Physicians undergo years of training and practice to amass the knowledge that equips them to lead a patient’s care. So they can spend more time in clinical care, the Texas Medical Association Knowledge Center helps them navigate the rest.
The Knowledge Center was created in October 2003, envisioned as a central hub for physicians to obtain accurate, timely, concise, and complete answers to their questions. In the 20 years it has operated, the center’s director, Claire Duncan, says the staff has remained true to that goal across numerous medical landmarks.
These days, Ms. Duncan says, the center receives calls and emails that run the gamut: questions about logging in to membership benefits; medico-legal topics; practice management issues; and concerns about current events, from legislation to public health.
“Events like the pandemic and natural disasters, and major pieces of legislation like the Affordable Care Act, really highlight the need to have that one-stop shop where physicians and their office staff can contact TMA,” she said. For example, during the COVID-19 pandemic, “Knowledge Center staff were listening to member concerns, answering questions, and helping navigate uncharted territory. We were able to relay member concerns to folks who were working on the ground with emergency preparedness organizations.”
The Knowledge Center tracks recurring questions and persistent issues to help develop and curate resources that better serve members. This may result in FAQs or white papers developed by TMA staff experts that physicians can reference. The way physicians interact with the Knowledge Center also may guide larger actions by the association, with the aim of continually improving members’ access to quality information.
During the pandemic, for instance, the Knowledge Center’s work included sharing FAQs and white papers TMA produced about the COVID-19 virus, as well as signage for physicians’ offices. It also helped facilitate the distribution of more than 23 million masks.
Most importantly: All the center’s many services hinge on person-to-person connections. This way, staff can ensure that issues – often nuanced and requiring precise care – are fully addressed.
Center staff are reachable by phone and email, so “it’s really easy to get ahold of us,” Ms. Duncan said. “We have live human beings answering the phone, during business hours, which is rare. You might have to leave a voicemail, but a human being will talk to you.”
Sometimes, that problem may be larger than TMA can tackle, like systemic issues with an insurance policy, or state or federal mandates. But hearing from physicians on these topics still informs TMA’s actions on behalf of its members and in its advocacy, which is why the association encourages those calls, too.
“If you don’t need practical information or guidance, but you just want to vent, we’re also here for that,” Ms. Duncan said.
Meet your information specialists
The center’s model is simple: Staff receive questions and answer them based on their accumulated knowledge and high-quality sources. If the center is unable to find a helpful answer, it will redirect the matter to the appropriate TMA staff expert.
“We really ... have to be jacks of all trades,” said Gerry Juarez, a TMA information specialist. “We have to know what each department does. There are different programs within each department, so we need to know who spearheads those particular programs.”
Such a wide range and volume of information requires the center’s information specialists to be organized, cooperative, continual learners. And the center’s lineup meets and exceeds those criteria. Physicians and their staff who reach out to the Knowledge Center are accessing a pool of experience that spans decades.
Especially after a tumultuous couple of years through the COVID-19 pandemic, center staff feel more prepared than ever to address member needs.
“I created a lot of new files and really started homing in on keeping a lot better notes,” said Gay Anderson, an information specialist for the center. “Still, very, very often I create new resources for myself when I get a question. [COVID] made me a little more efficient.”
Ms. Anderson and Mr. Juarez, along with the center’s coordinator, Stefanie Nanez, use their own notes, along with data the center logs about each call, to answer member questions quickly and accurately. After all, they understand that time is a highly precious commodity to physicians and their staff.
“What can we do for our members without having to transfer? How can we help them rather than keep on passing them down to the next person?” Ms. Nanez asked. “A lot of these physicians don’t have 45 minutes to an hour to try and figure out a solution.”
To meet those asks, Ms. Nanez says the team has no choice but to cooperate well and know their strengths.
“And if we need help, we’re not afraid to ask each other for help,” she said.
The eagerness to ask for and offer aid is part of the center’s DNA. It’s a service predicated on compassion for others who find themselves in a place of need.
Successfully getting the right information can sometimes require outside sources, whether it’s additional TMA staff or even agencies or regulating bodies.
“At the end of the day, my job is to solve their problem,” Ms. Nanez said. “If I can’t do it, let me find someone who can. If that person can’t, before the end of the day or before the end of the week – we’re still going to solve this problem.”
The Knowledge Center cannot dispense legal advice, though specialists can refer physicians to lists of qualified attorneys. They also cannot answer questions about setting fees, which would violate antitrust laws. What they can do is collect a wealth of information for physicians to use when making hard decisions.
“Many questions cannot be answered with a simple ‘yes’ or ‘no’,” Mr. Juarez said. “We’re not going to be able to tell you exactly what to do, but we can give you the guidelines and the rules so you know what you can do.”
Bringing data to physicians
Even with those limitations in mind, center staff emphasized that physicians – and their practice staff – can call or email with just about any question. Clinical questions, however, are typically directed to librarian Barbara Tims.
Ms. Tims oversees the Knowledge Center’s library resources and serves as the team’s point of contact for clinical and health business questions. Solo or small practices without academic affiliation may not have access to the most recent research, for instance, and regardless of practice type, all physicians have limited time to hunt through massive databases.
“It still takes a great deal of time and expertise to sift through [databases] and come up with the relevant papers,” Ms. Tims said. “Obviously, most physicians just don’t have time to do that.”
While the huge volume of information available through TMA may be daunting, Ms. Tims is glad to help physicians navigate it. There’s never a dull day, she says.
“I like that every day is a different question,” she said. “I don’t get bored, ever.”
That’s because the questions and topics posed to her span a wide variety. Whether it’s a physician with a particular research interest, an office preparing for a deposition, or a novel clinical presentation, Ms. Tims can research it – and give physicians the tools to do it themselves, too.
“It could be that [physicians] are doing research for a legal case; could be that they’re about to present a grand round and they want supporting information; could be that they want to look up the latest clinical guideline,” she said.
The Knowledge Center’s custom research services are available in one of two ways. Either Ms. Tims can find and distribute relevant articles, or physician members can use their TMA log-in to find those materials themselves – an especially useful option if a physician has a preferred database or publication in mind.
For an average research request, Ms. Tims will compile a list of citations. If a full-text article is available, it’ll be included; if only the abstract is available, she will send it as well, with the standing option to order the rest through interlibrary loan.
When researching on their own, physicians still have TMA’s help. Entering PubMed through TMA generates a link next to each article; clicking that link directs a physician either to full texts, when TMA has access to them, or to TMA’s loan option. Between this function and TMA’s publication finder page – which consolidates all of TMA’s owned collection – researching physicians are never far from the information they need.
For help with articles TMA doesn’t have access to, the Knowledge Center also partners with TexShare, a statewide consortium of academic libraries, public libraries, and libraries of clinical medicine. TMA members may request a TexShare card that gives them borrowing privileges at participating entities.
The history of medicine
The Knowledge Center has an additional responsibility: housing TMA’s archive of documents and artifacts, one of several History of Medicine activities.
History of Medicine activities – exhibits and archive management, among others – are overseen by the board-appointed History of Medicine Committee.
The archive sits at the core of those activities, established more than 100 years ago at the urging of the association’s 35th president, Frank Paschal, MD. Without dedicated effort, Dr. Paschal feared the association’s work would be lost to time.
But the robust archive doesn’t just preserve TMA’s past; it uniquely illustrates the story of medicine in the state, says Steve Steffensen, MD, an Austin neurologist and member of the History of Medicine committee.
“TMA’s collection is very intentional towards the creation of a historical accounting of health care in Texas,” he said. “That, to my knowledge, does not exist anywhere else.”
From decades’ worth of House of Delegates business to medical devices and doctors’ bags, across eras, locations, and fields of medicine, the archive is full of “snapshots” of Texas medical history, Dr. Steffensen says.
And beyond aligning with TMA’s mission to help physicians care for Texans, Ms. Duncan added, the archive “tells the story of how physicians in Texas have taken care of their patients from the get-go. It really is a way for us to educate the public on the value of medicine and the value that physicians provide in keeping patients healthy through history.”
The public is welcome at the rotating exhibits in the Robert G. Mickey History of Medicine Gallery, on the first floor of the Louis J. Goodman TMA building in Austin. The gallery showcases the collection through focused themes, such as “Stamping Out Disease,” which illustrated the fight against infectious disease through postage stamps collected by the late TMA member Kurt Lekisch, MD; and “Smoke and Mirrors,” which traced the history of tobacco and medicine.
“For the public, especially [those] interested in the future of health care in Texas, one of the better ways to improve the future of health care in Texas is to understand the past, and TMA has a wonderful collection to help understand that,” Dr. Steffensen said.
Now, at another milestone for TMA, the gallery hosts a new installation: “Greatest Hits” from the History of Medicine Gallery and archives. The association’s headquarters in the Louis J. Goodman building are set to be refurbished, making the pre-2020 decision to highlight the most remarkable of TMA’s artifacts especially prescient.
“The main motivation behind it is, especially with the changes happening within TMA, to be able to reflect back on its history,” said Audrey Griffin, former archive and museum exhibits assistant for TMA. “We’re able to give the public a peek into our archive and the highlights of our collection, and also look back on our past exhibits. We also give a little peek into the past buildings of TMA, our past health initiatives. There’s a little bit of everything.”
The educational role of the History of Medicine activities takes many forms. Medical history researchers and genealogists can access the archive on an appointment basis, for example.
And for students at The University of Texas at Austin Dell Medical School, where Dr. Steffensen is an associate professor of neurology and population health, the learning is even more up close and personal. Among TMA’s collection is a second edition of Andreas Vesalius’ De Humani Corporis Fabrica Libri Septem, printed in 1555, which makes regular (well-supervised) visits to neuroanatomy students at Dell Med.
“Vesalius is a very famous physician in medical history who, in the early 1500s, produced what is regarded as the first authentic medical anatomy textbook … that to this day is very accurate,” Dr. Steffensen said. “There are some inaccuracies, but it’s nice to be able to show students that this is the legacy upon which they stand. This is the legacy of medicine and health care and learning that they are now participating in. It connects them with a part of the history of their profession in a way that very few things can.”
Spreading the word
Students and TMA members not located near Austin can still benefit through the History of Medicine’s traveling banner exhibits. The exhibits, funded by the TMA Foundation, allow the association to take community outreach to a new level, Ms. Griffin says.
“The main benefit is portability,” she said. “Most, if not all of them, are abbreviated versions of our past gallery exhibits. We take a broad overview of the information, zoom out and include the most important things, and put them on a banner. They roll up so you’re able to ship them out, but then people are able to stand them up and it actually looks like a little mini exhibit.”
TMA banner exhibits have shipped, free of charge, to vaccination sites, physicians’ offices, medical schools, and more. They’re also used within the organization; the Women Physicians Section likes to display the “Women in Texas Medicine” banner exhibit at meetings, for instance.
Similarly, TMA already has received requests to use certain banners to commemorate special dates – such as “Courage and Determination,” an exhibit on Black physicians, being requested for Black History Month, or the “Women in Texas Medicine” banner for Women in Medicine Month.
“Certainly, if we can show those groups that they’re represented in our historical exhibits, that’s important for outreach to those groups,” Ms. Duncan said, citing an opportunity to introduce new potential members to the association.
The banner exhibits are also unique in that they can be translated into other languages. While pricey, doing so can have ripple effects on public health and community trust in medicine. TMA has translated into Spanish its “Stamping Out Disease” banner on infectious disease and vaccination, and its “Deep Roots” banner on botanical medicine and prescriptions.
From past to present to future
Even with so many programs and such a legacy already established, the History of Medicine Committee still has its eyes on the future. As the medical landscape changes, Dr. Steffensen says his mission of a comprehensive and comprehensible collection changes shape too.
“I look around at the next generation of physicians, the medical students that I teach at the medical school – so much of how they learn and interact and engage with the health system is in a digital environment,” he said. “How do you begin to catalog and archive that aspect without losing the importance of that physical nature of health care?”
To start, TMA has begun the process of digitizing existing artifacts, where appropriate, as determined by the committee. The undertaking is expensive and requires serious deliberation.
“Once you digitize [paper records], you need to make sure that the technology stays up to date so it’s still accessible – and then do you get rid of the paper or not? If you’re all digital and something terrible happens, there goes all your history,” Ms. Duncan said. “Those are the things that we wrestle with.”
But the challenges carry with them excitement, as another chapter of TMA’s history unfolds. For Ms. Duncan, the timing is poetic.
“This is like bookends,” she said. “The committee was reformed in 1989 when we were building the [current TMA] building. Now the History of Medicine Committee is helping guide us into the new iteration of what the archive looks like.”