| advocates-for-health-and-humanity | Advocates for Health and Humanity | WSMA_Reports | Shared_Content/News/Latest_News/2025/advocates-for-health-and-humanity | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/heartbeat-website-image-davis-bush-645x425px.png" class="pull-right" alt="Heartbeat column graphic, with Toren Davis, DO and Bridget Bush, MD" /></div>
<h5>Nov. 12, 2025</h5>
<h2>Advocates for Health and Humanity</h2>
<p>
By Toren S. Davis, DO, And Bridget Bush, MD
</p>
<p>
<em>From the Editors:</em> It's not often that you have a poem to publish in a physician general interest magazine and it's that much rarer to have two. But in this issue, we thought that Heartbeat- our regular column featuring the passionate perspectives of individual members-would be the appropriate place to publish two such poems that found their way across our desks. Each is timely and beautiful, and we hope you agree.
</p>
<p> First, from WSMA member Toren Davis, DO, who says, "I wanted to share my poem that was published earlier this year about our duty to advocate for our patients and health. Please share to anyone you would like." </p>
<p>
<em>Through the ancient words of Hippocrates<br />
we took an oath to fight disease.<br />
To see each patient's entire person<br />
and the many ways their health may worsen.<br />
So what happens when it comes to be,<br />
that disease is born from policy?<br />
When the greatest threats to a person's health<br />
are politics, power, and prospect of wealth?<br />
As these disorders show their intent,<br />
the treatment plan includes dissent.<br />
To refute what brings a person harm,<br />
and project our voice to sound alarm.<br />
If we neglect or fail to act,<br />
our oath does not survive intact.<br />
And the human lives that are at stake,<br />
will lose their shield of staff and snake.</em>
</p>
<p>
Next, from WSMA's new president for 2025-2026, Bridget Bush, MD, come these moving lines, which she included in her inaugural speech before the WSMA House of Delegates. She says, "I've struggled with depression and feeling disconnected, and I've learned that it's healthy to have a mask-literally and figuratively-at work to stay safe. Sometimes it's vital to help you to compartmentalize so you don't fall apart when everything around you is falling apart. I've also learned, however, that you have to have people and places where you're safe without the mask."
</p>
<p>
<em>I wear a mask at work<br />
I wear a mask to work<br />
I hide behind professionalism<br />
I tell myself-my mask keeps me safe<br />
I tell myself-my mask keeps you safe<br />
The less you know of my pain<br />
The less I show of what's inside<br />
The safer we are<br />
From questions<br />
From looks<br />
From fear that I'm not enough<br />
Well enough<br />
Keep it together<br />
Keep it hidden<br />
Keep it to yourself<br />
They tell me wellness is putting my own mask on first<br />
Perhaps I should turn on the oxygen too<br />
</em>
</p>
<p>
To watch Dr. Bush deliver her inaugural address, visit <a href="https://wsma.org/annual-meeting">wsma.org/annual-meeting</a>.
</p>
<p>
<em><strong>Toren Davis, DO</strong>, is a family physician affiliated with PeaceHealth Southwest Medical Center in Vancouver. <strong>Bridget Bush, MD</strong>, is an anesthesiologist in Everett with Optum Care Washington and serves as president of the WSMA.</em>
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/12/2025 3:32:12 PM | 11/10/2025 4:50:48 PM | 11/12/2025 12:00:00 AM |
| a-safer-smarter-approach-to-peer-review-and-patient-care | A Safer, Smarter Approach to Peer Review and Patient Care | WSMA_Reports | Shared_Content/News/Latest_News/2025/a-safer-smarter-approach-to-peer-review-and-patient-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/nov-dec-2025-reports-cover-cropped-645x425px.png" class="pull-right" alt="cover image from November-December 2025 issue of WSMA Reports" /></div>
<h5>Nov. 11, 2025</h5>
<h2>A Safer, Smarter Approach to Peer Review and Patient Care</h2>
<p>
By Brock Bordelon, MD And Sara Cameron
</p>
<p>
In today's rapidly evolving health care environment, peer review is no longer simply an administrative requirement. It has become a strategic necessity to ensure patient safety and clinical excellence. Whether it's deployed properly in hospitals or outpatient facilities, peer review plays a pivotal role in elevating care quality, reducing risk, and strengthening trust across clinical teams.
</p>
<h3>From punitive to proactive</h3>
<p>
In the past, peer review was often viewed as a punitive process, focused on finding fault in individual clinicians after an adverse event. Today's best practices emphasize a vastly different approach: continuous quality monitoring. Instead of looking at isolated complications in hindsight, modern peer review focuses on real-time trends and system-level concerns.
</p>
<p>
This shift encourages timely, unbiased feedback and helps organizations intervene before problems escalate. Well-designed peer review should no longer be about catching mistakes. It should be about learning from them and ensuring they don't recur. Caring for patients is the bottom line of any setting, and it's the responsibility of the medical staff to ensure that patients are receiving quality care.
</p>
<h3>A foundation of patient safety</h3>
<p>
Peer review is more than a compliance box to check. It's a frontline defense for patient safety. By evaluating care delivery through structured, objective criteria, peer review helps identify both individual and systemic issues that might otherwise go unnoticed.
</p>
<p>
This is particularly crucial in outpatient settings, where the clinical infrastructure can vary widely. Whether reviewing clinical notes, follow-up protocols, or procedural outcomes, peer review provides an opportunity to catch small concerns before they become larger risks. That goes for patients, physicians, and organizations alike.
</p>
<h3>Powered by clinical quality data</h3>
<p>
One of the most important developments in peer review is its integration with clinical quality data. Rather than relying on subjective case reviews, modern peer-review efforts draw on outcome metrics, documentation audits, and data trends. This enables reviewers to make evidence-based decisions that reflect real patterns of care.
</p>
<p>
These insights are especially powerful when combined with other quality tools like incident reports, root cause analyses, and patient satisfaction data. When seen together, they paint a more accurate, and actionable, picture of clinical performance.
</p>
<p>
Such data integration also enables comparative benchmarking, allowing clinics to evaluate how their processes stack up against peers or national standards. This can drive targeted improvement efforts and reduce unwarranted variations in care.
</p>
<h3>Credentialing, privileging, and professional practice evaluation</h3>
<p>
Another essential function of peer review is its role in credentialing and privileging. Today, regulatory bodies and accrediting organizations increasingly expect health care settings to move beyond one- time verifications and engage in continuous assessment of professional practice.
</p>
<p>
Peer review is often the cornerstone of ongoing professional practice evaluation and focused professional practice evaluation. These processes ensure that clinicians are consistently performing within the scope of their training and privileges, and that any emerging issues are addressed proactively.
</p>
<p>
Peer review helps credentialing committees make informed, fair decisions based on data and peer insight rather than hearsay or incomplete records.
</p>
<h3>Building a culture of safety and trust</h3>
<p>
Effective peer review supports both patient outcomes and clinician well- being and organizational culture. A collaborative approach to peer review can strengthen trust among the health care team, reduce burnout, and create a shared sense of accountability.
</p>
<p>
To get there, organizations must invest in reviewer training, clear processes, and psychological safety. This ensures that clinicians can give and receive feedback without fear of reprisal. Peer review should be collegial, consistent, and constructive, not a tool for turf battles or punitive actions.
</p>
<h3>Getting started</h3>
<p>
For organizations looking to implement
or improve a peer-review program, we
recommend:
</p>
<ul>
<li>Start with structure: Define clear criteria, workflows, and timelines for reviews.</li>
<li>Use multidisciplinary reviewers: Engage peers from similar specialties who understand the nuances of the clinical scenarios being evaluated.</li>
<li>Leverage quality data: Integrate peer review with clinical dashboards, risk reports, and quality initiatives.</li>
<li>Link to professional development: Use insights to guide mentoring, education, and privileging decisions.</li>
</ul>
<h3>A smarter path to safer care</h3>
<p>
In the end, peer review is more than a regulatory checkbox. It's a practical, data-informed way to make care better. As health care organizations face increasing complexity, regulatory pressure, and patient expectations, a well-run peer-review process can help clinics and other outpatient settings stay ahead of risk, strengthen clinical teams, and keep patients safer. By embracing peer review as a tool for learning, health care organizations can lead with transparency, improve outcomes, and create a culture where quality is everyone's responsibility.
</p>
<p>
<em><strong>Brock Bordelon, MD, FACS</strong>, is a surgery medical director and <strong>Sara Cameron</strong> a director of professional services with MDReview - A Hardenbergh Company.</em>
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/11/2025 9:33:21 AM | 11/10/2025 4:46:14 PM | 11/11/2025 12:00:00 AM |
| doctors-making-a-difference-patricia-egwuatu-do | Doctors Making a Difference: Patricia Egwuatu, DO | WSMA_Reports | Shared_Content/News/Latest_News/2025/doctors-making-a-difference-patricia-egwuatu-do | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/dmd-website-image-egwuatu-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Patricia Egwuatu, DO" /></div>
<h5>Nov. 10, 2025</h5>
<h2>Doctors Making a Difference: Patricia Egwuatu, DO</h2>
<p>
For Patricia Egwuatu, DO, a family physician at Kaiser Permanente's Capitol Hill clinic in Seattle, having conversations about evidence-based health information through her Instagram and TikTok accounts came as a natural extension of her commitment to advocacy and education. Her reach on social media has led to an even bigger platform: As a regular contributor on Fox 13's "Healthy Living" television segment, she's aiming to start conversations about topics that often don't make it out of the exam room and help the public make informed decisions about their health. She talked with <em>WSMA Reports</em> about what led her to the role and why physicians continue to be the best messengers for fact-based health care information.
</p>
<p>
<strong><em>WSMA Reports:</em> How did your role as a contributor to Fox 13's "Healthy Living" segment come about and why did you decide to do it?</strong>
</p>
<p>
<em>Dr. Egwuatu: </em>My interest in becoming a medical media correspondent started during residency. At the time, my sister was in medical school, and we often had conversations about our journeys and how we could encourage others to pursue careers in medicine. As Black female physicians, who represent only about 2% of the workforce, and as daughters of immigrants, we felt inspired to share our upbringing and experiences. That led us to start an Instagram account, which gained traction, opened doors to interviews, and gave us a platform to highlight our voices.
</p>
<p>
At the same time, I was deeply engaged in health equity work through my role as associate program director of equity, inclusion, and diversity. I began using social media, including Instagram and TikTok, to share evidence-based health information and connect with the community. That growing engagement in medical media, along with my work at Kaiser Permanente, ultimately led to the opportunity with Fox 13's "Healthy Living" segment.
</p>
<p>
I chose to do the segment because it allows me to extend my passion for advocacy and education beyond the clinic. It's a meaningful way to engage with the broader community while providing accessible, evidence-based health information that empowers people to make informed decisions about their health.
</p>
<p>
<strong>What topics do you feel are most important to be talking about in this context?</strong>
</p>
<p>
I think some of the most important topics to highlight are the conversations that often happen in the doctor's office but don't always make it into broader community discussions. Many people are looking for reliable information yet don't always know where to turn. For example, breast cancer screening or discussions around hormone testing and hormone replacement therapy are questions I frequently encounter. Segments like these are a valuable way to bring that information to the public in an accessible, evidence-based format so individuals feel empowered when making decisions about their health.
</p>
<p>
<strong>With limited time on air, how do you get the information across in a way that will be impactful for a broad audience?</strong>
</p>
<p>
I'm fortunate to have a great team at Kaiser Permanente that helps guide, research, and provide evidence-based information for each topic, which I then tailor with my own expertise. To make sure the message is impactful for a broad audience, I draw on my media training to present the information in a clear and digestible way. I also practice with my partner and my sister, who remind me to communicate as if I'm speaking directly to them making the conversation relatable and accessible.
</p>
<p>
<strong>Why do you think it's important to have a physician be the messenger for these types of public health topics?</strong>
</p>
<p>
Physicians are often viewed as a trusted source of information. We have the knowledge and expertise to provide evidence-based guidance, and that credibility helps ensure people feel confident in the information they're receiving, especially when it comes to making decisions about their health.
</p>
<p>
<strong>What are some challenges you see in reaching people with evidence-based public health information?</strong>
</p>
<p>
One of the biggest challenges is the sheer amount of information available today. People are constantly exposed to health messages from so many different sources, and not all of them are accurate. That can make it difficult to cut through the noise and highlight reliable, evidence-based information in a way that resonates with the public.
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/10/2025 3:31:09 PM | 11/10/2025 3:03:45 PM | 11/10/2025 12:00:00 AM |
| the-intersection-of-wall-street-and-the-exam-room | The Intersection of Wall Street and the Exam Room | WSMA_Reports | Shared_Content/News/Latest_News/2025/the-intersection-of-wall-street-and-the-exam-room | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/nov-dec-2025-reports-cover-cropped-645x425px.png" class="pull-right" alt="cover image from July-August 2025 issue of WSMA Reportscover image from July-August 2025 issue of WSMA Reports" /></div>
<h5>Nov. 10, 2025</h5>
<h2>The Intersection of Wall Street and the Exam Room</h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
In an era of increased financial pressures, practices struggle to remain independent. The result has been a huge upswing in consolidation, as some practices conclude that it is no longer feasible to remain a solo operation. "We saw hospitals get into the outpatient space in the 2010s. Then retailers came in, and then insurers," says WSMA CEO Jennifer Hanscom. "Now it's private equity."
</p>
<p>
The growing presence of private equity in medicine has sparked a debate about the corporate practice of medicine, or CPOM for short. CPOM is the legal concept that prohibits corporations, unless they are owned and controlled by physicians, from practicing medicine or dictating what physicians can do. Prompted by publicity about the negative effects of some private equity investments in health care, CPOM has become the focus of interest among legislators and physicians. A bill introduced in the Washington state Legislature last session would have placed stringent restrictions on the structure of corporate investment in practices in some instances. While the bill did not pass, it will be reintroduced in next year's session. (A bill with similar restrictions on CPOM was successfully passed by the Oregon state Legislature this year.)
</p>
<p>
Two resolutions introduced at the 2025 Annual Meeting of the WSMA House of Delegates in September also address the issue. One resolution called for "increased transparency, oversight, and regulatory safeguards for corporate and private equity acquisitions in health care." One of the sponsors of that resolution, Jose Flores-Rodarte, MD, a family physician who works in a federally qualified health center, says that private equity represents a unique threat to health care.
</p>
<p>
"I find it very concerning where Wall Street has reached out to acquire physician practices," says Dr. Flores- Rodarte. "The whole point is to turn the practice over and strip it for profits. If that's effective for a jewelry store, so what? While it's not a great practice, that's the economy we work in. Health care is different. It's a right."
</p>
<p>
At the same time, financial stresses are leaving practices with few options. "Some practices feel private equity investment is important for maintaining the viability of their organizations," says Sean Graham, WSMA's senior director of government affairs and policy. "It's a huge challenge for independent physician groups to maintain their viability in the face of all the pressures we know about."
</p>
<h3>CPOM: the law and the structures</h3>
<p>
As of 2024, 33 states have some form of CPOM law. Washington state's CPOM doctrine is based on case law and not legislation-yet is still generally considered to be one of the nation's strongest legal prohibitions. The fact that legislation was introduced last year to address CPOM indicates that, for some legislators and proponents, moving beyond case law to codifying in legislation is needed to strengthen the law further.
</p>
<p>
"This is a judge-made law," says attorney Luke Campbell, a member of the Health Law Section of the Washington State Bar Association. That said, there have been only a limited number of cases testing it. "It seems only to be infrequently applied right now by private litigants trying to avoid obligations, or by the Department of Health when there are threats to patient care," Campbell says.
</p>
<p>
Even so, says Campbell, the case law imposes limits. "There are only a handful of cases, but the courts have clearly stated that the CPOM doctrine exists and applies in Washington-this isn't some theoretical concept," he says. "What we don't have is published case law in Washington applying it to these modern private equity arrangements."
</p>
<p>
"Under Washington case law, courts look at the substance of the transaction and the reality of the business relationship to see what's really going on," Campbell says. If there is a question that the management company is too closely involved with the entity providing professional services or maintains a beneficial ownership interest in the practice, courts can-and have-intervened. In one example, a dentist and nondentist bought a building together that housed the dental practice. They structured the arrangement as a lease, with the dentist paying the nondentist "rent" equal to 50% of the practice's net profits-an amount that far exceeded the market rate for the building. When the dentist stopped paying, the case ended up in court. The court ruled that the percentage-based rent was really disguised profit sharing that gave the nondentist an illegal ownership interest in the dental practice itself, violating Washington's prohibition on nondentists owning or operating dental practices.
</p>
<p>
The existing case law would also suggest that the courts would closely scrutinize "friendly doctor" structures. Campbell has written that the structures "present material risks in Washington because, as described above, the courts have shown a willingness to look beyond formalities and into the essential nature of the relationship. For example, if the payments from the practice to the management company do not reflect fair market value for services but instead appear to reflect a return on an ownership interest, a Washington court may find that the relationship violates the CPOM doctrine."
</p>
<p>
The structures in place for CPOM are supposed to address the issues raised by the law.
</p>
<p>
The most common structure used by private equity investors gives physicians practice ownership while effectively transferring some functions and control of the practice to the management company through contractual relationships. Under this arrangement, the professional practice remains solely owned by licensed health care professionals, while the management company-which may include unlicensed investors-takes over some business operations. The practice transfers tangible assets and contracts to the management company, including real estate and equipment leases, while the management company provides administrative services such as billing, contracting, and strategic planning.
</p>
<h3>When private equity investment works</h3>
<p>
That common structure of private equity investment in a practice can be attractive in a market where there are limited financial options available. Moreover, practices sometimes feel the other available option is worse.
</p>
<p>
"When I have talked to physician practices, they went to private equity because they didn't want to sell to the local hospital system," says Hanscom. "A lot of times, the only option to stay independent is private equity. If you want a competitive marketplace and can't afford to make a go of it on your own, you need a funder."
</p>
<p>
The right partnership can work well, supporters of private equity investment say. Jarrod Durkee, MD, is medical director at RAYUS Radiology in Washington state, a subspecialty provider for advanced diagnostic and interventional radiology services with locations in more than 15 states. A separate entity, CDI Management Corp., is responsible for the nonclinical side of RAYUS.
</p>
<p>
The arrangement has been in place for almost 20 years. "They never tell us what to do clinically," says Dr. Durkee. "We make those decisions, we make those protocols. They never say to us, you need to see more patients, you need to perform more imaging. There's none of that going on."
</p>
<p>
What the management company does is handle the business side of the practice, including regulatory changes, infrastructure upgrades, and contracts. "I'm trained as a physician," says Dr. Durkee. "I'm not trained in building patient portals to see images and reports online. I don't know how to make those things happen. The same with talking to payers. That is their expertise." Because of the combined influence of RAYUS, Dr. Durkee says that his practice is able to get better deals than would otherwise have been the case.
</p>
<p>
Those savings can help patients. "As an independent physician group, we are at a minimum 30% to 40% less in what it costs patients than if they were to go to a hospital or closed system," says Dr. Durkee. "If you take away independent practices, patient access is going to be way more expensive."
</p>
<h3>The devil in the details</h3>
<p>
As in the RAYUS example, these structures have been in place in Washington state for years, typically involving individual arrangements between parties. But private equity is raising a whole new set of issues as its presence in health care increases rapidly, and, as investment in medical practices grows, private equity systematizes these arrangements and implements them broadly across multiple practices. An analysis earlier this year by the American Medical Association found that 6.5% of physicians said that their practice was private equity-owned, a jump from 4.5% since 2022. While the overall number is small, some specialties, such as orthopedics and ophthalmology, have seen substantial growth in private- equity investment over the past several years. By contrast, more than a third of physicians report working in hospital- owned practices.
</p>
<p>
For many observers, the devil can lie in the details of the management agreement. In some arrangements, particularly those using a "friendly doctor" structure, the management company gains substantial control through stock transfer restriction agreements or succession agreements. These provisions can restrict the physician from taking certain actions without the management company's consent, including hiring and firing employees-or even selling their ownership interest. In some cases, the agreements allow the management company to effectively remove and replace the physician owner if they don't comply with business directives. (This structure would have been barred under the proposed Washington state legislation.) Not all arrangements go this far. Some relationships maintain clearer boundaries between clinical autonomy and business management. The result is a sliding scale of control, with some physicians retaining meaningful independence while others may find themselves with ownership in name only.
</p>
<p>
While the law in Washington may be strong on its face, it is largely untested. For one thing, cases so far have largely involved disputes between two parties in an agreement. The potential pressure from a management company on a practice presents a more complicated scenario. "The reality is that the DOH [Department of Health] only responds to claims and is most concerned about harm to patients," says Campbell. "Unless it receives a complaint involving actual or potential patient harm, it doesn't seem that the DOH is interested in investigating these management company relationships."
</p>
<p>
Private equity has attracted a lot of attention primarily since much of the industry is so focused on profits. Some private equity investments in health care, particularly in hospitals, have resulted in widespread negative media coverage chronicling staffing shortages and bankruptcies at facilities that were bought out. Moreover, a study in the Journal of the American Medical Association in 2023 found that adverse events, including surgical infections, central line infections, and bed sores, skyrocketed among Medicare patients in the three years after a private equity fund bought a hospital. Another study showed significant price increases in 8 out of 10 practices acquired by private equity.
</p>
<p>
Such stories prompt worries among some physicians that CPOM has gotten out of control. Kim Ha Wadsworth, DO, a family physician who has a direct family care practice in Olympia, introduced a resolution at the September WSMA House of Delegates calling on the WSMA to support policy and legislation to strengthen CPOM restrictions in the state.
</p>
<p>
"Do we want lay people to have majority ownership of medical clinics?" she says. "If you have majority ownership, you make the decisions. That's really the crux of this policy question."
</p>
<p>
Dr. Wadsworth consciously chose a direct practice model so that she could focus on patients. "I want more of my colleagues to be able to enjoy medicine as it was meant to be before CPOM," she says. "We talk about the physician- patient relationship. When you are able to restore that connection, it brings back the joy of medicine. I'm looking at my colleagues who are suffering, and I know that there is a better way. We've done CPOM for 30 or 40 years, and how is that working for us? Physicians are burning out and talking about moral injury."
</p>
<p>
Dr. Flores-Rodarte echoes that sentiment that patients are suffering as a result. "These are questions about the quality of care that are at odds with what we do, which is our relationship with our patients," he says. "We're trying to do things in the best interest of the patient, when we're also trying to maximize profits for a private company. We've all had a favorite brand taken over by new owners, they extract the profit from it, and they destroy it. I don't want that to happen to our health care system."
</p>
<h3>Navigating the changing landscape</h3>
<p>
Dr. Durkee is sympathetic to physicians worried about corporate influence. "I understand and I agree that we don't want corporations telling us what to do as physicians, because that's not their area," he says. At the same time, he worries that too broad a crackdown on private equity will harm practices that actually do benefit from it.
</p>
<p>
"Are there bad actors out there? I'm sure there are. But don't throw everything out because they're under a certain label. That would cause more damage. Don't bring a shotgun when you need a surgical scalpel."
</p>
<p>
In point of fact, says Campbell, CPOM is now so embedded in the business of medicine that rolling back by the regulators may be impossible. "That ship seems to have sailed," he says. "Is the DOH going to suddenly take an aggressive enforcement position against these management-type service agreements? It seems unlikely that DOH will be the party to draw a line in the sand."
</p>
<p>
The main issue is how to maintain physician control over clinical decisions as the business of medicine continues to transform. "We all want clinical autonomy, first and foremost," says Hanscom. "But we also want to protect the workforce we have so that patients have access to the care they need. There's a lot of corporatization of health care. We need a comprehensive approach to it, something nuanced to the practice environment now, so as not aggravate problems and cause practice closures."
</p>
<p>
The likelihood of another CPOM bill being introduced in the Legislature next year will keep the issue front and center. "It's a new and complex issue," says Graham. "In my experience, what WSMA members are thinking about is that physicians should be in control of delivering care to patients."
</p>
<p>
The question is whether legislation can address physician concerns without creating new problems. "We don't want to make it more difficult for people to make the business decisions they want to make," says Hanscom. "We don't want to create a problem for physician owners who are already in relationships with private equity that they like."
</p>
<p>
No matter what happens in the next legislative session, the debate is unlikely to end. "We're all trying to struggle with how do we approach this," says Dr. Flores-Rodarte. "I don't think we have the answer, but we should be thinking about it."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/11/2025 9:40:27 AM | 11/10/2025 4:40:19 PM | 11/10/2025 12:00:00 AM |
| member-spotlight-lucinda-grande-md | Member Spotlight: Lucinda Grande, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/member-spotlight-lucinda-grande-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/Member-Spotlight-Website-Image-Grande-645x425px.png" class="pull-right" alt="Member Spotlight: Lucinda Grande, MD" /></div>
<h5>November 6, 2025</h5>
<h2> Member Spotlight: Lucinda (Cindy) Grande, MD, FASAM</h2>
<p><strong>Works at:</strong> Pioneer Family Practice in Lacey.</p>
<p><strong>How long in practice:</strong> 14 years.</p>
<p><strong>Specialties:</strong> Family medicine and addiction medicine.</p>
<p><strong>Additional roles:</strong> Clinical associate professor in the department of family medicine, UW School of Medicine; current president of the Washington Society of Addiction Medicine.</p>
<p><strong>Why WSMA:</strong> The WSMA is a powerful voice for physicians in our state. I learned how influential it could be in 2017 after I presented my first resolution to the House of Delegates. I had hoped to draw attention to an injustice with societal implications, one that had been experienced by my own patients. Denial of life-saving medications to treat opioid use disorder in jails and prisons creates an extremely high risk of overdose death after release. With help from veteran resolution writers at my county medical society, I crafted a proposal to advocate for legislation, standards, policies, and funding to make buprenorphine and methadone available to inmates. The resolution was adopted as a new policy by the WSMA and ultimately by the American Medical Association. WSMA and AMA advocacy helped to catalyze a growing awareness of the problem and led to real changes statewide and nationally.</p>
<p>I have since shepherded about a dozen resolutions through the process, often in collaboration with WSMA staff, family physicians, addiction specialists, and public health groups. Through my participation in the WSMA, I have learned that teamwork is essential to the power of organized medicine. Teamwork requires persistence and compromise, but results in much more attention from policymakers than any of us could hope for alone.</p>
<p><strong>What inspires me about medicine:</strong> I love to find solutions for whatever health problems patients bring to me. Often, I can use widely available treatments to address common problems. For example, for the petite white-haired lady who brought in a chart showing wild swings in blood pressure, I tinkered with the doses and timing of losartan and amlodipine. She returned at the next visit with a bright smile because her numbers were now perfectly steady.</p>
<div class="col-md-4 col-xs-12 pull-left">
<p><img alt="Dr. Grande at home" src="/images/Newsletters/Reports/2025/november-december/Grande_profile_secondary.jpg
" class="pull-left" /></p>
</div>
<p>But sometimes unconventional solutions are needed. A 38-year-old man, struggling to drop some of his 400-pound heft, yearned to try a GLP-1 agonist. Unfortunately, his insurance wouldn’t pay for it because he didn’t have diabetes. Compounding pharmacies are avoided by many physicians, but I was happy to use one to obtain generic semaglutide for him—enriched with Vitamin B12 for the inevitable fatigue of the overweight—for $200 per month. That man lost 15 pounds in the first 6 weeks. You bet he had a bright smile at the next visit.</p>
<p>A more adventurous area of my work is with patients who—like many millions of Americans—suffer from both chronic pain and psychiatric disorders. A favorite opportunity is to take a depressed and irritable middle-aged man with arthritis who has limped along for years on oxycodone, and initiate buprenorphine for his pain. There is art in luring that man into making the change, and in selecting a suitable starting dose and titration plan. But how thrilling to see the clouds lift and a new brightness in his step!</p>
<blockquote class="Quote">
<p>
Through my participation in the WSMA, I have learned that teamwork is essential to the power of organized medicine."
</p>
</blockquote>
<p><strong>What people may not know about me:</strong> My true passion is unlocking the secrets of daily sub-dissociative dose (or “microdoseâ€) ketamine. I have delighted in the frequently favorable and sometimes breathtaking outcomes among 600+ patients with common debilitating conditions from chronic pain, depression, and suicidal ideation to addiction, dementia, and existential distress at end of life. I have several research projects underway with the goal of bringing the rich potential of this treatment strategy into mainstream clinical practice.</p>
<p><strong>Recommended reading:</strong> I am immersing myself in the many wonderful books by the cognitive psychologist and psycholinguist Steven Pinker. My favorite is “The Sense of Style: The Thinking Person’s Guide to Writing in the 21st Century.†Next on my list is “The Better Angels of Our Nature,†based on the surprising premise that violence has declined over the course of human history. I am hoping for a refreshing break from the gloom and barbarism of today’s news.</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/10/2025 2:25:25 PM | 11/6/2025 2:21:17 PM | 11/6/2025 12:00:00 AM |
| healthy-food-resources-better-health | Healthy Food Resources, Better Health | WSMA_Reports | Shared_Content/News/Latest_News/2025/healthy-food-resources-better-health | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/november-december/nov-dec-2025-reports-cover-cropped-645x425px.png" class="pull-right" alt="cover image from November-December 2025 issue of WSMA Reports" /></div>
<h5>
October 21, 2025
</h5>
<h2>Healthy Food Resources, Better Health </h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
Jennifer Maxwell, MD, a family medicine doctor at Yakima Valley Farm Workers Clinic, often sees patients struggling with both food insecurity and making dietary changes to manage their diabetes. To address both, Dr. Maxwell doesn't just prescribe medication and tell them to "eat better." She provides these patients the means to do so through the clinic's partnership with the Washington State Department of Health's Fruit and Vegetable Prescription Program, or FVRx. It's one of 24 such health care partners participating statewide since the program started in 2016. FVRx serves people who have or are at risk for a diet-related illness and have food insecurity.
</p>
<p>
Produce prescription programs like FVRx fall under "food is medicine," a growing movement of science- and evidence-based initiatives that recognize the critical role of nutrition in preventing, managing, and even treating chronic disease. The Food Is Medicine Institute at Tufts University defines the movement as interventions that "reflect the critical link between nutrition and health, integrated into health care delivery."
</p>
<p>
Medically tailored meals and medically tailored groceries are the other disease treatment and management interventions. Prevention interventions include population-level health food policies and programs and nutrition security programs, such as the Supplemental Nutrition Assistance Program; Women, Infants, and Children Nutrition Program; and school meals.
</p>
<h3>Washington's FVRx program</h3>
<p>
In Washington state, depending on partner parameters, patients can receive between $250 to $500 in FVRx vouchers (and soon prefunded ecards) over six months. They are redeemable at certain grocers, food cooperatives, and farmer's markets statewide for fresh, frozen, or canned produce without added salt, sugar, or fat. At Yakima Valley Farm Workers Clinic, food insecure patients with an A1C blood test of 8% or higher receive $40-$80 in monthly vouchers for six months. The program is so popular, there's a waiting list.
</p>
<p>
"In this last cohort, patients on average had a decrease of a half of a percentage point for their A1C. Some patients had as significant a decrease of 8.3 percentage points, which is huge in terms of health improvement," says Gabrielle Frank, RDN, primary care nutrition services manager at Yakima Valley Farm Workers Clinic.
</p>
<p>
While robust research is scarce, <a href="https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.009520">one study</a> published in the August 2023 Journal of the American Heart found produce prescription programs associated with significant improvements in fruit and vegetable intake, food security, and health status for adults and children. Adults with poor cardiometabolic health also had clinically relevant improvements in A1C, blood pressure, and body mass index.
</p>
<p>
Many of Dr. Maxwell's patients work long hours, without paid time off, making it hard to convince them to schedule medical visits when they don't see immediate benefits. The FVRx program has incentivized patients to make and keep follow-up appointments, says Dr. Maxwell. "With this program, they see a direct benefit today, and then it translates into long-term benefits."
</p>
<h3>Medically tailored meals and groceries</h3>
<p>
Medically tailored meals, or MTMs, began in the 1980s in response to the HIV/AIDS pandemic. MTMs and medically tailored groceries support patients with severe, complex, or chronic conditions. They are typically provided by nonprofits and other community organizations and delivered to patients' homes. Upon referral from a physician or practitioner, registered dietitians assess each patient to develop meals and groceries tailored to their nutritional needs and condition.
</p>
<p>
Not all MTM programs are created equal. As food is medicine has gained traction, some traditional food and meal delivery companies have tried to rebrand themselves. "Most don't appear to meet voluntary accreditation standards crafted by medically tailored meal providers," found a STAT News investigation: Some provided patients with fried food or meals that were high in fat or sodium.
</p>
<p>
To develop quality standards, in 2023, the Food is Medicine Coalition, a leading national coalition of nonprofit organizations that provide medically tailored meals, created an accreditation program for medically tailored meal providers. Lifelong, a Seattle-based nonprofit, is the first in Washington state to receive FIMC accreditation. (FISH Community Food Bank in Ellensburg is a FIMC member, a precursor to accreditation, providing MTMs to clients in Kittitas County.)
</p>
<p>
Each year, Lifelong provides MTMs and MTGs to some 2,000 low-income clients in King, Island, and Snohomish counties. A significant portion are homebound and have challenges either accessing food or preparing their own food. "One of the things medically tailored meals, or even groceries, can do is reduce the stress around food access," says Emily Hanning, Lifelong's vice president of food and nutrition. The home delivery model can even help address the loneliness epidemic, she says.
</p>
<p>
"Bringing meals to clients fosters a sense of connection and community. Oftentimes we're one of the only people interacting with a client that week," says Hanning. "We're also able to do an informal mini wellness check. Then if there's any follow up needed, we'll reach out and make sure that we're getting clients the other support they need."
</p>
<p>
Along with providing condition-specific nutrition, MTMs also address dental or swallowing issues, barriers for many patients, says Hanning. "We're able to mechanically soften food to provide adequate nutrition."
</p>
<p>
Poor diets not only impact a patient's health, they also impact their wallet: 85% of all health care spending is related to the management of diet-related chronic diseases, according to Tufts' Food Is Medicine Institute.
</p>
<p>
In Lifelong's annual survey, 88% of responding clients reported improvements in their health. A <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2024.01307">recent Health Affairs analysis</a> estimated the one-year impact of MTMs (based on 10 weekly meals for eight months) would result in more than $3,000 net annual cost savings per person in Washington state and nationally $23.7 billion overall, after accounting for intervention costs. Nationally, this level would also avert over 2.6 million hospitalizations.
</p>
<p>
In recent years, the need has increased so much that Lifelong now has a waitlist. Hanning is hopeful that Apple Health will soon cover MTMs via Washington's Section 1115 Medicaid waiver, the federal mechanism that provides flexibilities for states to try new approaches with their Medicaid programs.
</p>
<p>
In February, the state Health Care Authority submitted a rate methodology under its Medicaid Transformation Project (its name for the Medicaid waiver) for reimbursable nutrition support services aimed at removing barriers to healthy nutrition. They include nutrition counseling and education, MTMs, meals or pantry stocking, fruit and vegetable prescriptions, and short-term grocery provisions. These <a href="https:/www.hca.wa.gov/assets/program/mtp-nutrition-supports-fee-schedule.pdf" target="_blank" rel="noreferrer">nutrition support services</a> are expected to increase the annual aggregate expenditures for nutrition service providers by approximately $50 million.
</p>
<p>
"We know that there are going to be reductions to food assistance and SNAP that people depend on coming up. So, the waiver, we hope, will provide an opportunity to help support our community members with healthy food," says Hanning.
</p>
<p>
In 2023, the Centers for Medicare and Medicaid approved an additional five years of payment for health-related social needs services under Washington state's Medicaid Transformation Project. The Trump administration has since rescinded CMS guidance that promoted these Section 1115 waivers for health-related social needs services addressing social determinants of health. While the new policy does not nullify existing approvals granted under the Biden administration, new requests will now be considered on a case-by-case basis.
</p>
<h3>Food insecurity and social determinants of health</h3>
<p>
Many food is medicine interventions are tied to food insecurity, a social determinant of health; not surprising, as poor diets and food insecurity are strongly linked, with both increasing the risk of early death, disability, and poor health. The U.S. Department of Agriculture defines food insecurity as "a household-level economic and social condition of limited or uncertain access to adequate food." The USDA's 2023 Household Food Report found 9.5% of Washingtonians are food insecure.
</p>
<p>
"We can't discuss food as medicine without addressing food insecurity. If people don't have reliable access to nutritious food, the idea of using food to prevent or manage disease isn't realistic. Things like affordability, transportation, food deserts, and lack of nutrition education all play a role in whether someone can consistently access healthy, culturally appropriate meals," says Chelsey Lindahl, RDN, CD, manager for health promotion and wellness at MultiCare Center for Health Equity and Wellness in Tacoma. The center and MultiCare Yakima Memorial Hospital are also FVRx health partners.
</p>
<p>
In recent months, patients have also told Dr. Maxwell they don't want to go out as frequently into the community out of fear. "Less frequent shopping trips means you can't buy as many fresh fruits and vegetables because they will expire," she says.
</p>
<p>
Food insecurity is often hidden in plain sight. Screening for insecurity is often something many physicians miss, says Dr. Maxwell. Yakima Valley Farm Workers Clinic uses the Hunger Vital Signs screening tool for all patients at intake and once yearly. Food cost is a big reason most don't eat healthier.
</p>
<p>
"Our patients are living in the margins, and sometimes food is not the most high priority for them in terms of what their needs are, or what they see as the vehicle to support health improvement three or six months from now," says Frank.
</p>
<p>
Over 22% of Yakima households receive benefits through SNAP, double the state average. Nearly 1 million Washingtonians use SNAP benefits each month. Statewide, nearly half of all babies, one third of pregnant women, and one quarter of children under age 5 rely on the WIC Program.
</p>
<p>
The Trump administration's budget bill cut SNAP by $186 billion over the next decade. In Washington state, the average household under the Thrifty Food Plan is expected to receive $56 less per month. The maximum allotment for a family of four would drop from $975 to $848. The cuts come at a time when food costs continue to outpace wage growth for many Americans.
</p>
<p>
Community health workers at Yakima Valley Farm Workers Clinics also help connect patients to local food banks and apply for SNAP benefits. The majority of their clinic locations in Washington and Oregon also contain embedded offices for WIC, the federal Special Supplemental Nutrition Program for Women, Infants and Children.
</p>
<p>
"As health care providers we really need to reserve judgment about eating choices, or what is behind why families feed their kids the way they do," says Frank. She recommends "How the Other Half Eats," by Priya Fielding-Singh, PhD, to better understand food insecurity and what informs food choices. "Most people do want to feel healthy and know when foods are healthy, but there are just so many complex barriers that get in the way of that being their day-to-day reality," she says.
</p>
<h3>Culinary medicine and whole-person care</h3>
<p>
Food is medicine interventions often include nutritional counseling, the educational, and sometimes emotional, support patients need to make lasting dietary changes. "Registered dietitians are trained in motivational interviewing and are able to take a broad concept like 'eat more vegetables,' and make it applicable to the context of their life," says Frank.
</p>
<p>
One FVRx client recently shared that after six months, she has regular meal patterns, stopped drinking soda, and takes her medication as prescribed. Her A1C dropped from 13.7 to 6.3. "She was struggling with depression and her dietitian connected her with a mental health counselor. The dietitian she worked with provided this older adult with whole-person care," says Frank.
</p>
<p>
Patients often share that changing their diet feels daunting and confusing, says Emma Dotson, DNP, ARNP, who specializes in cognitive neurology at the Swedish Center for Healthy Aging in Seattle. That's where culinary medicine comes in: a growing evidence-based field that blends the art of food and cooking with the science of medicine. The center includes culinary medicine in its shared medical appointments, an innovative program where a patient cohort meets for eight months to learn lifestyle interventions for disease prevention and management.
</p>
<p>
Once a month on Zoom, Dina Piatt, RDN, provides a virtual cooking demonstration of brain-healthy recipes and education around nutrition. "A lot of patients don't know the effect food has particularly on brain health," says Piatt. The center's plant-based recipes, such as blender banana bread, are intentionally simple and affordable, with easy prep and cleanup, so patients are more likely to make them.
</p>
<p>
In the past, generous funding allowed the center to deliver the ingredients to patients so they could follow along. Patients report feeling better and having lower A1C and blood pressure, from changing their diet, says Dotson. "Even those with early stages of dementia can participate with their care partner." The feeling of self-efficacy, she says, creates a domino effect to keep up with other needed lifestyle changes.
</p>
<p>
Yakima Valley Farm Workers Clinic's Toppenish Medical-Dental Clinic also offers all patients both in-person and virtual cooking classes around specific topics, such as heart health, diabetes management, and pediatric nutrition.
</p>
<p>
While the federal government's nascent Make America Healthy Again movement focuses on ultra-processed foods, Dr. Maxwell says cooking meals from scratch isn't an issue for her patients. "Most of my patients actually prepare their own food. It's the cost-and taking a risk in buying something that they don't know whether their family will actually eat it when they have a limited budget," she says.
</p>
<p>
"It's really not controversial that good nutrition is important. But how to actually make that work for our patients is key. And a lot of it is the health equity perspective," says Dr. Maxwell. "It's a reasonable question when patients are not eating fruits and vegetables to ask if they are afraid that they will run out of food before they have money to buy more. These are good questions before we continue to write more prescriptions and think that the patients just can't or won't."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the November/December 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 10/31/2025 1:42:26 PM | 10/21/2025 10:42:10 AM | 10/21/2025 12:00:00 AM |
| an_open_door_and_a_clear_path | An Open Door and a Clear Path | WSMA_Reports | Shared_Content/News/Latest_News/2025/an_open_door_and_a_clear_path | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports September-October 2025 cover" src="/images/Newsletters/Reports/2025/september-october/cover-wsma-septoct-2025-645x425px.jpg" class="pull-right" /></div>
<h5>Sept. 16, 2025</h5>
<h2>An Open Door and a Clear Path</h2>
<p>
By Milana McLead
</p>
<p><em>For WSMA 2025-2026 President Bridget Bush, MD, connections and stories empower her leadership journey and point to the future.</em></p>
<p>One might wonder what a piano teacher, the fictional Dr. Kay Scarpetta, the dinosaurs of Jurassic Park, and the book "Starship Troopers" have in common. The answer is that each was a throughline across Bridget Bush's journey into medicine. Like intersecting avenues on a map, the path is clear now, even if it wasn’t then.</p>
<p>An aunt who taught Dr. Bush piano lessons suggested biogenetics engineering as a cool career, igniting a fifth grader's imagination and dream of helping people have healthier babies. Patricia Cornwell's crime novels featuring the forensic pathologist and medical examiner Dr. Kay Scarpetta planted early thoughts of medicine combined with law (notably, both of Dr. Bush's parents are lawyers). In high school, Jurassic Park’s genetic scientists prompted the future Dr. Bush, who loved being outside digging and solving puzzles, to think: "Oh my God, I can do both! I can do dinosaurs and genetics!"</p>
<div class="col-md-4 col-xs-12 pull-right">
<p><img alt="Women in Medicine graphic" src="/images/Newsletters/Reports/2025/september-october/women-in-medicine-graphic.jpg" class="pull-right" /></p>
</div>
<p>Those interests led to a biochemistry degree from the University of Nevada in Reno, as the dream for medical school solidified. Then 9/11 happened during a time when she was rereading “Starship Troopers,†a favorite book of hers and her father’s. “The movie is campy and hilarious, but the book is phenomenal,†she says. “I remember its message hitting me so hard—the concept that if you’re willing to give your life for the country, then you get to vote for how it’s run. That made sense in my core, that if you’re willing to put yourself at risk, then you get a say. And the little voice in my head said, ‘Maybe you should serve.’ â€</p>
<p>As she was deliberating how best to pay for medical school, she’d heard of the Health Profession Scholarship Program through the military. The program made sense for her, especially since her grandfather had served in the U.S. Navy in World War II.</p>
<blockquote class="Quote">
<p>
One of my goals in life is to create connections with people and to say ‘yes.’ The more you say ‘yes,’ the more doors open and things change. I want to create positive change.†— Bridget Bush, MD
</p>
</blockquote>
<p>After medical school at Tulane School of Medicine in New Orleans, she served out her commitment in the Navy as a flight surgeon. “I had the chance to do a lot of things that most people will never experience,†she says. “I’ve been deployed to Afghanistan and Iraq, I’ve seen K2 from the air when we flew close to Pakistan, I’ve seen slopes on the Hindu Kush that I’d love to ski down. I’ve fast-roped out of a helicopter, did combat casualty care training, and made it through survival, evasion, resistance, and escape training. Would I go through SERE training again? Absolutely not! Am I happy I went through it? Yes. Those are important skills.â€</p>
<p>Besides those critical survival skills, Dr. Bush notes other skills that serve her well in her field of anesthesia. “One of my superpowers is as a ‘calmer,’ †she says. “It’s part of what drew me to anesthesia because I get to speak to people when they are most scared, and my calming influence helps them with their experience, mentally and physically, because they can go into it less stressed.â€</p>
<p>In clinical rotations, she loved nearly all the specialties except for emergency medicine, but that was because she never had a chance to get the patient stories. For Dr. Bush, the story, the puzzle pieces, and the detective work all add up to the care she wants to provide. “I was sold on anesthesia,†she says. “As anesthesiologists, we take the patient as a whole, looking at all the puzzle pieces to see where the cracks are, where the failing points are going to be and try to improve or circumvent or treat as needed. That’s what we’re doing the whole time, before, during, and after.â€</p>
<p>One of her first patients on third-year clinical rotations crystalized that care approach for her. The patient was a veteran, ill potentially with tuberculosis (common at the time in New Orleans) and was thus in isolation. “We were all in there wearing N95s, it’s super loud and he wouldn’t talk to anyone,†she says. “He had a lot of tattoos, and I’m fascinated by them, so I asked, ‘What kind of bike do you ride?’ He started talking to me. He opened up about having lung and prostate cancer and said that instead of more tests for something that couldn’t be fixed, he just wanted to go home. That molded how I saw care. Making the diagnosis, doing the tests, it was all puzzle work. It was being a detective but also talking to the patient to understand their story.â€</p>
<div class="col-md-4 col-xs-12 pull-left">
<p><img alt="Bridget Bush, MD" src="/images/Newsletters/Reports/2025/september-october/bridget-bush-md-photo.jpg" class="pull-left" /></p>
</div>
<blockquote class="Quote">
<p>
The WSMA is where you meet people.†— Dr. Bush</p>
</blockquote>
<p>People, their stories, making connections—all are woven through Dr. Bush’s approach to work, life, leadership, and her engagement with the WSMA. “One of my goals in life is to create connections with people and to say ‘yes,’ †she says. “The more you say ‘yes,’ the more doors open and things change. I want to create positive change.â€</p>
<p>Saying yes is exactly how Dr. Bush deepened her engagement with the WSMA. Her journey began when she was invited to serve as part of the WSMA Young Physician Section Governing Council, and from there on, she kept saying yes and found connections along the way. “One hundred percent, making connections is a WSMA resource anyone can tap into,†says Dr. Bush. “You’ll meet physicians in all different fields, you’re going to meet your mentor or your next boss or next best friend, and you’ll get to know what medicine is really like across the state. The WSMA is where you meet people.â€</p>
<p>It’s also how a physician in Washington state gains access to educational opportunities, knowledge, advocacy, and networking. “The WSMA is the path to making change—by standing with us, we provide that path and can help change and make things better,†she says. “And if it’s not in our power, maybe we can help you figure out a way. Joining the WSMA allows everyone to have a voice, to make change, and to take action,†she says.</p>
<p>As she steps up to lead the WSMA, her leadership approach will surely be inclusive, open, and engaging. “I believe the best leaders are the ones who bring up everyone around them and give voice to those who may not feel able to speak up,†she says. “I want to hear other people’s voices and to empower them to know that what they’re experiencing matters.â€&nbsp;</p>
<p><em>Milana McLead is WSMA’s senior director of strategic communications and membership.</em></p>
<h3>Snapshot</h3>
<h4>Family</h4>
<p>“It’s more of a family vine than a family tree!†Husband, Phil; dog, “mostly poodle,†named Ludo for the scary monster in Labyrinth who is kind and makes friends with rocks.</p>
<h4>Odd jobs</h4>
<p>Intern at the Yucca Mountain Project in Las Vegas greeting media and visitors; Department of Energy intern in Washington, D.C., where she managed $40 billion in taxes related to nuclear site decommissioning.</p>
<h4>Passions</h4>
<p>Mental health and well-being, women’s health.</p>
<h4>What keeps her up at night</h4>
<p>“Not a lot, unless it’s something my body is trying to figure out in dance.â€</p>
<h4>Meaningful quotes</h4>
<p>“I will survive†and “Walk into the room as though God sent you as a punishment!â€</p>
<h4>Wishful playlist for making an entrance</h4>
<p>Carmina Burana!</p>
<h4>Spare time</h4>
<p>Self-described movie nerd; Duolingo enthusiast (French, Spanish); pole dancing and instructing; gardening and tree planting (850 during the pandemic!).</p>
<h4>Movie references during interview</h4>
<p>PCU (Port Chester University), Star Trek, American Gods, Labyrinth, What Dreams May Come.</p>
</div> | 9/16/2025 2:35:43 PM | 9/16/2025 11:19:45 AM | 9/16/2025 2:35:43 PM |
| member-spotlight-charles-liu-md | Member Spotlight: Charles Liu, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/member-spotlight-charles-liu-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/september-october/member-spotlight-website-image-liu-645x425px.png" class="pull-right" alt="WSMA Reports Member Spotlight: Charles Liu, MD graphic" /></div>
<h5>Sept.&nbsp;12, 2025</h5>
<h2>Member Spotlight: Charles Liu, MD</h2>
<p>
<strong>Works at: </strong>University of Washington Medical Center Montlake.
</p>
<p>
<strong>How long in practice: </strong>First year in practice.
</p>
<p>
<strong>Specialty: </strong>Colon and rectal surgery.
</p>
<p>
<strong>Why WSMA: </strong>As a physician in my first year in practice and new to Washington, I was excited to join the WSMA both for the professional networking opportunities and to get involved in the WSMA's work in state legislative advocacy. One of the first WSMA initiatives I heard about was its effort to pass the Medicaid Access Program through the state Legislature and get it signed by Gov. Bob Ferguson. Low Medicaid reimbursement creates huge access to care issues for many of our low-income patients statewide, and the program-if and when it is hopefully approved in the future by the Centers for Medicare and Medicaid Services- would leverage federal funds to increase Medicaid reimbursement rates to Medicare levels. I'm excited to get involved in future efforts by the WSMA to support public policy that expands our patients' access to timely care.
</p>
<p>
<strong>Top concerns in medicine:</strong> My patients' ability to afford their medical care is one of my top concerns as a colorectal surgeon. In my specialty, this can manifest as patients with inflammatory bowel disease stopping or skipping doses of their medication, which can lead to worsening disease, complications, and emergency surgery, or patients delaying or deferring colorectal cancer screening, leading to late diagnoses of colorectal cancer. This problem is only becoming greater as expensive new biologic medications become standard of care, and as high-deductible health insurance plans become more common. In addition to stress around paying high medical bills, cost transparency is a huge challenge. So many patients ask me if their surgery will be covered by insurance, or how much it will cost, and I have very limited tools available to help them answer those very valid questions.
</p>
<p>
<strong>Challenges in medical profession:</strong> A major challenge our profession faces is the fallout of the recently passed cuts to Medicaid and the Affordable Care Act. Through these cuts, millions of patients nationwide and hundreds of thousands here in Washington will lose their health insurance, likely leading to more delayed disease presentation. I work at an urban referral hospital, but many of my patients travel from rural parts of the state and region to get care, and I am particularly worried about the closure of rural hospitals and emergency rooms as a result of these cuts.
</p>
<p>
<strong>Why my specialty:</strong> I love that I get to take care of patients ranging from young adults with inflammatory bowel disease, to older adults with cancer, to folks of all ages with diverticulitis and anorectal conditions. On the procedural side, colorectal surgery also allows me to use open, laparoscopic, robotic, and endoscopic techniques to treat disease, and my surgical cases range from short 20-minute procedures to all- day multidisciplinary operations. Finally, I really enjoy getting to work with and teach residents and medical students as a daily part of my job.
</p>
<p>
<strong>Spare time:</strong> I enjoy running, watching soccer, and all things aviation-related (I'm not a pilot but maybe someday). Over the past couple of years, I have been dabbling in mixology. More recently, my wife and I have our hands full with our three-month old son, who is currently learning how to hold his head up and that his hands belong to his body!
</p>
<p>
<strong>Recommended reading:</strong> Trevor Noah's "Born a Crime" is amazing, both personal and educational about apartheid South Africa. I loved listening to it on audio because he narrates the accents and languages so well. "How Democracies Die" by Steven Levitsky and Daniel Ziblatt is a bit too real but eye-opening. We have to learn about history to avoid repeating it. Lastly, "How to Avoid a Climate Disaster" by Bill Gates was really enjoyable. He is, of course, not a climate scientist himself but has clearly educated himself deeply on the topic, and as a result I think he explains climate change solutions in a really approachable and clear way.
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/19/2025 3:37:17 PM | 11/19/2025 12:24:53 PM | 9/12/2025 12:00:00 AM |
| how-we-pay-for-medical-care | How We Pay for Medical Care | WSMA_Reports | Shared_Content/News/Latest_News/2025/how-we-pay-for-medical-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/september-october/heartbeat-website-image-rotchford-645x425px.png" class="pull-right" alt="WSMA Reports Heartbeat: James Rotchford, MD graphic" /></div>
<h5>Sept. 11, 2025</h5>
<h2>How We Pay for Medical Care</h2>
<p>
By James K. Rotchford, MD
</p>
<p>
In the May/June 2025 issue of WSMA Reports, Amarita Stark, MD, discusses the threats to children's access to medical care due to potential Medicaid cuts. I heartily concur with her concerns and have concerns about access barriers for the vast majority of Americans.
</p>
<p>
Social determinants account for approximately 80% of health outcomes. Hence, significant societal changes are necessary to achieve substantial progress in American health outcomes. Meanwhile, what are the policies that hinder the provision of cost-effective medical care and, consequently, limit access to it?
</p>
<p>
Let's start with changing how we pay for medical care. Practitioner time and expertise would be the primary determinant for reimbursements, as they generally are for non-medical professional services. Coverage eligibility can determine the amount of health care coupons one receives, similar to food stamps. Let patients play a larger role in deciding what is most valuable and most helpful. Licensed professionals would remain accountable for ensuring that medical care options are reviewed and offered in accordance with established standards of care. Patient outcomes and satisfaction would become the driving forces for medical care. This contrasts with our current policies, in which CPT codes and their documentation commonly determine care.
</p>
<p>
</p>
Serious illnesses requiring hospitalization or significant procedural interventions could be covered by "large deductibles" as seen in the private sector. Prevention and early care could be incentivized by providing coupons for specified services, such as annual exams, breast exams, and others. Some contexts would have reimbursements based similarly to what is now done with CPT codes and their documentation. Professional time and expertise could still, however, be the primary determinants for most payments.
<p>&nbsp;</p>
<p>
Costs would be reduced by excluding third parties in decision processes. Third parties currently define available care and have limited accountability, especially regarding individual outcomes. As an example, Medicaid providers incur inordinate expenses that impact cost-effective outcomes. Administrative costs disproportionately drive expenses, along with documentation liabilities, disputes over necessity, and costs associated with managing legal and regulatory liabilities.
</p>
<p>
This approach would introduce competitive pricing based on the principles of supply and demand. Note supply might increase because practitioners would have more time to focus on patients rather than third-party concerns. Competitive pricing, combined with lower administrative overhead, would lead to predictable price reductions. Current incentives regarding the provision of relatively unproductive procedures would be reduced, and costs and outcomes would align with those of other advanced countries. Patients would recognize that care was being individualized as well as possible, rather than based primarily on what third parties cover and incentivize. Trust in physicians and advanced care providers would improve, with all the corresponding benefits.
</p>
<p>
In summary, cost-effective outcomes are compromised in large part by how we pay for medical care. If we do not address how we pay for medical care, our ability to ensure adequate and universal medical care remains compromised.
</p>
<p>
<em><em>James K. Rotchford, MD, MPH</em>, is an addiction medicine physician with Olympas Medical Services in Port Townsend.</em>
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/19/2025 3:37:17 PM | 11/19/2025 12:11:18 PM | 9/11/2025 12:00:00 AM |
| doctors-making-a-difference-wayne-larrabee-md | Doctors Making a Difference: Wayne Larrabee, MD | WSMA_Reports | Shared_Content/News/Latest_News/2025/doctors-making-a-difference-wayne-larrabee-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/september-october/dmd-website-image-larrabee-645x425px.png" class="pull-right" alt="Doctors Making a Difference: Wayne Larrabee, MD graphic" /></div>
<h5>Sept. 10, 2025</h5>
<h2>Doctors Making a Difference: Wayne Larrabee, MD</h2>
<p>
Even before he started medical school, Wayne Larrabee, MD, knew he wanted to make a difference on a global scale. After working in public health as an epidemiologist in Central and South America, his experience in Panama observing children suffering from congenital abnormalities including cleft lip and palate led him to the second phase of his career in plastic surgery. Dr. Larrabee talked with WSMA Reports about his nonprofit organization, Global Surgical Outreach, which is providing volunteer-led cleft lip and palate surgeries to children in Africa and investing in infrastructure and training support.
</p>
<p>
<strong><em>WSMA Reports:</em> How did you first get involved with volunteer surgical work?</strong>
</p>
<p>
<em>Dr. Larrabee:</em> I went into medicine with the dream of working in global health. I chose Tulane Medical School because it had a strong school of public health and tropical medicine, and I graduated with an MD and a master's degree in epidemiology. After my internship in the U.S. Army at Letterman General Hospital in San Francisco, I was assigned as the director of civic action and public health for the Southern Command and was stationed in the Panama Canal Zone. A highlight was my work with the Kuna people of the San Blas Islands off the Caribbean coast of Panama. They were a small but charismatic group that lived off the Atlantic coast. Because of their size and culture, they married only amongst themselves and there were many babies with congenital deformities including cleft lips and palates. I was fortunate to encounter Daniel Gruver, a missionary who did surgery to repair these children's clefts. I immediately fell in love with plastic surgery and decided to become a surgeon.
</p>
<p>
After my surgical training I moved to Seattle and worked first at Virginia Mason Medical Center and later launched my own practice, The Larrabee Center for Facial Plastic Surgery. From the beginning, I participated in cleft missions to Latin America, Asia, and, later, Africa. I decided to start Global Surgical Outreach to provide not only surgery but needed education and infrastructure.
</p>
<p>
<strong>You went to Ethiopia in 2024; can you tell readers a little bit about that trip and the patients you served?</strong>
</p>
<p>
We have been to Ethiopia many times before. We love the country and its people. The surgeons there are excellent but lack certain equipment for more complex cases. In terms of clefts, they requested education in cleft lip noses specifically. On this mission we focused on treating cleft lip and palate patients who also needed nose repairs. I was fortunate to have Susan Kurian, MD, from the Larrabee Center along to assist me with operating and teaching. She did an excellent job. Cristal Flores from our surgical center also came to assist and teach her peers in Ethiopia.
</p>
<p>
<strong>Why did the organization decide to build a hospital in Accra, Ghana, and who will it serve?</strong>
</p>
<p>
We are working with Kofi Boahene, MD, from Johns Hopkins to support building a teaching hospital in Ghana. The basic concept is that we can more effectively train surgeons in Africa with an African center. The hospital will be partially staffed with volunteer plastic surgeons from around the globe. I hope to work there myself. We will also of course repair clefts and more for African children, but training the African surgeons can eventually help many more.
</p>
<p>
<strong>Is there an aspect of your volunteer missions that is particularly fulfilling for you?</strong>
</p>
<p>
There are so many, including the lifelong friendships you develop. By far the most fulfilling, however, is watching the faces of the parents when they first see their child after a cleft lip repair. It is truly magical to share their joy.
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/19/2025 10:55:13 AM | 11/19/2025 10:52:10 AM | 9/10/2025 12:00:00 AM |
| its-not-what-you-say-its-what-the-patient-hears | It's Not What You Say, It's What the Patient Hears | WSMA_Reports | Shared_Content/News/Latest_News/2025/its-not-what-you-say-its-what-the-patient-hears | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports September-October 2025 cover" src="/images/Newsletters/Reports/2025/september-october/cover-wsma-septoct-2025-645x425px.jpg" class="pull-right" /></div>
<h5>Sept. 3, 2025</h5>
<h2>It's Not What You Say, It's What the Patient Hears</h2>
<p>
From Physicians Insurance
</p>
<p>
Communication is a core clinical competency. Communication competencies are necessary to build and sustain relationships with our patients, enable patient engagement and to optimize patient adherence to treatment plans and recommendations. Communication is complex and often changing, therefore developing a general understanding of these core competencies can be applied in multiple situations.
</p>
<h3>Developing communication competencies </h3>
<p>
Once words are spoken you have no control over how those words are understood. This is particularly challenging in difficult conversations, when there is a natural reaction to become defensive. This means is that the physician or practitioner will have to be deliberate in setting aside defensive mannerisms by engaging in active listening, ensuring the patient is understanding, and using appropriate vocal elements.
</p>
<p>
Difficult conversations may be met with unintentional meaning and therefore engaging the patient through the following active listening techniques may foster empathy by demonstrating that you are reflecting on the patient's thoughts and feelings. The patient's thoughts and feelings are believed, supported, and respected, instead of diminished or challenged. The patient will remember how they felt during the conversation.
</p>
<ul>
<li><strong>Paraphrasing:</strong> Restate the information you received in your own words. For example, "You understood that the medication was going to take two weeks to fully work."</li>
<li><strong>Verbalize emotions: </strong>Reflect on the patient's feeling and emotions in words. For example, "This made you feel unsure that the treatment was working."</li>
<li><strong>Ask questions: </strong>For example, "How are you feeling today?"</li>
<li><strong>Summarizing: </strong>Restating the patient's ideas, including the feelings they expressed. "You are concerned the medication isn't working and your symptoms are making you feel uncomfortable."</li>
<li><strong>Clarifying:</strong> Ask questions to clarify vague statements or restate your interpretation to acquire further clarification. "Was this on the same day?"</li>
<li><strong>Encouraging:</strong> Give space for the patient to keep talking. For example, "This appointment is yours, so we can talk about whatever you'd like."</li>
<li><strong>Balancing:</strong> Help the patient evaluate their own feelings by asking questions. For example, "How does that make you feel?"</li>
</ul>
<p>
Patient understanding is a huge piece of communication. Medical jargon should be avoided or explained in lay terms. Your words should be simple so if there is a complex issue, consider using visual aids to help explain. Check in with your patients understanding by using frequent pauses and asking questions, especially if explaining a complex process. A patient repeating back their understanding of what you said can also identify areas of needed improvement in communication.
</p>
<p>
Vocal elements include pitch, inflection, tone, rhythm, tempo, and pronunciation. There are some types of conversations that can be emotional and can impact tone which may result in an unintended consequence where the patient deciphers the message differently than how it was intended to be conveyed. There are strategies that can be used to alleviate fear and facilitate the physician or practitioner's ability to authentically convey emotions such as caring, empathy, and sincerity. These strategies include engaging in deep breathing exercises picturing talking to a loved one about the incident and having appropriate eye contact.
</p>
<p>
Body language is equally important in communicating with your patients. Some elements of body language to consider your use of are:
</p>
<ul>
<li>Blank facial expression (not having an expression deters a physician's efforts to create rapport and empathy).</li>
<li>Crossing your arms or legs (can come across to patients as if you are closed off, uninterested).</li>
<li>Sitting versus standing (standing over the patient while they are seated can be seen as intimidating).</li>
</ul>
<h3>Navigating multigenerational communication</h3>
<p>
Physicians and patients span generations, and it is imperative that communication preferences are understood for barriers to be removed. While there is no formula for effective and successful multigenerational communication, improved multigenerational communication requires an understanding of what shaped the generation, generational values and communication preferences and expectations. The following are generally recognized characteristics of four generations:
</p>
<p>
<strong>Baby boomers (1945-1964)</strong> grew up and were shaped during dramatic social change. They relate to public recognition and respect titles. Their focus is on process.
</p>
<p>
<strong>Generation Xers (1964-1980)</strong> grew up and were shaped during political and institutional instability. They relate fairness and define themselves by their broader life responsibilities. They respect ideas more than titles. Their focus is on results.
</p>
<p>
<strong>Millennials (1980-2000)</strong> grew up and were shaped by technology and instant gratification. They relate to ways that they can make a difference. They respect skills more than titles or ideas. Their focus is on involvement. Millennials outnumber Boomers. They are high-touch and consumer-centric. They are confident, have high expectations and aspire to make a difference. They appreciate partnerships and open communication.
</p>
<p>
<strong>Generation Z (approximately 1995 - 2010)</strong> are digital natives. They grew up and were shaped by access to technology from a young age. They communicate via instant messaging, texts, and social media. Generation Z values ethics, individuality, and independence. Gen Z forgoes labels for self-expression. They are focused on health, the environment, and social justice. They make their decisions in analytical and pragmatic ways. They are the most ethnically and racially diverse.
</p>
<p>
Understanding intergenerational communication can be rewarding. Here are some ways to bridge the generation gap:
</p>
<ul>
<li><strong>Active listening: </strong>Utilize nonverbal body language to convey listening and understanding.</li>
<li><strong>Empathy:</strong> Try to understand the perspectives and experiences of the patient's generation.</li>
<li><strong>Clear language:</strong> Slang may not be understood by another generation. Using straightforward language that is clear and simple to understand by any age is best practice.</li>
<li><strong>Technology: </strong>Ask questions and learn your patient's threshold for technology and preferred use.</li>
<li><strong>Ask questions:</strong> Show interest and appreciation in your patient's experiences and opinions to reach a meaningful relationship.</li>
<li><strong>Seek training:</strong> Improve your skills in providing intergenerational care through training.</li>
</ul>
<h3>Sex and gender identity in communication</h3>
<p>
Historically, health care focused on a patient's sex, their biology. In today's world, the inclusion of a patient's gender, which reflects the psychological orientation of a person, matters. As this area grows, we encourage attention to be given to a patient's preferred gender when communicating. Adding this can benefit your patient's mental health as well as lead to positive patient outcomes. A patient can feel respected and "seen" or "heard" when you honor their preferred gender while treating their biological needs.
</p>
<h3>Incorporating cultural sensitivity</h3>
<p>
While a very complex area, the significant barriers related to cross- cultural communication can be patient safety risks and ethical matters. Culture includes traditions, customs, norms, beliefs, values, and thought patterns that are often passed down throughout generations. Incorporating cultural sensitivity into your medical practice allows you to better understand and meet your patient's clinical needs. This can aid in positive health outcomes and greater patient safety. A patient's culture can influence their attitudes and even willingness to disclose information or consent to a treatment. Being culturally sensitive can enhance your trust with patients. In case of a language barrier a medical interpreter should be offered and used and documented in the medical record.
</p>
<p>
Focusing on the below principles can help improve cultural sensitivity when communicating with your patients.
</p>
<ul>
<li>Recognize your own ethnocentrism (believing that the customs and practices of your culture are superior to those of other cultures).</li>
<li>Develop a higher tolerance for ambiguity.</li>
<li>Reduce the level of evaluation in your messages.</li>
<li>Prepare your message. The roles and rules of the patient's culture should drive the communication. Physicians and practitioners should prepare their message by adapting to the patient's culture.</li>
<li>Remove assumption. Do not assume that nonverbal communication such as eye contact, gestures, posturing, touch, and physical distance are common to all cultures.</li>
<li>Seek training and education on diversity, equity, and inclusion to improve skills in providing culturally competent care.</li>
</ul>
<p>
None of us are perfect at communication. Practicing with colleagues, friends, and family to strengthen our skillset and application is recommended. Being aware of our shortcomings in communication is half the battle.
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/3/2025 12:23:24 PM | 9/3/2025 11:21:22 AM | 9/3/2025 12:00:00 AM |
| leveraging-trust-for-public-good | Leveraging Trust for Public Good | WSMA_Reports | Shared_Content/News/Latest_News/2025/leveraging-trust-for-public-good | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports September-October 2025 cover" src="/images/Newsletters/Reports/2025/september-october/cover-wsma-septoct-2025-645x425px.jpg" class="pull-right" /></div>
<h5>Sept. 3, 2025</h5>
<h2>Leveraging Trust for Public Good</h2>
<p>
By Rita Colorito
</p>
<p>
When a Longview city council member put forth a plan to remove fluoride from the town's water supply, Erin Harnish, MD, a longtime community pediatrician, sprung into action. The year-long advocacy campaign she led successfully defeated the plan (see p. 7 in the May/June 2025 <em>WSMA Reports</em> for more on the story). It's an example of how doctors can leverage the trust of their patients and community to ensure that public health initiatives remain based on medically and scientifically sound evidence.
</p>
<p>
Throughout Washington state, long-standing, evidence-based public health initiatives, such as fluoride in water or needle exchange programs, have come under attack in recent years. Dr. Harnish offers this step-by-step guide to push back and win:
</p>
<ul>
<li><strong>Stay informed.</strong> Dr. Harnish wouldn't have known about the plan to de-flouridate Longview's water if it wasn't for someone she knows who pays attention to city council meetings.
</li>
<li>
<strong>Build a coalition of community experts and concerned citizens.</strong> Dr. Harnish's coalition included working and retired dentists and pediatricians, teachers, parents and water treatment specialists. They quickly mobilized to send emails and letters to the community. They knocked door to door getting petition signatures. Some dentists didn't even know about the council's plan, says Dr. Harnish.</li>
<li><strong>Fill the room.</strong> Mobilize as many people as possible to attend public hearings. Dr. Harnish spoke to several community groups, like the Rotary, who were interested in the topic.</li>
<li><strong>Slow down the process.</strong>When speaking at the public portion of hearings, ask for time to study the topic. Dr. Harnish's coalition asked to convene a community workshop.</li>
<li><strong>Hold regular strategy meetings.</strong> Dr. Harnish's coalition held about five one-hour strategy sessions. They invited key experts to those meetings to discuss effective messaging, the timeline, opposition concerns, their strengths, and what information they still needed to know.</li>
<li><strong>Evaluate and address community concerns.</strong> The coalition's workshop included five expert speakers, each explaining a different part of the safety and health necessity of fluoride in water. They took a scientific approach to why removing fluoride would harm the community, especially children. It gathered evidence-based information and reviewed articles people were highlighting about their concerns. Speakers also had relevant studies at the ready to share.</li>
<li><strong>Focus on community health, not politics.</strong> Most people believe physicians have their family's health in mind. "We didn't take it as a political issue. We took it as a health issue, and I think that gave us the credibility to speak to it," says Dr. Harnish. People who lined up to speak and offer support asked council members to listen to the health experts.</li>
</ul>
<p>
<em><strong>Rita Colorito</strong> is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/3/2025 12:05:26 PM | 9/3/2025 11:21:29 AM | 9/3/2025 12:00:00 AM |
| truth-noise-and-nonsense-in-medicine | Truth, Noise, and Nonsense in Medicine | WSMA_Reports | Shared_Content/News/Latest_News/2025/truth-noise-and-nonsense-in-medicine | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports September-October 2025 cover" src="/images/Newsletters/Reports/2025/september-october/cover-wsma-septoct-2025-645x425px.jpg" class="pull-right" /></div>
<h5>Sept. 3, 2025</h5>
<h2>Truth, Noise, and Nonsense in Medicine</h2>
<p>
By Rita Colorito
</p>
<p>
Unqualified influencers, pseudoscience blogs, and posts with anecdotal cures: There's much dubious and downright dangerous health information online that can erode trust between patients and their physicians.
</p>
<p>
A 2024 report from The Lancet Digital Health underscores the danger, noting that overwhelming amounts of health information, increased social and political divisions, and poor health literacy has led to a sharp decline in public trust in physicians and hospitals from 72% in 2020 to 40% in 2024. Medical misinformation further exacerbates this decline in trust.
</p>
<h3>From problem to progress</h3>
<p>
While misinformation and disinformation have long existed, the proliferation of social media and the COVID-19 pandemic fueled the flames of fake health news. It's hard to quantify the universe of false information, but one study in Bulletin of the World Health Organization found the proportion of health-related misinformation on social media as high as nearly 29%.
</p>
<p>
Given an estimated 70% of adults use the internet to research health information, it's no wonder patients struggle to distinguish good from bad health information found online. This faulty "research" often makes its way to medical appointments, causing friction and frustration for patients and physicians alike.
</p>
<p>
There's hope here, though. Despite declining trust, research during the pandemic found people's personal physicians are still their number one most trusted source of information.
</p>
<p>
"One of the advantages that physicians have is the one-on-one context. You're already starting from a better place than a lot of public health communication campaigns that are just communicating into the void, out to millions of people," says Julia Minson, PhD, professor of public policy at the Harvard Kennedy School of Government. Her research focuses on the "psychology of disagreement" and scalable solutions for disagreement on hot-button topics like health decision-making.</p>
<p>Physicians, in turn, can feel pressure to
convert these sometimes confrontational
conversations into a collaborative
encounter, says John Wynn, MD, a
professor of clinical psychiatry at the
University of Washington School of
Medicine, a physician coach who often
cares for physicians facing mental health
challenges. “One of the reasons why
physicians get burned out dealing with
these patients is they feel like it’s their
job to overcome this misinformation and
convince this person to do the right thing.â€</p>
<p>
To keep the lines of communication open, it's better to view yourself as another source of information, says Dr. Wynn, instead of the "I'm-the-trained-expert" approach some physicians take. But how do you become the trusted source?
</p>
<h3>Steps to build or rebuild patient trust</h3>
<p>
Building or rebuilding trust when you don't see eye to eye can feel like a gargantuan task. Behavioral psychology, say Dr. Wynn and Dr. Minson, offers ways physicians and clinicians can engage patients with different beliefs to foster goodwill and good medicine.
</p>
<p>
Both nonverbal and verbal cues can affect patient trust and willingness to follow a care plan. Sitting down, making eye contact, and listening are the basic tenets of building patient trust, says Dr. Wynn.
</p>
<p>
"The best way to foster collaboration in any context-and by the way the best way to change people's minds-is to make sure they really feel like you're listening to them," says Dr. Wynn. But the listening part is where many physicians need help. He recommends these steps during patient interactions, but especially for potentially tense encounters:
</p>
<ul>
<li><strong>View all patient interaction as an effort at collaboration.</strong> "Say to yourself, whatever it is this patient's doing, no matter how confusing or frustrating it is, this is their effort to get through this. This is their way of joining the team," says Dr. Wynn.</li>
<li><strong>Give people time to speak.</strong> The average physician interrupts patients after 18 seconds. More surprising, the average patient will only talk for about 90 seconds if given the chance. While that can feel like a lifetime to physicians with crammed schedules, it's time worth taking. "There's social psychology research that goes back to at least the 1950s demonstrating that people are much more likely to listen to what you have to say, if, before you talk, they feel listened to," says Dr. Wynn. Time spent listening now saves time later in dealing with consequences of patients not following your clinical advice or pursuing dubious or dangerous alternative treatments.</li>
<li><strong>Ask questions about their research.</strong> Understand why the patient is investing trust in other resources. Questions to ask include: What's your sense of why this may help? How do you think this treatment might work? Why do you trust this source? Have you used it before and how did it help you?</li>
<li><strong>Speak so they'll understand.</strong> Avoid medical jargon and use metaphors to relay information. "One of the advantages of listening to the patient first is to understand their level of education and the type of language that's most likely to make sense to them," says Dr. Wynn.</li>
<li><strong>Praise their effort before offering your advice.&nbsp;</strong>Patients often complain that physicians sound dismissive or condescending of their online information. Instead acknowledge the work they did to learn about their health. Dr. Wynn suggests: "Wow, it looks like you've done a lot of research on this. I know you've got some strong ideas about this. Let me tell you how I see it and see what you think." Praising what they're already doing right, like getting regular sleep and exercise, also helps build rapport.</li>
<li><strong>Critique the information, not the source.&nbsp;</strong>Focus on the treatment that the resource is offering versus the one you understand as effective. Don't offer your opinion on the source unless asked. Even then, tread lightly. You might say: "I'm concerned that the person who might guide you in doing this is not well-trained. I don't know about their credentials; they don't make sense to me."</li>
<li><strong>Couch skepticism in humility.</strong> For example: "You know, I've read a lot about this problem, and I have not come across this explanation. I appreciate you telling me about it. It doesn't really make sense to me. Let me tell you how I think about it and then let's compare what you've read with what I've read."</li>
<li><strong>Steer them to credible online sources.</strong> Dr. Wynn suggests <a href="https://medlineplus.gov">MedlinePlus.gov</a> as a curated source for patients to do their own trustworthy medical research.</li>
</ul>
<h3>Engage minds: Now HEAR this</h3>
<p>
Resist the urge to correct patients, says Dr. Minson, which is a surefire way to end any conversation or hope of collaboration fast. "It's dangerous to get into persuasion land, where what you immediately want to do is change their mind," she says. "The worst-case scenario is when you fail to persuade and the patient feels like they can't talk to you anymore. Burning that bridge is really the biggest risk."
</p>
<p>
For confrontational interactions, Dr. Minson's research finds a technique called "conversational receptiveness" helps engage people with whom we disagree. The acronym HEAR describes the framework:
</p>
<ul>
<li><strong>H stands for hedging.&nbsp;</strong>In medicine, there's an exception for every rule-something social media is good at exploiting. Hedging helps address that. For example, instead of saying COVID-19 vaccines are safe and effective, you might say most physicians tend to believe that COVID-19 vaccines are largely safe and effective. "The point is still the same. But I make a little bit of space for your perspective," says Dr. Minson.</li>
<li><strong>E stands for empathizing agreement.&nbsp;</strong>You don't have to fake agreement with things on which you don't agree. Instead, find areas of common ground. For example, agreeing that you both want the patient and their family to be safe and healthy.</li>
<li><strong>A stands for acknowledgement.&nbsp;</strong>This step is one most physicians execute badly, especially when they're in a hurry, says Dr. Minson. "What people often do is something like, 'I hear that you've had a bad experience, but here's a reason why you should do this anyway.' That doesn't demonstrate that you really heard the person," says Dr. Minson. Acknowledgement reflects back what the patient tells you. For example: "I understand that a couple years ago, you had a vaccine that you thought gave you these side effects. You are really uncomfortable with the idea of getting vaccinated again because you had this experience."</li>
<li><strong>R stands for reframing the positive.&nbsp;</strong>Infuse your clinical advice with positive emotion and tone. Avoid contradictory or negative terms, such as no, can't, won't, or don't. For example, getting vaccinated helps prevent certain illnesses and make them less severe if you do get them. Not, if you don't get vaccinated you may get sick, hospitalized, or die.</li>
</ul>
<p>
"The key idea is that you're using language to communicate to your counterpart that you are truly engaged with their perspective," says Dr. Minson. "In the domain of COVID-19 vaccines, we found that following that framework does, in fact, make people trust you more, and does make them want to come back for your opinions on other topics again."
</p>
<h3>Embrace digital solutions</h3>
<p>
Speaking of credible sources, physicians may lament social media's hold on America's psyche. But social media can and should serve as a tool to disseminate legitimate health information. Some 65% of physicians already use some form of social media for professional purposes, according to a 2022 study published in The American Journal of Medicine.
</p>
<p>To help support physicians' online presence, in July, the WSMA broadened its <a href="https://wsma.org/your-care-is-at-our-core">Your Care Is at Our Core public awareness campaign</a> to include effective social media and public awareness health messaging. The goal is to help patients navigate health care information and bolster the evidence- based decision-making at the heart of the physician-patient relationship.</p>
<p>
"It is information that you can use directly to improve your quality of outreach," says WSMA President John Bramhall, MD, PhD. "It's information to help restore and maintain the confidence that people have when they go to see a doctor."
</p>
<h3>Make a human connection</h3>
<p>
While physicians' default mode is to present data and let patients make their own decisions, Dr. Minon's research also finds people view stories as being more trustworthy than evidence or data. Of course, personal stories are a large part of what draws people to social media influencers.
</p>
<p>
"To the extent that your goal is to get them to take a specific action, it's helpful to mix the science with personal experience," says Dr. Minson. That could include a personal or patient anecdote, such as your own bout with COVID-19, or a heart attack patient who had refused taking blood pressure medication and had another heart attack.
</p>
<p>
"It doesn't necessarily need to be scary, but it's helpful if it's a little bit vulnerable. Those stories tend to be more vivid than the data," says Dr. Minson. "As much as we want to rely on data, that's just not how humans are wired."
</p>
<h3>Redefine your end goal: replace correction with connection</h3>
<p>
Even with the best tips, one conversation is unlikely to change anyone's beliefs. Instead, focus on building a bridge to the next conversation and the long-term patient-physician relationship, say Dr. Minson and Dr. Wynn.
</p>
<p>
When you replace correction with connection, patients are more likely to come back. "Whatever it is you're talking about right now is one medical decision in a lifetime of medical decisions," says Dr. Minson. "The goal is, will this person come back and talk to me again? Not, can I make them do this specific action right now, or change a particular negative behavior?"
</p>
<p>
Building that human connection first can help steer patients through all the social media noise and nonsense, says Dr. Wynn. "Even the most troublesome patients offer us an opportunity to fulfill the role that is most important to us, the role of being a healer. Because of the interaction, because of the relationship you develop, that person's suffering stops … It's the privilege of being a doctor."
</p>
<p>
<em><strong>Rita Colorito</strong> is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the September/October 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/9/2025 11:23:01 AM | 9/3/2025 11:13:17 AM | 9/3/2025 12:00:00 AM |
| safeguarding-sexual-health | Safeguarding Sexual Health | WSMA_Reports | Shared_Content/News/Latest_News/2025/safeguarding-sexual-health | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/july-august/reports-julaug-2025-cover-645x425px.jpg" class="pull-right" alt="cover image from July-August 2025 issue of WSMA Reports" /></div>
<h5>July 22, 2025</h5>
<h2>Safeguarding Sexual Health</h2>
<p>
By Rita Colorito
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
In March, the Washington state medical and research communities mourned the passing of University of Washington Distinguished Professor Emeritus King Holmes, MD, recognized worldwide as the "father of STI research." Dr. Holmes' foray into sexually transmitted infection care started in the 1960s, with his use of doxycycline as a post- exposure prophylaxis for gonorrhea that was spreading among U.S. sailors in the Pacific. Today, the Centers for Disease Control and Prevention and the World Health Organization both endorse doxy PEP for bacterial STI prevention. Dr. Holmes and his students also developed treatments and preventions for numerous STIs, including syphilis, chlamydia, trichomoniasis, human papillomaviruses, genital herpes, Mycoplasma genitalium, hepatitis B, and bacterial vaginosis.
</p>
<p>
A giant in the field of STI clinical treatment, research, and public health, Dr. Holmes helped build the world in which today's public health and sexual health leaders live, as the fight against STIs continues into a new era.
</p>
<p>
Like much of the country, Washington state remains in an STI epidemic and syndemic. Nationwide, there were over 2.4 million STIs reported in 2023-a 1.8% decrease overall from 2022, but a more than 37% increase since 2013. Washington State Department of Health data from 2023 shows 43,019 diagnosed and reported STIs-a nearly 43% increase since 2013.
</p>
<p>
While Washington state has overall STI rates lower than the national average, more can be done to safeguard the sexual health of Washingtonians, say experts, especially when it comes to syphilis. While both state chlamydia and gonorrhea cases decreased from 2022, overall syphilis cases increased about 1% (2024 data was not available at time of printing).
</p>
<p>
Though any STI can cause serious complications, syphilis during pregnancy can cause congenital syphilis, which can result in prematurity, stillbirth, neonatal death, and birth defects. Syphilis cases nationwide, including congenital syphilis, are up over 1,000% from 2013.
</p>
<p>
Washington ranks 13th in the nation for primary and secondary syphilis and 25th for congenital syphilis. In May 2022, the Department of Health and Public Health Seattle and King County issued a congenital syphilis warning letter and updated syphilis screening guidelines after 51 reported cases of congenital syphilis statewide, 11 of those in King County. In 2023, there were 57 cases.
</p>
<h3>Check your risk bias</h3>
<p>
STI prevention starts with checking bias on who is at risk, says Colin Fields, MD, quality program director for the HIV/PrEP program at Kaiser Permanente Capitol Hill Medical Center. "I particularly want to dispel the presumption that syphilis just occurs in urban men who have sex with men," he says. Over the last decade, rates of syphilis have risen sharply, including among cisgender women, men who have sex with women, and men who have sex with men, according to the Department of Health.
</p>
<p>
It's also not just a big city problem. "Syphilis is something that is a risk for any sexually active person in urban and rural settings," says Dr. Fields.
</p>
<p>
Yakima family physician Jennifer Maxwell, MD, says the federally qualified health center where she works has seen STI infections in people of all ages who are sexually active. "We're seeing infections regardless of patient risk factors. I can think of one case where the patient was married and in a monogamous relationship and their testing came back positive," she says. "We're also seeing later stages of these diseases and the complications of those diseases."
</p>
<p>
Women with a prior history of HIV, chlamydia, and gonorrhea are at an increased risk of getting syphilis. In pregnancy-capable people, syphilis cases in Washington increased by 17% from 2022 to 2023. Among pregnant people, cases increased by 9%. Over 77% of people diagnosed with primary and secondary syphilis lived in five counties: King, Pierce, Spokane, Yakima, and Clark.
</p>
<p>
Prevention of HIV-a risk factor for syphilis-also remains an issue, says Larry Corey, MD, past president and director of the Fred Hutchinson Cancer Research Center and co-principal investigator of the HIV Vaccine Trials Network. "Forty percent of people who have HIV, both in state and nationwide, don't self-identify as being at high risk," he says. "We need to seek them out to provide prevention therapy and teach them how to reduce their risk."
</p>
<h3>From policy to practice</h3>
<p>
To help curb syphilis and other STIs, the WSMA House of Delegates shared three new policies with the Department of Health and the state Health Care Authority. Dr. Fields, a member of the WSMA board of trustees, co-authored the policies. The WSMA:
</p>
<ul>
<li>Endorses universal screening for syphilis in pregnant persons during their first trimester, third trimester, and at the time of presentation for delivery. (This aligns with American College of Obstetrics and Gynecology recommendations.)</li>
<li>Supports legislation to modify state law requiring submission of test specimens for rapid plasma reagin confirmation at the state level, enabling commercial labs to conduct confirmatory testing and share results with public health agencies. "Right now, state confirmatory testing sometimes has quite a lag period," says Dr. Fields. "People who are sexually active may end up having partners from the time they have a syphilis test to the time they find out about the result. We just want to reduce that window of time to treatment."</li>
<li>Supports public health jurisdictions having appropriate access to health system electronic health records to ease result integration, reduce burden on physician reporting, and expedite efficient treatment of patients and their partners.</li>
</ul>
<h3>Let's talk about sex</h3>
<p>
Sexual health should be discussed and normalized during wellness visits, says Dr. Fields.
</p>
<p>
These conversations can feel awkward for physicians and patients alike, but they don't need to be. "It's putting yourself in the health care professional role, rather than feeling like you're having a personal discussion about sexuality," says Dr. Corey.
</p>
<p>
Before asking sexual health-related questions, Dr. Fields asks, "Can we talk about your sex life?" "I want patients to feel invited into the conversation," he says. "Most people are really happy to talk. They also view it as an important aspect of their health."
</p>
<p>
To "de-pathologize" sex, clinicians should keep an open mind when discussing patient sexual health, says Dr. Fields. Reiterate that you are not there to pass judgement but to protect them by offering screening and treatment, if needed. For those at potential risk, discussions should include preventive medications, such as PrEP for HIV and doxy PEP, and making sure patients are current on vaccines for HPV, hepatitis A and B, meningitis, and mpox.
</p>
<p>
With any sexually active patients, STIs should stay front of mind in differential diagnosis, says Dr. Fields. "If there are any symptoms that could be suggestive of an STI, it's important to continue asking questions about people's behavior," he says. "Syphilis is sort of tricky to diagnose sometimes because it can mimic other diseases. So, it's just good to rule it out as a possibility."
</p>
<p>
STI prevention should be everyone's concern, says Dr. Maxwell. "It doesn't always need to happen in a primary care setting."
</p>
<p>
When someone is diagnosed with STIs, it can feel overwhelming. "Most of the time it is a very hard conversation," says Dr. Maxwell, who takes extra time explaining how it affects their care now and in the future. "We always let them know that we are reporting the case to the Department of Health, so [it] can help with partner notification."
</p>
<h3>Access to testing and prevention</h3>
<p> Timely testing and treatment make a difference. Washington state's Sexual and Reproductive Health Network includes 95 clinics statewide, run by 14 different partner organizations, including some geared to teens, that provide STI testing and treatment. As a reminder, teens aged 14 to 17 do not need parental consent to screen for HIV and other STIs.</p>
<p>
Access to care, however, remains a challenge for many people at high risk of STIs, especially those who are unhoused or more transient, says Dr. Maxwell. "The main issue is the ongoing shortage of primary care doctors," she says. "Even if they do establish care [with a primary care doctor], there is not good point-of-care testing."
</p>
<p>
Because STIs are largely asymptomatic infections, the true scope of the problem is bigger than the data suggests, says Dr. Corey. "Sexually transmitted infections, as well as HIV, are underdiagnosed diseases. Genital herpes is very prevalent and terribly underdiagnosed and undertreated," he says.
</p>
<p>
All-site exposure testing is critical to get the right diagnosis, says Dr. Maxwell. "Oftentimes people only think about urine testing or vaginal testing, but gonorrhea and chlamydia can live in the throat, can live in the rectal area. It's important to test in all of those areas."
</p>
<p>
Some patients are also reluctant to get the testing they need, says Dr. Maxwell. Self-collection of samples is one solution. During the COVID-19 pandemic, Department of Health guidance said physicians and physician assistants could offer self-collection of non-blood specimens for chlamydia and gonorrhea testing. Evidence finds self-collection can increase STI testing. To help patients, clinics can request free printable self- testing visual aids from the University of Washington STD Prevention Training Center, available in 21 languages.
</p>
<p>
Dr. Maxwell encourages all clinicians to understand STI current best practices. "Testing is more updated and more sensitive. There are also newer, easier treatments for HIV and for hepatitis that are much more tolerable," she says.
</p>
<p>
In July 2024, the Department of Health urged clinicians to familiarize themselves with doxy PEP treatment guidelines and use it to prevent bacterial STIs. The medication needs to be taken as soon as possible within 72 hours after vaginal, oral, or anal sex.
</p>
<p>
A new law signed by Gov. Bob Ferguson, House Bill 1186, may help reduce time to treatment. It expands situations in which hospitals and health care entities can dispense or distribute certain prepackaged emergency medications, including anti-infectives and HIV postexposure prophylaxis drugs. This includes instances where community or hospital outpatient pharmacy services will not be available within 48 hours.
</p>
<h3>Safeguarding wraparound care</h3>
<p>
Safeguarding sexual health also means safeguarding other programs that help reduce STI risk-some that routinely come under scrutiny. Take Washington's Syringe Service Program. In 1988, Washington became the first state to have a needle exchange program to prevent blood-borne diseases, including STIs, HIV, and hepatitis. Since starting its exchange program in 1993, the Yakima Health District has served more than 3,000 people a year countywide.
</p>
<p>
Syringe service programs operate in 26 counties. Many provide other preventive care, such as naloxone, vaccinations, and mental health counseling. In recent years, several local jurisdictions, including the Yakima City Council last fall, have debated the need for these exchange programs, concerned with enabling drug use despite decades of research to the contrary.
</p>
<p>
State statute authorizes syringe service programs, so local jurisdictions can't ban them outright, but they can regulate them. The Grays Harbor County Council voted to end the county-run needle exchange program. A nonprofit came in to fill the gap. In April, Lewis County became the first Washington county to officially restrict syringe service programs, including mandating they not be located near residential zones or within 750 feet of schools, libraries, and public parks. Dr. Maxwell says she's thankful the Yakima City Council decided to keep its exchange program for now.
</p>
<p>
Snohomish County serves as a prime example of the importance of continued funding at the state level. For 14 years, the county lacked a free clinic, after budget cuts forced closure in 2009. In that time, the county's case rate of gonorrhea more than quadrupled.
</p>
<p>
In 2022, then-Gov. Jay Inslee approved funding for a new STI clinic in Snohomish County. Since opening in late 2023, the Snohomish County STI Clinic has ranked among the top five clinics in the county for diagnosing new cases of chlamydia, gonorrhea, and syphilis. What's more, syphilis cases diagnosed there were treated three days sooner than those diagnosed elsewhere.
</p>
<p>
For the 2025-2027 biennial budget, the STI Workgroup recommended $5 million in STI services funding. The Washington State Legislature approved a one-time fund of nearly $1.4 million for the Snohomish County Health Department for field-based syphilis treatment and to maintain its public health STI clinic.
</p>
<p>
Federal budgetary cuts also loom large in the fight against STIs. Progress on an HIV vaccine depends on whether the current level of National Institutes of Health funding continues, says Dr. Corey. Overall, NIH funding for STIs was $388 million in 2024. For HIV/AIDS it was nearly $3.3 billion. Washington state received $1.5 billion overall in NIH funding in 2024. "We pull way above our weight … It's a huge concern for us," says Dr. Corey.
</p>
<p>
The concern is both professional and personal. Dr. Corey's work in the HIV immunology space was cultivated under the tutelage of Dr. Holmes, who served as Dr. Corey's postdoctoral advisor. Together, the two men co-founded the UW Center for AIDS Research. "He single-handedly changed the field from venereology to sexually transmitted infections," says Dr. Corey.
</p>
<p>
Dr. Holmes' passion lives on in the work of his colleagues, as Dr. Corey encourages the medical community to explain the importance of NIH funding to all their patients. "Government funding for research needs to continue if we're going to develop new therapies," he says. "Miracles start in the lab."
</p>
<p>
<em>Rita Colorito is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/22/2025 10:32:27 AM | 7/22/2025 10:21:28 AM | 7/22/2025 12:00:00 AM |
| managing-medical-documentation-after-a-cybersecurity-incident | Managing Medical Documentation After a Cybersecurity Incident | WSMA_Reports | Shared_Content/News/Latest_News/2025/managing-medical-documentation-after-a-cybersecurity-incident | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/july-august/reports-julaug-2025-cover-645x425px.jpg" class="pull-right" alt="July/August 2025 cover of WSMA Reports" /></div>
<h5>July 21, 2025</h5>
<h2>Managing Medical Documentation After a Cybersecurity Incident</h2>
<p>
By Heather Edwards, RN
</p>
<p>
The Change Healthcare ransomware attack in February 2024 stands as the most significant cybersecurity breach in U.S. health care history. Bad actors under the name of "BlackCat" exploited compromised credentials to access Change Healthcare's Citrix portal-a system lacking multifactor authentication. The attackers infiltrated the network, accessing sensitive data and deploying ransomware that encrypted critical systems, including those used for medical billing and claims processing. This incident not only compromised the personal data of approximately 190 million Americans, but also led to widespread operational disruptions across the health care sector.
</p>
<p>
The 2024 ransomware incident had a profound impact on the U.S. health care system, underscoring the vulnerabilities inherent in its IT infrastructure. In today's digital age, health care professionals face an ever-growing threat from cybersecurity incidents, particularly from ransomware attacks. Other events, such as software updates that led to the 2024 CrowdStrike event, can also disrupt system functionality. These situations can cripple organizations by locking access to critical systems and data, including essential medical documentation. When a cybersecurity event occurs, such as a clinic losing access to crucial records or when the system will not save documentation for a period of time, a swift, organized, and comprehensive response is crucial to mitigate impact and restore normalcy.
</p>
<p>
Addressing a cybersecurity or software incident involves a multitude of critical tasks. These include:
</p>
<ul>
<li>Having a clear plan for isolating compromised systems.</li>
<li>Eradicating malware.</li>
<li>Implementing robust backup and recovery strategies.</li>
<li>Complying with legal and regulatory requirements.</li>
<li>Communicating transparently with stakeholders.</li>
<li>Conducting post-incident analysis.</li>
</ul>
<p>
Physician Insurance's Cyber Center has resources to help with developing policy and plans on these topics. Your cyber liability insurance provider is another potential resource to help you with these issues.
</p>
<h3>Assessing documentation data and functionality post-incident</h3>
<p>
When a breach or issue is identified, conduct thorough quality control to determine the extent of the impact on your documentation. This includes evaluating whether critical components such as patient notes, medication ordering or administration, referrals, and lab and imaging orders or results have been affected, including interfaces, if indicated. By systematically reviewing these elements, organizations can identify any disruptions or data loss, address vulnerabilities, and implement a targeted plan for downtime documentation. These steps will help maintain the integrity of patient information. Here is one example of how this can be done:
</p>
<ol>
<li>Identify patients seen during the affected period.</li>
<li>
Identify the physicians and practitioners working during this period by sampling patients from different physicians and different departments or specialties.
</li>
<li>Determine your sample size, which will depend on how many patients you see daily or are on your unit.
<ul>
<li>
If the number of charts is less than 20, we recommend reviewing all of them.
</li>
<li>
If more than 20 patients are seen daily, review a minimum of 20 records and increase to 10% of total volume of patients.
</li>
</ul>
</li>
<li>
Identify who will perform the audits. This could potentially be different people depending on the information being audited. Clearly communicate with staff who will audit what and when.
</li>
<li>
Determine the components of the records needing to be reviewed. These components should be specific to your organization's standard documentation processes. For example:
<ul>
<li>General notes for all staff types (physician notes, nurses notes, medical assistants, therapy, etc.).</li>
<li>
Vital signs.
</li>
<li>
Medication prescribing and administration.
</li>
<li>
Lab ordering and the communication of results.
</li>
<li>
Diagnostic imaging ordering and results.
</li>
<li>
Referrals (internal and external).
</li>
<li>Documents (informed consent, patient education, downtime papers, etc.).</li>
</ul>
</li>
<li>Develop a tool to use when auditing charts, or adapt ours, titled "Data Loss Audit Tool," which can be found in our resource library and can be edited to fit your organization's needs.</li>
<li>Develop and distribute detailed guidelines regarding where assigned auditors are to look in the EHR for key information. It is important for your staff to know where your clinicians expect to find documentation. In EHRs, information can be viewed in a number of places, so be sure to confirm the specific areas that your organization utilizes.</li>
<li>Determine the process and timeframes for auditing the "closing the loop" process for referrals and testing. This crucial activity often takes days to weeks to complete. Reasons for an unclosed loop include the possibility that interfaces are not working as anticipated or that other parts of the organization's system are not functioning as designed.</li>
<li>If paper charting was used in your organization's downtime process, identify how the paper notes, orders, and all results will be imported or uploaded. For accurate tracking and rendering, take time to import or upload all the records as discrete or structured data instead of text based or scanned information. Future decision-making can be hindered and patient safety can potentially be compromised if clinicians seeking vital information are reduced to using non-intuitive methods and are looking in atypical areas of the patient record.</li>
<li>Communicate ongoing findings, in real time, to all staff members who utilize the EHR and are involved in the resolution of issues. This will facilitate a shared understanding among all stakeholders regarding up-to- date system capabilities.</li>
</ol>
<h3>Long-term strategies</h3>
<p>
Adopting long-term strategies is the best way to bolster patient safety and continuity of care, as well as protect and defend your medical practice. Conducting thorough risk assessments, updating cybersecurity policies, and implementing regular staff training on security and downtime best practices should happen regularly. Crucial steps in preparing for and mitigating future incidents also include reviewing and revising incident response plans, strengthening backup and disaster recovery strategies, and consulting with legal and insurance experts.
</p>
<p>
The loss of medical documentation due to a cybersecurity incident is a serious issue that requires a structured and proactive approach. By swiftly responding, identifying the gaps, fulfilling legal obligations, restoring data, maintaining transparency, and investing in future protections, physician practices and organizations can effectively manage such crises and safeguard their patients and operations.
</p>
<p>
<em>Heather Edwards, RN, CPHQ, is a senior clinical risk consultant with Physicians Insurance.</em>
</p>
<p>
<em>This article was featured in the July/August 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/22/2025 1:45:07 AM | 7/21/2025 11:58:44 AM | 7/21/2025 12:00:00 AM |
| wsma-reports-charting-the-future-of-ai | WSMA Reports: Charting the Future of AI | WSMA_Reports | Shared_Content/News/Membership_Memo/2025/July-11/wsma-reports-charting-the-future-of-ai | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2025/july/reports-julaug-2025-cover-645x425px.jpg" class="pull-right" alt="WSMA Reports cover for July-August 2025" /></div>
<h5>July 11, 2025</h5>
<h2>WSMA Reports: Charting the Future of AI </h2>
<p>
<em>Inside the July/August issue of WSMA's member magazine</em>
</p>
<p>In medicine, the promise of artificial intelligence is rapidly unfolding, including offering greater efficiency in workflow and clinical documentation within electronic medical records and returning more time to physicians for their patients. In the July/August 2025 issue of <em>WSMA Reports</em>, feature writer John Gallagher talks with physician leaders who are at the forefront of system adoption of new AI ambient scribe tools to explore what they're seeing in their settings, and shares the perspectives of practicing physicians who've already incorporated-or have considered incorporating-the tools into their daily practice. </p>
<p>Elsewhere, feature writer Rita Colorito honors the passing of University of Washington professor emeritus King Holmes, MD, recognized worldwide as the "father of STI research," by conducting a routine checkup on Washington state's battle against sexually transmitted infections. Featuring conversations with WSMA members and experts in the field of sexual health, public health, and immunology, Rita's story will bring you up to date on current best practices for screening-and advocating-for sexual and community health. </p>
<p>From our trusted partners at Physicians Insurance, clinical risk consultant Heather Edwards reflects on the repercussions of the Change Healthcare ransomware attack in 2024 and offers guidance for practices and systems on responding to cybersecurity events-increasingly a feature of our modern era rather than a bug. </p>
<p><a href="https://wsma-my.sharepoint.com/:b:/g/personal/gfs_wsma_org/EU_F-YHT8IJGksJTjsrECkYBV3miSxNRMcGyt5JFpjNKfg?e=VXCteh"> Download the issue</a>. </p>
<p>
Also in the issue:
</p>
<ul>
<li>Member spotlight on Kim Emery, PA-C. </li>
<li>2025 Leadership Development Conference: A story in pictures. </li>
<li>By the numbers: Virtual triage AI and care referrals. </li>
<li>An open letter and call to action from John Vassall, MD. </li>
<li>And much more. </li>
</ul>
</div> | 7/10/2025 3:38:08 PM | 7/10/2025 3:14:06 PM | 7/11/2025 12:00:00 AM |
| charting-the-future-of-ai | Charting the Future of AI | WSMA_Reports | Shared_Content/News/Latest_News/2025/charting-the-future-of-ai | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/july-august/reports-julaug-2025-cover-645x425px.jpg" class="pull-right" alt="cover image from July-August 2025 issue of WSMA Reports" /></div>
<h5>July 9, 2025</h5>
<h2>Charting the Future of AI</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By John Gallagher
</p>
<p>
In just a few short years, artificial intelligence has gone from an interesting idea to a widely available tool. With corporations racing to unlock the full potential of AI, the field will only continue to expand, with more and more applications that promise to improve processes. In medicine, that includes greater efficiency in workflow and clinical documentation within electronic medical records, with the potential to return more time to physicians for time with patients.
</p>
<p>
For physicians who were around when EMRs were instituted, that promise sounds awfully familiar-and not entirely reassuring. "When EMRs came along, I thought, this was it," says Christopher Kelly, MD, associate chief medical information officer for data and analytics at MultiCare. "Patient information would be a lot more accessible, and we would see a lot more data that would help us do our jobs better. That was one of the promises, but the technology took a long time to mature. I know a lot of clinicians couldn't adapt to the electronic medical record and ended up retiring early."
</p>
<p>
Yet, despite that experience, the level of interest in AI from the physician community is very high. "This may be the first time in my career for this kind of excitement from physicians," says Becket Mahnke, MD, chief medical information officer at Confluence Health. "There was a little for EMRs, but there's palpable excitement that these tools will have a significant impact. It's probably an overestimate of what the impact will be. A lot of my role is setting those expectations."
</p>
<p>
The excitement in large part is because AI is offering practical help more rapidly to physicians than EMRs did. Nowhere is that clearer than the development of dependable AI-generated notes, also known as ambient AI. While the technology still presents challenges, platforms such as DAX Copilot, which interfaces with EPIC, have in a short period become essential to many physicians who use them. With reliable notes generation, physicians no longer have to spend hours outside the exam room-and outside of business hours- finishing notes. AI offers the promise of empty mailboxes at the end of the day, a concept that many physicians have forgotten was possible.
</p>
<p>
"I just love it," says Anukrati Shukla, MD, an internal medicine physician in Monroe. As a primary care physician, she sees a high volume of patients, and DAX Copilot has made the volume bearable. "I wouldn't be able to do without DAX," she says. "With it, I never take my notes home with me." The technology has made her job so much easier, says Dr. Shukla, that now "I wouldn't take a job that wouldn't have DAX."
</p>
<p>
"Honestly, it's a game changer," says Jennifer Knox, MD, a family medicine physician at Coulee Medical Center in Grand Coulee. Because her system uses Cerner's EMR, she uses Cerner's AI-assisted notes. "Even our older physicians have said this is the number one thing, aside from support staff, that has made their life better at work."
</p>
<p>
The new technology solves a problem that has dogged physicians for years. The need to have a full record of the patient's visit meant physicians have often been stuck at their computers taking notes, which diverted them from more direct interaction with patients. Previous solutions have often been hit-or-miss.
</p>
<p>
Having a third person in the room changed the dynamic with patients, and the quality of the scribes' notes varied. "We had in-person scribes, whom we let go due to unreliable staffing," says Dr. Mahnke. "No one grows up and says, 'I want to be a scribe.' To have a good scribe is a great day, but a bad scribe is a terrible day." Confluence then turned to virtual scribes with a remote recording device in the exam room, but Dr. Mahnke said those results were "spotty," as well.
</p>
<p>
Dr. Knox had similar experiences with a remote scribe system. "The scribes were real people who were listening in," says Dr. Knox. "That was a lot better, but it still came with problems." The scribes were based in India, so occasionally there were language issues, as well as connectivity issues.
</p>
<h3>The tipping point</h3>
<p>
The option to switch to AI for notes is relatively recent. "I was a slow adopter, a pessimist," says Dr. Mahnke. "Earlier versions, prior to 2023, were pretty disappointing." By 2024, however, the technology had advanced enough to start to deliver on its promise of producing largely accurate notes.
</p>
<p>
The technology is extremely sophisticated. "This AI is not just transcription," Dr. Kelly points out. "The AI actually writes a draft progress note. The first step is a transcript of the conversation with a voice recognition model, which used to be a real challenge. But this technology has improved quite a bit. It then feeds the transcript into a large language model and uses that to write notes. It's extracting relevant information out of the encounter conversation. It will extract physical findings and the assessment and plan discussed. Physicians can then link those sections into notes."
</p>
<p>
Even though MultiCare only rolled out a DAX Copilot last year, Dr. Kelly says that already it's gotten much better. For example, previous iterations sometimes had problems with patients' pronouns, but that problem has since been corrected. Customization offers physicians choices: narratives vs. bullet points, or plain English vs. medical language.
</p>
<p>
What is particularly impressive is the ability of AI to discern what is important and what is extraneous. "I was surprised at how well DAX can discard the noise and small talk," says Dr. Shukla.
</p>
<p>
"If there's a patient who rambles, it doesn't necessarily pick up on that," says Dr. Knox of AI. On the other hand, "if a patient says they are really struggling with their roommate, it picks it up if its pertinent to their mental health." The AI also presents information in a neutral manner. To test the AI, physicians pretended to be angry or belligerent, but "it transcribes that in a very detached way."
</p>
<p>
AI does require physicians to modify how they interact with patients for the technology to capture information fully. "It's not so much training as experience with it," says Dr. Kelly. "It's talking through the reasoning process a bit more, being more vocal about how you're approaching a problem."
</p>
<p>
"I had to be more intentional for a physical exam," Dr. Shukla agrees. "A patient would just point, but you have to call that out, 'You have pain in the upper right side of your abdomen.' Sometimes you have to rephrase what a patient is saying" for the AI to correctly interpret it.
</p>
<p>
Like any technology, ambient AI notes can make mistakes. It can sometimes have a hard time differentiating between who the patient is when a family member is discussing another family member during their own visit. Some mistakes can be significant. Dr. Knox recounts an episode where a patient said there was no history of prostate cancer in his family only to have the notes say that there was. "You do have to proofread the notes," she says.
</p>
<p>
"This is just like old-school transcription or speech-to-text tools- you have to review what gets spit out by the tool," says Dr. Mahnke. "You still have to validate the transcript."
</p>
<h3>Conditioning for success</h3>
<p>
Not everyone takes to the new technology. "One of the things that is striking to me talking to my CMO colleagues around the state is that ambient has a 30-40% abandonment rate," says Dr. Mahnke. "It is a very different way of practicing."
</p>
<p>
About 10% of physicians at Confluence are using ambient AI. To ensure that physicians are ready to use the technology properly, they must clear a series of steps first. Before they can even become eligible, they have what Dr. Mahnke calls "a significant amount of homework" to understand the system. "That has prepared folks who opted in better," he notes. "They're thinking about how to structure a visit with audio output and how to work that into a document workflow that is 100% ambient."
</p>
<p>
Some physicians who do the homework decide the technology isn't right for their practice. But for those who do sign up, the rate of success is high. Only two clinicians at Confluence decided to discontinue use of AI.
</p>
<p>
With proper expectations, physicians often find the new technology extremely useful. "The feedback has been incredibly positive, and I'm somewhat surprised because I was very skeptical," says Dr. Mahnke.
</p>
<p>
Those physicians who have embraced ambient AI find it incredibly helpful. Because the AI determines what is pertinent for notes, it relieves doctors of having to do note-taking themselves, while listening to the patient and trying to remember the patient's history all at the same time. "It takes a lot of mental load off of our shoulders," says Dr. Knox. "You don't have to half listen while trying to remember what else the patient is due for. It helps me keep track with what I intended to do with my patients."
</p>
<p>
DAX has been especially helpful for Dr. Shukla because she didn't type notes in the exam room. "Once you step out of the exam room, you lose 50% of the information," she admits. "Patients are liking it that I remember everything. If it's not in my DAX, we didn't discuss it. I don't have to rely on memory."
</p>
<h3>Transparency with patients</h3>
<p>
The impact of AI on patients remains an important consideration. In 2023, the WSMA House of Delegates adopted a resolution on the use of AI in medicine, stating that any AI that is patient-facing should be transparent to patients so that they know an automated system is being used. The resolution supports the development of physician-guided guidelines defining "patient-facing AI" that will consider direct patient interactions, AI's role in information retrieval and interpretation, and its influence on decision-making to strike a balance between transparency to patients and the feasibility and necessity of disclosing AI's involvement when physicians remain the final decision- makers, reviewers, or editors of the information provided to patients.
</p>
<p>
So far, patients seem not to be concerned about AI-generated notes, knowing that their physicians are still the ones making decisions about their care. If anything, patient satisfaction seems higher with AI notes for a number of reasons.
</p>
<p>
"We surveyed patients about how digital tools met their needs," says Dr. Mahnke. "One of the questions was, when you are with the physician or practitioner, how do they interface with technology-are they looking at the screen or looking at you? Even in a small cohort of DAX users, they had by far the highest patient satisfaction."
</p>
<p>
Anecdotal feedback underscores how much patients value the interpersonal connection with their physician. "We've gotten unsolicited comments from patients that the doctors aren't treating the computer. They're treating them," says Dr. Kelly.
</p>
<p>
"I had met a patient who said, 'I never saw this doctor look in my eyes as much,' " recalls Dr. Mahnke. Moreover, the patient found the notes in the EMR far better than before.
</p>
<p>
While the consensus is that AI saves time note-taking, that doesn't necessarily translate into saving time, period. Dr. Kelly said that upon a review of the user activity records over a six- month period, MultiCare found that AI wasn't saving physicians "any time overall." But the time no longer needed for notes was still well spent.
</p>
<p>
"They took that time that they saved in notes and they put it back into face-to- face patient care," Dr. Kelly says. "There was a huge increase in physician and practitioner satisfaction. They were less likely to burn out, happier in their practice, and 100% of respondents would be disappointed if they lost access [to AI]. The overall majority felt that they were better doctors and nurses." (The survey was about 75% physicians and 25% advanced practice registered nurses.)
</p>
<h3>Weighing the costs and benefits</h3>
<p>
Large systems have been at the forefront of AI adoption, in large part because of the resources necessary to implement it. However, the platforms work well for smaller practices, as well. "I work for a relatively small facility, a critical access hospital and rural health care clinic," says Dr. Knox.
</p>
<p>
Right now, cost is a prohibiting factor for adoption by smaller practices. According to Dr. Mahnke, a 2024 survey of CMOs found that the cost of using ambient AI for a visit was about $5. "If you ask doctors if they were willing to pay the $5, 90% would say no," he says. "When you have an already small margin on a visit, that's a hard argument to make."
</p>
<p>
Still, he predicts that AI is the wave of the future. "Care delivery in 2030 will look like more of a transition to voice," says Dr. Mahnke. "We're starting to see that already. We'll have orders prepared for us, the ability to ask for additional information in that interface. This is not for everybody, but it will be a voice-based interaction, not just a documentation tool.
</p>
<p>
Dr. Kelly agrees that ambient AI is just the beginning of the many ways that AI can provide additional relief for physicians. "There's so much potential to improve the backend processes, the burdensome, repetitive things that physicians find frustrating but are critical to good patient care," he says. He cites medication reconciliation as an example. "If you are admitting a patient, they may not know if they are taking 20 milligrams or 40 milligrams of a medicine, but it can be critical to the patient's health," he notes. "Those things happen all the time. The pharmacy database should be communicating with the EMR so no one needs to spend time tracking down pharmacy records to make sure you have the doses right."
</p>
<p>
Indeed, the expansion of AI is clearly on the horizon. "When I walk into the room with a patient, there's no reason why AI can't read the entire chart in the EMR, generate a summary of the patient's health organized by problem and focused on my specialty with all the care gaps cued up," Dr. Kelly says. "The physician has the conversation with the patient and discusses a plan. Then AI generates the notes and appropriate codes. The referrals are queued up and medications prescribed. The physician concentrates on taking care of the patient, and the AI takes care of the EMR."
</p>
<p>
In fact, says Dr. Kelly, many of these options are available now. But it's incumbent on leaders to ensure that the technology actually delivers on the promises.
</p>
<p>
"We have to make sure our investment in AI is having the intended impact," he argues. "It's going to be very easy to take the vendors' word for it. We have to be certain that AI is improving patient care and delivering value.
</p>
<p>
In the end, despite its potential drawbacks, AI may be the key to helping lift medicine out of its current problems. "Health care faces a lot of headwinds. The population is aging, the workforce is burning out, and the finances just don't work," notes Dr. Kelly. "I don't see another solution for where we are. This is what we need to do."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the July/August 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/9/2025 11:20:16 AM | 7/9/2025 11:06:30 AM | 7/9/2025 12:00:00 AM |
| member-spotlight-kim-emery-pa-c | Member Spotlight: Kim Emery, PA-C | WSMA_Reports | Shared_Content/News/Latest_News/2025/member-spotlight-kim-emery-pa-c | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/july-august/member-spotlight-website-image-emery-645x425px.png" class="pull-right" alt="WSMA Member Spotlight: Kim Emery, PA-C graphic" /></div>
<h5>July 8, 2025</h5>
<h2>Member Spotlight: Kim Emery, PA-C</h2>
<p>
<strong>Works at: </strong>Columbia County Health System, Dayton.
</p>
<p>
<strong>How long in practice:</strong> 27 years.
</p>
<p>
<strong>Specialty: </strong>Family practice.
</p>
<p>
<strong>Why WSMA: </strong>I graduated from the University of Washington School of Medicine's MEDEX Northwest program in 1998. I joined the WSMA many years ago to broaden my experience with MD and DO colleagues, as well as with physician assistant colleagues. I'm also a member of the Washington Academy of Physician Assistants. Since moving to a rural community in 2012 and becoming more involved in promoting rural health, I feel that WSMA's information, classes, and resources keep me up to date on health care in our state.
</p>
<p>
<strong>Top concerns in health care: </strong>I am concerned with the complexity of the health care system in general, the skill and "inside" knowledge that it takes to navigate these complexities, and our aging population's ability to accomplish this. I live and practice in rural Washington. I have transitioned into an administrative role in these twilight years of my career and no longer have a panel of "my" patients.
</p>
<p>
But I still do see patients, and in my director of clinic services role, I am more involved in the politics of medicine. The effort it can take to understand the intricacies of insurance coverage, the steps needed to get a medication someone has been taking authorized because it is no longer on the insurance formulary, the decisions we need to make regarding reimbursement by the Medicare Advantage plans that often deem us too small to negotiate with, etc. These are some of my day-to-day concerns.
</p>
<p>
As more time is needed to complete these tasks, to measure and report our quality in the appropriate format, to advocate for patient care, to find resources needed to promote patient health, I worry about practitioner sustainability. The need for many resources necessary to care for our communities and populations is growing. Access to these resources is not. As my CEO says, "Transportation is part of health care. If you cannot get to your appointment, how will you get the care you need?" As I age and need these services as the consumer rather than the practitioner, I often think, "What if I didn't know the steps to take?"
</p>
<p>
<strong>What inspires me about being in medicine: </strong>The difference we can make in our patients' lives. It is so humbling to realize the impact we make on the life and health of another human being. We must always be aware of this and use words and actions with kindness, understanding, and grace to educate our patients and promote the best health possible.
</p>
<p>
One of my most touching memories was when a patient gave me her one- year sobriety coin. When I said that I could not possibly accept such a precious gift, she responded that if I had not inspired and encouraged her with kindness and without judgment that she would not have the coin or the sober life she was currently living. How could I not be inspired to be the best I can be?
</p>
<p>
<strong>Best advice I ever received:</strong> I was going through a stressful relationship disintegration in my mid-20s. Talking to one of my older friends, I said, "He makes me feel so guilty." I was expecting sympathy along the lines of, "Oh, you poor thing," and instead she said: "That's silly, only you can make yourself feel guilty. You have control over how you react to the actions and words of others. This is all on you." What a wakeup call!
</p>
<p>
<em>This article was featured in the July/August 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/8/2025 2:47:51 PM | 7/8/2025 2:45:31 PM | 7/8/2025 12:00:00 AM |
| standing-up-for-science-and-medicine | Standing Up for Science and Medicine | WSMA_Reports | Shared_Content/News/Latest_News/2025/standing-up-for-science-and-medicine | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/july-august/heartbeat-website-image-vassall-645x425px.png" class="pull-right" alt="Heartbeat: John Vassall, MD graphic" /></div>
<h5>July&nbsp;7, 2025</h5>
<h2>Standing Up for Science and Medicine</h2>
<p>
By John Vassall, MD
</p>
<p>
As physicians we speak with one voice against the unprecedented government overreach and political interference now depriving physicians and their patients of access to information, research, and clinical trials; resources necessary for excellent medical care and for physicians and patients to make informed choices in disease management.
</p>
<p>
We physicians are open to constructive reform and do not oppose legitimate government oversight. However, we must oppose undue government intrusion into the lives and decisions of medical professionals and our patients regarding the ethical and legal pursuit of evidence-based care, cure, comfort, and healing. We physicians urge our medical colleges and universities, medical associations and societies, institutions conducting medical research and delivering medical care, our elected and appointed public officials, and our patients to reject the coercive use and punitive withholding of public research funding, attempts to inhibit the distribution of evidence-based scientific information, and attempts to dictate the accreditation of medical schools and the training of physicians.
</p>
<p> America's health care systems are as diverse and varied as the communities and patients they serve. Yet every physician and every patient in every town and health system in America shares the need for timely, accurate evidence-based information from credible unbiased sources, such as an unencumbered National Institutes of Health and Centers for Disease Control and Prevention. Our medical colleges and universities share a commitment to teach and practice evidence-based medicine in an environment where scientific medicine is pursued and physicians, scientists, students, and staff are free from fear of retribution, censorship, loss of funding, or deportation.</p>
<p>
Every one of us has been the beneficiary of a medical miracle: a drug, vaccine, or surgical procedure that we now take for granted. Creating these miracles requires effort and attention, time and treasure. If we hope and expect the flow of life- enhancing miracles to continue, we must each in our own way, large or small, resist efforts to hinder and usurp science, medicine, and progress.
</p>
<p>
<em><strong>John Vassall, MD</strong>, is a retired physician in Seattle, with a 30-year history of service within the WSMA and the house of medicine.</em>
</p>
<p>
<em>A note from the editors: In May, WSMA President John Bramhall, MD, PhD, presented this open letter from John Vassall, MD, to the WSMA board of trustees with a request for WSMA support. The board moved to have the WSMA sign on to the letter and, as an organization, support the principles within.</em>
</p>
<p>
<em>This article was featured in the July/August 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 7/9/2025 10:51:39 AM | 7/7/2025 12:06:55 PM | 7/7/2025 12:00:00 AM |
| climate-checkup-for-health-care | Climate Checkup for Health Care | WSMA_Reports | Shared_Content/News/Latest_News/2025/climate-checkup-for-health-care | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/may-june/cover-wsma-may-june-2025-645x425px.jpg" class="pull-right" alt="cover image from May-June 2025 issue of WSMA Reports" /></div>
<h5>May 13, 2025</h5>
<h2>Climate Checkup for Health Care</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
By Rita Colorito
</p>
<p>
At Seattle Children's Hospital, during procedures, pediatric anesthesiologist Elizabeth Hansen, MD, can tell if kids have been exposed to wildfire smoke damage. Some 15 miles north in Kirkland, cardiologist Mark Vossler, MD, recalls one heart patient who was stable when they left a checkup, broke down driving home, and had a heart attack waiting for a tow in 100-plus-degree heat. Like these physicians, at some point nearly every health care professional will treat someone impacted by climate change. Yet health care's role in the climate crisis goes beyond patient health. The U.S. health care sector produces approximately 8.5% of all domestic greenhouse gas emissions-the highest health sector percentage of any country, according to the most recent analysis.
</p>
<p>
These and other unintended climate consequences challenge medicine's long-held credo of "first, do no harm." Increasingly, however, concerned members of the medical community, including the WSMA, are taking an active role in the climate equivalent of "physician, heal thyself," asking what health care can and should do to reduce its carbon footprint.
</p>
<h3>WSMA House of Delegates leads the charge</h3>
<p> Since 2016, the WSMA House of Delegates has adopted varied policies calling for solutions that both reduce pollution and promote healthier, sustainable communities, including those aimed at mitigating the health effects of climate change through sustainable practices statewide. Adding to the roster of climate-forward policy, last year, delegates passed new policies focused on specific actions for health care professionals and organizations. They include policies directing the WSMA to: </p>
<ul>
<li>Encourage hospitals and surgical centers in Washington to adopt programs to reduce the climate impacts from anesthesia.</li>
<li>Encourage hospitals and clinics to reduce their use of plastics, particularly single-use plastics.</li>
<li>Urge members, health care organizations, and affiliated stakeholders to decarbonize the U.S. health sector by following the National Academy of Medicine's Sustainability Journey Map (see sidebar on pg. 11).</li>
</ul>
<p>
"There's motivation for most people in health care to do what they can to reduce emissions. The challenge is picking what things to focus on and the costs," says Dr. Vossler, who co-authored the new policies. Dr. Vossler, now retired, serves as the president of Physicians for Social Responsibility and on the climate and health task force of the national advocacy group's Washington chapter.</p>
<p>
The priority? Reducing the use of anesthetic gases. "If we had to pick one thing to do first, that's the area to focus on for every hospital and every surgical center," says Dr. Vossler.
</p>
<p>
Desflurane and nitrous oxide gas are the worst offenders based on clinical equivalency, according to the American Society of Anesthesiologists. Desflurane is the inhaled anesthetic that is the most potent greenhouse gas, with a global warming potential 2,540 times that of carbon dioxide. N2O has a global warming potential 273 times that of carbon dioxide and an atmospheric lifetime of over 100 years. Currently, N2O is also the single greatest contributor to the destruction of the ozone layer. In the U.S., it's estimated to contribute some 3% to ozone destruction.
</p>
<p>
Reducing single-use plastics matters on two levels, says Dr. Vossler. One, the manufacturing of these materials is carbon intensive. Moving to reusables means less is produced and less carbon dioxide emitted.
</p>
<p>
The other issue is the proliferation of microplastics and nanoplastics in the human body. Dr. Vossler cites a study published in the New England Journal of Medicine that found microplastics in atheromatous plaque removed from carotid arteries.
</p>
<p>
"Patients who had microplastic in their carotid arteries at the time of surgery had higher subsequent cardiac event rates than patients who did not have it," he says. "The thing about plastics is that for a lot of things, we have alternatives. We just have fallen into this complacency."
</p>
<h3>Partnering for progress</h3>
<p> Following NAM's Sustainability Journey Map to decarbonize the health sector is the goal, says Dr. Vossler, but one that will take firm, continuous commitment and resources to achieve. To get health care there, the WSMA, at the direction of its House of Delegates, is working with the Washington State Hospital Association to explore ways to promote and implement these climate change policies.</p>
<p> "When we seek to mitigate health care's impact on climate change, we only want to do so in a manner that maintains patient safety and clinical excellence, doesn't increase the administrative burden or workload for physicians, and does not significantly increase the cost of delivering care," says WSMA President John Bramhall, MD, PhD. "Addressing the climate impacts of health care should not supersede the clinical judgment of a physician acting in a patient's best interest." </p>
<p>
At its Quality Leaders Collaborative this spring, hospital leaders throughout the state and the Washington State Health Care Authority shared what they are doing to mitigate climate change and improve resilience and adaptation. "Hearing from hospitals similar to theirs that are successfully implementing innovative approaches inspires meaningful change," says Tracy Wellington, RN, WSHA senior director of clinical excellence and rural programs, who oversees the Medicaid Quality Incentive Program, a partnership between the two organizations.
</p>
<p>
The increased use of telemedicine and wearable patient-monitoring devices, such as for blood glucose, are some ways hospitals identified to reduce their carbon footprint while maintaining high- quality care, says Wellington. "Reducing patient travel presents an opportunity not only to enhance accessibility and convenience for patients but also to significantly cut emissions, improving environmental sustainability."
</p>
<p>
WSHA is collaborating with the HCA to focus on measures in the Medicaid Quality Initiative Program to address climate change and highlight its impact on health, and with the American Hospital Association to plan a regional workshop on environmental impact on community health to take place in September.
</p>
<h3>Paving the way</h3>
<p>
Hospitals and medical centers throughout Washington state are already making climate change a priority. In a 2024 WSHA survey, 53 hospitals reported actively monitoring their greenhouse gas emissions.
</p>
<p>
Some, like Providence, have created executive roles to tackle climate change. In 2023, Providence appointed Brian Chesebro, MD, as its first medical director for environmental stewardship, a role he had served at Providence Oregon since 2019.
</p>
<p>
"The position isn't just standing upon a soapbox talking about environmental impacts. It provides perspective in a broader conversation and analysis of driving health care toward higher value," says Dr. Chesebro, defining value as quality divided by cost. Quality factors include safety, efficacy, efficiency, equity, patient centeredness, resilience, and compliance. Cost includes financial, social, and environmental costs.
</p>
<p>
Under Dr. Chesebro's leadership, Providence undertook two large anesthesia-related emissions mitigation projects, including one addressing nitrous oxide consumption-reducing these greenhouse gases by the equivalent of 10,000 metric tons of CO2 a year. N2O is relatively inexpensive, so an environmental impact analysis revealed something a scan of financial ledgers alone would have missed, says Dr. Chesebro: The hospitals' central pipe systems were leaking and wasting over 90% of N2O.
</p>
<p>
Leaks can happen throughout the system, making it challenging and unfeasible to avoid N2O losses through maintenance and repair. The environmental health impact to patients, caregivers, and staff is more difficult to measure but was also a serious concern, says Dr. Chesebro.
</p>
<p>
"It wasn't an issue with clinical overuse," he says. "Financially, it's not a huge expense for the hospital … But when we looked at it on our environmental ledger, we said 'whoa, this is an opportunity for us to start thinking about the other facets of value.' "
</p>
<p>
In October, following similar recommendations from the Royal College of Anaesthetists in the U.K. and referencing Dr. Chesebro's analysis, the American Society of Anesthesiologists recommended deactivating central piped N2O and transitioning to a portable source for N2O delivery for all clinical use-building on its 2022 guidelines to reduce the carbon footprint from inhaled anesthesia, which included:
</p>
<ul>
<li>Avoiding inhaled anesthetics with disproportionately high climate impacts, such as desflurane and nitrous oxide.</li>
<li>Selecting the lowest possible fresh gas flow when using inhaled anesthetics.</li>
<li>Prioritizing regional anesthesia and intravenous anesthesia when appropriate, since they have less of a negative environmental impact.</li>
<li>Avoiding centrally piped N2O, substituting with portable canisters that should be closed between uses to avoid continuous leaks.</li>
</ul>
<p>
Providence had already implemented these changes. Dr. Chesebro's current project is focusing on value-based solutions to reduce the use of metered- dose inhalers for people with asthma and chronic obstructive pulmonary disease. The propellant used has 1,000 times the global warming effects of carbon dioxide, and at 75% of the market, according to The Commonwealth Fund, has an equivalent emissions impact of driving half a million cars for a year.
</p>
<p>
"You have to go through that whole value analysis again. Is it going to improve [patient] resilience? Is it going to improve their disease control? Is it going to cost them 10 times more? How do you balance all of that? It's really complicated, but it is another opportunity," says Dr. Chesebro.
</p>
<h3>A data-driven approach to mitigation</h3>
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Anyone hoping to undertake a climate- change initiative should start with data- driven analysis, looking at all aspects of operations, including clinical delivery of care, says Dr. Chesebro. "It has to be this holistic assessment of the way our health system operates."
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A data-driven approach is at the heart of Senate Bill 5236, legislation the WSMA supported during the 2025 legislative session to require the Washington State Department of Ecology to address greenhouse gas emissions from anesthetic gases by establishing a multistep process to study, understand, and reduce these emissions in Washington. WSMA's support was driven by House of Delegates policy asking the WSMA to assist hospitals, surgical centers, and anesthesiology practices in their efforts to reduce greenhouse gas emissions.
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The Washington State Society of Anesthesiologists also supported the bill. "We were happy to support it as a generally environmentally responsible piece of legislation, perhaps not primary to our mission, but the board felt like we could support it, given that it preserved the autonomy of the physicians to make good patient decisions and that it was not unduly burdensome," says Erik Condon, MD, president of the society.
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The bill did not pass the Senate Ways and Means Committee but will automatically be reintroduced during next year's session. Dr. Vossler remains hopeful that some version will pass.
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Dr. Condon, an anesthesiologist affiliated with Providence Sacred Heart Medical Center and Children's Hospital in Spokane, remains encouraged by organizations like his own that have already taken action to reduce anesthesia-related greenhouse gases. "The more we do things of our own volition, the less likely we're going to have clumsy rules made that reduce our flexibility and ability to exercise our judgment at the point of care," he says.
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He advocates for physicians to review data and practices at the patient care level to mitigate the climate impact; for example, grouping medical procedures under a single anesthetic when possible. "From a patient standpoint and from a more environmental and just efficiency standpoint, it's better for us to be proactive," says Dr. Condon.
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When Dr. Hansen joined Seattle Children's eight years ago, data is what propelled her to become a climate change crusader. The hospital's then- manager of sustainability programs, Colleen Groll, produced yearly greenhouse gas emissions reports. Anesthesia gases represented 7% of the hospital's total emissions. Shocked by the data, Dr. Hansen resolved to learn and share all she could about mitigation.
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To build collaboration among different groups, Dr. Hansen took software Seattle Children's uses for clinical quality improvement metrics and used it to track climate change educational initiatives and emission mitigation strategies. Each month she sends out a performance report, highlighting high performers and sharing their strategies for reducing emissions. After each report, physicians often ask how they can improve and get recognized in the newsletter. That friendly competition helps motivate everyone to do better, says Dr. Hansen. "Now we're more than 90% lower in terms of our average emissions for every anesthetic that we do at Seattle Children's compared to where we started."
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Sustainability work by Dr. Hansen and others are part of Seattle Children's commitment to become carbon neutral by the end of 2025. Since Groll retired, the hospital has hired a sustainability director with a higher level of authority to implement sustainability programs.
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<h3>Building bridges</h3>
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Building consensus is a critical part of implementing any sustainability initiative, says Dr. Hansen. Before moving desflurane vaporizers out of the OR to a separate room-the idea being the effort to get it would cause someone to rethink its need-her group went through several rounds of use analysis and conversation. After one year, the group reanalyzed their decision and removed desflurane from Seattle Children's formulary altogether.
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"It took a little bit of time to have those discussions and really make sure that we were listening to everybody's viewpoints, taking into account patient safety and those concerns, and reviewing the literature ... And once we were able to all feel comfortable with that, then we moved forward," says Dr. Hansen.
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Sharing Seattle Children's emissions- reduction success during meetings of the Society of Pediatric Anesthesia led to the expansion of Project SPRUCE into a pediatric anesthesia quality improvement consortium. Dr. Hansen serves as its principal investigator. The group applies the same data tracking to their own hospital systems.
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<p> Since it began a little over a year ago, the consortium has grown to include 12 hospitals. Emissions from inhaled anesthetics have already decreased by 50% among the consortium's nine initial hospitals. This also results in cost savings. Yearly spending on inhaled anesthetics, minus nitrous oxide, has gone from a total of $250,000 a year down to about $75,000 a year, says Dr. Hansen.</p>
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"Sustainable care isn't just using the lower-carbon-intense widget," says Dr. Chesebro. In his own work, he often uses the Sustainability in Quality Improvement Programme from the U.K.-based Centre for Sustainable Healthcare. In this model, patient empowerment and disease prevention are the two most upstream principles of sustainability.
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"The greenest health care is the health care that we don't need to do," says Dr. Chesebro. "It includes partnering with our patients to make sure that they stay healthy … so they don't have to enter into care delivery in these high resource- intense hospital environments. That is climate action that does reduce the climate impact of health care."
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As we head into summer, Dr. Chesebro worries about the larger implications of dangerously high temperatures. At the top of his mind: heat domes-high pressure systems that create and trap extreme high temperatures over a region like the one over the Pacific Northwest in the summer of 2021. "One thing that's often overlooked is the impact on the day-to-day operations of health care facilities under a sustained heat dome," he says. "We're also having to think about how our facilities continue to operate safely in the face of these environmental challenges."
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One thing is clear as climate change continues to wreak havoc in Washington state and across the globe: Health care is an inextricable part of the problem and the solution.
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"There are so many opportunities for every single one of us in Washington state to be taking on some aspect of this work-whether that's advocacy, working with our patients on education, or doing the kind of mitigation work that we're trying to do," says Dr. Hansen. "We are trusted voices. We do understand and know this information. And we can make a big difference."
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<em>Rita Colorito is a freelance writer specializing in health care.</em>
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<em>This article was featured in the May/June 2025 issue of WSMA Reports, WSMA's print magazine.</em>
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</div> | 5/13/2025 11:01:19 AM | 5/13/2025 10:59:18 AM | 5/13/2025 12:00:00 AM |