Governor's Newsletter, Fall 2001

Joseph W. Stubbs, MD, FACP
Governor, Georgia Chapter

From the Governor's Corner

Since the beginning of our country, every generation of Americans has experienced one of those "never the same again" historical moments where one is irrevocably thrust onto a new and unchartered landscape, and the land of "same old, same old" is gone forever. Such was the moment for me on September 11, 2001, as I watched on the screen of my laptop the collapse of the World Trade Center. As the Towers collapsed, I could almost feel a sense of instability in the floor beneath my own feet. Though certain of the implications as to what was occurring in the present moment, I had no clue of what to do next.

When I entered the next patient's room, I was in a state of shock and almost numb. I listened to his history, but at first could not process the words. As my mind kept replaying that image of those planes exploding into the Towers, I began to feel beneath that immediate sense of horror and tragedy, a deeper understanding seeping into my consciousness. Life is so very fragile. Yet, out of this intense appreciation of the fragileness of life, my sensibilities were suddenly reawakened to the rich meaning in life felt through the act of caring and the awareness of being connected with one another.

I suddenly found myself wanting to hear far more of my patient's story than even he intended to tell. I wanted to know not just how far Clark walked, but what he smelled along the way. Seeing my next patient Frank, I wondered what could I do to make him realize that he's not superman anymore. I could hardly bring myself to stop the examination of him, nor that of the next patient, nor the next one after that. Out of that moment of unthinkable human tragedy, I had experienced a renewed sense of the fulfillment and meaning that lies gift-wrapped in the practice of medicine.

The profession of medicine has been maligned, misunderstood, and overburdened. Recruitment shortfalls, burnout, depression, and early retirement are ominously on the rise amongst our membership. Yet, I return to a fundamental question, "What other career allows you, even trains you, to perform such enriching and fulfilling work, day in and day out?" The future is full of uncertainty; yet, no matter what occurs, the joy of medicine shall remain for all of us if we can only open our eyes with the right perspective. It has been and will always be a profession of caring and connecting. "Would I do it all again?" In a heartbeat, for certain.

Special Upcoming Events

Second Annual State Leadership Day—
The Georgia Chapter ACP-ASIM, in conjunction with the Georgia Academy of Family Physicians and the Georgia Academy of Pediatrics, will be hosting its Second Annual State Leadership Day. This event will take place at our state Capitol on January 28. The program will consist of a breakfast and a luncheon where featured state government officials will speak, and there will also be time to meet with legislators regarding specific healthcare legislation. You will be receiving a flyer about this later, but please mark your calendars now.

Second Annual Medicine and Literature Retreat—
Our Second Annual Medicine and Literature Retreat will take place April 5-7, 2002, at Amicalola Falls State Park. This should be a beautiful time of year to be at Amicalola Falls. Dr. Evan Weisman is again charing this important event, and will be sending a flyer with registration to you in the near future. The program will again feature Dr. Gregory O'Dea, a Literature Professor with the English Department of the University of Tennessee at Chattanooga, as the discussion leader. Last year, the program was extremely well received and was felt to be a great addition to our annual educational offerings.

Annual ACP-ASIM Meeting—
This upcoming year's Annual Meeting will be held April 11-14, 2002, in Philadelphia. This upcoming Annual Session will continue the College's tradition of offering a wide assortment of educational opportunities. This is by far one of the best overall educational opportunities for any internist. Please make every effort to attend, and has been our tradition, we will plan to have a Georgia Chapter reception Saturday evening, April 13 (see Annual Session article on page 7).

Georgia Chapter ACP-ASIM Annual Meeting—
Next year's Georgia Chapter ACP-ASIM meeting will be held May 3-5 at the Wyndham Conference Center in Peachtree City, Georgia. The Scientific Program Committee is organizing a great selection of educational programs under the theme, "The Spectrum of Internal Medicine." The program will again feature finalists of the associates' competition from the internal medicine residency programs throughout the state.

Resident's Corner

At this time of year, many residents are pondering what career path they should take next. Fortunately, the field of internal medicine offers an enormous variety of choices from which to choose. While certainly each individual has to decide for themselves what is the best fit, a number of web sites have some very useful information with regard to making career decisions. Listed below are useful web sites that Dr. Don Brady, Professor at Emory University School of Medicine, felt would be most worthwhile for residents:

Job Opportunities:
ACP classifieds - http://www.acponline.org/jobs
New England Journal of Medicine classifieds - http://www.nejm.org/careerlinks/
General Information regarding career counseling - http://www.acponline.org/counseling/index.html

Fellowship Opportunities:
GIM Fellowship Directory - http://www.sgim.org/Publicweb/Publications
Robert Wood Johnson Clinical Scholars Program (Individual program data available through this central site) - http://www.uams.edu/rwicsp/

Academic Career Counseling:

Inpatient Physician Opportunities ("Hospitalists"):
National Association of Inpatient Physicians (NAIP) website - http://www.naiponline.org

Locum Tenens:
StaffMD - http://www.staffmd.com
Umbrella group - http://www.physicianwork.com

Firms:
J&C Nationwide (Based in Atlanta) - http://www.jcnationwide.com
CompHealth (Based in Salt Lake City, UT with regional office in Atlanta) - http://wwwcomphealth.com
Medical Doctor Associatesm (Based in Atlanta) - http://wwwmdainc.com
Linde Healthcare (Based in St. Louis) - http://www.lindehc.com
Delta Medical Consulting (Based in Dallas) - http://www.deltamedcon.com

Bioterrorism Alert

Bioterrorism is now more than a passing interest for internists. Our offices across the country are being deluged with inquiries from patients regarding all aspects of bioterrorism. Fortunately, our public health system has been very resourceful in maintaining very up-to-date information about managing bioterrorist threats. The following links should be useful sites for you to get information about this serious threat to the health of our nation:

Advocacy Activities In Regulatory Issues In The September 11 Aftermath

While national defense now occupies center stage in Washington, DC, ACP-ASIM continues to advocate on behalf of its members. With this shift, a higher priority will be placed on bioterrorism in our advocacy and public policy activities. The College is also examining the potential impact of proposed anti-terrorism legislation on the confidentiality of personal health information.

The College is monitoring discriminatory policies that may affect current and future International Medical Graduates (IMGs). IMG's already in the United States may face additional requirements and surveillance, as well as other forms of discrimination. Policies aimed at restricting visas from "higher risk" countries may make it difficult for IMG's to accept residency positions in the United States.

Access to affordable health insurance will remain a top priority, particularly as the economic fallout from the terrorist attacks of September 11th places an even greater number of Americans at risk of losing their health insurance. The College supports legislation to specifically propose federal subsidies for individuals to maintain COBRA coverage during the time they are unemployed. We will continue to press for expansion of Medicaid, S-CHIP, and for tax credits for ow-income uninsured Americans.

Other priorities, such as the patient bill of rights, Medicare reform and restoring cuts in payments to teaching hospitals, face steeper hurdles. Congress' focus on national security affects the time and money spent on these issues. Issues that will trigger partisan disagreements are even less likely to receive favorable consideration.

The College will expand its advocacy efforts on priority issues, although some actions are likely to be postponed until next year. We are seeking bipartisan compromises on Medicare regulatory relief and expansion of health insurance coverage in the hope of bringing final action on these issues before Congress adjourns for the year.

Patient Safety

In the last couple of years, the Institute of Medicine has released two reports, which have raised concerns about patient safety in a healthcare environment. The ACP-ASIM has taken a lead role, particularly in the area of educating physicians and other healthcare providers, to improve patient safety in their office environment. The following are three articles that address some of the College educational initiatives:

The ACP-ASIM Launches Three Year Project to Improve Patient Safety—
The College is launching a three-year initiative to help reduce medical errors and improve patient safety in doctors' offices and other non-hospital settings. The effort will be funded by a grant from the Agency for Healthcare Research and Quality (AHRQ). The project draws on the strengths of ACP-ASIM's role as the largest medical specialty organization in the United States and its 77 local region and state chapters.

The project aims to raise physician awareness of patient safety issues. ACP-ASIM will develop a patient safety curriculum that can be offered in chapter and regional meetings. In addition, an interactive online forum will be developed to assist physicians in developing local strategies to improve office-based systems that affect medical care. The education will offer a systems approach to reduce medical errors, including communications between physician and patient, and the role of the patient; team training and application of information technology in the office. Since most research on patient safety has occurred in hospital and institutional settings, this project is unusual in that it addresses patient safety in the office setting.

The new initiative is the result of a searching examination by ACP-ASIM leaders and committees to determine the organization's optimal role in reducing medical error and improving patient safety. The project has a strong research component. It will include pre-tests of physicians' information about patient safety and post-tests after participating in the education modules.

Medication Samples and Safety—
Medication samples are an everyday part of ambulatory medicine. They can insure that low-income patients get the medications they need, and they help patients get started on their medication as quickly as possible. However, samples bring with them risks that can lead to accidents. To use samples safely, consider the following tips:

  • Keep a sample distribution log of what medications patients were given, and how much.
  • Use stickers or otherwise mark or separate look-alike and sound-alike items.
  • Make sure the sample storage area is well lit and secure.
  • Provide explicit written directions on how to use the medication.
  • Involve patients in the safety check: ask them to repeat back to you how they should take the medicine.
  • Provide empty childproof bottles to store the samples in to patients living with children.

Patient Compliance, The Missing Link to Medication Safety—
All physicians know that care of the patient doesn't stop at the clinic door. In fact, most ambulatory patient-safety accidents happen outside the clinic, as a result of medication errors, including non-compliance. But you can know the risk factors associated with medication errors and non-compliance, and you can work to prevent them. Below are just a few of the factors associated with errors of non-compliance:

  • Advanced age
  • Multiple co-morbidities or medications
  • Depression
  • Perception of overmedication

For example, in a study of elderly primary-care patients, 86% misunderstood physician instructions regarding medication schedules, patients with depression are three times more likely to be noncompliant with medical recommendations. For patients with noncompliance risk factors, take a little extra time to explain how to use the medication, and why it's important. If side effects are a possibility, let the patient know what to expect and what to do if the side effects are more than transitory. Working together, patients and physicians can promote safety beyond the clinic door.

ACP-ASIM Provides Adult Immunization Patient Education Tools

In the first week of October, more than 43,000 general internist members of ACP-ASIM will receive free patient education kits to help them prepare for National Adult Immunization Awareness Week, October 14-20, 2001. This kit was developed by the ACP-ASIM Adult Immunization initiative in response to member's requests for materials that prompt patient self-identification and queries about adult immunization. The tools have a central theme of "Show & Tell." They encourage patients to ask their doctors to show them the facts about immunization, and to tell their doctors if they have received immunizations at another location, so their records can be updated. The tools include:

  • The "Show & Tell" patient awareness poster - A 17"x 24" four-color poster for exam and waiting rooms that covers indications for a number of recommended adult immunizations-not just influenza and pneumococcal vaccines. Flyer-sized versions are also provided for doctors who have limited wall space.


  • "I've Been Immunized" forms - A checklist that helps patients remember what immunizations they may have received at health fairs, pharmacies, travel clinics or emergency rooms and allows the doctor to update the patient's files. This form also reminds the patient of immunizations they might need.


  • Vaccine Administration Records - For physicians and staff to document immunizations the patient has received, and review what immunizations may still be needed

All of these materials are available for download from the Adult Immunization section of the ACP-ASIM Web site at (http://www.acponline.org/aii/), where members can also find background information on the Advisory Committee on Immunization Practices (ACIP) recommended adult immunizations. Members who did not receive the kit in the mailing to general internists can request one for free by calling Matt Smith at 215-351-2602 or by sending an e-mail to (msmith@acponline.org).

End Of Life Care Patient Education Brochures And Doctors Tip Sheet Available

In September, the Center for Ethics and Professionalism inaugurated its Patient Education and Caring: End-of-Life (PEACE) Series by releasing three patient education brochures designed to guide patients through various stages of palliative and end-of-life care. The brochures offer clearly worded advice for patients and caregivers and are suitable for distribution in doctor's offices. The available brochures are:

  • "When You Have Pain at the End of Life"
  • "Living with a Serious Illness: Talking to your Doctor When the Future is Uncertain"
  • "Making Medical Decisions for a Loved One at the End of Life"

Also available is "Improving Your End of Life Care Practice," a tip sheet for doctors, with suggestions on how to identify patients who would benefit from the brochures and tips on how to "break the ice" in face-to-face discussions about sensitive end-of-life issues.

The patient brochures are available at no charge in packages of 50 each from the Center (call 800-523-1546, ext. 2839 or e-mail ssmith@acponline.org); they can also be accessed in PDF format at (http://www.acponline.org/ethics/patient_education.htm).

What Can The Practice Management Center Do For You

The Practice Management Center (PMC), located in the Washington office, is a valuable benefit of College membership. It supplies free assistance to members on how to handle the business issues associated with running or working in a practice. Internists are provided with timely information to succeed in today's health care environment through three different means.

First, PMC offers over forty practical written guides on various topics. These publications can be downloaded via PMC's web page, or ordered through the College's customer service desk. The first copy of each publication is complimentary as a part of your College membership. These guides cover everything from starting a practice to negotiating an employment contract and complying with Medicare regulations. Laminated pocket reference sheets on coding, documentation, and preventive services are some of the most popular items.

Second, PMC's management and regulatory experts respond to individual member inquiries via e-mail and telephone calls within 24 to 48 hours. If PMC experts cannot answer your question, then they may research the question, refer to another source, or, as needed, offer a list of qualified consultants. It is important to note that Center specialists do not address clinical questions nor do they provide legal advice.

And finally, PMC offers management tools for members to use in assessing and improving their practices - "Check Ups." The Patient Satisfaction Check Up (PSCU) provides a survey instrument developed by internists for internists. After you survey your patients, PMC supplies customized comparison patient satisfaction assessment reports. The Office Laboratory Check Up (OLCU) is a spreadsheet program enabling you to evaluate and optimize the profitability of your office laboratory. The Practice Management Check Up (PMCU) is a benchmarking tool for conducting an overall assessment of the practice and identifying opportunities for improvement. Each of the three "Check Up" tools comes with a guide to help improve the practice and can be downloaded free of charge from the PMC web page.

Under the umbrella of the Practice Management Center, members receive one-stop service from two organizations. PMC's own professional staff has years of experience managing medical practices and this expertise is augmented by that of the Managed Care and Regulatory Affairs Department, whose staff write guides and respond to inquiries in their respective fields. This expertise combination enables PMC to offer a remarkable range and depth of knowledge to assist College members.

In addition, PMC supports the Young Physicians Subcommittee (YPS) in developing products and educational programs of interest to young physicians. Together, YPS and PMC have begun to assist chapters interested in developing their own practice management programming and young physician committees.

What is the best way to access the Center's services and resources? Go to the PMC web page where everything is right at your fingertips—downloads, e-mail questions, links, tools, and a host of other resources. The PMC web page offers members access to the various guides for the topic of concern to them. If still more specific information is needed, the next step is to e-mail a question directly from the web page to the PMC specialist in that field. With all of its services instantly available on the web page, PMC represents a rich and valuable resource for College members. Visit http://www.acponline.org/pmc/ to explore it yourself. For more information, please contact Margo Williams at (mwilliams@acponline.org).

ACP-ASIM Email Campaign

ACP-ASIM wants your email address. In an effort to ensure that you receive urgent health commucnications from the College, go to (http://www.acponline.org/college/aboutacp/email_change.htm) and submit your current email address. ACP-ASIM will not sell or share your e-mail address and will ensure the judicious use of your e-mail address.

Experience Annual Session—Philadelphia Style

Join the College April 11-14, 2002 and be a part of Annual Session 2002 in Philadelphia. Experience over 275 sessions covering the spectrum of internal medicine and the subspecialties. Upholding tradition, ACP-ASIM promises to offer a rich educational experience with an emphasis placed on content that is clinically relevant and practice oriented. Be Sure Not to Miss...

Clinical Pearls—
Remember those words of wisdom from your most respected clinical teachers? Those Pearls were based on an experience of depth and knowledge of medical literature of remarkable scope. Pearls are noteworthy for their clarity, timelessness, and clinical applicability.

Introduced at the 2001 Annual Session and an instant hit, Clinical Pearls rekindles the joy of bedside learning, using a highly engaging, case-based format. With the audience-response keypad-system, you'll have a chance to test the depth of your clinical acumen. You'll leave each session with a rich collection of Pearls, ready to be applied directly to the patients.

Multiple Small Feedings of the Mind—
Rated by many as the best of Annual Session, Multiple Small Feedings of the Mind uses a creative format to address some of the most common, yet challenging or controversial, patient-management issues. In these highly focused, fast-paced sessions, faculty offers answers to some of the most frequently faced dilemmas in patient care.

The Learning Center—
Experience the excitement of the Learning Center. Refine your techniques in a variety of office-based examination and procedural skills. Take advantage of small group or individual tutorials with experts in the field. The Learning Center is unique to Annual Session and offers a wide range of opportunities for closely supervised, hands-on practice. Become familiar with procedures and examinations you don't perform on a routine basis. Try out the latest software for clinical information management and patient care. The Learning Center is a dynamic collection of hands-on activities, which you can immediately apply to your clinical practice.

Update—
Keep up to date on the year's most important published papers in the subspecialty areas. Learn significant findings and their impact on patient care. Nationally recognized faculty reviews the literature and presents the year's highlights.

Experience Annual Session...

ACP-ASIM Annual Session 2002
April 11 - 14, 2002
Philadelphia, PA

Registration and other meeting information is available online (http://www.acponline.org/cme/as/2002/index.html), or contact Customer Service at 800-523-1546, extension 2600. Early sign-up is encouraged for the best selection of workshops and seating at breakfast/lunch sessions.

What's New

Contact Information

Vincent Nicolais, MD, FACP,
Governor, Georgia Chapter

Karen Townsend
Executive Director
Ph: 770-693-9973
Georgia Chapter

Michelle Dietz
Administrative Assistant
Ph: 770-920-6995