San Antonio Medicine May 2015

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MEDICINETHE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY • WWW.BCMS.ORG • $4.00 • MAY 2015 • VOLUME 68 NO. 5

Why IBecameA Doctor

4 San Antonio Medicine • May 2015

Why I became a doctorUltimate Altruism By Robert R. Ramirez, MD .....18

A Calling Within My SoulBy Wendy B. Kang, MD, JD ......................................19

Understanding why things happened andhow I could improve themBy Brent Jackson, DO ...............................................20

Expanded my practice by one speciesBy Fred H. Olin, MD ..................................................21

A family doctor like my DadBy Lewis Rose, MD ...................................................21

I didn’t go into medicine for that! By Jeffrey Meffert, MD .......................................22

BCMS President’s Message ..........................................................................................................8

BCMS Alliance..............................................................................................................................10

BCMS News, Mentoring Initiative, Groundbreaking, First Tuesdays ............................................12

BCMS Member Services (BCVI) ..................................................................................................16

Lifestyle: The Art of Charcuterie by Beth Bond ............................................................................24

Lifestyle: Destination Washington County by Julie Catalano ......................................................26

Legal Ease: Do I have to? and How much? Part I of II, by George F. “Rick” Evans ..............................30

UTHSCSA Dean’s Message by Francisco González-Scarano, MD ........................................................32

Business of Medicine: Concepts to consider when measuring physician productivityby Joseph P. Gonzales, MHA, FACHE, PMF ......................................................................................34

BCMS Circle of Friends Services Directory ............................................................................................37

Book Review: Tana French’s “Dublin Murder Squad” Novels, reviewed by Fred H. Olin, MD ..............40

In the Driver’s Seat ..................................................................................................................................43

Auto Review: Mercedes S550, by Steve Schutz, MD..............................................................................44

MEDICINETHE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY • WWW.BCMS.ORG • $4.00 • MAY 2015 • VOLUME 68 NO. 5

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BOARD OF DIRECTORS

OFFICERSJames L. Humphreys, MD, PresidentLeah Hanselka Jacobson, MD, Vice PresidentMaria M. Tiamson-Beato, MD, TreasurerAdam V. Ratner, MD, SecretaryJayesh B. Shah, MD, President-electK. Ashok Kumar, MD, Immediate Past President

DIRECTORSJorge Miguel Cavazos, MD, MemberJosie Ann Cigarroa, MD, MemberKristi G. Clark, MD, MemberJohn Robert Holcomb, MD, MemberJohn Joseph Nava, MD, MemberCarmen Perez, MD, MemberOscar Gilberto Ramirez, MD, MemberBernard T. Swift, Jr., DO, MPH, MemberMiguel A. Vazquez, MD, MemberFrancisco Gonzalez-Scarano, MD, Medical School RepresentativeCarlos Alberto Rosende, MD, Medical School RepresentativeCarlayne E. Jackson, MD, Medical School RepresentativeBonnie Harriet Hartstein, MD, Military RepresentativeRebecca Christopherson, BCMS Alliance PresidentGerald Q. Greenfield Jr., MD, PA, Board of Censors ChairDonald L. Hilton Jr., MD, Board of Mediations ChairGeorge F. "Rick" Evans Jr., Legal Counsel

CEO/EXECUTIVE DIRECTORStephen C. Fitzer

CHIEF OPERATING OFFICERMelody Newsom

DIRECTOR OF COMMUNICATIONSSusan A. Merkner

COMMUNICATIONS/PUBLICATIONS COMMITTEEFred H. Olin, MD, ChairEstrella M.C. deForster, MD, MemberJay S. Ellis Jr., MD, MemberJeffrey J. Meffert, MD, MemberRajam S. Ramamurthy, MD, MemberJ.J. Waller Jr., MD, Member

The theme of this month’s issue of San Antonio Medicine is,“Why I became a doctor,” and there are several stories from ourcolleagues on that topic. I wanted to contribute one myself, andas I reflected on it, the reasoning behind my decision to applyfor medical school in the first place is a little hazy to me, since somany years have passed since that day.

I know that I enjoyed science, particularly biology, in highschool and wanted to major in it at university. My father was anobstetrician, and while I had no desire to practice obstetrics andgynecology, I did like the idea of practicing medicine. My initialreasons were that I would find it interesting (which I did and stilldo), that I could apply my science education (which is mostlytrue), that it was a glamorous occupation (not so much, as itturns out), and that it would make my parents proud of the pathI chose (which it did). When I applied for medical school, I wascareful to add in a desire to help people and build a healthiercommunity through my efforts, both of which are true but werenot necessarily primary drivers of my decision.

My road to a career in pathology took a few turns along theway, as I’m sure happened to a few of you as well during the med-ical school experience. I remember being a high school juniorand being dead certain that I wanted to practice anesthesiology,all the way up until my first general surgery rotation as a third-year. That experience cured me of any interest in pursuing eitheranesthesiology or general surgery as a career, though I am pro-foundly grateful for my colleagues who do enjoy that work andpursue it daily. It takes a village to care for most patients thesedays, as the saying goes.

I think it is important to not get lost in the daily frustrationsof modern medical practice in the United States and to take afew minutes every now and then to remember why we starteddoing this work in the first place. Those few moments of reflec-tion usually seem to spark up a bit of my wide-eyed excitementas a brand-new, first-year medical student and keep me going foranother week.

PRESIDENT’SMESSAGE

Why I became a doctorBy James L. Humphreys, MD

2015 BCMS President


Dr. James L. Humphreys(left) was installed as 2015BCMS President Jan. 24 at Oak Hills Country Club,with his father, Dr. JamesM. Humphreys, and other family members in attendance.


BCMS ALLIANCE

Are you a foodie or do you want to acquire the skills to become one? If so,then Tasty Tuesdays is right up your alley. Here, Alliance members get togetheron the last Tuesday of every other month to learn new culinary skills and trydelicious recipes.

Want to get out into the community and make a difference? Our civic andphilanthropic arm provides many opportunities to do just that! We are a vitalvolunteer presence at San Antonio’s Siclovia, where we fit children with free bi-cycle helmets.

We also serve the community through our nursing and allied health scholar-ship program. The Alliance Junior Volunteer Council, or JVC, provides serviceopportunities for high school-age children of Alliance and BCMS members.We also serve San Antonio’s refugee community by providing medical and officesupplies to the Refugee Triage Clinic.

If you’re a booklover (or even ifyou’re not), ourmonthly BookClub offers stimu-lating conversationand friendly fellow-ship. Our socialprogram Sips andDips provides avenue in whichcouples can get to-gether over drinksand appetizers.

The Alliance alsohosts four mainprograms each year:our New Member

We’ve got it going onBy Rebecca Christopherson, 2015 BCMS Alliance President

I was conversing with a physician friend the other day about our organization. “The BCMS Alliance has really gotit going on,” he said. “This group really knows how to have fun and be out in the community.” His comments made me think. We ARE out there, and he is right — we REALLY do have an awesome time at

whatever we do! I encourage those physicians and their spouses reading this article who have not yet joined the BexarCounty Medical Society Alliance to come to one of our events and check us out. We have a variety of programs thatI believe will appeal to a wide range of interests.

visit us at www.bcms.org 11

BCMS ALLIANCE

Welcome Luncheon, the Past Presi-dents’ Luncheon and Fashion Show,our Fall Coffee and, of course, ourHoliday Brunch.

We DO have it going on, and wewould love for you to join us! We arehere to support one another in thefamily of medicine. Come and seewhat you’re missing! I am happy to an-swer any questions you might haveabout membership or the BCMS Al-liance in general.

Just give me a call at 210-387-9544 or shoot me an email at [email protected]. I truly would love to hearfrom you, and I know our Alliance would love to get to know you!


BCMS NEWS

Bexar County has a vast wealth of licensed physicians, all capableof shaping the future of medicine. According to Texas state records,Bexar County has 5,321 licensed doctors. These physicians haveaccumulated great knowledge and skills, encompassing all special-ties of medicine. By partnering with local physicians, medical stu-dents, residents and fellows can expand their understanding andskills in a practical and personalized manner outside the lecture hallor teaching wards. Physicians who mentor these trainees providethe setting and context for developing critical skills required to be-come healers of the highest caliber.

PROGRAM SPECIFICS The Bexar County Medical Society (BCMS) Mentoring Initia-

tive provides local physicians with a personalized and customizableapproach to training medical students, residents and fellows. Mem-bers can choose to work with trainees according to their interestsand time, whether that means answering questions, going out fora meal, or providing shadowing opportunities.

BCMS members can be a part of the initial stages of the Men-toring Initiative in three ways: communicating with trainees via e-mail or telephone, meeting trainees for coffee or a meal, andproviding shadowing opportunities.

Communicating with trainees provides a simple way to answertrainees’ questions or concerns about your specialty, lifestyle or prac-tice. Meeting trainees for coffee or a meal provides a low-key butmore personal opportunity to interact with physicians in training.This could be expanded to include significant others and include dis-cussions on family life and how to nurture healthy relationships dur-ing medical training and beyond. Physicians-in-training will be ableto see what the art and practice of medicine look like through expe-rienced members’ eyes. Participants will have a chance to share in-sights and provide clinical context to assist physicians-in-training asthey seek out their own professional identity.

The last element of the program is called “Journeys in…” This

is a program that highlights exceptional physicians in a variety ofspecialties and allows them to tell their story in a brief speech tophysicians-in-training and their fellow BCMS members. This willopen the eyes of trainees to the vast array of choices available withineach field of medicine, as well as create an avenue for them to net-work with physicians in the fields in which they are interested.

APPEAL TO PHYSICIANSThe School of Medicine at UT Health Science Center San An-

tonio trains 860 medical students and 730 residents and fellowsannually who could benefit from the collective medical experienceof Bexar County physicians. Think back to a time when you wishedthat something was different in medicine, or you wished you hadknown or done something different in your training years. Nowimagine that you can do something about it — because you can.By joining the BCMS Mentoring Initiative, your voice is heard.Your ideas, passions and skills take life outside yourself and give vi-sion and direction to all trainees who have the opportunity to workwith and learn from you.

HOW TO PARTICIPATE All BCMS members are able to participate in the Mentoring Ini-

tiative. You may have already signed up for the program by check-ing off the appropriate box on the BCMS annual request forinformation form sent to you in early March. You also may signup by contacting BCMS membership director Brissa Vela by emailat [email protected] or at 210-301-4371.

Trevor Memmott is a first-year medical student atUT Health Science Center at San Antonio and amember of the BCMS Membership Committee. He re-ceived his B.A. in Spanish from Brigham Young Uni-versity in Provo, Utah. Outside of school, he and his

wife stay busy keeping up with their two children.

BCMS Mentoring Initiative:Training the next generation of local physicians

By Trevor Memmott

“It is one of the most beautiful compensations of this life that no man can sincerely try to help another without helping himself.” — Ralph Waldo Emerson

BCMS NEWS


BCMS BREAKS GROUND ON NEW OFFICE BUILDINGArticle and photography by Susan A. Merkner

Turning over the first shovels of dirt at the BCMS ground-breaking March 30 were (from left) Shavano Park Mayor A.David Marne; BCMS CEO/Executive Director Stephen C.Fitzer; San Antonio Mayor Ivy Taylor; San Antonio District 8City Councilman Ron Nirenberg; Bexar County Judge NelsonWolff; 2014 BCMS President K. Ashok Kumar, MD; and 2015BCMS President James L. Humphreys, MD.

Groundbreaking ceremonies included BCMS representatives (from left) BernardT. “Buddy” Swift Jr., DO; Bonnie H. Hartstein, MD; Adam V. Ratner, MD; Ger-ardo Ortega, MD; Dr. Maria “Maggie” Tiamson-Beato, MD; Leah Hanselka Ja-cobson, MD; Jayesh B. Shah, MD; James L. Humphreys, MD; K. Ashok Kumar,MD; and Stephen C. Fitzer.

Guests at the BCMS groundbreaking rep-resented healthcare, finance, government andother business sectors.

A tent was used for groundbreaking cere-monies at the 1.88-acre site of the new BCMSoffice in Shavano Park.

Approximately 150 people turned out March 30 for the Bexar County Med-ical Society’s groundbreaking ceremony at the site of its new building, 4334North Loop 1604 West.

The Shavano Park location, on the Loop 1604 east-bound access road be-tween Lockhill-Selma Road and N.W. Military Drive, was chosen for its con-venience for physician-members, many of whom work and live nearby, saidBCMS CEO/Executive Director Stephen C. Fitzer.

Construction of the $5 million project is expected to be completed by De-cember. The medical society will occupy the second floor of the 20,000-square-foot building, and 8,500 square feet of space is available for lease on the groundfloor. General contractor is R.C. Page Construction. The projectmanagement/owners’ representative is Huffman Developments.

Event sponsors were BB&T, Favorite Healthcare Staffing, Neurosurgical As-sociates, P.A., River City Cardiovascular, Spice of Life Catering, TMAIT, TMLTInsurance and University Health Systems.

Major contributors ($25,000 or more) to the BCMS Capital Campaign asof March 30 include Frost Bank, BB&T Bank, Favorite Healthcare Staffing,Mark Wood/Northside Ford Dealerships, and Mednax/Pediatrix.

To learn more and make a contribution, visit www.bcms.org.


A large contingency of physicians, medical stu-dents and Alliance members from around the statemet April 7 in Austin to participate in the AprilFirst Tuesdays visit to the Capitol. With a multi-tude of bills making their way through the process,a number of medicine’s issues were discussed, in-cluding: occupations tax; preferred provider ben-efit plans and exclusive provider organizations;ACA exchange plans ID cards; vaccinations andImmTrac registry; state budget; Medicaid pay-ments; GME and residency slots; ER temporaryholds; EpiPens in schools; insurance issues;telemedicine; scope of practice and end-of-life care.

Many thanks to the following participants:BCMS Board Treasurer Maria “Maggie” Tiamson-Beato, MD; Michael Guirl, MD; Pam Hall, MD;TMA Board of Trustees member David Henkes,MD; Alex Kenton, MD; Gabriel Ortiz, MD;BCMS president-elect Jayesh Shah, MD; DavidShulman, MD; Ryan Van Ramshorst, MD; andAlliance members Jun Beato, MD; DanielleHenkes and Alliance president-elect JenniferLewis. There were approximately 15 medical stu-dents from San Antonio in attendance who partic-ipated in separate meetings with TMA andlegislators.

The last First Tuesdays visit is May 5. If you areinterested in participating, please visit the TMAwebsite at www.texmed.org to register.

For local discussion on this and other advocacytopics, consider joining the BCMS Legislativeand Socioeconomics Committee by contactingMary Nava at [email protected].

BCMS LEGISLATIVE ANDADVOCACY NEWS

APRIL FIRST TUESDAYSAT THE CAPITOLA BIG HITBy Mary E. Nava, MBABCMS Chief Governmental and Community Relations Officer

First Tuesdays attendeesfrom BCMS paused for aphoto with the state Capitolin the background: (frontrow, from left) Gabriel Ortiz,MD; Jennifer Lewis; MaryNava; Maria Tiamson-Beato,MD; Jayesh Shah, MD;(back row, from left) PamHall, MD; Michael Guirl,MD; and Alex Kenton, MD.

BCMS physicians discussed medicine’s bills with Juan Estrada (seated atdesk), legislative aide in the office of Rep. Joe Farias (Dist. 118), on April 7.Physicians (from left) are Pam Hall, MD; Maria Tiamson-Beato, MD; AlexKenton, MD; and Gabriel Ortiz, MD.

Visiting with Heather Fleming (in blue jacket), legislative policy director inthe office of Speaker Joe Straus, on April 7 were (from left) Alex Kenton, MD;David Henkes, MD; Danielle Henkes and Gabriel Ortiz, MD.


GUEST SPEAKER ADDRESSES FREEDOM, MEDICAL EXCELLENCE

Dr. Richard B. Gunderman, vice chair of the radiology depart-ment at Indiana University School of Medicine, spoke March 13 inSan Antonio, addressing medical school students and faculty as theAlpha Omega Alpha Visiting Professor. His visit was sponsored bythe Patient Institute, UTHSCSA and BCMS.

IN MEMORIAMSister Melba Beine, OP, MD, died Feb. 27, 2015. Sister Melba,

69, was in the 40th year of her religious profession as a member ofthe Dominican order. She received a doctorate in medicine from theUniversity of Maryland at Baltimore and was a BCMS member since1996.Robert L. Brusenhan Jr., MD, 83, died March 16, 2015. He

served as a flight surgeon in the U.S. Air Force and practiced urologyfor more than 40 years. Dr. Brusenhan was a BCMS life member. Mauricio A. Escobar, MD, died April 4, 2015, at age 77. A resi-

dent of Pearsall, Dr. Escobar was a BCMS member. Jesse D. Ibarra Jr., MD, died April 7, 2015. A resident of Temple,

Dr. Ibarra, 96, was a professor of medicine at Texas A&M UniversityCollege of Medicine and a BCMS member.Odville A. Rinn, MD, died Feb. 19, 2015. After serving in the

U.S. Navy in World War II, he served as a physician and surgeon.Dr. Rinn, who died a week before his 90th birthday, was a BCMSlife member.Thomas A. Tucker, MD, 77, died March 28, 2015. Dr. Tucker,

a psychiatrist, served in the U.S. Air Force and was a BCMS lifemember.

BCMS NEW MEMBER WELCOMEJoin us in welcoming the new physician-members of BCMS!Wednesday, June 3University of the Incarnate WordRosenberg Sky Room847 E. Hildebrand Ave., San Antonio 78212

Mix and mingle: Complimentary buffet and cocktail party. Enjoyan evening of networking, camaraderie and music.

The BCMS Foundation will award scholarships to local highschool students pursuing careers in the medical profession.To RSVP, call 210-301-4381, ext. 193, or visit www.bcms.org.

BCMS NEWS

Drs. Jayesh Shah and Pam Hall visited with Rep. Rick Galindo(Dist. 117) during the April 7 First Tuesdays visit to the Capitol.

During the April 7 First Tuesdays visits, Jayesh Shah, MD,met with Rep. Justin Rodriguez (Dist. 125) (seated at end oftable) and chief of staff Brian Hodgdon.

Jayesh Shah, MD, reg-istered his support for animportant bill heard inthe House Public HealthCommittee on April 7.

Pausing for a photo with Rep. Lyle Larson (Dist. 122) on April7 were (from left) Michael Guirl, MD; Jayesh Shah, MD; Larson;Pam Hall, MD; and Mary Nava.


MEMBERSERVICES

Bexar Credentials Verification Inc. (BCVI), the credentials verifi-cation subsidiary of the Bexar County Medical Society, slashes thetime, aggravation and expense of verifying the necessary credentialson San Antonio physicians for the area hospitals and managed-careorganizations that contract with them.

The objective of credentialing is to ensure the highest quality carefor patients through the detailed verification and review of a physi-cian’s background, training and experience. All physicians must gothrough a formal credentialing process to gain “privileges” with thelocations and health plans through which they treat patients. Eachentity incurs a substantial expense to verify the authenticity of in-formation provided.

Primary source verification involves contacting the originalsource of education, training, licensure and other physician andallied health professional credentials. BCVI provides primarysource verification of credentials data that meet The Joint Com-mission (TJC) and the National Commission for Quality Assur-ance (NCQA) for Credentialing Verification Organizations criteriafor healthcare entities.

Last year, BCVI’s systems and files were reviewed for accuracy andquality control by the NCQA. BCVI received the highest possiblescores with no adverse findings in any category for which it appliedfor certification.

“BCVI is the industry leader for health facility primary source ver-ification,” said BCVI director of operations Mary Jo Quinn. “Ourgoal is to overwhelm our current customers with satisfaction and toencourage those who are currently not part of the team to join.”

In 2005, BCVI organized a cooperative approach to provide con-sistency and efficiency to the process. Initially, several key San Anto-nio area hospitals, the Bexar County Medical Society, healthcareinsurers and the Greater San Antonio Hospital Council joined forcesto inaugurate the cooperative program for primary source verificationof physicians.

Through BCVI, all traditional users of credentialing informationin Bexar County can participate in a common database that elimi-nates duplication and needless expenses. The cooperative subse-quently expanded, and currently BCVI provides primary sourceverification for 73 clients across Texas.

Among BCVI’s largest local participants are the Methodist Health-care Systems, Southwest General Hospital, Warm SpringsRehab/Specialty Hospitals, as well as other area hospitals and health-care facilities.

To learn more about BCVI, contact Mary Jo Quinnat 210-582-6355, email [email protected] or visitwww.bexarcv.com.

BCVI FACILITATES CREDENTIALING FOR HEALTHCARE PROVIDERS


WHY I BECAMEA DOCTOR

The answer to “Why I Became a Doctor” is as complex andmultifactorial as it is individual and personal, but there are somecommon elements. An obsessive interest in the life sciences at anearly age is a must, of course, in order to plant the seed for furtherexploration of biology, biochemistry and, ultimately, medicine.

Also essential are the competitive drive and endless commit-ment and dedication needed to rise to the ultimate personal chal-lenge of completing the long and arduous training necessary toearn that all-prestigious medical degree, often overcoming diffi-cult obstacles in the process. (Not to mention the many years ofresidency and, in many cases, fellowship training, that follow.)As the saying goes, “Ad astra per aspera.”

But it is the answering of a calling, whether divine or otherwiseprofoundly metaphysical, that, in my opinion, best characterizesthe desire of aspiring physicians to achieve this profession of ulti-mate altruism in the advancement of healing and in the bettermentof the human condition. It is a calling not only to never stop learn-

ing, which is inevitable in the always rapidly changing field of med-icine; but also to use that knowledge, and any and all skills acquiredalong the way, to heal. Because only a calling, as with many otherprofessions of customer, community and public service, can justifythe incredibly long hours, unselfish devotion, mental taxation andpersonal sacrifice that medicine demands.

Furthermore, the reward, of course, lies not so much in theremunerative aspect, as in the ability to make a difference in thelives of others by helping to save such lives, stamp out disease,provide palliative care, alleviate suffering, or otherwise aid inhealing just by listening.

For me personally, being a doctor ranks among the mostheroic, noble and selfless undertakings of humankind.

Robert R. Ramirez, MD, is an internal medicinephysician with Gonzaba Medical Group.

‘Ultimate Altruism’By Robert R. Ramirez, MD



‘A Calling Within My Soul’By Wendy B. Kang, MD, JD

Some intellectually meander onto the road to medicine. Oth-ers like me know from the dawning moments of consciousnessto take the only path in life: that of becoming a physician. Pre-destination or a lucky chance?

While many young girls my age played with dolls, I doctoredmy teddy bear with dressings and tender loving care. Even inmy rural Taiwanese village, I took care of my classmates. Whenmy American elementary school classmate had the wind knockedout of him by a large, stiff, red rubber ball, I undid his collarbutton and laid him flat while sending another classmate to findour teacher. There was no panic, no fear, merely instinct to dowhat I thought needed to be done for Ricky’s sake.

Having no relatives to pattern my future professional behaviorafter, I lucked upon two family physicians who took care of meas I grew up in a small American town of 5,000. Dr. Vigor wasthe kindly white-haired G.P. who let me play with his white poo-dle in their backyard until his nurse/wife would call me into thehome office. Dr. Hodges was bald and no-nonsense who stillexuded great kindness as he carved out the wart from my fingerjoint. Both physicians looked after everybody in that small town;they were greatly admired. They are still my role models.

The tough road to becoming a physician never appears ardu-ous when you know it is your road in life. I had no doubts.Scholastic achievements, volunteering to help out veterans at thelocal VA hospital, participating in extracurricular club activities,or looking after an ill mother and active bratty brothers werenormal things to do; they were not activities to fill out on a fu-ture application form for medical school. In my naiveté, fouryears of university studies, four years of medical school and thenebulous years of residency were merely part of the price to bepaid for the privilege of looking after people.

I did know that I needed to be above reproach in my behavior,just like Drs. Vigor and Hodges. No self-respecting doctor

would use marijuana! Besides the ghastly possibility of being ar-rested for smoking pot, I did not want anything to cloud mymind nor obfuscate my path to medical school. My straight-as-an-arrow approach was described by an aunt as a calling withinmy soul.

As I approach my 35th medical school reunion, I muse uponall the cataclysmic changes in medicine. Bigger governmentalintrusions, more bureaucratic headaches, increasing quality as-surance pink sheets to fill out, learning computer lingo, facingconstant threats of medical malpractice lawsuits from disgruntledpatients who demand unrealistic perfect care and absolutely nopain after surgeries, less pay while working harder as I becomeolder — what rational person would voluntarily pick this pot-holed road in life?

The answer to that question is getting slightly iffier — until Ihear a “Thank you, doc.” Then I remember the first baby I per-sonally delivered as a third-year medical student, the sweet pa-tient who patiently tolerated my inept attempts to draw bloodout of anemic veins, or the alcoholic, chain-smoking obese pa-tient who claims I’m the first doctor to explain his health in away he understands such that he’ll work on taking better care ofhimself. I am a sucker for patients.

It’s relationships, connections to our patients, that keep usphysicians wanting to take care of them. Whether it is an in-nate calling within one’s soul or a thoughtful intellectualization,we understand the great privilege — and hard work! — in-volved in helping people as their physicians. Fortunately forus, there are many smart and idealistic young people gettingon the road to medicine.

Wendy B. Kang, MD, JD, is professor/clinical inthe Department of Anesthesiology at the University ofTexas Health Science Center San Antonio.



“Why did you become a doctor?” is a question I receive muchmore often than I expected. Most commonly, the underlyinginquiry relates to changes in medicine and whether I think prac-ticing medicine is worth all the “red tape.” I appreciate the ques-tion because it causes me to reflect upon why I undertook theyears of training and effort to become an orthopaedic surgeon.

I’ve always believed a job or profession is something to be en-joyed and appreciated. Growing up, I learned from my father, ageologist, what it meant to love a job. I never recall hearing himcomplain about his job, the long hours, or problems with clients.It was obvious he looked forward to work each day and relishedwhat he did. I never let myself imagine the possibility of not en-joying my profession, whatever that might be.

As a young adult, my passions and interests fueled my visionfor any future job. I considered ideas as varied as being a marinebiologist saving coral reefs, to coaching basketball, teaching kidsto love a game that meant so much to me. Then, as I headed tocollege, a theme emerged in my search for a profession as I foundmyself constantly curious about how things work. While thisinitially led me to engineering, which may seem very differentfrom medicine, I believe the common thread for me was to un-derstand why things happened and how I could improve them.During college, I took a job with St. Joseph’s Health System as aphysical therapy tech and wound care specialist and discovered

that medicine offered the opportunity I was looking for, with theadded benefit of making a meaningful difference in people’s lives.

But what about all the changes in medicine? While more ofmy time is spent dealing with insurance companies and regula-tions on how to run my practice, I still see my job as embracingthe same simple concept: help people meet their goals of ahealthy and active lifestyle. Although the main focus of theirtreatment is the art and science of medicine, I see these additionalchanges and hurdles physicians must conquer as pieces of oneconnected puzzle in treating a patient. I am emotionally moved,sometimes almost visibly, when I see my patients recover andable to get back to the life and activities that they love. It’s likea runner’s high; it keeps me coming back for more.

And, now, I am at that point I envisioned many years ago.Each day I wake up with my three wonderful kids, who see meenjoy my job and look forward to each day of work. It is thenthat I truly realize that all is right, and the years of training wereworth the effort, as my kids see what it means to be passionateabout a profession.

Brent Jackson, DO, is an orthopaedic surgeon at hispractice in orthopaedic hand and upper extremity sur-gery, Jackson Orthopaedics in San Antonio.

‘Understanding why things happenedand how I could improve them’

By Brent Jackson, DO



‘Expanded my practice by one species’By Fred H. Olin, MD

‘A familydoctor likemy Dad’By Lewis Rose, MD

In my case, I already had earned the title “Doctor” by becoming a veterinar-ian, something that had been my goal since I was about 12 years old. In mysix years in a small animal and zoo veterinary practice here in San Antonio inthe 1960s, there were several events that caused me to consider switching pro-fessions. Perhaps the most influential was the fact that there were economiclimitations on what we were allowed to do, even though we were educated andtrained and had the experience to do the treatment. An animal is a piece ofproperty, and the owner can do as he or she pleases with that property. Toomany times a case came along that was diagnosable and/or treatable, but thefamily would decline, and usually ask that we euthanize their pet … becauseeven the low prices prevalent at the time were perceived as too much.

Now, if it is a choice between feeding your children or fixing the dog’s frac-tured femur, there is no contest. But many times it was, “He’s just a dog (orcat). Go ahead and put him to sleep. We’ll get another one.” Along cameChristmas week of 1967, and there was a whole series of these events. Thatweek sort of pushed me over the edge.

During 1967 another factor was that the local medical school was comingalong in its organization. I had done some research and realized that I had allthe prerequisites for admission, except for two math courses. I took them atSan Antonio College and aced them both … much to my surprise. I knew myown psyche enough that if I didn’t make the effort, I’d always regret it.

Here’s a quotation attributed (probably incorrectly) to Mark Twain:“Twenty years from now you will be more disappointed by the things you

didn’t do than by the ones you did do. So throw off the bowlines. Sail away fromthe safe harbour. Catch the trade winds in sails. Explore. Dream. Discover.”

I applied for the class that matriculated in 1968, but my application was late.The Dean of Admissions, Joe G. Wood, PhD, interviewed me and asked meto reapply for the 1969 class, and told me that applications opened on July 1,1968. I was busy, had a family and a mortgage and friends and activities andgreatly enjoyed the practice of veterinary medicine, so I didn’t submit the ap-plication on the first of July. About two weeks into July, Dr. Wood called andasked where my application was. I sent it in, and somewhat to my wife’s con-sternation, I was accepted and eight years later was turned loose on the unsus-pecting public.

I am asked fairly often if I regret making the change. The answer is a re-sounding “NO!” The next question is usually along the lines of, “Which edu-cation was harder?” That’s unanswerable. Neither was easy. Although the basicknowledge is the same, the emphases are different in the two professions. Myusual response includes the line, “I just expanded my practice by one species.”

Fred H. Olin, DVM, MD, is a semi-retired orthopaedic surgeonwho had the pleasure of taking care of some of his veterinary clientswhen he was in practice.

My father was a gifted and well-recognized fam-ily doctor in Britain. When in 1938 he and hispartner rebuilt and expanded their office behindour home, I was fascinated by the architect’s plansand watched the plans translated into brick andmortar reality. I decided I wanted to be an archi-tect. Four years later I decided that the math of ar-chitecture was beyond me, so I chose to be to be afamily doctor like my Dad. I graduated from med-ical school just before my 24th birthday, andearned my first paycheck as a locum intern twoweeks later. I retired last year, just a few weeks shyof my 84th birthday. I enjoyed every day of beinga physician for almost 60 years.

Lewis Rose, MD, is a BCMS LifeMember.



There are many reasons to seek a career in the medical profession.To get rich is not a good one, and there are easier and shorter routesto riches than medical school, residency and years of practice. Onthe other hand, some of our colleagues are doing better than youmight think.

Of the following, which drug do you think has the SMALLESTmarketing budget: a revolutionary new oral medication that allowsyou to treat hepatitis C without the discomfort and misery of in-terferon, an injectable biologic treatment for arthritis that has beenavailable for over a decade, or a new “oral biologic” that has closeto a 50 percent side-effect rate and on its best day is slightly betterthan placebo? The answer is the first medication described because,to some extent, it will “sell itself ” and big budget advertising isn’tnecessary.

The highest marketing budgets go to “me too” medicationswhich have stiff competition with other products in their class andto medications which are not especially effective when used in yourclinical practice. That is because marketing is meant to convinceyou, the prescriber, to give their product a go, and to tell you thateven if the efficacy is not great and even if there are other effectiveand cheaper alternatives, this is something your patients need andwant. Part of that marketing, occasionally billed under the expen-diture category of research and development, is the employment ofyour fellow physicians and key opinion leaders (KOLs) in your spe-cialty to write the articles, develop the practice guidelines, give theseminars, and appear at your local society meetings to sing thepraises of the “latest and greatest.”

CONFLICTS OF INTERESTAnyone who reads their journals for the latest practice guidelines

must first wade through at least a page of stated conflicts of interest.Every acknowledged KOL has taken some money some time fromindustry. It is the rare industry-sponsored meeting that can makeany claim to represent unbiased continuing medical education, andmost are now done by consultants who have a company-preparedPowerPoint presentation that, if they are to be paid, must be pre-sented exactly as it is put together with all the graphs, charts anddata that will tend to make your eyes glaze over as you enjoy thatsteak dinner. These presentations give you the message that,whether this is a new product or an old one that has been slightlyreformulated and repackaged, this is what you should be using ifyou really care.

Until recently, there was no way to tell how beholden yourspeaker was to the company picking up the tab, but now there

are options to clear the smoke and make more plain whetheryour speaker is just an expert who had the time to tell you whatis really new or a KOL who really should be more properly con-sidered an over-educated (and overpaid) pharmaceutical detailrepresentative.

An excellent website worth consulting before you head to the“educational program” at a local steakhouse is Dollars for Docs(http://projects.propublica.org/docdollars/). You key in thespeaker’s name, and you not only will find out how much they aregetting from the pharmaceutical industry but how much specifi-cally from this meeting’s sponsor. Sometimes you need to checkother versions of someone’s name (Ted vs. Theodore) to get thewhole picture, and you usually will have to use the speaker’s firstname even if they go by their middle name.

You also can search by facility name if you want to see how mucha research organization or a medical school is getting from industry.Not all companies participate in the program yet, and it seems tobe months between updates so not every dollar spent is reported.There are state and national laws coming into effect that will con-tinue to make this industry-physician economy more transparentand accurate reporting a requirement for doing business.

SHOWING GRATITUDEThis is not to say that just because a speaker gets $20,000 or

$30,000 a year from Company X that they will necessarily betelling lies on behalf of the product. Some of your speakers mayhave been researchers who developed the product and may feelquite passionately about the value of the treatment.

On the other hand, it must be recognized that we are taught frombirth to show gratitude for what we are given. If one is not legallyrequired to mention those pesky negative studies (and they aren’tincluded in my pre-packaged slideshow), why would I do so? I alsomight gloss over side effects that don’t rise to the severity of “blackbox” warning, even if they are going to afflict dozens or hundredsof your patients.

Also, if I am being paid thousands to talk to you over a steak anda glass of wine, I might forget to make sure you really understandthat if the product shows 50 percent improvement and placeboshows 35 percent improvement, that the true efficacy is only 15percent. I’m only human, right?

Jeffrey Meffert, MD, is a dermatologist at the Univer-sity of Texas Health Science Center San Antonio.

‘I didn’t go into medicine for that!’By Jeffrey Meffert, MD

Matin Tabbakh is well known for his “Make it Happen” attitude. He has been actively involved

in the Real Estate industry for over a decade. Having experience in both Luxury Residential and Com-

mercial properties, Matin has a proven record of Excellence! He has earned a Broker’s Real Estate Li-

cense which is the highest professional licensing in the state of Texas and an Accredited Luxury Home

Specialist (ALHS) designation; he is an active member of the CCIM Institute (Certified Commercial In-

vestment Member) as well. Matin’s real estate education, business academics and experience are ex-

ceptional; his success comes from his unsurpassed need of excelling at what he does!

Matin’s expertise in the Luxury and Commercial market makes his knowledge priceless! If you want to

achieve outstanding results, call Matin for a private consultation.

Matin Tabbakh, PhD, Realtor®/BrokerKuper Sotheby’s International Realty

4 Dominion Drive, Building #2

San Antonio, TX 78257

[email protected]

www.SALuxuryRealty.com

(210) 772-7777


LIFESTYLE

In short, they’re turning whole hogs intocharcuterie: prepared meats (often but notexclusively pork) preserved to lock in theirflavors. Think of it as the all-meat version ofa cheese platter: an assortment of texturesand tastes best experienced with sweet orsharp accompaniments to cut the richness.

Preserved meats predate the refrigerator byhundreds of years, and the styles most pop-ular today were first cured and eaten bySouthern European peasants. The local chefsprofiled here each work with a strong senseof classic French, Spanish and Italian tradi-tions while adding modern style and distinc-tively Texas-forward flavors to theircharcuterie boards. They each use every lastbit of animals ethically raised at area farms— all with the end goal of amusing and evensurprising their customers’ taste buds.

CONTIGO AUSTINPhotography by KNOX PHOTOGRAPHICS

This East Austin wonder takes relaxeddining seriously so you can take it easy. Itsmenu encourages splitting and sampling sev-eral small portions, which chef/owner An-drew Wiseheart describes as a selfish design“because it’s the way we like to eat.” But

honestly, we’re just happy he’s generousenough to share his ranch-inspired cooking.

Find a spot at a picnic table under a stringof lights and pick and choose from the char-cuterie options as you please. With the ex-ception of the pork liver pâté, the menuchanges daily but typically lists five of theseven to 10 items in rotation at Contigo.

“People like that they can try somethingfor $7 rather than make a $20 to $30 com-mitment,” Wiseheart said. “We offer our

items a la carte so that we can create a com-posed dish out of each item. We start withthe main ingredient and create a dish aroundthat depending on the ingredients and theflavors and how rich it is.”

That pork liver pâté? Its texture is comple-mented by eggplant fritters drizzled withhoney from the restaurant’s namesake ContigoRanch and served with a toasted baguette.“Once you put everything into a bite, it’s allreally harmonious,” Wiseheart said.

Face bacon is another Contigo mainstay.Here’s the process: A hog’s entire head is sea-soned and cured like bacon, then rolled up,smoked, cured and sliced thinly. The fin-ished product is “a really pretty slice with lotsof textures because the tongue and ears havelots of cartilage.” Pickled tomatillo andarugula add both acidic and peppery flavors,Texas-style. Give it a shot. You’ll most likelylove it — and you get to say, “I ate facebacon for dinner.”Contigotexas.com | 512.614.2260

CUREDPhotography by DAVID RANGEL

Sure, Cured deals in cured meats, butthere’s more to the name than that. After

CHARCUTERIEBy Beth Bond

Say you’ve got a whole pig on your hands and you’re feeling bold. How do you coax out

the most intense flavors using only salt, a few spices and the umami-producing magic of time?

This is the challenge readily accepted by a handful of chefs in Central Texas, and their answers range from

rillettes and pâté to sausage and even face bacon. Yes, face bacon — keep reading and we’ll explain.

CONTIGO

CONTIGO

The Art of


LIFESTYLE

learning the restaurant ropes in New Orleansworking with John Besh for 10 years, SteveMcHugh relocated in 2010 to run a neweatery for the acclaimed chef in San Antonio.Around the same time, he was diagnosedwith lymphoma. He calls the move“serendipitous — because I couldn’t get thecare I needed back in New Orleans.”

He went through treatments of chemother-apy, got cured and then got Cured.

“When you have that kind of scare in yourlife, you reevaluate,” he said. “My wife and Idecided to do something on our own. Some-times things like that jumpstart you.”

Since December of last year McHugh’sbeen making what he calls “the best hamyou’ll find in San Antonio,” plus bloodsausage, braised kidneys, a super-popularsmoked duck ham, bresaola and more in agiant custom-built curing case that greetscustomers as they step through the door. Theseasons dictate the daily changes in theSouthern-style menu, which features charcu-terie made from all parts of a hog because,McHugh said, “there’s no such thing as apork belly farm.”

As Cured’s curator, McHugh creates hischarcuterie boards as a mix of animals —from a lamb-and-citrus terrine to venison toa “very approachable” chicken liver mousse— plus housemade brewer’s crackers flavoredwith coriander and cumin, mustard, mar-malades and pickles of cucumbers, broccoli,cauliflower, pumpkin and more. One of thechef/owner’s favorite items? Whipped porkbutter. “I don’t know of anyone who is doing

that,” he said. “It eats like butter and lookslike icing. I spread it on cornbread but I’veseen people put the whipped pork butter ona sausage. “There’s no wrong way to eat it.”Curedatpearl.com | 210.314.3929

LÜKEPhotography courtesy of BESH RESTAURANT

GROUP

At Luke San Antonio, the recipes havebeen around the world, but the food is fromright here. “It’s the food of the Alsace regionof France and Germany mixed with Texas in-gredients and a whole scoop of New Or-leans,” said executive chef John Russ. “Outof all the menu items, 100 percent of thatplate comes from within 65 miles from us —with the exception of the glass of the plate.”

Whole animals are transformed intopancetta, ham and sausage, and sometimesthe process takes up to a year. “It’s so fun be-cause we can show people the product at dif-ferent stages,” Russ said. “We’re not buyinga Cryovaced product and opening it up. Webuy it from producers and let it hang andcure it.”

A selection of about five charcuterie itemsvaries, but two constants are a pâté de cam-pagne of pork shoulder and a chicken andrabbit liver mousse (“earthy, buttery andspreads so nicely on toast,” Russ raves). Awintertime special is hog’s head cheese, asemigelatinous forcemeat that’s great spread

on a saltine or a po-boy. If the name givesyou pause, here’s the chef speaking in termswe Texans can understand: “It’s bursting withflavors and textures and it’s like the best bar-bacoa that you’ve ever had.”Lukesanantonio.com | 210.227.5853

SALT & TIMEPhotography by ROBERT LEMA

Sometimes you don’t have to pick betweenquality and quantity — at Salt & Time, youget both. This capital city lunch-and-dinnerspot is also a full-service retail butcher thatan produce 80 to 100 different types of char-cuterie items, with 40 to 50 of those availableon any given day.

“We do a lot of things but try to do themall well,” co-owner Ben Runkle said humbly.

Order a salumi board to sample a varietyof meats or try putting charcuterie to use an-other way: as a component of entrees likepastas or sandwiches. Runkle suggests addingcoppa, which is cured pork shoulder, to ri-cotta gnocchi or slathering spicy, spreadablesalami called n’duja tejano to your burger.

Hankering for those Texas flavors? Salt &Time uses classic techniques to create curedmeats with a local flavor profile. Try thepecan-studded salami or the salami flavoredwith chili pequin and Mexican oregano.saltandtime.com | (512) 524-1383

CURED

LUKE

SALT & TIME


LIFESTYLE

Destination:

WashingtonCountyBy Julie Catalano

Named for the father of our country, Washington County is a top destination forhistory buffs, antique hunters, music loversand wildflower enthusiasts. Small towns with evocative names like Independence,Mount Vernon and William Penn dot therolling landscape in southeast Central Texas,and the county seat of Brenham draws visitors to its historic downtown. Visit aworking ranch, attend a world-renownedconcert series, or enjoy a quiet stroll througha history-making spot by the Brazos River —none other than the birthplace of the Lone Star State itself.

visit us at www.bcms.org 27visit us at www.bcms.org 27

LIFESTYLE

2015 ROUND TOP MUSIC FESTIVALMay 31-July 15 • Round Top • Festivalhill.orgPhotography courtesy of Round Top Festival Institute

Every summer, the tiny town of RoundTop turns into a classical music Mecca thatdraws audiences from all over Texas andbeyond with the Round Top Music Festi-val, an internationally acclaimed gatheringof renowned conductors, esteemed facultyand brilliant young talent. Celebrating its45th year, the Round Top Festival Institutewill once again host a dazzling array ofmore than 30 concerts from May 31-July15, featuring a diverse repertoire from an-cient to 21st century music.

Internationally acclaimed concertpianist,founder and artistic director JamesDick can hardly believe this signature Texasevent he created in 1971 has spanned almostfive decades, but the success of his brainchildis indisputable. In addition to the physicalgrowth of the Festival Institute campus to a200-acre haven of gardens, historic build-ings, library and museum collections, Dickis both proud and happy to witness thegrowth by leaps and bounds of the FestivalInstitute’s reputation, putting it on par withlegendary music festivals at Tanglewood and

Aspen. Of the 700 applications the FestivalInstitute received this year, about 98 were ac-cepted to study and perform.

They’ve also made full use of socialmedia, he says, adding that their YouTubechannel has more than a half million views.Still, there’s no substitute for the real thing,and that includes the experience of attend-ing performances in what is unquestion-ably one of the most architecturally andacoustically perfect venues anywhere —the magnificent 1,000-seat Round TopConcert Hall.

“It’s like sitting inside a glorious instru-ment,” he says, “and hearing that soundwhether it’s orchestral or choral.” Dick sayshe gets outstanding feedback from visitingconductors who have played some of thegreatest venues in the world. “It trulystands out as one-of-a-kind. It was builtand fashioned by hand, the wood cut ei-ther with a knife or router, every inch ofit.” If you miss the summer series, you canmake plans for the April to August serieswhich can include everything from West-

ern music to the holiday favorite The Nut-cracker ballet.

Visitors are enthralled not only with theconcert hall but also the ambiance of thegrounds, with one of the highlights beingthe 1883 Edythe Bates Old Chapel. Thevarious flora are also popular, most notablythe McAshan Herb Gardens, along withherbs, medicinal plants, roses and more.Year-round events at the Festival Instituteinclude forums in theater, museums, po-etry and herbs.

Growing up in Kansas, James Dick sayshe’s always loved nature. “I even sold veg-etables door to door so I know the value ofland and how precious it is. I wanted aplace that the public could enjoy as a greenspace. Over the years we have planted24,000 trees.” He delights in the surround-ings and hopes that audiences do, too.“Where else can you picnic on real grassunder glorious live oaks and then walk afew feet into a concert hall of such magnif-icence?” No place but Round Top.

For program and ticket info, Festivalhill.org, 979.249.3129

Continued on page 28


LIFESTYLE

Continued from page 27

WASHINGTON-ON-THE-BRAZOS STATE HISTORIC SITE,WASHINGTON, BIRTHPLACEPhotography courtesy of Brenham/WashingtonCounty Chamber and Convention & VisitorsBureau

On March 2, 1836, a group of Texas del-egates met at a hall by the Brazos River, de-clared independence from Mexico and arepublic was born. The aptly-named Wash-ington-on-the-Brazos is a significant andpopular spot that draws nature lovers, bird-watchers, picnickers and anybody interestedin standing at the spot where the Texas Dec-laration of Independence was signed. Expertand knowledgeable guides make historycome alive as they take visitors through whatled up to that historic event. The award-win-ning Star of the Republic Museum showcasesa fascinating collection of cultural artifactsfrom 1836 to 1846.

Don’t leave without driving over to Bar-rington Living History Farm where the orig-inal restored home of Anson Jones — the lastpresident of the Republic of Texas — featurescostumed interpreters of life on a 19th cen-tury farm. Admission fee: Combo tickets areavailable for Independence Hall, Star of theRepublic Museum and Barrington Farm.

BRENHAM VISITBRENHAMTEXAS.COMAntique Rose Emporium photo by Mike Shoup

The county seat of Washington County,Brenham makes an ideal base from whichto explore the nearby sights. The charmingAnt Street Inn (antstreetinn.com) is a long-time favorite in the heart of downtown. Stopat Must Be Heaven (mustbeheaven.com) for

freshmade soups, sand-wiches and pie straightfrom the pastry gods.Ranch Interiors (ranchin-teriorstx.com) specializesin custom ranch, modern,Western and transitionaldesign. And no visit toBrenham is completewithout a trip to the en-chanting Antique Rose

Emporium (antiqueroseemporium.com),where “Rose Rustler” and owner Mike Shoupwill regale with tales of “rescued” roses fromdays gone by.

TEXAS RANCH LIFE CHAPPELL HILLTEXASRANCHLIFE.COM

No drugstore cowboys here — this is thereal deal. Warm and welcoming owners Johnand Taunia Elick have preserved a workingranch and opened it to visitors looking foran authentic ranch experience. Nine historicTexas homes from the 1800s were savedfrom demolition, carefully moved to theranch, and restored and decorated with an-tiques, rugs and unique Texas furnishings toserve as well-appointed residences forovernight guests (the largest sleep up to 10or 13). Activities are extra and include dayfishing, mountain biking, skeet shooting andopen range horseback riding for all skill lev-els, undoubtedly one of the most popular

pastimes on the 1,800-acre ranch that fea-tures one of the largest covered horse arenasin the state. Six organic gardens supply thekitchen with fresh produce. A nice down-home touch is the “meet the horses” sectionon their website, with notes from the ranchhands, pictures of the nursery, the moms andhorses in training.

THE INN AT DOS BRISAS,WASHINGTONDOSBRISAS.COMPhotography courtesy of The Inn at Dos Brisas

Luxury to the max. There’s no other wayto describe what began as a ranch retreat andgrew into the ultimate indulgent (and ultra-romantic) stay. The only Forbes five-starrestaurant in the state is here, with a 7,000-bottle wine cellar that earned “Wine Spec-tator” magazine’s Best of Award ofExcellence. An eight-course grand tastingmenu is served on custom Bernardaud chinain an elegant but relaxed dining room in themain building. The inn touts its 42 acres(out of 300 total) of organic farms that pro-duce vegetables, herbs and fruit that turn upon both your plate and in creative cocktails.Accommodations are off-thechart gorgeous— nine individual haciendas and casitas fea-ture overstuffed leather chairs, stone fire-places, steamshowers, luxelinens, pri-vate patiosand golf cartsshould youneed to getto the infinitypool, tenniscourts or totake a cook-ing or wineclass. Golfprivileges areavailable atnearby clubs. Better yet, stay “home” andhave an in-room massage.

For more info, Visitbrenhamtexas.com.

Plenty to see, do, buy, and try,

So stay and play for a while:

visit us at www.bcms.org 29visit us at www.bcms.org 29


LEGAL EASE

I’ve heard these two questions so often over my career that I’vejust got to use that hackneyed, old expression of, “If I had a dimefor every time X happened, I’d be a millionaire by now.” Maybethat’s an overstatement, but it’s not far from the truth. I get thesetwo questions about once every week from some doctor, some place.Let me try to put them to rest.

Exactly what are these two questions? The first one is the phonecall I routinely receive in which a doctor has been asked to testify.Sometimes it’s a deposition. Sometimes it’s for a trial. Maybe it’s arequest that some attorney is making over the phone or by letter.Or maybe the doctor has received a subpoena demanding he appearat such-and-such a place and time to testify. The doctor wants toknow: “Do I really have to do this?”

The second question follows from the first. How much money,if any at all, can the doctor charge for testifying? There are somefollow-up questions and practice pointers you may not have con-sidered that I’ll also address. This is the first of a two-part articleintended to tackle these issues. Let’s begin with the first issue.

QUESTION ONE: DO I HAVE TO?If you are somehow involved, even peripherally, in a legal dispute

between two or more people, the answer is usually yes, you have totestify. Sorry, but there you have it. Let me give you an analogy.If you were walking down the street and saw a car run a red lightand hit another car, like it or not, you’re an eyewitness to the event.You can be required to come to court and tell the jury what yousaw. Just like a district attorney could call you to testify in a criminalcase if you happened to see a burglary or some other crime. Youcan be subpoenaed to testify for any case as to what you saw orheard. You’re an eyewitness.

Similarly, if you’re a treating physician of a person involved in alegal dispute, you can typically be required to testify in that capacity.Let me give you some examples. A person is hurt in an accident,and you provide medical care. Your patient files a lawsuit concern-ing those injuries which has the legal effect of waiving his right tophysician/patient confidentiality. Either his attorney or the defenseattorney could require you to testify about your care of the patient.If you won’t do it voluntarily, they can drop a subpoena on you andmake you do it. You’re a medical eyewitness to an event relevant tothe lawsuit. You can be required to testify as to the patient’s condi-tion, what your treatment was, how he’s doing now, and so forth.

Or suppose you’ve been caring for a patient for years, and he’s in-volved in a custody dispute as part of his divorce. If part of your careinvolved treatment for addiction, mental illness or other issues per-taining to his suitability to care for a minor child, you might be re-quired to testify. I could go on with many examples but the point issimple. You are like the guy who witnessed the car crash. Or the bur-glary. As an eyewitness, you are uniquely positioned to help the jurydecide the case, and the law requires that you share that knowledgewith the jury whether you want to or not. The same principle applieswhen you are the eyewitness to medical care you provided to a patientif that care somehow is relevant to the legal dispute.

So, the short answer to, “Do I have to?” is yes, IF you are theequivalent of a medical eyewitness to an issue of relevance to thelegal dispute.

Here’s a little caveat to subpoenas. They have an effective “range”of no more than 150 miles from where you reside or where you’reserved. In other words, you can’t be required to travel more than150 miles from where you live or where the subpoena is deliveredto you. A Houston attorney handling a Houston case can’t forceyou to come to Houston to give a deposition about a patient youtreated. However, that same attorney could just drive over to SanAntonio and, using a subpoena, make you testify in San Antonio.You haven’t avoided testifying. You just avoid having to travel morethan 150 miles to do it.

Now, let’s assume you’re not a “medical eyewitness,” but, instead,have nothing to do with the case or any of the parties. If you’ve gotabsolutely nothing to do with the patient or the case, then you can’tbe forced to testify. You don’t have to. This question arises whensome attorney is trying to get you to be an expert witness on someissue relevant to a lawsuit or pending claim. They want you to re-view something and render an opinion on some issue. The answerto whether you have to do that is a resounding no. The choice is100 percent yours. Nobody can force you. You can’t be subpoenaedor otherwise made to do it unless you agree.

Now, with that behind us, next month we’ll discuss just howmuch, if anything, you can charge for testifying.

George F. “Rick” Evans Jr., is the founding partner ofEvans, Rowe & Holbrook. A graduate of Marshall Col-lege of Law, his practice for 36 years has been exclusivelydedicated to the representation of physicians and other

healthcare providers. Mr. Evans is the BCMS legal counsel.

‘Do I have to?’ and ‘How much?’Part I of IIBy George F. “Rick” Evans


UTHSCSADEAN’S MESSAGE

This month I will highlight the work of another recent out-standing addition to our faculty: Dr. Manzoor Bhat, professor andchairman of the Department of Physiology and the Zachry Foun-dation Distinguished Chair in Neurosciences. A major focus andlongstanding interest of Dr. Bhat has been to understand themechanisms of how nerve cells break down in the nervous systemand interrupt the conduction of signals across their length, ulti-mately leading to many debilitating symptoms and diseases in-cluding multiple sclerosis (MS).

Dr. Bhat’s scientific curiosity started as a young boy, when hefirst noticed that tadpoles lose their tails and grow legs as they de-velop into frogs. His father, a veterinarian, encouraged his son’sexploration and loaned him the tools to dissect frogs. That cu-riosity expanded as he grew up, and led to a career in science. Heobtained his master’s degree in biochemistry and graduated fromhis university with a gold medal and distinction. He then gradu-ated with a joint Ph.D. degree in molecular biology from the pres-tigious Indian Institute of Science, Bangalore, and in biochemistryfrom Shiga Medical University, Japan. He began his postdoctoraltraining at the Howard Hughes Medical Institute, Departmentof Molecular and Human Genetics, at Baylor College of Medi-cine, Houston; later he became a Howard Temin Fellow of theNational Cancer Institute. Before joining our school in 2012, heheld many positions, including professor and interim associatechair of the Department of Cell and Molecular Physiology, andmember of the Neuroscience Center and Carolina Institute forDevelopmental Disorders at the University of North CarolinaSchool of Medicine.

FRUIT FLIES STUDIEDDuring the mid-1990s to 2000, Dr. Bhat and his collaborators

worked with genes that affect the development of the peripheralnervous system in the fruit fly, Drosophila. Three specific genessuspected in nervous system disorders had been identified by othergroups, but not much follow-up had been performed to fully es-tablish their roles in nerve cell development. As we know, fruitflies have a very fast generational cycle, and they are easier formost genetic manipulations than many other research models. Dr.Bhat’s team first used immunofluorescent methods to identify thelocation of the newly identified proteins in the fly nervous systemand then targeted them for genetic mutations to determine theconsequences of their loss on their development. Upon removalof these specific genes (knock-out mutations), they observed spe-cific nervous system dysfunction in various stages of fly develop-ment and also in adults. These neurological dysfunctionsresembled characteristics of MS and similar human diseases.

MS affects nearly 2.5 million people worldwide. In MS, theimmune system attacks the insulating membrane (the myelinsheaths) of the nerve axons that carry signals for long distances.Ultimately, nerve conduction becomes severely compromised, aprocess that is currently deemed irreversible. The damaged myelinforms multiple scar tissues (sclerosis) in the brain, spinal cord andoptic nerves, giving the disease its name.

Signs and symptoms of MS patients vary widely depending onthe amount and neuroanatomic location of the damage. Somepeople with severe MS might eventually lose their ability to walk,while others experience long periods of remission during which

By Francisco González-Scarano, MD

Dr. Manzoor Bhat


UTHSCSADEAN’S MESSAGE

they have no symptoms. The disease is thought to be triggeredin a genetically susceptible individual by a combination of one ormore environmental factors. While there is no current cure forMS, treatments can help speed recovery from attacks, modify thecourse of the disease and allow better management of symptoms.Treatments for MS target the immune system and are generallycalled immunomodulators.

A basic nerve cell consists of dendrites on the receiving end, acell body (soma) and a long, thin axon that runs to the terminalend. The axon has an insulating sheath made up of specializedglial cells known as myelin that covers its entire length leaving in-termittent gaps that are devoid of myelin. The thick multilayeredmyelin sheath facilitates fast conduction of nerve impulses inaxons and is therefore critical for fast signal transmission andproper function of axons in the nervous system. The gaps pro-mote this conduction (saltatory conduction). As Dr. Bhat’s teammoved from the fruit fly model to targeting the genes in mousemodels, they focused on uncovering the specific molecular mech-anisms of the nerve dysfunction and came to realize that it wascaused by a breakdown of the axon’s myelin sheath.

MOUSE MODELSDr. Bhat’s research has focused on close to 10 genes, and

demonstrated the resultant neurological dysfunction after theirmanipulation. Their work continues to focus on the genetic andmolecular basis of the highly complex and intricate interactionsbetween the neurons and glial cells in the nervous system. Glialcells not only play a key role in axonal insulation for proper andfast transmission of nerve impulses, but also in blood-brain barrierformation and axonal guidance.

Part of Dr. Bhat’s research in mouse models is to determinehow long the axon remains functional in the process of myelinbreakdown. Many questions emerge, such as: At what point doesthe damage significantly compromise motor function? At whatpoint(s) can the process be halted or reversed? At what point isthe loss of function simply beyond recovery? Where is the thresh-old for “rescuing” a paralyzed mouse? What is the treatmentprocess for rescuing a paralyzed mouse? Can one get it to thepoint of being able to ambulate again?

Addressing these questions requires a genetic strategy, which isalso a significant part of Dr. Bhat’s work now. Regrettably, it takesyears of meticulous experiments. Determining a terminal break-down threshold of the axon — and a successful therapeutic in-tervention before that threshold is reached – is an important goalnot only for MS, but has implications in many other neurologicaldisorders, from Parkinson’s disease to ALS and spinal cord injury.

It has taken Dr. Bhat’s team a decade to systematically knockout the genes of interest to prove that each was necessary and suf-

ficient to impair nerve function. One of the challenges posed bythe knock out mice was that they had a short lifespan, so Dr.Bhat’s team had to find a way to take a healthy adult mouse witha certain genetic makeup, and knock out the gene in these adults.They devised a strategy to suppress the gene(s) after the mice weremature. The mice would then take approximately three monthsfor the symptoms to materialize.

Currently, one of the goals is to “turn the genes back on” andsee if the nerves are able to recover their function. Will thesenerves function after 30, 60 or even 90 days of no function? Thisresearch has the potential to provide clues for axon recovery inpatients with MS, and hopefully will lead to therapeutic remedies.Dr. Bhat’s team is looking into all aspects of the equation: thepathology and the time course of deterioration, how the post-synaptic tissue processes work, and how to halt and/or reverse thelack of function on the receiving end.

INSPIRED HIS DAUGHTERDr. Bhat always gives all credit to his mentors, trainees and col-

laborators, which include a dedicated team here, and researchersat NYU Medical Center, UNC at Chapel Hill, University ofChicago and Virginia Commonwealth University, as well as tohis continued federal and private funding. He is supported bygrants from the National Institutes of Health, the National Mul-tiple Sclerosis Society, the Zachry Foundation for NeuroscienceResearch, the Simons Foundation as well as generous funds fromthe School of Medicine at the Health Science Center.

All of the work his team and collaborators have performed iscataloged in a number of seminal publications in various high-profile journals, including Nature, Neuron, Cell and The Journalof Neuroscience, as well as in many others. Some of his work hasappeared on the covers of these journals, which adorn his office.

On a personal level, Dr. Bhat has successfully inspired hisdaughter, Heba, who is now a neuroscience major at UT Austin,who no doubt has inherited the genes to also be a terrific scientist.We are fortunate to have him among our faculty, and his workhas a tremendous potential to help many people with neurologicaldisabilities around the world. To read more about his research, orcontact him, please visit our website athttp://physiology.uthscsa.edu .

Francisco González-Scarano, MD, is dean ofthe School of Medicine, vice president for medicalaffairs, professor of neurology, and the John P.Howe III, MD, Distinguished Chair in HealthPolicy at the University of Texas Health ScienceCenter at San Antonio. His email address [email protected].


BUSINESS OFMEDICINE

When discussing productivity with respect to a profession, it

usually is part of a conversation with respect to compensation,

and this may apply to both “employed physicians” and “physician

owners in group practices.” The purpose of this article is to pro-

vide some information as it relates to the topic of physician pro-

ductivity. It is not meant as the last word on the topic, nor is it

intended to be comprehensive in nature, but it can serve as a sort

of primer on the subject both for physicians and others who are

interested in the topic.

INTRODUCTIONIn most professions, to include healthcare, the term “produc-

tivity” is used as a measure of output (e.g., widgets, cars, or patient

visits) that can be produced given a combination of inputs (e.g.,

number of employees, hours worked and machines). Productivity

can be measured for a specific input, such as labor, or one may

consider the productivity of a system — i.e., productivity related

to spending in a hospital, physician practice, health system, or

within a country — by studying the output achieved for a given

amount of resources devoted to healthcare.

Like life, the issues related to productivity usually begin and

end with some form of measurements. What did the baby weigh

and what was its length at birth? How old was she when she

passed away? Our development and progress through life, school

or sports, is associated with some form of measurement against

something or someone. The use of measurements is usually a

means of improving a person or situation. An employee’s annual

review is designed to determine if they have met their objectives.

Raises or bonuses may be based on meeting objectives and com-

parisons to peers. Now consider patient care. If a child’s weight

is off the age-height-weight scale at a well-baby visit, the parents

are counseled in an attempt to bring the child to a healthy weight.

If an HbA1c result is high compared to norms, the diabetic pa-

tient’s medications and diet are managed more closely.

To be an effective clinician, one must understand many clinical

values, and to be an effective manager, you must understand many

business values. As a provider, you are responsible for monitoring

not just the health of your patients but also the health of the clinic,

practice, or facility in which you work. You also may have respon-

sibility related to mentoring peers or managing other providers.

Your compensation also may be tied to productivity and quality

measures. Optimal patient care should be the primary objective

in any medical practice, clinic, or hospital, but the financial suc-

cess of the practice is also critical. A business or practice con-

stantly in the red will, at some point, cease to exist and will no

longer be able to provide patient care. By having a better under-

standing of the various performance measures used to determine

a practice’s health, a provider can do his part to keep the

practice/business viable, even thrive, and remain functioning in-

definitely for the patients they serve.

Concepts to consider whenmeasuring physician productivityBy Joseph P. Gonzales, MHA, FACHE, PMP


BUSINESS OFMEDICINE

Productivity and efficiency are closely related. However, they

are distinct from quality and service. A provider may be very pro-

ductive and very efficient, but the quality of his or her work can

be very low. For example, if the provider sees 10 patients in two

hours yet does so in such a way that none of the patients’ concerns

are addressed and the patients leave the visit feeling like their con-

cerns were not addressed, then the quality of the provider’s work

may be considered low, even though the productivity and effi-

ciency are high.

EXISTING MEASUREMENTSOne traditional measure is the number and types of patient vis-

its. The number and types of patient encounters says nothing

about the efficiency of the provider, so this measure is often ac-

companied by measures of time. For example, how many total

hours did the provider work? How many hours were spent in di-

rect patient care or on-call? Combining patient visits with meas-

ures of time allows for measurement of efficiency (visits per hour)

as well as productivity.

Another measure of provider productivity is dollars generated

to a practice. Traditionally this was measured by charges for serv-

ices rendered. With the prevalence of discounted fee-for-service,

collections may be a more accurate measure of dollars generated.

This measure is also limited since it is highly dependent on the

patient’s type of insurance coverage. Two providers providing the

same services may generate entirely different collections for the

practice depending on the payer mix of their patients.

Similarly, measures of time and patient encounters suffer from

the limitation that, conceptually, not every office visit or time

period spent with a patient is the same. For example, an office

visit for treating tinea pedis with topical therapy is not the same

as an office visit to evaluate and manage a patient’s complaint of

chest pains. Likewise, an hour spent providing critical care in

the hospital is not the same as an hour spent counseling a patient

in the office.

Today, provider productivity and compensation are moving to-

ward models based on Relative Value Units (RVUs). RVUs reflect

the relative level of time, skill, training and intensity required of

a physician to provide a given service. This is a method for cal-

culating the volume of work or effort expended by a provider in

treating patients. A well-patient visit, for example, would be as-

signed a lower RVU than an invasive surgical procedure. In this

case, “work,” rather than number of patients or billings, is the be-

havior being measured and rewarded.

In 2007, the Medical Group Management Association’s

(MGMA’s) Physician Compensation and Productivity Report in-

dicated that 16 percent of group practices used an RVU formula

to calculate physician compensation and productivity. This same

report also showed that 34 percent of physicians had their com-

pensation/productivity tied to RVUs. In MGMA’s 2010 report,

in comparison, 35 percent of group practices were using RVU

compensation/productivity metrics, and 61 percent of physicians

had their compensation/productivity tied to RVUs.

In a similar study, the 2011 Review of Physician Recruiting In-

centives, by Merritt Hawkins, found that in 74 percent of the

physician search assignments it conducted between April 1, 2010,

and March 31, 2011, a salary plus a production bonus was the

form of compensation offered to physician candidates. Fifty-two

percent of the searches featuring a salary plus production bonus

based the production component on RVUs, rather than number

of patients seen, revenue generated, or quality and cost effective-

ness measurements. There are presently a plethora of RVU for-

mulas being used in employment contracts for determining

physician compensation. Frequently these formulas are compli-

cated, confusing, or even beyond comprehension.

A problem with tying physician compensation strictly on RVU

production is that when insurer payments change or groups have

a bad year with a negative operating margin, the model may not

be sustainable. For instance, for primary care providers, in addi-

tion to RVU productivity, achieving benchmarks for management

of chronic diseases like diabetes or hypertension, patient satisfac-

tion, care coordination and other important functions must be in

the mix. This concept is more important with the popular med-

ical home concept. Participation and contribution to the group’s

overall strategic plan also should be rewarded.

THE FUTURE AND MEASUREMENTSThere are a variety of benchmarks that can be used to set goals

and measure success in a medical setting. A benchmark is “a stan-

dard by which something can be measured or judged.” By com-

paring a provider’s practice to a benchmark there is an

opportunity to:

• Quantify performance measures

• Quantify the gap between your organization and

“best practices” Continued on page 36


BUSINESS OFMEDICINE

• Encourage new ideas, innovation and creative thinking

• Make improvements in your operations by using an

objective basis for your decision-making.

Healthcare reform legislation (PPACA) has provided an envi-

ronment for the establishment of Accountable Care Organiza-

tions (ACOs), and they are being established in every state. Large

and small physician groups are becoming part of ACOs, especially

in large metropolitan areas. In addition to Medicare ACOs, com-

mercial ACOs also are taking off. According to Bhagwan Satiani,

MD, MBA, FACS, FACHE, president of Savvy-Medicine, and

author of the three-volume set, “The Smarter Physician,” pub-

lished by MGMA, “productivity” must include measures other

than clinical productivity. The metrics that should be included

are patient-satisfaction scores, and mortality and morbidity rates.

ACOs also will need physicians to lead in the operations, inno-

vation, and quality and customer service areas. It appears clear

that reimbursements are not going up, and so physician leaders

are needed who are intimately aware of costing, budgets and fi-

nancial controls. These leaders, according to Dr. Satiani, must be

compensated or be given credit for these activities when calculat-

ing productivity.

Although there are many well-defined measures of physician

productivity, each has its own limitations. It is important to be

aware of these limitations and of the factors that can impact pro-

ductivity measures especially for providers whose productivity is

being evaluated and for those administering a productivity-based

system.

Joseph P. Gonzales is a specialist master with De-

loitte Consulting, LLP. An adjunct faculty member

at the University of Texas at San Antonio, he teaches

in the MBA program, business of healthcare track.

Continued from page 35

THANK YOU to the large group practices with 100% MEMBERSHIP in BCMS and TMA

Contact BCMS today to join the 100% Membership Program! *100% member practice participation as of April 15, 2015.

ABCD Pediatrics, PA

Clinical Pathology Associates

Dermatology Associates of San Antonio, PA

Diabetes & Glandular Disease Clinic, PA

ENT Clinics of San Antonio, PA

Gastroenterology Consultants of San Antonio

General Surgical Associates

Greater San Antonio Emergency Physicians, PA

Institute for Women's Health

Lone Star OB-GYN Associates, PA

M & S Radiology Associates, PA

MacGregor Medical Center San Antonio

MEDNAX

Peripheral Vascular Associates, PA

Renal Associates of San Antonio, PA

San Antonio Gastroenterology Associates, PA

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South Alamo Medical Group

South Texas Radiology Group, PA

Tejas Anesthesia, PA

Texas Partners in Acute Care

The San Antonio Orthopaedic Group

Urology San Antonio, PA

Village Oaks Pathology Services/Precision Pathology

WellMed Medical Management Inc.

Physician productivity (cont.)


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There are five volumes (so far) in Tana French’s series of booksset in Dublin, and I’ve read all six of them. “Wait…didn’t you saythere were five? Yeah, you did. Huh?” Let me explain…

I recently read a review of the fifth book in the series, “The SecretPlace,” and decided that it sounded promising. It was more thanthat: It was captivating, so I looked up the first four and decided toread them in order of their publication. When I got to the end ofthe fourth book, I decided to re-read “The Secret Place.” It was evenbetter the second time around.

These are books about murders in Ireland, the detectives whowork to solve them, the perpetrators and others involved, but, aswas said in a New York Times review, “Ms. French is a psychologicalstoryteller much more than a forensic one.” The people and imagerythat inhabit these tales represent some of the best characterizationsand descriptions I’ve ever run across. At the end of each book, Ifelt that I knew the individuals involved and the places where theaction occurred. Following are brief summaries of each book.

Spoiler alert: There are no spoilers here.“In the Woods” involves the disappearance of two children from

a patch of suburban woods 20 years or so before the action in thebook. They are never found, but the third child who was with themis found, scared, minimally injured, and unable to tell the worldwhat had happened. That child, Rob Ryan, grows up to be a de-tective whose partner is a woman, Cassie Maddox. They are inves-tigating the murder of a 12-year-old girl in the same area. “The Likeness” finds Cassie Maddox out of the murder squad,

but her boyfriend (not Ryan) catches a case where the victim, wholooks exactly like Cassie, has been living a sort of communal exis-tence with several other grad students in a mansion one of them in-herited. Her ID says that she is Lexie Madison…a name Cassieused years ago in an undercover operation. Lt. Frank Mackey is asecondary character who runs the undercover squad.

Nineteen-year-old Frank Mackey lives with his amazingly dys-

functional family on a street named “Faithful Place,” the title ofthe third book. He’s planning to run away to London with his girl-friend, Rosie, to start a new life. Rosie doesn’t show, and Frank andeveryone else assume that she went off without him. Twenty yearslater, Rosie’s suitcase is found hidden in a derelict house, and herbones are found under the basement floor. By this time Frank is di-vorced and has weekend custody of his daughter, Holly, who be-comes a witness in the murder of one of Frank’s brothers…in thesame house. One of the police involved is Mick “Scorcher”Kennedy, whose partner is Stephen Moran.

Brianstown is a subdivision developer’s rechristening of “BrokenHarbor,” a resort camp on the Irish coast and the title of thefourth book, where Mick Kennedy and his family went for sum-mer holidays in his childhood and a family tragedy occurred.Kennedy is the lead detective investigating the stabbing murderof a man, the smothering of his two children and the seriouswounding of his wife.

A year later, Holly Mackey, now 16 and a student at an exclusiveDublin high school for girls, finds a note on the “Secret Place,” abulletin board where the students can post anonymous notes. Thenote has a picture of the victim, and says, “I know who killed him.”She takes it to Stephen Moran, now a cold case detective with am-bitions to be part of the murder squad. If you read this book, youwill know the characters – you may not like them, but you willknow them.

My advice: Go online for that New York Times review of “TheSecret Place.” Then start reading with “In the Woods.” The SanAntonio Public Library has them all, in various formats.

Fred H. Olin, MD, is a semi-retired orthopaedic sur-geon and chairman of the BCMS Communications/Pub-lications Committee. On St. Patrick’s Day, he spells hisname O’Lin.

BOOK REVIEW

Tana French’s‘Dublin Murder Squad’ Novels

Reviewed by Fred H. Olin, MD



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Tom Benson Chevrolet9400 San Pedro Ave.

Gunn Chevrolet12602 IH-35 North

Ancira Chrysler10807 IH-10 West

Ingram Park Auto Center7000 NW Loop 410

Ancira Dodge10807 IH-10 West


Northside Ford12300 San Pedro Ave.

Cavender GMC17811 San Pedro Ave.

Gunn GMC16440 IH-35 North

*Fernandez Honda8015 IH-35 South

Gunn Honda14610 IH-10 West(@ Loop 1604)

*Gunn Infiniti

12150 IH-10 West

Ancira Jeep10807 IH-10 West


*North Park Lexus611 Lockhill Selma

North Park LexusDominion

21531 IH-10 WestFrontage Road

*North Park

Lincoln/ Mercury9207 San Pedro Ave.


Mercedes-Benzof Boerne

31445 IH-10 W, Boerne

Mercedes-Benzof San Antonio

9600 San Pedro Ave.

*Mini Cooper

The BMW Center8434 Airport Blvd.

Ancira Nissan10835 IH-10 West

Ingram Park Nissan7000 NW Loop 410

Ancira Ram10807 IH-10 West


North Park Subaru9807 San Pedro Ave.

Cavender Toyota5730 NW Loop 410

*Ancira Volkswagen5125 Bandera Rd.


The new Mercedes flagship S-class sedan,the S550, is one of the best cars for saletoday, but it’s not wrong to say that theS550 is all about the tech. The S550 lookslike an alpha car and has an interior like theFour Seasons. But it’s the technology thatsets it apart.

What kind of technology are we talkingabout? Some of it is completely new and all-world, though it should be noted that mostof the coolest goodies are optional.

Let’s start with a few unusual featuresthat aren’t options. The new S-class has tworeverse gears. Probably only chauffeurs whoneed to worry about kidnappers care aboutthis, but it’s nice to know it’s there just incase. There are seven interior mood-light-ing colors, which can be switched easily byusing the COMAND controller on the

center console. I actually checked these outand changed them a few times. It was in-teresting for a minute, and one or two coloroptions seems fine. But seven? In a car?

UNUSUAL TWISTS ON OPTIONSThen there’s the “Magic Vision Control”

that uses nozzles to squirt washer fluid di-rectly in front of the wiper blades so thatyour vision isn’t momentarily obstructed bya big splash of fluid like it is in lesser cars.I like this feature a lot, but doesn’t it seemlike its name was chosen in a Stuttgart barat 2 a.m.?

Mercedes also has added unusual twistson options that we thought we knew. Likeseat coolers that suck air in for four min-utes before they blow cool air out, which,Mercedes engineers say, results in more

rapid cooling on sweltering days. Massag-ing seats aren’t new, but Mercedes’ “hot-stone massage” feature feels as ifsomebody’s gently nudging your back withwarm golf balls. I loved this gizmo and usedit frequently. And the super soft pillows onthe headrests of the two optional “execu-tive” rear chairs are much softer than anyothers on the market (regrettably, my testcar didn’t have these.) Also, presumablywith South Texas in mind, Mercedes saysthat the S-class’ new air conditioner is extrapowerful — the strongest available, in fact.

Still not impressed? Buyers who enjoyconstant olfactory stimulation will love the“Air-Balance” system, which perfumes thecabin with your choice of pleasing scents,“a world first,” apparently.

Perhaps the S-class’s most high-tech fea-

AUTO REVIEW


Mercedes S550:All about the tech

By Steve Schutz, MD

ture is the “Magic Body Control,” an ad-vanced feature that comes with the op-tional hydraulic “Active Body Control”suspension. This ingenious system uses thecar’s forward viewing cameras to see bumpson the road ahead, and then it relaxes thesuspension in order to float you over saidbumps. This is really something in 2015,but given how rapidly the computer worldmoves I can imagine non-luxury cars hav-ing this in 10 years.

OK, you get it. There’s lots of technol-ogy in the new S-class. What about the restof it? Design-wise it looks like what anymaster-of-the-universe might drive,though it’s clearly different from the lastversion of the S-class. While that car wasangular in the usual early- to mid-2000sMercedes manner, the new S is notable forits roundness. In fact, it seems that everyangled area on the old S-class sedan hasbeen smoothed out. Mercedes hopes youlike that, because if you don’t, too bad.The automotive market of the future,China, prefers soft curves to sharp angles,and those customers drive luxury car de-velopment these days. Still, the new designhas enough gravitas to make you moveover if you see one in your rearview mirror,which is probably all that matters.

Driving the new S550 in everyday life isa lot like driving the previous one, which isto say rock-solid and completely confident.Sports car-esque point-and-shoot is not itsthing, but otherwise piloting the newest S-class is like hiring an automotive celebritybodyguard. It can handle any road situa-tion you might encounter with aplomb,and it makes sure you get where you needto be as efficiently and comfortably as pos-sible. I drive a lot of cars every year, andthis one is special.

NOT A FUEL SIPPERNot surprisingly, the S550 does not sip

fuel. The standard engine is a twin turbo4.7-liter V8 that produces 449 HP, so fueleconomy figures of 17 mpg city and 25mpg highway shouldn’t surprise anybody.In fact, the only surprise is that they’re notworse.

As always, Phil Hornbeak can fill you inon the particulars, but the S550 starts at

around $95,000, and it’s reasonable to ex-pect to pay quite a bit more than that if youwant some of the tech described here.

Yes, the newest Mercedes S-class is allabout the tech, which is quite amazing.But otherwise it’s a top-shelf luxury sedanthat costs a lot of money and is worth it.There are other luxury cars you can buythat cost more than the S550, but noneof them are better than this Mercedestour de force.

Steve Schutz, MD, is aboard-certified gastroenterol-ogist who lived in San Anto-nio in the 1990s when he wasstationed here in the U.S. Air

Force. He has been writing auto reviews for SanAntonio Medicine since 1995.

For more information on the BCMSAuto Program, call Phil Hornbeak at 301-4367 or visit www.bcms.org.

AUTO REVIEW



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San Antonio Medicine May 2015

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