprechaun would vanish.
THE
BULLETIN
22 The Bulletin | 2020 March/AprilMonday, March 23, 2020
OCMS Membership Meeting and
50-Year Physician Recognition
Speaker: John Armitage, MD, CEO –
Oklahoma Blood Institute
Free for members, guests/non-members $25:
okcountymed.org/rsvp
Saturday, April 18, 2020
A N D U PDAT ES
OSMA House of Delegates
Do you know an early career physician who
Marriott Southern Hills – Tulsa
is interested in leadership? Submit their name
okcountymed.org/hod
for the OCMS Physicians Academy. The
OCMS Physicians Academy is open each
year to physicians who want to expand their
Changes to the 2020 OCMS Directory leadership skills, learn more about the business
Ross Vanhooser, MD and politics of medicine, and learn how their
1408 Paseo Bridge Court active participation is vital to the strength of
Edmond, OK 73034 our medical community. The Academy sessions
are one Saturday morning each month for five
months. More info: okcountymed.org/academy
2020March/April | The Bulletin 23A L S O DIES
Hanna A. Saadah, MD
w
hen expressed by Elizabeth
Tennyson Browning’s famous sonnet,
penned In How Do I Love Thee.
Memoriam,1 it was a
requiem for his beloved Cambridge friend, … I love thee with the breath,
Arthur Hallam, who had died suddenly at Smiles, tears, of all my life!—and, if God
22 of a cerebral hemorrhage. However, his choose,
gratitudinal2 stanza, lamenting love lost to death, I shall but love thee better after death.
has been expanded by Time to include love lost Many fear falling in love because of the thorns
to life. that loving sprouts along its long, rosy stems.
Nevertheless, even the most resistant ultimately
I hold it true whatever befall succumb to Love’s overpowering, siren calls and
I feel it when I sorrow most surrender their sails to the wild winds of Eros. In
‘Tis better to have loved and lost Midsummer Night’s Dream, Shakespeare had
Than never to have loved at all. Lysander say to Hermia:3
Even though love always dies when we die, “The course of true love never did run smooth;”
it also lives because it mentors by example
from womb, to birth, to motherhood, to life,
5
leaving its heritable impressions upon successive Whenever we fall in love, we become delusional
generations. Indeed, having experienced and sincerely believe that our love will last forever.
love transforms and enriches souls long after In this vigorous freshness of love, we strut unaware
relationships or loved ones die. We cling to love that love is ephemeral and inevitably dies. Stanzas
as long as it survives and then we live thereafter like this one, powered by painful truths, dishearten
in its Elysian Fields, a concept so brilliantly us, hurling us into a melancholy abyss.
24 The Bulletin | 2020 March/AprilYes, I am well aware
That nothing lasts
Beyond the moment’s edge,
That love at first will crawl
Then springs like roses marvelous and tall
Then browns and all the petals fall
And scatter through the air
Only the thorns remain
On branches, pleading, bare
With every thorn a pain
Yes, I am well aware. 4
But then, in the same breath, the next two stanzas of the poem remind
us that love continues to power the world, not only because wherever there
is life there is love, but also because, as Gandhi said, wherever there is
love there is life.5
But love is never lost
It softens life, unburdens, beautifies
Restores the broken souls
Redeems the spring within the hollowed eyes
Awakens seeds from dust.
Love is not lost
It flows from rose to flower like a bee
And every heart it liberates is free
To reach the height of smiles, the depth of tears
The mighty calm of peace, untouched by fears
The kindness of the cross that nails our souls together
And changes us forever.
Beyond love’s empowerment by life, love can also be empowered
and immortalized by literature. When lovers die, their love lives on
in the memories of a generation or two before fading into oblivion.
However, when love stories are turned into literature, love is resurrected
with each reading and rekindled by our collective emotions with every
remembrance. Romeo and Juliet forever live in our global consciousness
because their love was turned into great literature,6 and because that great
literature continues to inspire other art forms such as music, sculptor,
paintings, and ballet.
Continues on page 26 …
2020March/April | The Bulletin 25LOVE ALSO DIES, Continued from page 25 …
Loves powered by literature, immortalize the lovers. But words are things, and a small drop of ink,
In this Shakespearean sonnet,7 the last couplet tells Falling like dew, upon a thought, produces
the beloved that as long as that sonnet lives, it will That which makes thousands, perhaps
continue to do him living homage. millions, think;
Nor shall death brag thou wand’rest in his shade, ‘Tis strange, the shortest letter which man uses
When in eternal lines to time thou grow’st, Instead of speech, may form a lasting link
So long as men can breathe or eyes can see, Of ages; to what straits old Time reduces
So long lives this, and this gives life to thee. Frail man, when paper - even a rag like this -,
Survives himself, his tomb, and all that’s his.
Written love does not die, nor does it grow weary.
It does not deceive, nor does it become unfaithful.
5
It does not change with time, nor does it turn into
vengeful hate. When Shakespeare penned sonnet 116,8 I wrote the following love sonnet, My Fifty Season,
stating that love is not time’s fool, he idealized love, to ensure that my love for my wife will endure despite
elevating it to unearthly heights, which every lover the ravages of old Time, which holds in its trigger-happy
knows are not sustainable. fingers Pandora’s jar of disease, dementia, and death.
The sonnet is a manifesto against relentless
Love is not love aging, written in a literary form that defies old Time,
Which alters when it alteration finds, transcends group ethos, and asserts Protagoras’s claim
Or bends with the remover to remove: that, Man is the measure of all things.11
O no! it is an ever-fixed mark
Building on Protagoras’s sagacious adage—which
That looks on tempests and is never shaken;
created a major controversy when interpreted by
5 Plato to mean that there is no absolute truth but that
which individuals deem to be the truth—I proclaim
However, old Time, which does change everything
my own truth that, The individual is the only measure
alive and dead, cannot change what has been written.
of true love.
As Khayyam observed,9
The Moving Finger writes; and, having writ, My Fifth Season
Moves on: nor all your Piety nor Wit Sonnet 112
Shall lure it back to cancel half a Line, I am seasonal, as I have always been
Nor all your Tears wash out a Word of it. Like life and weather, and all that’s in between
Written love is life’s Fifth Season, the season that I spring up high, then summer fly, then falter
is ever-present, and the bond that holds humanity And fall like ice into a livid winter.
together. Written love does not separate people into I voyage between death and resurrection
groups, tribes, and nations, as the rest of our written Re-living all the verdicts of my seasons
languages do. Rather, literary love is the only language From boldest action to coldest inaction
that transcends groups, tribes, nations, and holds us Nature conducts my life and gives no reasons.
together as a bouquet of beautiful individuals. But you and I fly in a lofty atmosphere
Lovers, when you love, do not just repeat the words, Beyond our planet’s surly bonds and twirling sphere
I love you. Repetition does not vouchsafe endurance to Where love’s a season that endures forever
love. Take time to write your love because, on paper, And changes not with times or climes or weather.
words become things, things that survive their authors You are my fifth, unending, love-lit season
and their times, as Byron so aptly put it.10 My joy, my gratitude, my sun-lit reason.
26 The Bulletin | 2020 March/AprilENDNOT ES
1
In Memoriam is a 252-page poem by the British poet Alfred, Lord Tennyson, completed in 1849. It is a
requiem for the poet’s beloved Cambridge friend Arthur Henry Hallam, who died suddenly of a cerebral
hemorrhage in Vienna in 1833.
2
Gratitudinal is my made-up adjective form of the noun gratitude.
3
The main characters in William Shakespeare’s play “ A Midsummer Night’s Dream” which takes place in Athens, Greece are Lysander
and Hermia, two lovers whose love is forbidden by Hermia’s father, Egeus.
4
From the poem, Love Is Not Lost, from the poetry book, Vast Awakenings, by Hanna Saadah.
5
Mahatma Gandhi: The truth is that where there is love, there is life. Love is the power of the universe, and everything is alive through an
inexplicable power that could be called, ultimately, love.
6
Romeo and Juliet, a play by William Shakespeare, continues to speak to all of humanity.
Sonnet 18 begins by comparing Shakespeare’s beloved gentleman to a summer’s day: Shall I compare thee to a summer’s day – Thou art
7
more lovely and more temperate.
8
Shakespeare’s Sonnet 116 begins with, Let me not to the marriage of true minds - Admit impediments.
9
Omar Khayyam (1044-1131) was a Persian poet whose Quatrains were translated into English by Edward Fitzgerald in 1859.
10
Lord George Gordon Byron (1788-1842) was a British romantic poet. The quote is taken from his poem, Don Juan. THE
BULLETIN
11
Protagoras (490-420 BC) was a Greek philosopher trained by Democritus.
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| The Bulletin
5:07:24 PM 2728 The Bulletin | 2020 March/April
DIRECTOR’S
DIALOGUE
SHOWING UP!
By Jana Timberlake,
Executive Director
T
he months of March and April are among 3. March 25, 2020 - OSMA Medicine Day
my favorite times of the year. The ground is Legislative Reception - 5:00 - 6:30 p.m. -
reawakening from its winter’s sleep, the redbud OSMA Multi-Purpose Room - This reception
trees are showing off with their spectacular provides OCMS/OSMA members with the
color, and perennials are pushing through the ground opportunity to visit with legislators regarding
towards the sun’s warmth. It’s life! issues important to the practice of medicine.
As I am writing this Director’s Dialogue, my Remember to wear your white coat! There
thoughts are filled with East Texas and the new great will be a session at the Capitol earlier in the
niece who made her appearance on Valentine’s Day! afternoon. If you plan to go, meet at the OSMA
She is joining two other siblings – 5 years old and 22 building at 2:00 p.m. This is important!
months old. And their parents accepted my offer of
help! The children’s mother is my namesake. She was 4. April 18, 2020 - OSMA House of Delegates
born exactly two weeks after my birthday, and my Annual Meeting - Southern Hills Marriott -
heart swells every time I think about this incredible Tulsa, OK - All elected OCMS Delegates need
young woman. This special time together will be one to attend. Please look for email reminders from
of my greatest gifts. Alison and RSVP.
Now, down to business... There are some important
March and April dates that are listed below: Showing up and working towards the greater good
1. March 5, 2020 - OCMS Delegate Caucus - is an important goal for each of us. You never know
5:30 p.m. - OSMA Board Room - If you are an what action you take will make THE difference!
elected OCMS delegate, please plan to attend. “Start by doing what’s necessary;
then do what’s possible;
2. March 23, 2020 - OCMS Membership and suddenly you are doing the impossible.”
Meeting - 6:00 p.m. - OSMA Multi-Purpose ~ St. Francis of Assisi
Room - 50 year physicians will be honored, and
Dr. John Armitage, OBI, will be the keynote Jana Timberlake, CAE
speaker. Make your reservations soon! Executive Director
THE
BULLETIN
2020March/April | The Bulletin 29You can also read
