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May 2012 George W. Meyer, MD, FACP, ACP Governor


Governor's Message

Dr. Meyer

Internal Medicine 2012

New Orleans, LA
18-21 April 2012

What a great meeting we had in New Orleans. The weather was perfect; warm during the day and cool at night without high relative humidity. We shared the week with the Navy with the N.O. equivalent of Fleet Week. One Navy helicopter carrier was open to the public and there were four multiple mast sailing ships from four different countries in port. I thought the fireworks at night were for the ACP but I suspect it was for the Navy. It was raining on Saturday when they were planning a Blue Angels demonstration at Lake Pontchartrain but I fear it was cancelled for bad weather.

We were proud of the number of CANO members who joined the procession on Thursday night at the annual awards ceremony and who took the pledge as new Fellows. Davisí Nancy Lane was selected as MACP this year but was unable to participate. Next year the annual meeting will be in San Francisco 11-13 April 2013. We hope you all plan to join us. At that meeting, Gordon Fung will become the Governor for the northern California (CANO) Chapter.

Fellows
Congratulations, to the New Fellows

The all CA and HI reception, a Friday night annual event, was well attended. I was pleased with the support of our students and Associates who presented posters (see photos).Congratulations to poster winners, medical student Jocelyn Chin, from Stanford University School of Medicine, along with medical student Rung-Chi Li, from Touro University College of Osteo Med, Vallejo, CA. We had one resident, Maria E. Andrae-Hammond, from St. Maryís Hospital & Medical Center, San Francisco invited to give an oral presentation on Saturday. Our Doctors Dilemma team performed well but did not reach the finals. Congratulations to all of you who participated.

The Board of Governors meeting was excellent. Several resolutions were considered and several referred to the Board of Regents for their consideration and College action:

Recommended for Adoption as Amended:

5-S11. Investigating Possible Work-Related Abuses for Physicians Working Under the Conrad-30 Program
1-S12. Studying the Financial Consequences of Provider-Based Billing on the Value of Health Care

Recommended for Reaffirmation:

5-S12. Collaborating with the ACP Foundation to Help Patients Become More Prudent Consumers of Health Care
7-S12. Developing a Strategy to Become the Leader in Use and Development of Technical Innovations in Communication, Education, and Membership Outreach

Recommended for Study and Report Back to the BOG:

6-S12. Pursuing a Joint ACP-Hospitalist Membership and Dues Structure with the Society of Hospital Medicine

ABIM representatives presented important information for ALL board certified physicians for maintenance of certification (MOC). Not only are all specialty organizations participating in MOC but we were informed that State Licensing Boards are going to initiate MOL (Maintenance of Licensure) programs for all physicians, whether certified or not, and would be the ongoing requirement of CE specific to oneís practice. The ABIM is working with the major stakeholders including ACP and the council of State Licensing Boards but is moving ahead with this. So stay tuned. One major change in the ABIM program will be to get physicians to maintain their maintenance activities continuously over the 10 year period. The ABIM also offer at least two payment options, one will have the participant pay a yearly fee; the other is to pay the full 10 year fee up front. This will not affect how they participate in the program. An issue that the ABIM is grappling with is what to do with the non-ABIM certifications e.g., for Echocardiography, Hypertension, or lipidology. The ACPís MKSAP program will meet many of the MOC requirements. The MKSAP 16 program is expected to be released at the end of July 2012. To order please go to the website(http://www.acponline.org/products_services/mksap/16/)

Another interesting presentation was by Dr. Karen DeSalvo who was at Tulane during Katrina. In Tulaneís effort to help New Orleans reemerge from its disaster Tulane has developed numerous satellite health centers, several of which have been declared Patient Centered Medical Homes (PCMH). Tulane actually has done so many of these that they have pretty much developed a template for building such homes. By the way for those interested in building their own homes there is a PCMH tool on the ACP website (http://www.acponline.org/running_practice/pcmh/help.htm)

Another interesting announcement was the decision to offer affiliate membership to all Physician Assistants, Nurse Practitioners and other non physician members of health care teams including Clinical Pharmacologists and others. Affiliate membership will give these persons access to ACP educational materials and programs. Membership applications are available at the ACP website (http://www.acponline.org/membership/join/affiliates/). Cost will be $119 annually.

In closing I would like to invite everyone to join us at the CANO annual meeting to be held in San Francisco at the Parc 55 hotel from 16-18 November 2012. The coprogram directors, Raminder Gill, MD, FACP and Scott Enderby, DO, FACP, have put together an outstanding agenda with topics aimed at both outpatient physicians and hospitalists.

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IM 2012, New Orleans
Photo Gallery

Duong
Medical Student, Le Duong, San Jose

Chin
Medical Student, Jocelyn Chin, Stanford

Thieu
Medical Student, William Thieu, UC Davis

Crabtree
Medical Student, Katherine Crabtree, UC Davis

Anderson
Medical Student, David Anderson, UC Davis

Sombredro
Associate, Allison Sombred, Highlands

Srinivansan
Associate, Sowmya Srinivansan

Shoshankaiser
Associate, Stacy Shoshan, Kaiser, Oakland

Busa
Associate, Swapmn Busa

Lin
Associate, Patrick Lin, UC Davis

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Telephone Communication for Physicians

When carelessly conducted, telephone communications can lead to diagnostic errors and misunderstandings that culminate in medical malpractice claims and lawsuits. Telephone conversations may be inherently deceptive because reliable communication is incomplete without facial expressions and body language to clarify and qualify what the voice is expressing.

Once you offer medical advice on the phone, you can legally become the attending physician of a patient you have never seen. The best way to protect yourself from such potential liability is to practice effective telephone communication:

  • Listen very carefully and pursue questions relevant to the medical problem.
  • Avoid distractions when speaking with the patient, such as checking e-mail or attending to other duties.
  • Obtain as much information as possible about the patient who is calling. Prescribe or advise by phone only when you know the patientís medical history.
  • Accept a third partyís description of a medical condition only when you have confidence in the third partyís competence to describe what he or she sees. Ask the patient to repeat the instructions back to you to ensure his or her understanding.
  • Be especially wary of calls concerning abdominal or chest pain, fever of unknown origin, high fever for more than 48 hours, convulsions, vaginal bleeding, head injury, dyspnea, casts that are too tight, visual alterations, or the onset of labor.
  • Be particularly careful that the pharmacist understands all dosages and instructions for drug prescriptions given by phone. Spell out the drug when names are similar, and use individual numbers for dosages, e.g., ďfive zeroĒ for 50. Include the reason for the use of the drug. Insist that the pharmacist repeat the information to you. Make sure the same is true of hospital nurses taking your orders.
  • Be especially careful if you take a call for another doctor. In several instances, covering doctors have been held completely responsible for damages resulting from a telephone misdiagnosis, while the original physician was exonerated.
  • Provide your covering physician with a brief status report on your acute patients.
  • Prescribe only the amount of patient medication required for the period you are covering another physician. Pain medications and narcotics should be refilled or ordered only in small amounts.
  • Document all phone calls to and from patients and keep the medical record updated.
  • Provide documentation of your coverage period to the absent physician.
  • Be sure to record any hospital telephone conversations with nurses that pertain to a patient in the patientís hospital medical record.

Follow these telephone loss prevention measures to help you avoid giving inadequate information or experiencing a miscommunication:

  • Always see the patient yourself when in doubt.
  • Obtain the services of an interpreter if there is a language difficulty.
  • Repeat instructions you give on the phone and then ask that they be repeated to you.
  • Allow the caller both time and opportunity to ask questions.
  • Make prompt referrals and follow up with the referred provider if the patientís medical problem is outside your specialty.
  • Be aware of your surroundings if you are talking with a patient outside of the clinic, such as on a cellphone.
  • Speak clearly and enunciate carefully.
  • Verify patient compliance through follow-up contact to ensure continuity of care.
  • Be especially diligent when the caller is an unknown patient.
  • Remember that drowsiness, fatigue, or distraction on the part of either party is a giant step toward miscommunication.
  • Document, document, and document again.

Disagreements about what was said are invariably a major problem when cases are tried. It is of prime importance, therefore, to obtain all of the necessary information on the phone. If you still feel there is any area of ambiguity, we strongly advise that you see the patient. An alternative is to have either a physician in the hospital or a licensed staff member check the patient. The critical point is that you must arrive at an accurate and totally reliable appraisal of the patientís condition either while you are on the phone or within a few minutes thereafter. Use standardized language when at all possible.

The information you received, what you advised, and the orders you gave must be immediately recorded to avoid future discrepancies about what was said. This is especially important when the phone call occurs after office hours or on weekends. During office hours, take steps to resolve the callerís questions and problems. The patientís problem should be appropriately addressed and the process should be documented. Office staff should tell the caller when the physician is most likely to return his or her call and follow up to ensure that the callerís questions and problems were resolved.

Conclusion Effective communication is particularly important on the telephone. Physicians who use telephones carefully will reduce misunderstandings that can lead to legal action.

About the Authors

This article by Governor Emeritus Mark Gorney, MD, FACS, Laura A. Dixon, BS, JD, RN, CPHRM, Director, Department of Patient Safety, Western Region, and Susan Shepard, MSN, MA, RN, Director, Patient Safety Education.

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