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Chapter Newsletter - Fall 1997

Associates Day

Wednesday, October 15th, 1997 was Associates Day and it was sensational. I introduced the program by reviewing the mission statement and telling the Associates, "You are our Future." Dr. Steve Potts runs the Associates' Program, and this was our biggest ever in its 24th year. Steve did a wonderful job. Dr. Shannon Carson and Dr. Jim Woodruff of The University of Chicago faculty, were a major help, as were Chief Residents, Dr. Andy Anderson and Dr. Dave Rubin, and Program Director Dr. Holly Humphrey.

We met at the Ida Noyes Hall on the University of Chicago campus on a beautiful autumn day—sunny—high in the 70s. Three hundred forty residents came from all over the state, nineteen vignettes from eighteen programs were presented. The vignettes were great and Chitra Raman from the University of Chicago won the trip to the Annual Meeting in San Diego for, "Not Your Average Rapid Rule Out." The top three finalists presented their vignettes again at the Regional Meeting two days later. Judges included Dr. David Steward, Downstate Governor and Chair of Medicine, Southern Illinois University School of Medicine.

The program, between the two blocks of vignettes included twice done simultaneously run sessions by: Dr. Stuart Levin, Chair of Medicine, Rush Medical School: Unknowns in Infectious Disease; Dr. John Fennessy and Dr. Heber MacMahon (U of C): Unknowns in Radiology, Dr. James Shaw (U of C): Unknowns in Dermatology, and Dr. Dane Ehrmann and Dr. Roy Weiss (U of C): Unknowns in Endocrine in a delightful play-off-each-other fashion. We finished with food and a beverage "of your choice," and a good time was had by all.

The Regional Meeting

Outstanding! On Friday, October 17, 1997, the Regional Meeting of the Northern Illinois Chapter of the American College of Physicians was held at the Gleacher Center, the University of Chicago's new business school on the North Bank of the Chicago River. Dr. Faroque Khan, the Chair of Medicine, Nassau County Medical Center was the College Representative and was a gracious, reassuring, well-informed and dignified presence throughout the meeting. Dr. John Seibel, endocrinologist, from Albuquerque, New Mexico and ASIM House of Delegates, spoke on the ASIM/ACP merger. Dr. Craig Backs, ACP Member and President of the ISIM, participated in Saturday's panel on Health Care Reform and Managed Care.

The program was selected from two themes, Internal Medicine: Who We Are, and Current Clinical Problems based on last years regional meeting critiques. I started again with the Mission Statement: "To enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine and when Dr. Clarke's carousel wouldn't fit on the projector and we needed audiovisual support, I sang a song that Louis Armstrong helped make famous, "It's a Wonderful World." Mr. Armstrong could well have been referring to our striving for diversity and our recruitment for our Associates' Program.

It was good and the rest of the morning went without a hitch. Dr. Bart Clarke spoke on Osteoporosis; Dr. Jim Foody, Headache; Dr. Faroque Khan, TB in the 90s; and Dr. Charles vonGunten: Palliative Medicine.

At noon we gave Laureate Awards to two women, Dr. Vesna Skul, and Dr. Sarah Rusch, and to Dr. "Janu" Janardan D. Khandekar of whom Dr. Steve Kurtides said, "He is at the pinnacle of success of which any US-trained or International Graduate would dream". We also heard from Howard Shapiro of our Washington office; Dr. Faroque Khan gave the Report from the College; and Dr. John Seibel gave the ASIM report.

After lunch the program continued superbly. Attendance was excellent, I was pleased to see Dr. Arv Vanagunas, Asst. Chief of Medicine at Northwestern, stay all day. Dr. John Seibel did a very nice job with the computerized record. John told me he had a great time at the meeting and felt it one of the best he had ever attended. Dr. Rob Hirschtick of the Northwestern Aids program did a great update on HIV, and Dr. Lynn Cunningham from Southern Illinois University, gave us a final take home message about Depression and Anxiety stating, antidepressants often help both depression and anxiety while tranquilizers do nothing for depression. Dr. Ray Curry, of the Medical Student Program at Northwestern said Jim Foody's headache discussion has already influenced his office practice.

The top three winners in the Associate Vignettes contest were introduced and presented their vignettes: Anne Dean, MD, Loyola; Carlos Retall, MD, Weiss Hospital, and Chitra Raman, MD, U of C. It was fun for us and so very important to have Associates in close touch with our regional meeting. We had a reception at the Inter-Continental Hotel with enough snacks to feed those looking to save money and not so fancy that most wouldn't take the chance to dine on the town. Saturday morning was again magnificent.

We distributed the Call to Action To Defend Health Care, a recent copy of the Physicians for National Health's Newsletter, and a tribute to Dr. Roger Bone, The Taste of Lemonade on a Summer Afternoon, Another "Taste of Lemonade," Lemonade: The Last Refreshing Taste, and Dr. Frank Davidoff's, Everyone Sang—all 50 copies of Roger Bone went quickly.

The first speaker, Dr. Paul Jones, is a young African American from East St. Louis, IL, an economically depressed area, where many young men meet violent ends or are in jail. Yet Dr. Jones went to St. Louis University, University of Illinois College of Medicine, Mercy for medical residency, Loyola for Cardiology, and is one of the leading interventional cardiologists in the area. He says family, church, and personal goals made it possible. We clearly had more people of color than ever before, and Paul made them and me proud. He was beautiful. Dr. Andy Hedberg showed the two campaign films entitled What is an Internist.

The Town Meeting panel included Dr. Norm James, President of Cook County Physicians Association, Dr. Quentin Young, Physicians for a National Health Program, Dr. Arnie Widen, Former Medical Director, Blue Cross/Blue Shield, Dr. Craig Backs, ISIM, Dr. John Seibel, ASIM, Dr. Charles Derus, "ACCORD" Catholic Healthcare Group. Speakers from the floor included Dr. Niva Lubin, Speaker of the House for the National Medical Association, Dr. Prentiss Taylor, Vice President Blue Cross/Blue Shield, Dr. Joe Murphy, President, Chicago Medical Society, and Dr. Amelia Conte-Russian MD, private practice. Dr. Kahn moderated the session.

I wrapped up quoting from Dr. Bill Hall from the Observer, on the three essential characteristics of a profession:

Professions emerge around a distinct body of common knowledge, standards and values that need to be defined, renewed and expanded; The members of a profession characteristically perform a service or services primarily for the benefit of others and to a lesser extent to achieve personal gain; Members of any worthy profession recognize a responsibility to provide sustenance, renewal and opportunities for development to their fellow members.

This regional meeting is our sustenance and renewal and opportunity for development and as Joseph Bernardin said:

We are both involved in more than a profession—a vocation—a life to which we are called. We have a covenant with our patients, and the stewardship of our resources is far too important to be left to the insurance companies and the politicians.

We exist as a profession to teach, to do research, to prevent disease, to heal, to comfort. We must work together as a profession to keep this the finest medical system of care in the world."

ACP-ASIM Merger

On September 19, 1997 the Board of Governors of the American College of Physicians voted to approve a merger of the ACP and the ASIM. Recently American Society of Internal Medicine House of Delegates also approved the merger. The new organization will be known as The American College of Physicians- American Society of Internal Medicine for three years. At that time the name will be reviewed. The first Regents meeting of the ACP-ASIM will be in April 1998. Domestic Violence Prevention Workshop
Saturday, Jan. 17, 1998, 8 am-2 pm

The Northern Illinois Chapter of the ACPin conjunc- don with the Chicago Chapter of Physicians for Social Responsibility (PSR) will offer another violence prevention training workshop on Saturday, January 17, 1998 from 8am-2pm. This session will focus on family violence. Participants will learn advanced techniques in screening for domestic violence in the clinical setting using the "RADAR" program developed in the Philadelphia area. After completing the workshop, participants will be able to utilize the slide show resource in their own academic centers and practices and will have the opportunity to join PSR's speakers bureau.

The workshop will include both breakfast and lunch and will be held at the Center for Family Health, 455 East Illinois Street, #651, in downtown Chicago. There is a nominal registration fee of $20 for ACP and PSR members. Registration is required.

Call Leesa Albert at 312 663-1777 for additional information.

Status of Advanced Practice Nurse Legislation

By John Shneider, MD, FACP

ISMS along with representatives of many specialty societies has been interacting with the task force on Advanced Practice Registered Nurses (APRN) of the Illinois Nurses Association since January of 1997. As a result of that discussion, comments were incorporated with modified ISMS draft legislation. Subsequently, the nurses prepared a draft of their proposed legislation which has been pre sented to ISMS for comment. This process has been a fruitful one and there is general agreement on many of the issues which were controversial in the past. There are however several issues that represent areas of disagreement.

The APRN draft grants licensure to APRNs under the Illinois Nursing Act. The Medical Society is concerned that either there should be a separate license act and Board or that the Board responsible for oversight, i.e., the Board of Nursing, should have a greater physician participation in the licensure and disciplinary oversight of APRNs.

A second issue has been education and experience requirements. Both the APRNs and physicians agree that post-graduate formal education programs and cerdficabon would be required. The disagreement is as to when one should expect nurses to have satisfied those requirements. ISMS favors the year of 2000, the APRNs the year 2003, with the expectation that a nurse would have to have had ten years experience in advanced practice nursing prior to that date to be grandfathered.

Most of the details of the written collaborative agreement between the APRN and the physician have been worked out. Two areas remain unresolved. One is the scope of practice. ISMS believes that the Advanced Prac tice Registered Nurse must be restricted to providing services with the collaborating physician, that the physician provides to his or her patients in the normal course of medical practice, whereas the APRN proposal would permit the nurse to provide services she has had training that would make her competent to provide. For example, a nurse midwife would be able to provide services to pregnant women even if the physician with whom she has a collaborative agreement does not provide obstetrical care.

The other related issue has to do with prescriptive authority; both parties agree that within the bounds of the written collaborative agreement, APRNs should be able to prescribe schedule III through V drugs. There is still a desire on the part, particularly of the CNRAs in being able to also prescribe schedule II drugs.

Continued discussion is anticipated and likely will result in submission of legislation next year.

1997 Illinois Associates Meeting—Clinical Vignette Winners

First Place: Chitra Raman, MD
University of Chicago
"Not Your Average Rapid Rule Out"

Second Place: Carlos Rettally, MD
Weiss Memorial Hospital
"Taking the Mask off Vitamin B12 Deficiency"

Third Phace: Anne Dean, MD
Loyola University Medical Center
"Actinomycosis Presentingas a Chest Wall Mass: the importance of oraltygfene"

ISIM Brookens Award, 1997

The Brookens Award is named after Norris L. Brookens, MD, an internist from Carle Clinic in Urbana who was a charter member of the ISIM and its' first President from 1957-1959. The award is given annually to an outstanding internal medicine resident. This year's award was presented to Dr. Lisa Orelind.

Dr. Orelind is a resident from Rush-Presbyterian-St. Luke's Medical Center and is involved in ISIM through the Resident Section. She has consistently and continuously been rated superior in each and every category of monthly rotation evaluation—knowledge, judgement, clinical skills, humanist/c qualities, interpersonal communications, moral and ethical behavior, and overall clinical competence. She received the Intern of the Year Award, Senior Resident of the Year Award, and the Aesculapius Award for outstanding teaching by a resident physician. She participated in community acavities and won the Ciba Geigy Award for outstanding community service by co-founding a youth service tutoring program at the Henry Homer projects.