A Message from The President: Health Care Decisions

Bruce A. Snyder, MD | SCMA President

Today marks the Seventh Annual National Healthcare Decisions Day. As physicians, we often spend a great deal of time talking with our patients about end-of-life-care issues, but today I want to remind you that it is equally important that we take the time to also make those decisions for ourselves.

The goal of National Healthcare Decisions Day is to ensure that all adults with decision-making capacity in America have both the information and the opportunity to communicate and document their future healthcare decisions.  The first years’ results were impressive—over 750,000 people obtained resources to make their health care decisions known.

My siblings and I have experienced the advantage of our parents open discussions and planning for their futures.  We were pleased that both of our parents completed Advance Directives with the advice of their physicians.  Twenty years ago my mother chose to not again be placed on a ventilator because of her day to day struggles due to severe emphysema.  Likewise two years ago my father died without aggressive intervention or CPR.   Both understood their need to make the decision that was most appropriate for them, and to share that with their loved ones.  My mother was confined to the home, required a walker, slept poorly, and was constantly short of breath even with oxygen.  Two years earlier she spent five days on a ventilator and was able to return home, but saw her health steadily deteriorate and therefore eventually chose comfort care.  My father at age 85 started dialysis and for over two years was able to drive himself back and forth for treatments three days a week, have an active social life, and remain active in his church.  Then as his health deteriorated, he required transportation for his dialysis treatments, required an electric scooter, and became short of breath with minimal activity.  He discussed his options with his physicians, family, and friends; and then he also decided not to undergo more extensive care. I had served as his health care agent with his wish for me to make healthcare decisions if he could not make them for himself.  Having completed both his Advance Directive and Health Care Power of Attorney gave him and all of his children assurance that his wishes would be followed and when confronted with his final illness, I was able to honor his wishes.

I encourage you to visit www.nationalhealthcaredecisionday.org for a variety of free information (including free advance directives forms for every state) and tools to assist you with your own thoughtful reflection on your healthcare choices.

I also encourage you to check out the work being done by our very own SC Coalition for the Care of the Seriously Ill (CSI). Their mission is that all persons in South Carolina with serious, chronic or terminal illnesses will have an active voice in the care decision process.

I hope you will take the time to spread the word to your patients, as well as make your own wishes known to your loved ones---- remember, your health care decisions matter, too.

Where in South Carolina is Dr. Snyder?

By Dr. Bruce Snyder, SCMA President

Where in South Carolina is Dr. Snyder?  That was the recent text message from my wife as I was preparing to leave Columbia a few weeks ago.  The unfortunate thing is that she didn't know where I was and her question was serious!  I had been able to attend the first hour of the SCMA Childhood Obesity Taskforce, and then drove to downtown Columbia to the South Carolina Health Coordinating Council General Meeting.  In addition, recently, I have spoken to an enthusiastic audience at the Greenwood County Medical Society about the SCMA legislative agenda and the benefits of membership. Dr. Larry Ware, the SCMA Board Chairman, and I, along with our spouses have also had a delightful dinner with four Rock Hill physicians in the home of the local SCMA District Trustee, Dr. James Welch and his wife Sheree.  We discussed their efforts to re-energize the county society and I am certain that they will be successful.  When I have met with physicians across the state I have been asking what they see as their local health issues, how they are addressing them, and what the SCMA can do to help. This last week I spoke to the Sumter, Clarendon, and Lee  Medical Society.  Dr. Blanchard, a retired OB/GYN physician expressed her concern that the state was not doing anything to combat the issue of an increasing percentage in our state of children born out of wedlock.  I provided her with both my email and snail mail address and have asked her to send me an Op-Ed piece that the SCMA can help her have published.

I have moderated an afternoon session at the TAP (Trustees,  Administrators, and Physicians) Conference, jointly sponsored by the SCMA and the South Carolina Hospital Association, in Hilton Head.  On the way to Hilton Head for the meeting, I stopped in Columbia for an interview with WIS Television to discuss the new health insurance exchanges. Then Friday morning at the meeting I participated in a panel discussing the activities regarding Proviso 33.34, the Medicaid Accountability and Quality Improvement Initiative funded by our state legislature this last year.  The next week I was able to provide an update of our obesity prevention and treatment activities to the Statewide Stakeholders Meeting at the DHEC auditorium. This month I will also attend the  meetings of state medical associations in Georgia and North Carolina, hoping to bring back new information to the SCMA and South Carolina physicians.

As you can tell, the last month has been busy and I have been on the road from Greenville frequently as President of the SCMA representing you and all that you do for our fellow citizens of South Carolina.  The coming months will also be busy travel times as I attend the AMA Interim Meeting as well as the Columbia and Charleston Medical Societies.  I have promised my wife I will do a better job of keeping her informed where I am at all times when I travel.  And I promise you I will not be texting and driving!

The Power of Our Voice to Our Patients

By Dr. Bruce Snyder, SCMA President

I recently had the pleasure of opening the Greenville News and seeing on the front page of the Wednesday City People section a picture of Dr. Justin Moll of Parkside Pediatrics.  Dr. Moll, a member of the SCMA, was recognized for the practice’s participation in the “Reach Out and Read” program in which children receive a developmentally appropriate book at each well child visit between the ages of 6 months and 5 years.  Although I am a grandparent of two boys not yet a year old, who both already have stacks of books, I realize that many families do not understand the value of early reading, or unfortunately, do not have the resources to provide either books in the home or access to public libraries.  We know the number of books physically present in the home has been shown to correlate with future success.  Screen time such as TV or computer exposure at this young age is not successful at helping brain development in children. 

Programs like “Reach Out and Read” encourage parents to read to their children and a physician’s participation reinforces to the parents ,as well as the children, the benefits of book ownership and reading.  We as physicians must understand how powerful our voice is to our patients and their families.  Would it be as powerful an incentive to read if a local big box store handed every child shopping with his or her family a book to take home? I do not think the value would be the same.  We should never underestimate the positive influence that we as physicians, through our words and deeds, can have on all aspects of society if we will just take the first step.  Thank you Dr. Moll and your practice for helping South Carolina be a better place to live.

From the President - HIV Screenings, Lexington Medical Society, AMA

By Bruce Snyder, MD, SCMA President

President Snyder stays busy as he represents the South Carolina Medical Association across the state and even nationally at the AMA. Tune into The Voice as Dr. Snyder describes his adventures each month. 

June is turning out to be a busy month as president of the South Carolina Medical Association. I had an opportunity to participate in an interview with a reporter from the Spartanburg Herald Journal this week to give the physician perspective about the recently announced guidelines from the U.S. Preventive Care Task Force of the CDC regarding HIV testing for all adults aged 15 to 65. As many of us know, the previous recommendation was for testing of high risk adults and all pregnant women. The new guidelines published at the end of April are designed to remove the stigma of HIV testing and to identify as many of the estimated 200,000 individuals unaware of their positive status to allow early treatment. The goal by antiviral treatment is to improve longevity for the individuals themselves as well as to reduce transmission of the virus to others. Since this is a Grade A recommendation, the testing for insured individuals would be performed at no expense to the individual but instead would be borne by the insurer (and likely passed along through premium cost increase). As a Vascular Surgeon, I had to go back and "hit the books" to discuss the subject. The most interesting information I learned was that transmission of the virus to women is overwhelmingly caused from heterosexual activity with an infected partner, obviously not suspected by the woman carrying the HIV virus. What are your thoughts about the expansion of the guidelines? Is the benefit vs the cost a value in South Carolina? To read my comments in the news article, click here.

I traveled to the Lexington Medical Society this week as well and had an enjoyable dinner with several members and their spouses. This is an active and enthusiastic county society. I was pleased to learn of the number of members who have spoken at local schools regarding health related issues. Likewise, there have been numerous individuals who have authored op-ed pieces and letters to the editor. Clearly, they are an active group in their community. This is exactly the dedication I am looking for through my Leadership Campaign, which you'll hear more about soon.

Lexington Medical Society is well represented in the SCMA by their Trustee, Dr. Leon Bullard, and the Vice-Speaker of our House of Delegates, Dr. March Seabrook. I discussed the benefits of SCMA membership as well as Medicaid expansion and the APRN scope of practice issue in a presentation before dinner. I am looking forward to traveling and speaking to other county societies throughout the state as the year progresses.

As I write this, I am sitting in the GSP airport awaiting to board my flight to Chicago to attend the AMA Annual Meeting. Unfortunately, although we routinely see the airline industry used as an example of quality that medicine should emulate, the two hour delay for the flight doesn't seem high quality service today. I wonder what United's HCAPS scores would be today. I suspect not very good. The AMA meeting will run from Friday through noon on Wednesday. We will all be there in support of our own Dr. Gerald Harmon in his election campaign for AMA Trustee!