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Governor's Newsletter, Fall 1999

Governor's Column

James L. Bernene, MD, FACP
Governor, Connecticut Chapter

Greetings from the Connecticut Governor's office. As you can see from the contents of this newsletter, much has been happening. We have just completed a very successful annual meeting and for those of you who could not attend, you really missed a great one. Dave Podell and his Program Committee put together a wonderful program that very successfully mixed and matched both the art and science of medicine. We were also fortunate enough to have Dave Gullen, the current Chair of the Board of Regents and Alan Nelson, Associate Executive VP of the Washington office in attendance to provide timely updates regarding national ACP activities as well as a review of medically relevant legislation. We gave Laureate Awards to two Connecticut physicians—Drs. Paul Dolinsky and Majid Sadigh and the George Thornton Award to Dr. Frank Davidoff. Brief descriptions of each Laureate Awardees are contained in this issue as well as Frank Davidoff's acceptance letter.

A Connecticut ACP sponsored medical student contest was held at St. Raphael's Hospital. Nine medical schools from throughout the Northeast sent teams to compete. This is the first such regional competition that I know of in the nation. Drs. Barry Wu and Sherri Clayton organized the event and deserve our sincere thanks and congratulations.

We continue to remain extremely active on the legislative front with Drs. Robert McLean and Paul Dolinsky chairing our Health & Public Policy Committee. This year the Connecticut Chapter will be submitting two resolutions for consideration to the Spring Board of Governors meeting. One resolution concerns Managed Care and Restrictive Drug Formularies and the other stresses the need for Payment For An Annual Health Maintenance Review for Medicare Patients.

Lastly, the time has come to "pass the baton." My term as Governor will end in April 2001 and two candidates have been selected by the Nominations Committee. They are, in alphabetical order, David Podell, MD, FACP, from Waterbury and Noel Robin, MD, FACP, from Stamford. Both have been extremely active in the Chapter over the past several years as chairs of the Chapter's various committees and as Council members. Both are superbly suited to assume the role of Governor. As you recall, this is in actuality a five-year term—one year as Governor-Elect and four as Governor. In addition to a brief summary of their careers, I have asked both candidates to write statements as to what their goals would be if elected Governor. Both are included in this issue of the newsletter. Ballots will be mailed out from Philadelphia in November. Please take the time to vote —leadership of your Chapter is very important!

I wish you all a very Happy and Healthy Holiday Season and may the transition to the next millennium be a gentle one for you.

Bio-Sketches And Personal Statements For Governor-Elect Candidates

David Neil Podell, MD, FACR, FACP

David Neil Podell was born in 1951 in New York City, New York and graduated Magna Cum Laude from Hobart College in 1973 with a Bachelors of Science in Chemistry and Mathematics. He then joined the Clinical Investigator Training Program at the University of Rochester School of Medicine and became a Fellow in the Medical Scientist Training Program. In 1980, he graduated AOA and received both his Medical Doctorate with a Distinction in Research and his PhD in Immunology from the University of Rochester School of Medicine. He received the Robert Kates Award for excellence in clinical medicine and in research. He came to Yale-New Haven Hospital for his Internal Medicine Residency training and in 1983 was awarded the Samuel Kushland Award for clinical excellence. He remained at Yale for his Rheumatology fellowship.

After completing his fellowship, Dr. Podell remained at Yale as an Assistant Professor of Medicine and attending physician in the section of Immunology. In 1989, he joined Waterbury Hospital as the Director of the Section of Rheumatology, Physical Medicine and Rehabilitation and became the Associate Director of the Rheumatology Fellowship Program at Yale University School of Medicine.

Board-certified in Internal Medicine and Rheumatology, Dr. Podell has written numerous articles and several papers world-wide in the area of Immunology. He is a Fellow of the ACP and has been extensively involved in the activities of the Connecticut Chapter for the past 10 years as a member of the Governor's Council and Program Committee. He was the recipient of the CT Chapter's Laureate award in 1998 for his contributions to medicine and education.

Dr. Podell is currently the Director of Medicine at Waterbury Hospital Health Center and Associate Clinical Professor of Medicine at Yale University School of Medicine. In addition, he has an active practice of Rheumatology at the Comprehensive Center for Arthritis at Waterbury Hospital Health Center. Dr. Podell is married to Jill K. Countryman, PhD, and they have 2 children, Kate and Sam.

Election for Governor of the Connecticut Chapter of the ACP
David N. Podell, MD, PhD

As we stand at the beginning of the new millennium, health care reform and health policy changes daily. Greater and greater hurdles are challenging physicians who dedicate their lives to taking care of adults. It is within this context that I have decided to run for the position of Governor of the Connecticut Chapter of the ACP. My present role as Director of Medicine at The Waterbury Hospital Health Center has provided me with a wide breath of administrative, clinical and educational experiences that I feel has prepared me for such a position. As a clinical educator, I have been dedicated to maintaining the highest level of practice of medicine and to ensure that educational programs at my hospital continue to provide quality teaching to our residents and students. As an administrator, I am faced with challenges that have dealt with funding for medical education and for programs necessary for enrichment of my medical staff, resident teaching and the benefit of our community. I am constantly aware of problems facing members of our medical staff as they practice medicine and face the challenges that health care reform has brought to Connecticut. In addition, as a practicing rheumatologist, I am personally aware of the challenges and frustrations that face practitioners in delivering care of the highest quality to our patients.

I have read with great interest a article by Edmund B. Pellegrino and Arnold S. Relman, entitled: "Professional Medical Associations, Ethical and Practical Guidelines," which appeared in a recent Journal of the American Medical Association. The authors propose that physicians should "associate to improve the care of the sick, to advance the health of the public, and to assure their fellow associates are faithful to that mission." I feel that these guidelines are more important today that at any time in the history of medicine. We as physicians need to come together to speak out on the issues of medicine that affect the well being and health of our patients and community.

If I were elected Governor, I would first build upon the strong foundation of the Governors before me and continue to advance the work of the ACP in areas of medical education, resident and student involvement, health care policy, managed care reform legislation, and resource development of medical information. Being aware that the ACP is many things to many different practitioners in the state, I would open up the lines of communications to those who practice medicine in large groups in our urban centers, in solo practices and small groups in the more rural areas of the state, or in academic centers. By accessing either our web site or direct line to the Governor, I will encourage physicians to speak out on behalf of their patients so that they may be allowed to engage in the practice of medicine that they feel is proper and appropriate.

Through the use of the web site, continued frequent communication and outreach to physicians throughout the state, I will continue to provide members with information and the support to make their lives more enriched and fulfilled as they practice medicine. Finally, I will attempt to continue to unite physicians who are dedicated to the welfare of their patients and use this opportunity to bring about health care reform, which our patients want and our country needs. As stated by Drs. Pellegrino and Relman, "the public would respond to such leadership and it would accord to the profession the trust and the respect that ethically motivated physicians deserve."

Noel Ira Robin, MD, FACP

Noel Ira Robin was born in 1940 in Brooklyn, New York and received his baccalaureate degree in Chemistry from Hofstra University in 1961. In 1965, he received his Medical Doctorate at Downstate Medical Center. He stayed in New York for residency training in Internal Medicine at Long Island Jewish Hospital, but then went on to Harvard Medical School and the Peter Bent Brigham Hospital for his endocrinology fellowship.

After completing his fellowship, Dr. Robin remained at Harvard as Assistant Director of Medicine of the Cambridge Hospital, and as an Instructor and then Assistant Professor of Medicine. He returned to New York as the Physician-in-Chief and Program Director of the Internal Medicine Residency Program at Stamford Hospital in 1973, became Professor of Medicine at New York Medical College in 1980 and was Chairman of the Medical Board at Stamford Hospital from 1982-84. He was Associate Dean for New York Medical College from 1992-1998.

Dr. Robin is board-certified in Internal Medicine, Endocrinology and Metabolism, and has Added Qualifications in Geriatric Medicine. He has written numerous publications including articles, case report, abstracts and the book, "The Clinical Handbook of Endocrinology and Metabolic Disease." Dr. Robin is a Fellow of the ACP and has been extensively involved in the activities of the Connecticut Chapter for the past 10 years as a member of the Governor's Council. He was the recipient of the CT Chapter's Laureate award in 1996 for his contributions to medicine and education. He has received 23 awards for "Excellence in Teaching," one annually from 1974-1998 from New York Medical College, which is unprecedented.

Dr. Robin is currently the Chairman of the Department of Medicine, Program Director for the Internal Medicine Residency Program and Physician-in-Chief at Stamford Hospital. In addition, he is also a Professor of Clinical Medicine and Associate Dean at the Stamford Health System for Columbia University College of Physicians and Surgeons.

Governor-Elect Candidate's Personal Statement
Noel Ira Robin, MD, FACP

I feel that the values and precepts espoused by the American College of Physicians underscore an uncompromising commitment to excellence in the standards of our profession and in the conduct of our practice. All internists have an important role to play in the ACP, and it is the responsibility of the ACP to see that its constituent physicians are enfranchised in its many activities. Our organization has become large and diverse, but the voices of all of our physicians are to heard. Their academic, scholastic, intellectual, and clinical practice needs must be met and the ACP, through its many activities, programs and actions, must remain a strong, responsive and supportive organization.

The ACP must also continue to foster programs and activities that reach out to our residents and medical students. Our chapter has a wonderful and proud history in this regard. We must continue to strive to attract future internists with quality, compassion, commitment and enthusiasm. We must impart to them the stimulation, challenge and intrinsic love of our profession and the nobility of our art. We must see that they continue to have a vital and inclusive part in our organization and in its many teaching and clinical activities. Indeed, they are the future of our profession.

If elected your Governor, I will take this responsibility most seriously. I pledge to be responsive to the concerns and needs of all internists, and to foster programs and activities that enrich and upgrade their professional lives. I will see that issues unique to our state are clearly enunciated at the national level, and I will do my utmost to champion the concerns of internists in all modalities of clinical practice and professional environments. I will be respectful and mindful of the fine deeds and accomplishments of outstanding physicians who have come before me, and I will do my utmost to secure the lasting future of our wonderful profession.

I am deeply honored to be nominated for this position.

1999 ACP Laureate Award

The Laureate Award honors those members of the ACP in Connecticut who have demonstrated by their example and conduct an abiding commitment to excellence in medical care, education or research, and in service to their community and the ACP. Recipients of the award shall bear the title "Laureate of the Connecticut Chapter." This year's recipients are:

Paul A. Dolinsky, MD, FACP

Dr. Paul Arthur Dolinsky was born in 1954 in Hartford, Connecticut. After graduating from Hall High School in West Hartford in 1972, he attended Tufts University. He graduated from Tufts in 1976 Summa Cum Laude with a Bachelor in Science in Engineering. Dr. Dolinsky attended Columbia University, College of Physicians and Surgeons and received his Medical Doctorate in 1980. He then helped pioneer the newly created Primary Care Internal Medicine Residency track at Rhode Island Hospital, a Brown University teaching facility. After successful completion of his internal medicine residency and attaining board certification, he entered private practice in West Hartford, Connecticut in 1983.

During the past 15 years, Dr. Dolinsky taught internal medicine residents and students both at Hartford Hospital and in the office setting, for which he was made Assistant Clinical Professor at the University of Connecticut.

Dr. Dolinsky as been involved in leadership positions within numerous medical organizations. He had chaired a committee on Medicare for the Hartford County Medical Association, and later, for the Connecticut State Medical Society. As a member of the state Medicare Advisory Committee, he represented the concerns of internists.

He was an active member in the Connecticut Chapter of the American Society of Internal Medicine (ASIM), participating in both local and national events and in 1996 Dr. Dolinsky became president of the organization. When the national internal medicine organizations were merging in 1998, he was involved with the transition to combine the Connecticut chapters of the ASIM with the American College of Physicians. He remains active in the newly formed ACP Connecticut Chapter, aiding in the development of bylaws and creation of a state chapter web site. As a member of the Governor's Advisory Council, in 1999 he was appointed Treasurer and transferred the organization's paper based financial history onto computer. Dr. Dolinsky co-chaired with Dr. Robert McLean the Health and Public Policy Committee, actively addressing both state and national issues.

Dr. Dolinsky is married to Karen Dolinsky, RN, MSN. They reside with their two daughters, Laura and Michelle, in Farmington, Connecticut.

Majid Sadigh, MD, FACP

Majid Sadigh was born in Iran in 1949. Upon completion of undergraduate studies, he received a doctor of medicine degree from the Pahalavi University School of Medicine, Shiraz, Iran in 1976. Following a fellowship in infectious diseases he became chief medical resident and later assistant professor in the Department of Medicine.

After emigrating to the United States, Dr. Sadigh served an internship and chief residency at St. Mary's Hospital in Waterbury. In 1986 he was appointed a clinical and research fellow in the division of infectious diseases at Pritzker School of Medicine at the University of Chicago.

In 1988, Dr. Sadigh was appointed director of medical education in the Department of Medicine at St. Mary's Hospital and became associate chairman in 1993. In 1997 he was appointed to lead Continued Medical Education Program in this hospital. From 1991 until the present, Dr. Sadigh has been associate program director for the Yale Primary Care Internal Medicine Residency program at St. Mary's. He is an Associate Clinical Professor of Medicine at the Yale University School of Medicine.

Among Dr. Sadigh's honors is included being named "Teacher of the Year" by the Internal Medicine Residency Program at St. Mary's (1986), and by the Yale Primary care Internal Medicine residency (1990 and 1994). He has received the American College of Physicians Governor's Award (1994), the "Excellent Teaching" award from Griffin Hospital (1997) and from Kazan State Medical University in Russia (1998).

He is board certified by the American Board of Internal Medicine and is a diplomate in the subspecialty of infectious diseases. Dr. Sadigh held memberships in the ACP's Connecticut Chapter's Associate Committee and Scientific Program Committee. He became a member of the Governor's Council in 1993.

Dr. Sadigh resides in Woodbridge with his wife, Shahrzad Hojjat. They have four children including 21 year old twins Katrin and Kaveh, 19 year old Keyvan, and Mitra, age 9.

George F. Thornton Award

The George F. Thornton Award is given to an individual in recognition of outstanding contributions to medical education. It recognizes the individual's excellence in clinical teaching as well as his or her motivational impact on students, residents, and attendings.

In honor of his outstanding contribution to medical education and his enthusiastic sharing of knowledge, which has been an inspiration to generations of students, residents, and attendings, the Connecticut Chapter of the ACP is proud to present the George F. Thornton Award to —Frank Davidoff, MD, FACP

Frank Davidoff, Editor, Annals of Internal Medicine, received his MD degree from Columbia University in 1959. His residency and fellowship training (endocrinology) were at the Massachusetts General Hospital. For eight years he was Director of the Diabetes Unit at the Beth Israel Hospital in Boston, during which time he was recipient of an NIH Research Career Development Award.

He served on the faculty of Harvard Medical School from 1965-1974, where he was Associate Professor of Medicine from 1971 to 1974. He then was appointed Professor of Medicine at the University of Connecticut School of Medicine (1974-1987), where, in 1974, he was Chief, Division of General Medicine, a position he held until 1982. From 1982 until 1987 he was Chief, Department of Medicine, New Britain General Hospital, New Britain, CT. In 1987 he became Senior Vice President for Education at the American College of Physicians, and remained in that position until his appointment as Editor, Annals of Internal Medicine, on March 1, 1995.

Dr. Davidoff has been the principal investigator of research grants from the National Institutes of Health, the National Fund for Medical Education, the Commonwealth Fund, and the Pew Charitable Trust.

Dr. Davidoff was certified by the American Board of Internal Medicine in 1966. He is a founding member of the Society of General Internal Medicine, and a member of the American Federation for Clinical Research, the American Society for Clinical Investigation. He is a Fellow of the College of Physicians of Philadelphia and of the American College of Physicians.

Dr. Davidoff has served on Study Sections of the National Institutes of Health, and advisory panels of the National Academy of Sciences, the National Research Council, the American Board of Internal Medicine and the National Board of Medical Examiners. He has also served on the editorial board of the Journal of General Internal Medicine, and has been a manuscript reviewer for the New England Journal of Medicine, the Journal of the American Medical Association, the Annals of Internal Medicine, and the Journal of General Internal Medicine. He has published more than 60 original papers on a range of subjects including lipid metabolism, diabetes, molecular pharmacology, medical education and medical decision making, and editorials on a variety of topics related to clinical medicine, medical editing, and the environment of medical practice.

Letter from Dr. Davidoff to Dr. Bernene

I can't tell you how pleased I was to learn I would be receiving the teaching award given in memory of George Thornton. Here's why. First, my Connecticut roots go very deep: I grew up there; I came back there to work at UCONN; most of our family is still there; and one of these days, when I leave off this incredibly interesting job I now have, we plan definitely to come back to Connecticut. Who knows? I might even wind up doing some teaching there again. As Jerry Kassirer said recently (in a very different context), "You may not have seen the last of me."

Second, I was privileged to know George Thornton during my UCONN days. He was, as you know, himself a brilliant teacher—a number of the Grand Rounds he gave at the Health Center are among my more vivid and enjoyable UCONN memories. But more than that, he was a man full of the juice of life, and of the excitement and the satisfaction of medicine. His death touched us deeply; we miss him, and I welcome the opportunity to honor him.

And third, the award gives me a chance to say a few things about education—something I'm never reluctant to do. Since I unfortunately can't be with you for the Chapter meeting, I hope you'll pass along these thoughts to whomever cares to listen.

Probably the main thing I learned about education over the years is that the amount of advice on teaching and learning out there is enormous but, at least, when it comes to medical education, most of that advice is pretty useless. Fortunately, over time I also discovered a small number of principles, many of them not thought of as being "educational" at all, that tap into deep educational truths. They cut through the fog, crystallize an amorphous mass of ideas; they therefore serve as extremely powerful tools, particularly in clinical teaching and learning.

Thinking about it, I suppose that the essays on education I wrote some years ago in the ACP Observer, later collected in a book called "Who Has Seen a Blood Sugar? Reflections on Medical Education," were efforts to capture those principles. Here are some of the more important ones.

  1. Education is too important to leave to educators.

    This is exactly parallels the wisdom of the adage that "War is too important to leave to the generals."

  2. If you don't continue to learn all the time, part of you is already dead.

    It is now well documented that each patient encounter in office practice generates on average 2-3 clinical questions, but only a small proportion of those questions actually gets answered. In the pressure cooker of daily practice, continued learning tends to wither and die.

    But it doesn't have to be like that. One of the great clinical teachers, David Seegal at Columbia, suggested the following formula for preventing the "death of learning":

    WDLB + LUBB = K

    Here is the explanation of what this means:

    "When you run into something with a patient you don't understand, Write it Down in a Little Book, then Look it Up (later) in a Big Book; the result is Knowledge." In Seegal's time, the "Big Book" was, of course, Cecil and Loeb's textbook. Nowadays, of course, the Big Book is an entire universe of information available electronically.

  3. Use problem lists.

    Lawrence Weed may have invented the Problem-Oriented Medical Record, but it was Tony Voytovich, right here at UCONN, that gave the Problem List "legs." Tony showed us that you can only make four kinds of errors in formulating a problem list—premature closure; inadequate synthesis; ommission; and wrong. He showed us how their level of diagnostic thinking. He showed us how building a problem list with your team on rounds can organize and focus the teaching process.

  4. Mining for gold.

    Most patients are pretty decent people, but occasional patients are "difficult," some even "hateful." Although there is no simple way to manage difficult patient, Wendy Levinson's principle of "mining for gold" helps. This is the idea that even the most difficult of patients has something about them that is likeable or admirable; a fleck of "gold" hidden in the gravel, so to speak. The lesson to be learned, and taught, is how to dig it out, how to "mine for gold," then how to work from there.

  5. The predictive value of a test is not the same as its sensitivity and specificity.

    This one take some really concentrated effort, but once you've mastered it the teaching of diagnostic reasoning falls beautifully into place. Understanding predictive value also prevents you from being intimidated by people who wave around terms like "Bayes theorem," since predictive value is Bayes theorem.

  6. There is no such thing as an uninteresting patient.

    Believe it. (I also freely admit that some patients are more interesting than others). Interest is in the mind of the beholder; making patients interesting is therefore a teachable and learnable skill. Besides, all patients are interesting to themselves.

One of the more pithy comments about education, hence one of the most useful, comes from the poet Robert Frost. I'll end with that, therefore: "Education is hanging around until you get it."

Best regards,
Frank Davidoff, MD, FACP

ACP Medical Student Jeopardy Tournament

By: Barry Wu, MD, FACP, Chair of Medical Student Committee

This year the Connecticut ACP sponsored the First Annual ACP Medical Board Review Jeopardy Tournament. Medical schools from the northeast were invited to send a team of third and fourth year medical students to participate in a tournament to promote internal medicine and to prepare for the medicine board examination.

Nine schools from four different states participated including: Yale, University of Connecticut, New York Medical College, Mount Sinai, NYU, SUNY Brooklyn, SUNY Stony Brook, New Jersey Medical College and Brown. The tournament was held on September 25, 1999, at the Hospital of Saint Raphael in New Haven.

Dr. Robert Nardino, from the Hospital of Saint Raphael's, served as master of ceremonies and hosted three preliminary rounds. The winners from the preliminary rounds were SUNY Stony Brook, Mount Sinai and New Jersey Medical College. They met in a final round and New Jersey Medical College, consisting of Greg Richards, Jan Pattanayak, Scott Sexton, and Denise Bell, was crowned the winner of the First Annual ACP Board Review Jeopardy. The winners each received a Harrison's Textbook and all other participants received a Washington Manual courtesy of the Connecticut ACP.

Many thanks to the attendings who submitted questions for the event and to the exceptional assistance from Karen McCausland. We look forward to bringing the crown back to Connecticut in the year 2000.

Contact Information

Robert Nardino, MD, FACP
ACP Governor, Connecticut Chapter

Nancy Sullivan
30 Dwight Drive, Middlefield, CT 06455
Phone: (860) 349-8995
Fax: (860) 349-3004 or
E-mail: ctacp@comcast.net

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