Barker, Arthur J

Ezzo, Joseph A

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The Linacre QuarterlyVolume 40 | Number 3 Article 18August 1973The St. Petersburg Diocesan Health ProgramJoseph A. EzzoArthur J. BarkerFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationEzzo, Joseph A. and Barker, Arthur J. (1973) "The St. Petersburg Diocesan Health Program," The Linacre Quarterly: Vol. 40 : No. 3 ,Article 18.Available at: http://epublications.marquette.edu/lnq/vol40/iss3/1815. For a discussion of these i_ssues, see Arthur J . Dyck, "An Alterna tive to the Ethic of Euthanasia," op. cit . . 16. A Theory of Justice, Cambndge: Harvard University Press, 1971. . 17. See Karen Lebacqz, op. cu ., for a discussion of such views. 18. The Right and the Good, Oxford, 1930, Chapter 2. 19_ Boston: Beacon Press, 1960. 20. Ibid., p. 5. 21. Ibid., p . 6. . . 22_ New Haven: Yale Umvers tty Press, 1970. 23. Ibid., pp. xi-xii .. 24. Ibid. , pp. XV-XVI. 25. Ibid., p . xviii. . 26. " Medical Ethics: Professtona l_ or Universal?," Harvard Theological R evtew, Oct., 1972. . 27. W . K. Frankena, Ethtcs, Engle-wood Cliffs: Prentice-Hall , 1963, ~P· 92-94 and Bernard Williams, Mora/uy: An ln;roduction to Ethics, New York: Harper and Row, 1972, PP· 20-26. 28. w. K. Frankena, ibid., pp. 94-96. 200 29. w. K. Fr.ankena, ibid., PP· ' and Bernard Williams, op. c~t ., PP: 30. Ibid. See also the dtscusstC• relativism by R. B. Brandt, Ethical T Englewood Cliffs: Prent ice Hall, I ~ 31. Ralph B. Potter, Jr., War ana a / Discourse, op . cit., PP· 23-29. 32. This is an actual case ~ut what changed to hide the identtty ' sons invo lved. . 33 . The clearest formulatw_n < kind of theory is by Roderick F trth ical Absolutism and the Ideal Or T heory," Philosophy and Pheno logical R esearch 12 (1952), pp. 3 1. See also w. K. Frankena, op. ct 94-96. . 34. As we noted earlier, pohc~ ments hinge in part on the loya_l those who make them. Loyaltz "interests" and "passions." If m~r icy is to be rational, the loy~ltze take on the universal perspective implied in disinterestedness an passiona teness. . 35. William J . Curran, op . ell. 94, 26. of >ry, 'or-me-' er-this ~th-rver ' 110· 345. pp. udg-s of are pol-must at is dis-Linacre QuarterlY Doctors Ezzo and Barker de-scribe the health program for re-ligious that has been in operation for several years in . the St. Peters-burg, Fla. , Diocese. The article of-fers a blueprint to diocesan officials and doctors in other parts of the country who are concerned about the health care of religious per-sonnel in their areas. Both authors are in private prac-tice in St. Petersburg: Dr. Ezzo in internal medicine and cardiology, Dr. Barker as a surgeon. Among other honors, Dr. Ezzo is a Diplo-mate of the American Board of Internal Medicine and a Fellow of the American College of Physi-cians, and Dr. Barker is a Diplo-mate of the American Board of Surgery. The St. Petersburg Diocesan Health Program Joseph A. Ezzo, M.D. and Arthur J . Barker, M.D. In an effort to render our priests and sisters better health services, Catholic guilds in some areas have instituted programs for periodic physical examinations and foll ow-up care. Programs vary from mass screening to intensive, individual diagnostic surveys, but few of these attempts have been successful. We believe the program that started in 1968 in the St. Petersburg, Fla., Diocese is meeting with reasonable success and we are outlining it in The Linacre Quarterly as a guide for other guilds. The objectives of our program: I. To get a comprehensive his-tory and physical examination doc-umented on all religious in the dio-cese. 2. To establish doctor-patient relationships with all of them. 3. To detect asymptomatic dis-ease and advise therapy as indi -cated. August. I 97 3 4 . To orient the religious to their health needs. Health Kit To do this, a "health kit" has been produced and distributed to every priest and sister in the dio-cese. It contains three essential components: I. An explanatory letter of di-rection. Essentially this explains the program and asks the examinee to fill out the enclosed health ques-tionnaire; to make an appointment with the physician of his or her choice in the month of birth ; to bring a urine specimen (clean-catch, first-voided morning speci-men) and to report to the doctor's office in a fasting state. 2. T he health questionnaire. This is a comprehensive 12-page questionnaire (similar to the Cor-nell Medical Index) that seems best sui ted to our purposes. "Con-fidential" is printed in large let-20 1 ters on the front page to remind the patient that the doctor-patient confidence is not violated. The last page is the physical exam-ination form to be filled in by the examining physician, with the back of this page reserved for lab-oratory values, X-rays, ECGs and additional studies. 3. The final components of the hea lth kit are lab supplies: Four vacuum test tubes (for SMA-12 profiles), sterile needles, Pap smear slides and containers, urine speci-men containers, gummed labels for identification, and identification cards to be mailed to the labora-tory with the specimens. These suppl ies are contained in a mail-away container that is pre-addressed and need only be dropped in the mail. Physician's Role When the physician sees the pa-tient, he can quickly evaluate the questionnaire which is the yes-no answer type before soliciting further history and discussing any problems with the patient. Pap smears are done on a ll nuns, and sigmoidoscopies are suggested for those patients over 40. C hest X-rays a re taken either by the exam-ining physician or a radio logist. Electrocardiograms are done dur-ing the first visit at the discretion of the examining physician . The doctor, his nurse or technician then draws four vials of blood. With the Pap slides, · this material is put back into the original containers and mailed to the laboratory. The urine specimen may be examined by the physician or it may be sent along to the laboratory for exam-202 ination. the The physician either kee completed health questic aire for his personal records and I low-up or- reta ining pertinen data for his files - mails it to m cen-tral records library where it ; re-viewed for abnormalities :fore filing. This is done only by hysi-· cians. Similarly, results ·, the SMA-12 studies, the chest -ray, electrocardiogram and Rap nears may all be kept by the ex< ining physician or mailed to ou r ·ntral library. In either event, all f the materia l is kept in the stri• ·st of confidence and no one but e ex· ammmg physic ian and atient knows of the examination ·suits. Shortcomings The program has som< built· in shortcomings. First, s.it .! the examining physician may 1 t for· ward the health records to e col-lection point, there is diffi lty in knowing how many of the 1 igious have actually had their e tmina· tions; this requires rather ' ~quent follow-up reminders to the 1. Sec· ond, since the material is c nfiden· tial, the physician may n( reveal his findings, making it irr ossible to collect enlightening !> ttistical information. Third, there is no way of knowing that patil ,ts w.ho have physica l problems a r rec~1V· ing adequate medical : tentJOn. Obviously, the advan• :ges of this system outweigh the several drawbacks, and indeed, perh~ps the only significant shortcom~ng is the one relative to collecung statistics and has nothi ng to d~ with good patient care. The smal number of cases involved make for I rl)' Linacre Quar e no statistical value; however, it should be noted that of the first 30 nuns examined, one breast can-cer and one ovarian carcinoma were found. These were both sur-gically corrected at an asympto-matic phase of their disease. Patient Education A major problem that arises in this type of program is that of ed-ucating the patient-to-be. It is im-portant to distribute the health kits and information about the health program to every religious in the diocese and to maintain awareness with periodic follow-up letters. Many of the religious spend only the school year teaching in the diocese and return to their mother-houses in the summer. They have become accustomed to getting their annual examinations there, and consequently we do no t have in-formation on the results instantly available. It is desirable for health records to follow the priest o r sister to assignments in other dioceses. This is arranged if the patie nt writes a letter asking that his or her health jacket be forwarded to the chosen physician. Summary Following is a summary of our thoughts regarding periodic medi-cal examinations: of age and every year if over 30. Those individuals who do have medica l problems should be exam-ined as frequently as the examin-ing physician feels necessary. For example, an individual with a his-tory of colonic polyps should be examined at least yearly or more often should symptoms arise; a 35-year-old brittle diabetic can be ex-pected to have more problems than his non-diabetic counterpart, and therefore he should be seen at more frequent intervals. In addition to the history, the head-to-toe physical examination, and the necessary basic laboratory profile, what else should be done routinely? It is important to edu-cate the female patient in self-examination of the breast, giving her an opportuni ty to Jearn about the feel and consistency of her breast tissue in order to detect changes and get help at an early stage. Mammography has taken its place in the physician's arma-mentarium. Its use should probably be limited to those patients who have breast problems difficult to evaluate, such as nodular fibrocys-tic d isease; those with a family history of breast carcinoma; and those patients who have been treated for carcinoma of the breast - evaluation of the remammg breast by mammography is quite useful. Pap Smear . Just how often should a well pa-!1ent be examined? It is our opin-Ion_ that physician efficiency and Patient health maintenance are both served if this rule is observed: The well patient with an absolutely ~egative history and no abnormali-ties should be examined every two Years if between 20 and 30 years With regard to vagina l and cer-vical cytology by means of the Pap smear, we feel that women who have three consecutive nega-tive Pap smears should have rou-tine Pap smears every three years, August, 197 3 203 ·, ... •• · : provided there is no visible abnor-mality or history of abnormal vagi-nal bleeding. In those women who present physical characteristics ac-companying endometrial carcino-ma - obesity, hypertension, dia-betes and menses into the late 40' s or 50's - endometrial cell wash-ings are helpful in early detection of endometrial cancer. In order to detect carcinoma of the ovary at its earliest state, bi-manual pelvic exams should be done on a yearly basis on all women over 35 years of age. The chest X-ray is an important part of the physical exam because of the information it yields (as re-gards heart size, etc.). It should be repeated every three or four months for those who smoke three or more packages of cigarettes a day, every six months for two-package-a-day smokers, and at least yearly for patients who smoke a package daily. The rectal examination should be a routine part of all periodic ex-aminations. Using simplified tests, available stool guaiac studies should also ·be done. Idea lly, proc-toscopy should be a part of the periodic examination ; however, it may be reserved for those with positive guaiac studies, those with a family history of carcinoma of the gastro-intestinal tract, and those with a history of colonic polyps or other significant histo ry. Cost and Progress The initial costs of the progra m are considerable since health kits must be purchased, costing about $3 per kit. It is best to have them 204 produced on an as-needed 1sis, since vacuum test tubes lose )me of their negative pressure ring long term storage. Costs th• ac-crue as the Diocesan Healt Of-fice is billed by the Jaboratf' for profiles done and for any -ray, ECG or physician fees. Th dio-cese has a self-administered ·a lth insurance program, and any d tor's fees submitted are paid dire y to the physician by the , ins ance office. There are an estimated f 0 to 700 priests and sisters in t .:: St. Petersburg Diocese, but tht mm-ber involved in the program hard to estimate. Some patients refer that their own doctors kee1 their health records instead of fc. ·vard-ing them to the Diocesan ealth Office ; they may also fail to .::turn questionnaires asking if the have had their yearly checkups. B July, 1972, an estimated 60 to i per cent of the priests and sis rs in the diocese had undergone < least one comprehensive physical ·xam-ination . About 50 per ce1 , had yearly follow-ups and an~ indi-cated diagnostic tests or t· : rapy. A s ignificant deve lopm• •lt in the program was the appot ttment of Sister Gladys Sharkey a dioce-san health director. The a minis-trator of St. Anthony's Hm.,.ital in St. Petersburg, Sister Sha1 key is acutely sensitive to the n1edical needs of re ligious and has a long and excellent background in health care. A qualified diocesan health officer and staff, along wi th much time and effort - prima1 ily by participating physicians - are keys to a successful diocesan program· Linac re QuarterlY Father Moraczewski holds a Ph.D. degree in pharmacology from the University · of Chicago. At present he is affiliated with the lnstitut~ of Religion and Human Develop-ment of the Texas Medical Cen-ter, the Baylor Uni versity College of Medicine and the Texas Re-search Institute of Mental Sciences all in Houston. ' Theological Pharmacology: A Study of Drugs and Values Albert Moraczewski, o.P., Ph.D. ~arx stated that "religio n is the o_prum of the people., Phrased pre-cr~Jy in that way, we have the ~rs for a new area of investiga-tion· the ph I Fro. . armaco ogy of religion. . m this perspective, then reli -~on . ' ti would be stud1ed as it func-ons for some individuals as if it were a drug· a h . .1. • n anest et1c, a tran-qul lzer t "d and an I epressant, analgesic perhaps even as a ha llucino-gen. However, there is a lso the reverse c &loa oncept and tha t is the reli-1 0 or pharmacology and its close re atlve the theology of pharmacoi-G~Y. As it stands, the latter titl e ~II&Usl, 1973 primarily means the applicatio n of theology to p harmacology in a fashio n analogous to the theology of work or of suffering or of the sac~aments. These are purely theo-logical endeavors. What I wish to propose is different. It is a new discipline and could appropriately be c~ ll e~ theological pharmacology for It IS concerned with certa in questions that pharmacology ra ises for_ theology. This paper , then, de-scnbe.s how this interdisciplinary area ~~ c~nstituted and cata logues the pnnclpal value questions aris-ing from the use and abuse o f 205 ·. 

The St. Petersburg Diocesan Health Program

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The St. Petersburg Diocesan Health Program

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