By Nancy L. Belcher, Ph.D., MPA
CEO, King County Medical Society

September is Suicide Awareness Month. Sadly, many of the depressive disorders that lead to suicide are often overlooked or misunderstood. Women frequently experience depression and anxiety related to the hormonal changes brought on by perimenopause, specifically due to the drop in estrogen and progesterone levels. Unfortunately, the correlation between depressive symptoms and menopause are often missed, and the consequences are profound. While menopause is not a disease to be cured, the symptoms can certainly be treated. 

The data speaks for itself. There is a significantly higher rate of mental illness and suicide in women aged 42–52 years of age, a time when most women experience perimenopause.1 The seriousness of mental health issues during perimenopause cannot be ignored. Menopausal women's suicide rates have increased by 45% over the past 15 years.2 Anxiety and depression are some of the most reported issues in this female age group, but there is a gap between these symptoms and the recognition that they could be menopause-related. I wonder, is this due to a stigma surrounding the transition into menopause, or is it due to a true lack of awareness that perimenopause often causes anxiety and depression?

To add to the confusion, the psychological symptoms of perimenopause often occur up to five years before the most obvious physical symptoms. Friends in their late 40's often say, “Oh, I’m not in menopause!” I believe this denial stems from a desire to preserve their youth, AND that they truly are unaware that they are perimenopausal because they still have a monthly period. Sadly, they are likely mistaken. The delay in physical symptoms (hot flashes or end of menses) makes the diagnosis of perimenopausal depression often retrospective, meaning women are suffering from mental health issues unnecessarily due to a missed diagnosis. 

Perimenopause can impact both a woman’s mind and her body. The risk for depressive symptoms is elevated even in women with no prior history of depression, and women who experience a worsening of a previously well-controlled depression may also be experiencing a perimenopausal relapse.2 This phase of a woman’s life often marks other significant life changes such as children leaving for college, helping aging/ailing parents, facing increased career demands, and now Covid-19.4 This combination of physical and environmental changes poses an increased risk of suicidality.3 

The good news is that there are effective treatments. If a woman’s medical history allows, the anxiety and depression could be abated with hormone replacement therapy (HRT), antidepressants, or both.1  It is common for women with perimenopausal symptoms to experience depressive symptoms that do not meet the clinical criteria for a diagnosis of depression, but low-level depressive symptoms can be treated with HRT.5  Most women with perimenopausal depression respond to appropriate treatment. It is not acceptable to deem this type of depression as minor or presume it will improve with time. The process of menopause can take over a decade to complete.

Perimenopause is a very vulnerable time for women. Trust me, I know. There is no need for a woman, their families, and their colleagues to suffer unnecessarily with these menopausal symptoms. If left untreated, depression can significantly impact a woman’s quality of life and that of her family.4 Tragically, suicide in middle-aged women is becoming a more common occurrence that could be prevented with increased awareness of the root causes and the availability of options for proper treatment.

A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984.

Physicians Premier ER charged Dr. Zachary Sussman’s insurance $10,984 for his COVID-19 antibody test even though Sussman worked for the chain and knows the testing materials only cost about $8. Even more surprising: The insurer paid in full. Read more below.
The Cost of Covid Testing

Thank you, RealNetworks!

Thank you to RealNetworks
Foundation, the philanthropic arm of RealNetwork Inc., which has provided $25K in funding to the King County Medical Society Community Foundation, specifically Frontline PPE! With this donation, Frontline PPE is now able to continue to provide PPE to frontline workers in our region.
The RealNetworks Foundation stated that they were,  "...thrilled to make this grant as it is significant for us and represents the Foundation’s confidence in your organization’s ability to help make a real and lasting impact in the lives of people who are suffering especially because of injustice during this historic pandemic."
Thank you again to RealNetworks Foundation.  
Nancy L. Belcher, Ph.D., MPA

Members on the Move

Sound Medical Center (SMC) is currently looking for a family/internal medicine physician who is preferably bilingual (English/Korean). SMC is a busy primary care practice located in Federal Way, serving mostly geriatric patients. SMC will be offering competitive benefits to the qualified candidate. If you are interested, please send your resume to or call 253-350-3538 for more detailed information. 

KCMS Intern's Research

As we shared in the last newsletter, KCMS has had some amazing interns this summer. Each wrote articles about their given topics. We think you will find their summaries fascinating. 

Washington State Medical Examiner

By Bailey Harmon

This summer, I worked on researching the medicolegal death investigation system in Washington State. The primary goal of this research was to compare Washington’s county-based system to statewide medical examiner systems in Virginia, Oregon, and Massachusetts and observe any potential differences in the efficiency and equity of the systems. In Washington State, death investigations are conducted by either a coroner, prosecutor/coroner, or a medical examiner (M.E.). The smallest counties have prosecutor/coroner offices where the prosecuting attorney also takes on coroner duties. Mid-size counties have coroner offices with an elected coroner and the largest counties have an appointed medical examiner. The biggest difference between the coroners and medical examiners is training. The medical examiners are required to be physicians and pass the pathology exam administered by the American Board of Pathology within three years of being appointed while there is no such requirement for coroners.
Washington State Medical Examiner

Homelessness in King County

By Dori Buttleman
Since November 2015, King County has been under a homelessness state of emergency. The 2020 Point-In-Time count for the region found that a total of 11,751 people were experiencing homelessness (53% sheltered, 47% unsheltered), which represents an increase of about 5% from 2019. As the homeless population has continued to increase, policymakers have begun to look at the upstream causes of homelessness, including the affordable housing crisis, the criminal justice system, and the health care system.
King County’s Homelessness Management Information System has worked to provide specific information on people engaged in the homeless service system so that each person can get the services they need.
King County Homelessness

KCMS Historical Article

By Rohan Raman
As we look back at the long history of King County Medical Society (KCMS), we are proud to revisit its previous efforts to support its neighbors and draw inspiration from these efforts in order to inform future programs. 

It’s no secret that King County’s inhabitants, like people around the world, are facing numerous challenges due to the COVID-19 pandemic. However, the pandemic hasn’t affected every King County resident in the same way. Specifically, low-income residents have been disproportionately affected by these trying circumstances, often due to poor access to healthcare.
In March of 1982, thousands of King County’s low-income residents suddenly lost their medical coverage due to job layoffs and cutbacks in government health-care programs. Urgent action was required – and KCMS stepped up. KCMS launched a new referral service for low-income patients and physician members agreed to take free or part-pay patients in an effort to mitigate the effects of lost medical coverage (see newspaper article below).

Immediately, KCMS’ impact became apparent as the referral service’s phone line serviced callers from Ship Canal to Yesler Way, Renton, Auburn, Federal Way, and even Snohomish County. In the first week of its existence, the program received over 170 calls from patients that needed access to family practitioners, obstetricians, and other physicians that could provide aid. 

It didn’t take long for other medical societies to notice KCMS’ actions. Sister societies in Pierce County, the Tri-Cities, and the Skagit Island counties began planning similar services designed to assist residents affected by similar circumstances. To quote Jean Knights, an official with the Washington State Medical Association at the time, the KCMS program “served as a catalyst for other programs." 

More recently, in 2009, KCMS collaborated with Evergreen Hospital, Swedish Medical Center, and Pacific Medical Center to create Project Access. Project Access assisted low-income patients that required specialized care by managing their cases. The project’s case managers scheduled appointments and made reminders while also assisting with transportation, childcare, and interpreters. Similar to 1982, KCMS' impact was immediate - studies showed Project Access patients had an impressively low no-show rate of 7%, as compared to the double-digit percentages of many commercial insurances. 

In 2020 KCMS has been providing free PPE and telehealth equipment throughout the region to protect our frontline providers. In the face of ever-evolving circumstances, it is critical to remember that KCMS has a history of helping those in need and will continue to challenge itself to consistently renew that tradition.

Providing Information for Practice Closures

Provided as a courtesy by your KCMS Staff
Since the beginning of Covid-19, KCMS has received steady correspondence from our members requesting more information about best practices for closing their medical practices. We felt it was prudent to provide you with the following information as an example of what is required:
Most providers put a lot of thought into the financial aspects of their retirement but are often
surprised to learn about their responsibilities for protecting and providing access to patient records.
While WA State doesn't currently have statutory requirements for physicians to store and
provide access to patient records, guidelines from the DOH and WSMA suggests that patient records should be maintained for ten years for adult patients and until the age of twenty-one for minor patients. Your malpractice carrier is also a great resource to help you understand your liability for protecting and providing access to former patient's records.
Rules for timely production of records (within 15 days in Washington State) and HIPAA regulations are still applicable once you retire. Failure to meet these standards opens you up to potential fine as well as reputational damage. HIPAA requires copies to be made available to patients within 30 days. Failure to do so can result in fines. One notable example is the $4,300,000 fine assessed to Cignet Health of Prince George’s County for denying patients access to their medical records.
Read the full article to learn more about your risks as a retiring physician, your options, and a recommended plan of action: 
Your Risks as a Retiring Physician

Surge in Opioid Overdoses Linked to COVID-19

A new study by Ochalek et al confirms an increase in opioid-related overdoses during the early months of the pandemic. The study also highlights an additional problem: the failure to deliver effective treatment for opioid use disorder. 
Medscape Medical News

WPSR presents: COVID, Climate, and Economic Inequity 

Sept. 24th, 2020 6:00-7:15 PM
You’re invited to join Washington Physicians for Social Responsibility (WPSR) for a discussion and training on how Washington health professionals can support a state recovery that prioritizes the health of our climate and communities. Our state's public health response must include investments in climate resiliency, sustainability, and the long-term economic security of those hardest hit by the COVID-19 crisis. The voices of health professionals are needed to ensure that any state policy response protects public health and upholds the principles of climate and economic justice.

Come learn how health professionals can advocate for a just recovery by elevating the Climate Alliance for Jobs and Clean Energy’s new “Resilient Future Platform!” We will outline how the principles of this platform are critical to upholding public health in the face of a statewide recovery and provide resources and guidance on how you can contribute to this campaign going forward.

As health professionals, our voice carries weight, and it is our responsibility to use our power and privilege to protect our climate and most vulnerable communities as we recover from the COVID-19 pandemic. We hope you will join us!

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