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Governor's Newsletter
Summer 2002

Robert W. Bradsher, MD, FACP
Governor, Arkansas Chapter

Letter From the Governor

At the Annual Session of the ACP-ASIM meeting in Philadelphia this April, the ACP-ASIM President, Dr. William Hall, FACP, gave an interesting convocation speech. I reproduce excerpts from his talk here:

I am going to direct my remarks tonight primarily to you, our candidates, who are about to be inducted into Fellowship in the College. You are all here because in the eyes of your peers-the harshest critics of them all-each one of you has been judged to be exemplary in the way you conduct your professional life. In a few minutes a time-honored and important ceremony will be taking place when each of you will be asked to take a pledge affirming your commitment to the principles of this venerable profession of Internal Medicine.

I suspect many of you are just slightly bemused and a little uncomfortable marching in this processional in cap and gown. Clearly in my travels this year around the country, one of the most common questions I have been asked is, "What is the significance of Fellowship?" I think it is only fitting that we consider together what it really means to be elected into Fellowship in this organization? So permit me to explore with you the true significance of this ritual and the implications for the years ahead. For your families present here tonight, perhaps you too will see your spouse, child or parent in a different light.

In preparation for tonight, I've looked into the history of the concept of fellowship. I started my inquiry with a search for the origins of fellowship, especially in medical organizations. Like so many other traditions of our College, we have emulated the rich tradition of the Royal Colleges in the United Kingdom. We trace the origins of our own College only back about 80 years. In contrast, The Royal College of Physicians of London received its charter from King Henry VIII in the year 1516, and the Royal College of Physicians of Edinburg received its charter in 1681 during the reign of Charles II. These societies in turn trace their origins back to antiquity. In fact, all learned societies have found it advantageous to have a special class of membership to allow recognition of those who are the standard bearers. And so all of you and all of us assembled here tonight are engaged in one of the oldest and most consistent rites of professional passage in civilization.

Actually we are indebted to the UK for two concepts of fellowship. The first, being this long tradition of fellowship in the Colleges, and the other being a somewhat more recent one, namely, the writing of J. R. Tolkien, who of course wrote the The Lord of the Rings. Now it may have been quite a few years since you have last read Tolkien. However, as many of you with children know only too well, the first of three motion pictures is now all the rage in this country, and this film is named, appropriately for us tonight, The Fellowship of the Ring.

For those of you who haven't seen the film or read the books, a brief overview of Tolkien's story is appropriate. The future of civilization of a mystical kingdom called Middle-Earth rests in the fate of a magical ring that has been lost for centuries. Powerful, evil forces are unrelenting in their nefarious quest to subjugate the world. But fate has placed it in the hands of a young fellow named Frodo, who inherits the ring. A daunting task lies ahead for Frodo when he becomes the ringbearer: He must make an important decision that in a way all of us are called upon to make. Should he simply discard the ring with the justification that the world's problems were of no concern to HIM? Or, though poorly equipped, he can accept the responsibility to do something about it. He accepts the responsibility to do something very dangerous. He will take the ring to a horrible place called Mount Doom where it was forged and the only place where it, and the associated evil forces, can be once and for all destroyed. The journey, however, will be perilous and he will encounter all sorts of monsters and dragons on the way.

Right from the start, he knows he cannot do this alone. He is quickly joined by a small group of like-minded volunteers who band together for the dangerous journey. It is only through their collective strength that they find the courage, as Garrison Keillor reminds us on Saturday nights, "to do the things that need to be done." They form the fellowship of the ring-and you will have to go see the movie yourself to find out if that particular form of fellowship turns out to be a good idea.

No doubt you can see where I am going. I think there are many parallels in this retelling of a very common ancient tale with what we are about to ask you to do as Fellows in this College. No, we do not inhabit Middle-Earth, few of us are brave Frodos, and none of us has magical powers-or are we so sure?

Many forces out there are seeking the magic ring to influence health care in ways that most of would say is not in the best interests of our patients. Unfortunately for us, there is no single dragon we can slay to improve this world. Yet our monsters do have names: problems of quality and patient safety, the plight of the uninsured, access, regulatory excesses, gender and racial inequities, and on and on.

And the great paradox of course is that these growing problems are occurring at precisely the time in history when the diagnostic and therapeutic tools available to internists have never been more powerful. Can anyone seriously doubt the alchemy and magic you have in your hands to treat congestive heart failure, deal with cancer, prevent future disease with your knowledge, find the time to hold the hand of a dying patient and help them die with comfort and dignity. If this is not magic, what is?

Tonight I'd like to highlight three characteristics that seem to be quite universal and highly predictive of success. I suspect most of you share these qualities.

First, these internists have a distinct clinical style, something we used to call "bedside manner," but might more appropriately be termed the art of healing. In a poem by the same title, W.H. Auden said, "Healing is not a science, but the art of wooing nature." Wooing nature, I love that term. These internists have learned how to patiently deal with the vagaries of chronic illness, rarely, I suppose, "curing," but always bargaining with nature to improve the quality of their patient's lives. It is a unique partnership, and it lies at the very core of what a good internist does. Unfortunately, the increasing pressures of clinical practice make this style of practice increasingly difficult. But you, many of whom share this attribute, must continue to teach by example. Do not underestimate your power to create good by doing what you do best. It is an enormous treasure, and the health care system and the College needs you.

Secondly, in a society that increasingly seems to value less and less any sort of group activity, these internists are constantly investing in what some observers call "social capital." That is to say, they are joiners-in ACP-ASIM activities and in various causes in their communities. They, like Frodo, recognize that if you want to change the world, it is prudent to involve some trusted colleagues for the journey. They spread their enthusiasm among their peers.They recognize how appreciative we all are when a highly respected colleague seeks our counsel. In this way, their impact on their colleagues and communities-and their elected representatives-is nothing short of astonishing. So continue to lead in your communities by finding time to devote to worthy causes, and always try to involve others. You will be surprised how favorable people respond!

The final attribute is the most important and most basic. It is sometimes referred to as Character, but I've learned that a better term might be "Virtue." In classical philosophical terms, virtue describes a set of personal values developed by years of self-reflection and mentoring by family and respected colleagues. It is the inherent tendency to intuitively do the right thing. When transposed to our clinical world, virtuous personal values allow us to easily establish trust and confidence with our patients. Virtue is the basis of professionalism.

In my experience, Fellows in this College know themselves very thoroughly and have more satisfying relationships with their patients as much by whom they are as by what they know. Virtue is a trait worth recognizing and preserving in your careers. Your colleagues, especially younger ones, will recognize this trait and seek you out. Bring them into the fellowship.

This address by Dr. Hall, I wanted to highlight because I think it aptly describes many of the practicing internists in Arkansas. Plus I have always been a big fan of Frodo, the ringbearer; now I can think of him as a classical internist!

ACP-ASIM Arkansas Chapter 2002 Annual Scientific Meeting

I am really looking forward to our fall meeting. We have another great meeting planned by Dr. John Schultz that will be held at a new spot, Hot Springs. It has been many years since we met in Hot Springs and it is high time. The first day, Friday, will be at the Clarion Resort on Lake Hamilton. Plus, on the second day, we will be meeting at the Garvan Gardens on Lake Hamilton. Here is the description from their website:

Garvan Woodland Gardens is Arkansas' botanical garden. Located near Hot Springs National Park, the Garden's gently sloping Ouachita Mountain terrain covers 210 acres of a forested peninsula jutting into Lake Hamilton. The gardens showcase floral landscapes, free-flowing streams and waterfalls, as well as breathtaking architectural structures in a natural woodland setting. This woodland habitat is home to hundreds of natural and exotic plant and animal species and is nestled near one of the nation's oldest and most intimate national parks.

In 1920, the land that is now Garvan Woodland Gardens thrived as a pristine woodland sanctuary. That year the 210-acre site was purchased by Arthur B. Cook, and the land's future as a protected environment was secured forever. Beginning in 1956, Cook's daughter Verna C. Garvan set about cultivating 30 acres of the property for a garden that she would ultimately develop as a tribute to natural conservation and protection. Seed-by-seed, plant-by-plant and tree-by-tree, Mrs. Garvan supplemented the existing natural habitat with rare shrubs, flowers and trees. She planted more than 100 different types of azaleas, antique rose varieties and unique plant specimens from throughout the world. With her longtime employee Warren Bankson at her side, Garvan blazed footpaths through the woodlands and handpicked each site for her plantings. In 1985, eight years before her death, Garvan donated the acreage to the University of Arkansas Department of Landscape Architecture. It was the first step toward the Garden becoming a world-class botanical garden-Verna Garvan's ultimate goal. Public tours of the Garden began in 1986, and the sites first major structure, a Pavilion designed by renowned architect E. Fay Jones and Maurice Jennings, was completed in 1994. Development of the Garden's master plan was begun in 1995. Today, Garvan Woodland Gardens continues to grow under the guidance of the University of Arkansas. Thanks to Verna Garvan's love and dedication to preserve and enhance this pristine land, generations of visitors will find beauty, inspiration and a better understanding of nature. I hope you will look at their website and will plan on being with us to visit the gardens.

Finally, the Abernathy Award Dinner will be held at the Hamilton House, again on Lake Hamilton. The program is listed below. Please put this on your calendar and join us on the Lake.

Arkansas Chapter
2002 Annual Scientific Meeting
Hot Springs, Arkansas
September 20-21, 2002
Dr. John Schultz, Program Director

Friday, September 20, 2002

7:00 am - Exhibits/Continental Breakfast: Cove Room, & Registration: Foyer

7:45 - Welcome, John C. Schultz, MD, FACP, Program Chair, 2002 Scientific Meeting

8:00 - Medical Education-Challenges and Prospects, George L. Ackerman, MD, MACP; Richard P. Wheeler, MD, FACP

8:45 - Evaluation of Renal Function, James T. Henry, MD

9:45 - Break, Visit the ACP Display & Exhibits: Cove Room

10:15 - Curricular Issues in Medicine/Pediatrics, Robert H. Hopkins, MD, FACP

11:00 - Adolescent Medicine: Psycho-Social Issues, Gregory V. Whorton, MD

11:45 - Lunch: Clipper Room ; Presentation by the Representative

1:00 pm - Refractory Anemia, R. Timothy Webb,MD, FACP

1:45 - Update on Non Hodgkin's Lymphoma, Omar T. Atiq, MD, FACP

2:30 - Break: Cove Room

3:00 - Use of COX-1 and COX-2 Drugs, Melody D. St. John, MD

3:45 - Disease Modifying Drugs in Rheumatoid Arthritis, Ricardo Zuniga, MD

4:30 - Town Meeting

6:15 - Board: Belle of Hot Springs Riverboat (Sunset Dinner Dance Cruise)

Saturday, September 21, 2002

7:30 am - Shuttle Departure from Clarion Resort to Garvan Woodland Gardens

8:00 - Exhibits & Continental Breakfast: Foyer

8:30 - Anti- (anxiety, depressants, psychotic) in Geriatrics and Senior Health Center Development, Allan S. Pirnique, MD, FACP; Ruxandra Jadic, MD

9:15 - Update of Hypertension Treatment, John Wayne Smith, MD, FACP

10:00 - Break: Foyer

10:15 - Associate Presentations, Moderator: Rebecca E. Martin, MD, FACP, Presenters: Forrest D. Glover, MD; Johann Herberth, MD; Russell A. Linsky, MD; Rahul S. Nanchal, MD; Matthew C. Robinson, MD

12:15 pm - Lunch: Pavilion

1:00 - Tour: Arkansas' Botanical Gardens

2:30 - Fever and Rash, Carl Abraham, MD

3:15 - Asthma, James R. Phillips, MD, FACP

4:00 - Type II DM and DM Education, Kevin D. Ganong, MD; Bilinda Norman, RNP

5:30 - Shuttle Departure from Garvan Woodland Gardens to Clarion Resort

7:00 - Reception: Hamilton House

7:30 - Awards Banquet, Presentation of: Associates' Award, Robert Shields Abernathy Award

Fellowship Advancement Made Easy (FAME)

Marc Shabot, Texas Southern Governor

Prerequisites:

  • ABIM, RCPS, or AOBIM certified*
  • Licensed practitioner
  • Member > 2 years
  • Be proposed/seconded by 2 Fellows/Masters

Then, qualify by one of the four pathways:

Pathway 1: Academician

Write a lot of papers, teach, etc.

Pathway 2: Scholar/Teacher

  • CME activity, teaching, community involvement
  • Recertified or dual boarded
  • MKSAP for score

Pathway 3: ACP-ASIM Veteran

  • 10 years membership in the ACP-ASIM
  • Active in ACP-ASIM meetings/committees

Pathway 4: Senior Statesman

  • May not have been active in the ACP-ASIM
  • Has demonstrated longstanding (20-25 years) professional activity in the community, in teaching, in patient care or in service

*Pathways are not mutually exclusive, and "combos" are permissible*

Selection of new EVP/CEO and DEVP/COO

I am very pleased to announce the Board of Regents appointed John Tooker, MD, MBA, FACP, Executive Vice President and Chief Executive Officer of the College. John will take office as EVP/CEO on July 1, 2002 to replace Dr. Walt McDonald. In addition, I am pleased to announce that John A. Mitas II, MD, FACP, has accepted the position of Deputy Executive Vice President and Chief Operating Officer of the College. He will take office as DEVP/COO on July 1, 2002. Dr. Mitas has extensive leadership and business administration experience, and has been an active member and leader of ACP-ASIM. He served as ACP Governor for the U.S. Navy Region from 1991-1995, and on the Ethics Committee.

Board of Regents Take Action on Spring 2002 Recertification Resolutions

At the April 9, 2002 meeting of the Board of Regents, Dr. David Dale, FACP, Chair-elect, Board of Governors, presented for discussion and vote four Spring 2002 Recertification Resolutions from the Board of Governors, along with recommendations for their referral and implementation. As such, the BOR took the following action on these resolutions:

The Board of Regents voted to refer Resolution 5-S02, Accountable, Literature-based Continuous Medical Education, to the Education Committee for study and report back with recommendations:

RESOLVED, that the Board of Regents investigate the feasibility of developing programs of accountable, literature-based continuous medical education specifically for general internists as well as for all the subspecialty practitioners of internal medicine with consideration of awarding a certificate of accomplishment for those physicians who successfully participate in the program and this could be presented as a possible pathway for recertification.

The Board of Regents voted unanimously to amend and then adopt and refer Resolution 28-S02, Recertification Positions of the ACP-ASIM, to the Recertification Negotiating Team for implementation:

RESOLVED, that the Board of Regents insist that the proposed plan for a Peer and Patient evaluation module be optional; and be it further

RESOLVED, that the Board of Regents advocate that educational resources, such as MKSAP, serve as substitutes for all ABIM self-evaluation modules.

The Board of Regents voted unanimously to amend and then adopt and refer Resolution 30-S02, Recertification Positions of the ACP-ASIM, to the Recertification Negotiating Team for implementation:

RESOLVED, that ACP-ASIM reaffirm its commitment to life long learning and professional accountability through the process of recertification; and be it further

RESOLVED, that the Board of Regents work towards a formal and ongoing "Recertification Partnership" between ABIM and ACP-ASIM that preserves the important separation of responsibilities between these organizations while recognizing a common goal of establishing a rational and effective process for recertification of internists and subspecialty internists. This process would include a review for comment on proposals for new components and revisions of existing components with key stakeholders prior to implementation; and be it further

RESOLVED, that the Board of Regents work with ABIM to establish multiple pathways for recertification, one of which would be a process that includes a secure exam; and be it further

RESOLVED, that all pathways meet the following criteria: relevance to a variety of practice settings, elimination of redundancy, accommodation to different learning styles and sensitivity to cost and time; and be it further

RESOLVED, that whatever methods of recertification are chosen to be subject to continuous testing and validation; and be it further

RESOLVED, that it is the position of the ACP-ASIM to encourage the maintenance of certification of subspecialists in both general internal medicine and their subspecialties and therefore continue to work with the ABIM to eliminate barriers and facilitate the process of dual recertification in both general internal medicine and the subspecialties; and be it further

RESOLVED, that if the ACP-ASIM and ABIM cannot reach a mutually agreeable solution, the Board of Regents consider the possibility of committing ACP-ASIM resources to developing an alternative to an ABIM recertification process.

The Board of Regents voted unanimously to adopt and refer Resolution 31-S02, Recertification Negotiating Team, to the Chair, Board of Regents for implementation:

RESOLVED, that the Board of Regents support that the ongoing negotiating team include the Chair, Board of Governors and a Governor from the Education Committee.

If you need additional information regarding the Spring 2002 Recertification Resolutions, or if you have any questions regarding the BOG Resolutions Process, please contact Alison Dufner, Resolutions Administrator at (800) 523-1546, ext. 2716, or (adufner@acponline.org).

Prescription for Safety

Physicians' handwriting is a source of endless jokes, but illegible orders are no laughing matter. Illegible handwriting on prescriptions takes extra time to interpret, and pharmacist callbacks result in lost time to the practitioner. Tragically, illegible handwriting is a common cause of medical error and has led to patient injury and death. According to a 1997 American Medical Association report, errors related to misread prescriptions were the second most common and expensive malpractice claim over a seven-year period. To prevent errors, prescriptions should:

  • Be legible
  • Use the metric system
  • Avoid abbreviations and decimals
  • Include the medicine's purpose

ACP-ASIM promotes patient safety through its three-year initiative, Patient Safety: the Other Side of the Quality Equation, supported by a grant from the Agency for Healthcare Research and Quality. To find out more about the College's patient safety program, visit ACP-ASIM Online or call Kyle Bartlett, PhD, at (215-351 2838).

Contact Information

Clark Fincher, MD, FACP, Governor, Arkansas Chapter

Donna Seawards, Arkansas Executive Director
Phone:623-225-5527