Governor's Newsletter, Spring 2000

From the Governor's Corner

The 21st century has finally arrived, and I trust all of you are still ticking just like the Timex watch. I am sad to report that my Casio watch did not survive into the new millennium. It is not, however, a true reportable victim of the Y2K bug. While these watches may survive in 100 feet of water, they do not perform well in even two inches of champagne.

I confess some disappointment in how quietly the New Year arrived. As best I could see, the only story Headline News could gather was that some guy's alarm clock did not go off. I only wish it had been mine. While I was relieved that Armageddon did not occur, I was saddened to realize that my Y2K fantasy was indeed just fantasy, and that all of the insurance companies and HMO's utilization management software are still humming along in their usual burdensome and irritating way. When it comes to survivability, medical utilization software ranks right up there with the roaches and the Energizer bunny.

Here, at the turn of the new millennium, I find myself being very circumspect. What does the future of medicine hold for internists in this new millennium? Perhaps the more important question is, "What will our future agenda be?" Every year since I have been in practice I have heard physicians declare, "Medicine stands at a crossroads." The truth of the matter is that our profession is growing and changing so fast we do not have time to stand at any "crossroad," but rather are blindly flying right across them, often having no clue as to the direction we need to be going or the destination we need to be trying to reach. Worse, this light speed pace of change creates such a sense of fear and insecurity that we look to "others" to lead us rather than be the mapmakers of our own destiny.

Therefore, the first agenda item I propose for the New Millennium is to recapture control of the agenda for our healthcare delivery system. Many outside forces are trying to redefine us in ways that demean and devalue our profession, primarily for their own economic gain. The essence of our professional being and the sanctity of the doctor-patient relationship depend upon our ability to take back a leadership role in defining the future of healthcare. As leaders, we must define and exemplify the difference between a "physician" and a "healthcare provider," a "patient" and a "healthcare consumer" and a "doctor-patient relationship" and a "provider's panel of patients." We must demonstrate persuasively that such distinctions have a major impact on the quality of care our patients receive. To achieve this goal, we must establish and enforce within our own ranks a high moral code of conduct that reflects self-effacement, self-sacrifice, compassion and integrity in the care of patients. We must also find fair and equitable means of measuring our quality of care, and seek to continuously improve upon the processes we utilize in caring for patients.

Item Two: Advocate for our patients. We understand the problems in our health care delivery system better than anyone else. The rising number of uninsured is not just another statistic for us; it is a human tragedy that we have all experienced first hand in our practice. From this experience, we must play an active role in creating a workable solution that enables everyone to have affordable quality health care. While the Information Age has provided us with enormous tools with which to improve patient care, we cannot let the life stores of our patients be drowned in an avalanche of databases, computerized check boxes, and default documentation templates. The patient and her story must always remain the core of our focus. The informational tools and protocols that we develop must be judged primarily on the basis of how well they help to improve upon that focus.

Item Three: Recapture the joy of medicine. Of late, I think we have become a pretty depressed lot. I realize that the College did a recent survey that indicated high job satisfaction among internists, but I believe they did it on a day all of us took Prozac. My observations are that we are not at all happy with our situation. The downward economic pressures and the rising regulatory demands have contributed to an epidemic of "burn-out." This is important not just to our own sense of happiness, but also to the care of our patients, as well. As healers, our most potent weapon in caring for patients is not prescribing medications, but rather listening. As we listen, we transfer a sense of belonging and empathy that can only come from our being physically and emotionally there for them. This transference is almost impossible to accomplish if you are spending all your time "gaming" a system rather than taking care of patients. The College and this Chapter must continue to use every tool and strategy available in advocating for a reduction in these economic burdens and an easement of these regulatory hassles. Our success will depend upon the leverage we provide these organizations by standing together and speaking in a unified voice.

As long as there are patients that need care, the potential joy that first drew us to this profession still remains. The challenge is for us to be able to refocus our attention and see it again, as if for the first time. I close by lifting my champagne glass high and offering this toast to all of you: May the highways and superhighways that we build to lead us into the future not bury or destroy, but rather make more accessible the paths you've chosen to walk. Happy New Millennium!

Annual Meeting, Philadelphia, April 13-16, 2000

The Annual National Meeting is undoubtedly the most comprehensive and high quality meeting for Continuing Education for Internists anywhere in the world. The Spring 2000 program in Philadelphia will provide an outstanding mix of science, practice guidelines, ethics, subspecialty workshops and social opportunity in one of North America's great historical cities. As has been our tradition, we will again plan to have a Chapter reception one evening with our Florida and Alabama neighbors. It always proves to be a great time to catch up with old friends and make some new ones.

Connect With Members Through ACP-ASIM's New Online Directory

Do you need to correspond with a member of the College, but find that you don't have his/her current mailing address? Use Member Connection, the College's new online membership directory, which is accessible to members only via ACP-ASIM Online.

Updated daily, the information in Member Connection is taken directly from the College's main membership database and can be used to search for colleagues by name, state, city, zip or postal code, country, region or specialty.

Members who wish to be excluded from Member Connection must notify the College in writing. Members can obtain a Directory Exclusion Form on ACP-ASIM Online, or by calling Customer Service at (800) 523-1546, ext. 2600, or (215) 351-2600 (9 a.m. to 5 p.m. EST).

Supporting Your Chapter Through Chapter Dues

Chapter dues are the backbone of local activities and vital to the success of our chapter. While we are provided some financial support from the national office, the chapter dues collected provide the majority of financial support for local activities. Educational meetings, mentoring programs for medical students, local Associates' research competitions, advocacy with state legislators, and participation by chapter leaders in Leadership Day on Capitol Hill are just some of the activities supported by your chapter dues.

Many of these activities are orchestrated by unpaid volunteer leaders in our chapter. However, the increase in activities at the local level has created the need for additional staff support to help manage the day to day operation of the chapter. Your chapter dues help support the cost of local staff and provide funding for new and existing chapter initiatives. When you receive your national dues notice, please remember to include the chapter dues in your payment. You will be contributing to the success of many grass roots activities happening right here at home.

Tips for Office Based Preceptors

What do students and residents want from a community-based teaching experience?

To students, preceptor characteristics are the most important factors defining a successful office-based experience. One of the most highly related teaching characteristics is the preceptor's ability to promote student independence (1).

Most often this was accomplished by giving the student increasing patient care responsibility. Other highly favored characteristics is the willingness to allow students to practice technical and problem-solving skills, enthusiasm and interest in students, and the ability to actively involve the student in learning. The willingness of a preceptor to act as a mentor and advise the student is also highly valued (1-3).

Characteristics of the office are of secondary importance to the learner when compared to preceptor characteristics. Valued office characteristics include having a wide mix of different available preceptors, a wide variety of presenting patient problems, and a range of patient ages (1).

The areas providing the most difficulty for students are learning to work within the time constraints of the office setting, performing a focused examination, and learning to rely upon data gathering skills and problem-solving abilities rather than the imaging and laboratory tests (4).

Other highly valued educational experiences include discussion of general management issues, diagnosis, and demonstration of physical examination skills (5).

Residents value the opportunity to discuss differential diagnosis and management issues, and appreciate the close supervision, feedback, and to practice and improve clinical and procedural skills (5).

The message from the learners is consistent and clear; they want the opportunity to practice basic data collection and management skills on a wide variety of patients typically seen in the office setting. They desire feedback on their performance and a role model to emulate.

  1. Biddle WB, Riesenberg LA, Dacy PA. Medical student's perceptions of desirable characteristics of primary care teaching sites. Fam Med 1996; 28:629-33.
  2. Prislin MD, Feighny KM, Stearns JA, et al. What students say about learning and teaching in longitudinal ambulatory primary care clerkships; a multi-institutional study. Acad Med 1998;73:680-87.
  3. Epstein RM, Cole DR, Gawinski BA, Piotrowski-Lee, S, Ruddy NB. How students learn from community-based preceptor. Arch Fam Med 1998;7:149-54.
  4. Feltovich J, Mast TA, Soler NG. Teaching medical students in ambulatory settings in departments of internal medicine. Acad Med 1989;64:36-41.
  5. O'Mallery PG, Kroenke K, Ritter J, Dy N, Pangaro L. What learners and teachers value most in ambulatory educational encounters: A prospective, qualitative study. Acad Med 1999:74:186-91.

Georgia Chapter Executive Council "Wildcats"

Sports Illustrated: Never in the history of the game have we seen a new franchise loaded with such talent.

Flash News Release

The award winning Georgia Chapter ACP-ASIM Scientific Meeting will be held this year, May 19-21, 2000, in Savannah, at the Westin Savannah Harbor Resort. This year's theme is "The Medical Practitioner in the New Millennium." The program covers a broad array of topics and has an absolutely outstanding faculty. We are especially privileged to have as our College Representative Dr. Whitney Addington, who is the current President of the College, and on the faculty this year will be the incoming President of the College, our own Dr. Sandy Fryhofer. If that's not enough, we are also again combining our regular meeting with that of the Associates and will have an opportunity to hear research and clinical case presentations from residents in internal residency programs across the state. We are indebted to Dr. Guillermo Umpierrez and his Committee for their hard work in putting this program together, and to Dr. Otto Goyco for organizing and coordinating the Associates' Program. The only thing that is missing now is you. Please carefully read over the program information included and make plans to attend. You can register by filling out the form that will be mailed to you. Your support of this program is vital to the success of our Chapter.

Member Milestones

Our medical student Advisory Council member, Tripp Morgan, has been elected Chairman-Elect of the Council of Student Members for the American College of Physician-American Society of Internal Medicine. This is a great honor for Tripp.

Prior to this election, Tripp served on the Georgia Chapter Advisory Council as a medical student member. Way to go, Tripp!!

Doctors for Adults Campaign

If you go to the streets and ask John Doe, "What is an internist?" you are likely to get an answer worthy of the "Smile You're on Candid Camera" show. Our specialty clearly has a public relations problem that has frustrated many of us. For the last several years, the ACP-ASIM has had a national public relations campaign to educate the public about what an internist is. Our Chapter would like to bring this message home to our local communities. Dr. Jacqueline Fincher is heading up our Public Relations Committee, and plans to hold a workshop with the help of public relations support staff from the College at our annual Chapter meeting in May. This workshop will introduce you to the campaign and familiarize you with the ACP-ASIM "Community Speech Kit" which contains a sample speech, "Doctors for Adults," slides, speech aids, speaking tips, and information on how to obtain and publicize speaking engagements. The kit also includes a supply of the new patient information brochure, "Where We Fit in Today's Primary Care Picture," for distribution to patients and audiences.

2000 Georgia Chapter Scientific Meeting

Savannah, Georgia
May 19-21, 2000
The Medical Practitioner in the New Millennium

Friday, May 19, 2000

8:30 a.m. - 5:00 p.m., Registration

8:30 - 10:30 a.m., Continental Breakfast

8:30 a.m. - 12:00 p.m., Mount Associates' Posters

10:30 - 11:30 a.m., Committee Meetings

11:45 a.m. - 1:00 p.m., Governor's Advisory Council Meeting (lunch)

Scientific Program:

1:05 - 1:15 p.m., Welcome, Joseph W. Stubbs, MD, FACP, Governor, ACP-ASIM Georgia Chapter

1:15 - 2:00 p.m., How to Prevent Diabetic Complications, Guillermo Umpierrez, MD, FACP, Atlanta Medical Center, Atlanta, Georgia

2:00 - 3:00 p.m., Symposium "Small Feedings for the Mind"

2:00 - 2:20 p.m., Current Issues in Community Acquired Pneumonia, Jeffrey Stephens, MD, Mercer University, Macon, Georgia

2:20 - 2:40 p.m.Hypothyroidism and Post Partum Thyroiditis, Kaveh Ehsanipoor, MD, Memorial Hospital, Savannah, Georgia

2:40 - 3:00 p.m., Current Issues in Anticoagulation, Abdullah Kutlar, MD, Medical College of Georgia, Augusta, Georgia

3:00 - 3:20 p.m., Break

3:20 - 4:10 p.m., End of Life Care, Wendy Hawke, MD, Georgia Cancer Specialists, Atlanta, Georgia

4:20 - 6:20 p.m., Associates Presentations (8 presentations)

6:45 - 8:00 p.m., Wine and Cheese Reception, View Research Posters

Saturday, May 20, 2000

7:30 a.m. - 4:00 p.m., Registration

7:30 - 9:30 a.m., Continental Breakfast

7:30 - 8:00 a.m., Town Meeting

8:00 - 8:45 a.m., College Representative, Whitney Addington, MD, FACP, President, ACP-ASIM, President Chicago Board of Health, Chicago, Illinois

8:45 - 9:15 a.m., Chapter Business Meeting

Scientific Program:

9:20 - 10:20 a.m., Update in Internal Medicine, Joyce Doyle, MD, Emory University School of Medicine, Atlanta, Georgia

10:20 - 10:40 a.m., Break

10:40 - 11:40 a.m., Panel Discussion: "The Hospitalist Physician in Georgia", Moderator: William Branch, MD, MACP, Emory University School of Medicine, Atlanta, Georgia

11:40 a.m. - 12:30 p.m., Hormonal Treatment for Cardioprotection, Nanette Wenger, MD, MACP, Emory University School of Medicine, Atlanta, Georgia

12:30 p.m., Lunch

1:00 - 2:00 p.m., Meet the Professor Lectures

Update on Women's Health, Deborah Kelly, MD, Piedmont Hospital, Atlanta, Georgia

Rheumatology Update, John Hardin, MD, Medical College of Georgia, Augusta, Georgia

Hepatitis Update, Edward Rydzak, MD, Memorial Hospital, Savannah, Georgia

Physicians' Retirement Plans, Michael Smith, CFP, Elizabeth Jetton, CFP, Financial Vision Advisors, Atlanta, Georgia

1:30 - 4:00 p.m., Associate's Presentations

2:10 - 3:00 p.m., Dermatology Pearls for the General Internist, Mac Rachel, MD, Kaiser Permanente Group & Atlanta Medical Center, Atlanta, Georgia

3:00 - 3:50 p.m., Osteoporosis Update, Nelson Watts, MD, FACP, Emory University School of Medicine, Atlanta, Georgia

3:50 - 4:30 p.m., Folic Acid: Vitamin B in the Spotlight, Sandra Fryhofer, MD, FACP, Piedmont Hospital, Atlanta, Georgia

4:00 - 5:00 p.m., Associates' Poster Judging

6:00 - 7:00 p.m., Cocktails

7:00 - 9:30 p.m., Banquet and Awards Ceremony

Sunday, May 21, 2000

7:30 - 10:00 a.m., Registration

7:30 - 10:00 a.m., Continental Breakfast

7:00 - 8:00 a.m., Women Physicians' Breakfast

Scientific Program:

8:00 - 8:50 a.m., Medicare Reimbursements, James Lyle, MAG Mutual

8:50 - 9:40 a.m., Washington Update, Robert Doherty, Senior Vice-President for Governmental Affairs and Public Policy, ACP-ASIM (Washington, DC)

9:40 - 10:00 a.m., Break

10:00 - 10:50 a.m., Update on Changes in the State Merit Employee Health Plan and Statewide Efforts to Improve Healthcare Access, Irene Rude, Division Director, Public Employees Health, Department of Community Health, Georgia

10:50 - 11:40 a.m., Physician Financial Planning, Michael Smith, CFP, Elizabeth Jetton, CFP, Financial Vision Advisors, Atlanta, Georgia

11:40 a.m., Adjourn

This educational activity has been designated for 15.5 CME credits.

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