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March 2012 Mark W. Purtle, MD, FACP


Governor's Column

As the Iowa Chapter prepares for its annual Scientific Meeting March 30-31, and as the ACP community continues to engage with healthcare challenges on the local and federal level, I am reminded of what the college is doing to meet its strategic priorities: A) To be the premier synthesizer and distributor of education and information, B) To be the professional home for all internists (specialists, subspecialists, and hospitalists) through focused and customized membership development, C) To define and communicate the unique value of internal medicine, and D) To support changes in the U.S. healthcare system that improve patient care, improve health, and promote cost conscious care.

Both in the academic/teaching realm and in the private practice world, all physicians are facing significant changes and pressures and it is important that you be aware of the many resources available to you through ACP. Your local Chapter is a valuable source of support to find help in meeting these challenges.

Begin by coming to the March 30-31 Iowa Chapter Scientific Meeting. This meeting is designed to provide exposure to essential skills of practice in an internal medicine clinical setting. We have focused on practical challenges and lined up an excellent faculty. You will learn to:

  • Manage Chronic Pain and identify alternatives to opioid medications
  • Exercise key components of treatment of patients at End of Life
  • Select appropriate cost effective agents for therapy of Type 2 Diabetes Mellitus
  • Apply systematic manner to Interpretation of CXR
  • Identify new treatment regimens for Hepatitis—especially Hepatitis C
  • Identify newer treatment regimens in Rheumatologic Diseases
  • Describe newly available Anticoagulants, their indications and use
  • Demonstrate Hands-on Joint Injections
  • Demonstrate Hands-on Line Placement
  • Demonstrate Hands-on Thoracentesis
  • MOC Self-Evaluation Module--Critical Care
  • MOC Self-Evaluation Module--Infectious Diseases

Some of these topics are selected to help you satisfy new Iowa Board of Medicine rules and complete SEP modules and submit for ABIM credit. For interested members, an “Advancement to ACP Fellowship” noon workshop is available—clarifying and facilitating this important process. We encourage you to pursue becoming an ACP Fellow. Fellowship in the College is an honor. Being an FACP is a mark of esteem from colleagues who recognize accomplishments and achievements over and above the practice of medicine. The most important considerations for ACP Fellowship are excellence and contributions made to both medicine and to the broader community in which the internist lives and practices. Listen to two ACP members discuss what it means to be a Fellow of the American College of Physicians (FACP), and how it has shaped their lives both professionally and personally at http://www.acponline.org/membership/fellowship/

Looking ahead to 2012, we can hope for more wisdom from our national leaders—that they may put aside politics and their own agenda to focus on the real issues of our country. We will be fortunate to have as a meeting guest, Bob Doherty, the ACP’s Senior Vice President for Government Affairs in Washington DC. He has senior staff management responsibilities for ACP’s department of legislative affairs, public policy, regulatory affairs, practice management and improvement, and ethics and professionalism. His award winning blog is highly recommended.

After Friday workshops, a reception will celebrate our award honorees and also provide a relaxing time for you to visit with friends, and greet newcomers. This is a great way to touch base with colleagues, socially and professionally, to ask and answer questions, to discuss back burner issues for which there is not enough time during everyday medical life as we know it. Additionally, our Young Physican Group is sponsoring a “family-night” get together at the North Ridge Pavilion in nearby Coralville, also on Friday evening. You will find details about this event on the Chapter facebook page which has been newly organized for facilitating communication among our young physicians throughout the state.

Complete meeting information and an electronic registration form are available at the chapter website. You may also call my Administrative Assistant, Fran Blanc, 319/467-5595, and register directly by phone. Registration rates increase March 17. A form is also available with this newsletter, the completed form should go to: francoise-blanc@uiowa.edu.

As always, I welcome your input and look forward to sharing time together March 30-31.

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2012 Laureate Award Honorees

We are pleased to announce 2012 Laureate honorees. These awards are given as a mark of honor and recognition for achievement of excellence in internal medicine. Congratulations to:

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Douglas B. Hornick, MD, FACP - Laureate Honoree

Douglas B. Hornick, MD, FACP
Professor, Pulmonary, Critical Care and Occupational Medicine
UI Carver College of Medicine, Iowa City, IA

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Daniel P. Allen, MD, FACP - Laureate Honoree

Daniel P. Allen, MD, FACP
Vice President and Medical Director
Iowa Health System Central Region, Lakeview Internal Medicine, Johnston, IA

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2012 Excellence Award Honoree

This year’s Excellence Award is given in recognition of contributions to the American College of Physicians, The University of Iowa Carver College of Medicine education programs, and the greater Iowa medical community as well as to leadership, to commitment in Internal Medicine, and for dedication to clinical excellence and lifelong learning. Congratulations to:

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Janet A. Schlechte, MD, MACP - Excellence Award Honoree

Janet A. Schlechte, MD, MACP
Professor, Interim Director, Division of Endocrinology-Metabolism
UI Carver College of Medicine, Iowa City, IA

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Young Physicians Report

Sadia Benson & Hendrik Schultz

Our Young Physician group is growing—in size, in increased activity, and in demographic reach. We are pleased to announce a new website facebook page which will act as a much anticipated forum to facilitate all kinds of engagement among Young Physicians throughout the State. Our goal is to enhance professional development and quality of life for early career physicians in Iowa, foster their involvement in College activities and ensure that their voices are heard in Chapter discussions.

The purpose of the Council of Young Physicians is to aid young physicians in a variety of ways:

  • Increase participation of young physicians in advocacy for healthcare at the local and national level
  • Assist young physicians in the transition from training to practice, including contract negotiation and financial planning
  • Provide networking opportunities with other young physicians
  • Address topics of concern to practicing physicians, such as balancing work and home life and preventing burn-out
  • Assist young physicians in navigating the pathway to Fellowship in ACP and other leadership opportunities

Visit our new facebook page on the Chapter website and also visit the CYP website to learn more about the important issues facing young physicians and how ACP is positioned to improve the way you can meet today’s healthcare challenges.

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Associates Report

Jon Van Der Veer, DO

Serving as an Associate Representative to the Iowa Chapter ACP Council is the extracurricular highlight of my time in residency. Reflecting back, three specific components illustrate what a privilege it is to have such a strong state chapter of the American College of Physicians.

First, the opportunity to meet and foster meaningful relationships with well-respected Internal Medicine mentors from across the State of Iowa is inspiring. Experiencing Dr. Peter Reiter’s, Dr. Bob Weiss’, Dr. Steve Joyce’s, or Dr. Dick LeBlond’s passion for Internal Medicine makes me proud to be a future Internist.

Secondly, the Iowa Chapter of the ACP really is truly special. When I was a first year medical student, my wife made me attend my first Annual Scientific Meeting in Iowa City. After the first case of “Stump the Professor,” I was hooked. Besides offering excellent presentations from outstanding speakers, it is a terrific opportunity for medical students and residents to engage in public speaking through a “Stump the Professor” case or the annual ACP Clinical Vignette presentations. In addition to the Scientific Meeting, much effort is being put into developing ACP On-the-Road presentations allowing for more local ACP events.

Lastly, during my time working with the Iowa Chapter ACP Council, I have been afforded priceless experiences in seeing how health policy is shaped. ACP has a well-respected role in developing and shaping our nation’s health policy. My annual trips to Washington D.C. for ACP Leadership Day have rewarded me with a greater understanding of the necessary role providers play in advocating for policies on behalf of our patients.

As I graduate from residency and embark on a career in Internal Medicine, I strongly encourage you (students, residents, young physicians, seasoned physicians) to get involved with the Iowa Chapter of the ACP. You will not regret it, I promise!

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Clinical Vignette Competitions

The Des Moines Clinical Vignette Competition was held February 8 at Iowa Methodist Medical Center. Dr. William J. Yost, MD, FACP, Residency Program Director hosted the event which included an awards presentation and a dinner. Drs. Lisa A. Veach, MD, FACP, Michael T. Flood, DO, and Steven R. Craig, MD, FACP acted as the deliberating judges.

Thank you to the following participating presenters.

I’m All Ears, Andreas G. Ahlas, MD, R3, Mentor: Lisa A.Veach, MD

Don’t Be Rash, Brock J. Cookman, DO, R3, Mentor: Matthew L. Hill, DO

The Case of the Unknown Exposure, Ryan R. Mertens, DO, R2, Mentor: Sudhir C. Kumar, MD

When a Rolling Stone Doesn’t, Ahmed A. Morsy, MBchB, R3, Mentor: Douglas L. Hanson, MD

When Low K is Not OK, Megan J.Romine, DO, R3, Mentor: Luis G. Beltran, MD

How High Can I Go Before Someone Notices, Mark D.Young, MD, R3, Mentor, James P. Lovell, DO

Diarrhea Flushing and Wheezing Are Not All It’s Cracked Up to Be, Andrew Dunn, M4, Mentor Tech K. Khoo, MD

Congratulations to the resident winners:

Megan Romine, DO, 1st place. The Chapter will award her $1500 to attend the ACP National Meeting.
Ryan Mertens, DO, 2nd place. The Chapter will award $250 for purchase of ACP educational resources.
Both presentations will be featured at the Chapter Meeting on March 31.

The Iowa City Clinical Vignette Preliminary Competition was held February 17 at University of Iowa Hospitals and Clinics. Scott A. Vogelgesang, MD, FACP, is the Residency Program Director. The event was moderated by Chief Residents Suzette L. Barakat, MD, and Bashar Al Jayyousi, MBBS. The judges were Gwen Z. Beck, MD, Christopher J. Goerdt, MD, MPH, Rachel A. Miller, MD, Joseph F. Szot, MD, FACP and Scott A. Vogelgesang, MD, FACP. The event included a preliminary awards presentation and dinner.

Thank you to the following participating presenters.

X Marks the Spot, Marti L. Hlafka, MD, R3, Mentor: Mohammed M. Milhelm, MBBS

A Case of Dyspnea, Jacob T. Hodges, MD, R3, Mentor: Douglas B. Hornick, MD

Bleeding: Could it be an Unusual Presentation of a Thrombophilic Disease?, Belal O. Al Khiami, MBBS, R3, Mentor: Tamara L. Nelson, MD

The “Odd” Daughter, Lindsay J. Orris, DO, R3, Mentor: Judy A. Streit, MD

Bang’s Disease, Manpreet K. Dhaliwal, MBBS, R2, Mentor: R. Todd Wiblin, MD

Black Esophagus: An Ominous Sign, Travis R. Williams, MD, R3, Mentor: Ron Schey, MD

Fever in a Returning Traveler, Stephanie L. Henderson, MD, R3, Mentor: William L. Iverson, MD

An Unusual Cause of Diabetes: Ectopic ACTH Secreting Small Cell Lung Carcinoma, Amy N. Sanford, MD, R3, Mentor: Lori J. Rosenstein, MD

Hemophagocytic Lymphohistiocytosis Treated Without Immunosuppression, Nicholas L. Hartog, MD, R1, Mentor: Hilary J. Mosher, MD

Getting to the Heart of Altered Mental Status, Mahdiesadat S. Aliroteh, MD, R3, Mentor: Ezzatollat T. Shivapour, MD

URI Symptoms and Intention Tremor, Michael B. Walker, MD, R3, Mentor: Scott A. Vogelgesang, MD

A B-wildering Case of Paraplegia, Roberto A. Leon-Ferre, MD, R2, Mentor: Lori J. Rosenstein, MD

Fever, Malaise and Weight Loss, Anthony J. Klappa, MD, R1, Mentor: Paul D. Lindower, MD

Hydralazine: The Good, the Bad, and the Ugly, Zaid S. Shakir, MBchB, R3, Mentor: Scott A. Vogelgesang, MD

Persistent Hypoglycemia in a Gastric By-pass Patient, Tara M. Hochwalt, MD, R3, Mentor: Amal S. Shibli-Rahhal, MD

Cirrhosis and Necrotic Skin Lesions, Andrea O. Akpoguma, MD, R3, Mentor: Manish Suneja, MD

A Complicated Case of Delirium, Julia M. Jones, MD, R3, Mentor: Amal S. Shibli-Rahhal, MD

Hindered by History: A Confusing Case of Meningitis, Michael J. Swift, MD, R3, Mentor: Birgir Johannsson, MD

64-Year-Old With Fever of Six Months, Michael L. Haugsdal, M3, Mentor: Hilary J. Mosher, MD

Concomitant Diagnosis of Aplastic Anemia and Kaposi Sarcoma in Non-HIV Patient, Alian A. Al Balas, MBBS, R3, Mentor: Mohammed M. Milhem, MBBS

A Little Dizzy, John J. McAnelly, MD, R2, Mentor: Melinda J. Johnson, MD

Fever of Unknown Origin in the Mississippi River Valley, Andrea N. Ryan, M4, Mentor: Ambar Haleem, MD

Missing the (GOLD) MARK:A Case of Anion Gap Metabolic Acidosis, Jessica Cyr, MD, R2, Mentor: Joel A. Gordon, MD

Case of a 23-Year-Old Man Presenting with a Creatinine of 29.0 mg/dL, Nicole E. Worden, MD, R1, Mentor: Rebecca L. Hegeman, MD

Hand/Foot Swelling and Hematuria, Luke M. Gessel, MD, R3, Mentor: Petar Lenert, M.D., MSc, PhD

Hepatocellular Carcinoma in a Non- Cirrhotic Patient: A Link Between Obesity and Atypical Presentations, Lara Voigt, M3, Mentor: Antonio J. Sanchez, MD

Sore Arms and Altered Mental Status, Susan P. Nelsen, MD, R3, Mentor: Ravneet S. Dhaliwal, MD

Congratulations to the student competition winner:

Michael L. Haugsdal, M3, 1st Place. The Chapter will award $250 for purchase of ACP educational resources.

Congratulations to the resident winners:

Roberto A. Leon-Ferre, MD, 1st place. The Chapter will award him $1500 to attend the ACP national meeting.
Jessica Cyr, MD, 2nd place. The Chapter will award $250 for purchase of ACP educational resources. Both presentations will be featured at the chapter meeting on March 31.

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ACP National Abstracts Competition

Congratulations to Andrea Ryan, M4, University of Iowa Carver College of Medicine. Her clinical vignette abstract has been selected by the Abstract Review Board for presentation as a poster finalist and will be judged on-site at Internal Medicine 2012 in New Orleans, LA on Saturday, April 21, 2012

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Medical Student Report

Andrea Ryan, M4

As I begin the final stretch of medical school, I continue to reflect on my journey and those people and moments that ultimately inspired my future career. I am sure I began my basic science years no different than many of my classmates. I was confident and expected my academic success to persist without difficulty. I never expected to be so humbled during those first two years of classes by both the amount of information I was expected to interpret and understand, but also by the talent, ambition, and experiences of my classmates. During my struggles those first two years I probably would have preferred a few more honors grades than I received, but looking back I feel fortunate for those struggles. They formed a foundation of respect for my future field and my colleagues and for the strength of humility as a care provider.

As I ventured into my clinical years, I was fortunate to have outstanding mentorship and opportunities to serve my community through a wide array of free clinics. During my internal medicine rotations, my attending and resident physicians impressed me with not only their knowledge of medicine, but also their eagerness to share it with both students and their patients. As a member of the ACP Internal Medicine Interest Group leadership during my clinical years, I was fortunate to add to that list of mentors and was given opportunities to further explore their experiences at meetings and social functions.

As far as my service opportunities, I credit my time spent at the Free Mental Health Clinic in Iowa City for making me realize my true calling in medicine. Starting my second year of medical school, I slowly became aware of what it was for a patient to truly suffer from both mental illness and being unable to obtain primary medical care. I grew very passionate about this population and wanted to choose a residency that would provide me with the best overall training to serve them. While many students have been discouraged to pursue combined residencies at other institutions, I was encouraged to seek a combined residency in internal medicine and psychiatry and was able to connect with even more mentors who had completed similar residencies and shared similar career goals. I hope to spend the rest of my career providing evidence-based and empathetic medical and psychiatric care to my community.

As I near the end of my medical school journey, I’d like to thank all those mentors in the internal medicine department, the psychiatry department, and the ACP community who helped me explore my talents and affirm my goals as a physician. I would also like to encourage all medical students to spend time in their community, serving an underserved population regardless of specialty interest. You can never understand your patients too well and it is never too early to start.

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2012 Iowa Chapter Scientific Meeting

Friday, March 30
7:15-8:00 Registration Continental Breakfast
8:00 Introduction & Announcements Mark W. Purtle, MD, FACP, Governor, Iowa Chapter
8:15 New Regimens and Drugs in Rheumatologic Diseases
Bogdan N. Cherascu, MD, MS
9:05 Political & Legislative Landscape 2012 Bob Doherty, ACP Sr VP, Governmental Affairs-Public Policy
9:55 Break/Refreshments: Industry Support Displays ACP College Staff Display
10:20 Concurrent Workshops (Session I) Joint Injection Scott A. Vogelgesang, MD, FACP Christopher J. Goerdt, MD, MPH
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Critical thinking in Disease Diagnosis Richard F. LeBlond, MD, MACP Steven P. Joyce, MD, FACP
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Chronic Pain Management Part 1 George Lederhaus, MD
11:10 Concurrent Workshops (Session II) Repeat of Session I
12:00 Lunch & Industry Support DisplaysFellowship Advancement Luncheon Workshop” Dick LeBlond, MD, MACP
1:05-1:30 Business Meeting Mark W. Purtle, MD, FACP
1:30-2:30 Curing Hepatitis C—The Future is Now Michael D. Voigt, MD, FACP
2:30-3:00 Break/Refreshments: Industry Support Displays ACP College Staff Display
3:00 Concurrent Workshops (Session I) Ultrasound Use in Common Bedside Procedures Gregory R. Bell, MD
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Chronic Pain Management Part 2 Steven R. Craig, MD, FACP
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End of Life Care Bradley J. Archer, MD, FACP
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CXR Interpretation John F. Fieselmann, MD, FACP
4:00 Concurrent Workshops (Session II) Repeat of Session I
5:15 Awards Reception: Hors d’oeuvres/Wine - [ALL WELCOME!] Chapter Awards Ceremony at 6 PM
7:00 Adjourn
7:15-9:00 Young Physicians Group “get-together” North Ridge Pavilion (event venue) locator map on reception table
Saturday, March 31
7:15-8:00 Registration Continental Breakfast
8:00 Cost Effective Agents for Therapy of Type 2 Diabetes Mellitus Mark E. Molitch, MD, FACP
8:50 Stump the Professor Richard F. LeBlond, MD, MACP
10:00 New Agents in Anticoagulation—Indications of Their Use Steven R. Lentz, MD, PhD
10:50 2011 Associate Clinical Vignette Competition Finalists
11:50 Drawing for Prizes (21 prizes) Must sign up (box by 2117 door)—must be present to win
12:00 Adjourn
Maintenance of Certification Course
(separate registration required if you have not already pre-registered)
12:15-1:00 Registration Pick up Pre-paid Box Lunch
1:00-3:00 SEP Module 1: Critical care Kevin C. Doerschug, MD, MS, Brian K. Gehlbach, MD
3:00-3:15 Break/Refreshments
3:15-5:15 SEP Module 2: Infectious Diseases Birgir Johannsson, MD, Judy A.Streit, MD

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ACP Iowa Chapter Scientific Meeting Registration

Here is the registration form to complete and return to the Iowa Chapter.

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Contact Information

Mark W Purtle, MD FACP,
Governor, Iowa Chapter

Denise Floerchinger
Ph: 319-356-2732