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Chapter Newsletter - Winter 1999

From Our Northern Illinois Governor

I was invigorated by the Regional Meeting of the ACP-ASIM in Springfield the 23rd and 24th of October, 1998. We had a pre-meeting dinner at Dave Steward's home where I had a chance to meet Dr. Sergio Rabinovich, former Chair of Medicine, SIU, a Peru-born Illini, now retired, and a symbol of excellence in the state capitol and College Representative and Regent, Dr. Sara Walker from Columbia, Missouri and her husband, Dr. Don Kay - license plate RHEUM 2 - for two of the nicest people and one of the most capable College Representatives. Listening, counseling, and participating, Sara Walker is just plain awesome.

We had our maybe-final meeting of the ACP Council Friday at 8:00 AM with the major agenda to approve our new Bylaws. The meeting was led by David Steward, Governor Illinois Downstate. Present were Mike Greenberg, Steve Potts, Jim Dove, Rolf Gunnar, Serafino Garella, Craig Backs, Steve Goetter, Andy Hedberg, Nancy Furey, Vesna Skul, John Schneider and Whitney Addington, pres.- elect of ACP-ASIM.

David McPherson, Professor of Cardiology at Northwestern, a leader in the field of echocardiography, opened our session with what we should know and should do and what the possibilities are for the future. Raj Chadaga, Professor of Medicine at SIU and Chief of Staff at the Marion VA Hospital discussed Polycythemia Vera and Nancy Khardori discussed Viral Hepatitis, "A through G and More.

In the afternoon, Gerald Soff discussed his research in Angiogenesis - a Potential Target for Cancer Therapy, and he held us spellbound. It was one of those sessions that was much appreciated for the excitement of what is going on and the potential for something big happening. This was followed by three simultaneously run special interest breakouts: 1. Women's Health, an amazing two hour trip through the current literature by Vesna Skul, 2. The Facts and no Baloney starring Paul Rockey, James Graumlich and Sara Walker, three fine clinicians discussing ten of the toughest diagnostic and therapeutic challenges facing the practicing internist, and 3. The Rural Internist, with Ted Yetter, Larry Jennings and Kentucky Governor, Joe Weigel.

Saturday morning Vesna Skul, Larry Jennings and James Graumlich gave capsules of the three breakout sessions. Larry Jennings expressed concern that his rural medicine program might seem mundane compared to the cutting-edge research presented by Dr. Soff. Dr. Jennings was assured and Dr. Soff would agree that where the doctor meets the patient is never too mundane and he is a role model for all of us. The every day discovery and care in Dr. Jennings' clinical office is the practice of medicine. Dr. Soff and Dr. Jennings represent the alpha and the omega of health care. Larry Jennings delivers the discoveries to our patients.

Patrick Fahey, Chair of Medicine at Loyola, discussed current diagnosis and therapy of pulmonary embolism, Wisconsin and Illinois soil and farm lands, and how he enjoyed seeing Joe Murphy, John Schneider, Craig Backs and other leaders of the Chicago Medical Society, the Illinois State Medical Society, and ACP-ASIM present at the same meeting.

The resident and student session, as always, was marvelous. Tracy Irwin, sophomore medical student at Northwestern, presented her summer's research on Domestic Violence, which was funded by the ACP-ASIM, Illinois Chapter. Five clinical vignettes were presented. They were a lot of fun.

A town hall meeting followed with dialogue between the membership, the College Representative, the Governors and the President-elect. Finally, a public policy session chaired by Dr. Craig Backs in which State Representative Gwen Klingler, State Senator Larry Bomke, and Joyce Nardulli, the Illinois State Medical Society lobbyist presented. There was testy give and take. Craig Backs is well-spoken and passionate for participation in the political scene.

A memorable presence at the meeting was Dr. Gerasim Tikoff who was singled out as a mentor by Gerry Soff when both were at the Medical College of Virginia and by Pat Fahey when they were at the Hines VA. Congratulations Dr. Tikoff and thanks for joining us. I thank Dave Steward and Regina for being marvelous hosts and everyone for being such active participants.

Warren W. Furey, MD, FACP

From Our Downstate Governor

The Downstate Region of the Illinois ACP-ASIM Chapter was pleased to host the 1998 Annual Scientific Meeting in Springfield last October, and we appreciate the positive review by Warren Furey in the preceding piece in this newsletter. I'd also like to thank Jo Dierks, our staff person for serving as the organizer and manager of the meeting, including a truly heroic effort in assembling the syllabus for the meeting. Additional thanks to SIU medical student Jim Abraham, who pitched in to help assemble meeting materials, and who also presented exciting information about the SIU MedPIGs (Medicine-Pediatrics Interest Group), which he has almost single-handedly organized and which has now taken an active role in some local community service activities. Of course, the very best part of the meeting was the opportunity to mingle with colleagues, residents, and students who gave the meeting its spark and energy.

The agenda for the Downstate ACP-ASIM includes several events, planned and tentative, and a reforming of the organization in the wake of the ACP-ASIM merger. The Second Annual Primary Care/Geriatrics CME Symposium, will be held June 3, 1999 at the John A. Logan Community College in Carterville, Illinois. This event is co-sponsored by the Downstate ACP-ASIM, the Marion VA Hospital, and the SIU Department of Internal Medicine. We hope many true southern Illinoisans will attend.

Other potential events, include a second Community Based Teaching seminar to follow the successful first meeting in Peoria last year and a spring meeting for Downstate associates and students to complement Associates program held annually in the fall in Chicago (see comments by Steve Potts elsewhere in this newsletter). To expand our role as an active Downstate professional organization, Downstate ACP-ASIM is eager to collaborate with, and provide financial support for, individuals or groups who wish to present educational programs for health care providers or the public. For information, contact me at one of the addresses posted at the end of the newsletter.

We await final approval, by the Philadelphia office, of new bylaws that will complete the merger of the Illinois ACP and the ISIM. Among other things, the new bylaws will result in a clear method to elect members of the Council and will require our business meetings to be conducted more formally. The result, it is hoped, will be a representative organization that is accessible and accountable to its members. The new bylaws define fairly well the relative role of the two Illinois regions. The opportunity for Downstate participation in the Illinois ACP-ASIM's formal governance structures will be substantial, perhaps exceeding the ratio of Northern compared to Downstate members. The Downstate region, with more than 500 members, remains less well organized and less active than desired, perhaps because of its spread-out rural territory. I hope many of our members can take on important new roles and figure out ways to advance the Downstate cause in the new organization.

A couple of final notes. First, congratulations to Gail Clifford Mullen, MD who was featured in the ACP-ASIM Community Speech Program's "Speaking of Health", newsletter. Dr. Mullen has taken to the local radio airwaves to promote preventive and women's health care, and the ACP-ASIM's "Doctors for Adults" effort. Second, I look forward to seeing many of you at the Annual Session in New Orleans, April 22-25, 1999, for the world's best continuing education program, not to mention some pretty good food, music, and fun!!

David Steward, MD, FACP

From Our Transitional Governor

As a transitional governor I am made aware of the policy proposals being developed by ACP-ASIM. We are eager to receive opinion from all of you. A recent position paper dealt with changes in Medicare by the Bipartisan Commission on the future of Medicare. This commission proposed to establish a defined contribution or voucher program. Based upon members' comments your Governors responded. The result of that input and others was reflected in the article in the Washington Perspective published in the ACP-ASIM Observer, January, 1999. A policy paper is being considered.

Other issues that are undergoing consideration include "Laboratory Negotiated Rulemaking". The College participates with a number of other organizations in attempting to modify the rules related to physician documentation requirements for ordering laboratory tests. The goal is to simplify and decrease the hassle for physicians. Another provocative area of policy development addresses selling products out of the physician's office. Concerns include coverage for all related costs for provision of chemotherapy and other medications administered to the patient while they are in the physician's office and selling health related or non-health related products for profit or not-for-profit. A paper on "Professionalism, Ethics, and Managed Care" raises concerns. Many physicians believe that managed care places the physician in a position of conflict with his/her commitment to being the advocate for his/her patient and being able to assure his/her patient receives necessary care. On February 10, the ACP-ASIM Health Insurance Plan was published. Again, your comments on the Plan are desired. Also, an article by Dr. Sox addresses proposed changes in Graduate Medical Education support. Congress is proposing moving components of Graduate Medical Education support out of the Medicare budget and establishing them as a separate online item. The concern is that this will result in decreased Medicare payments for Graduate Medical Education and coupled with the decreased amount of resources available through managed care our ability to maintain outstanding training programs in internal medicine will be stressed. After reviewing Dr. Sox's comments you are encouraged to contact your congressional representatives. You can call toll free 888-218-7700. Provide your 8-digit ACP-ASIM ID number at the prompt. Choose from several options: Hear a legislative update, receive a Legislative Alert or Talking Points via fax or be connected to a member of the Washington office staff for more information; or if you enter your zip code, be matched with and patched through to your federal legislator.

We encourage you to use the website for additional information on these and other activities of the College. Also the resolutions that have been submitted for consideration at the upcoming meeting in April will be posted on the Webpages providing you with an opportunity to provide input directly to us for our comments at the annual Meeting of the Board of Governors which precedes the Annual Session. See the last page for our addresses. The website also provides access to what's new in the publications of the College including The Annals, The Journal Club, The Observer, and Evidence Based Medicine.

It is truly an exciting time to be part of the new ACP-ASIM and the opportunities that it provides for increasing input from the grassroots members. This will result by our taking responsible positions on individual health and public policy for the benefit of the public, our patients, the medical profession and our members.

John F.Schneider, MD, FACP

Illinois Laureate Awards: 1998

Patrick J. Fahey, MD, FACP

"I grew up in Madison, Wisconsin. Both my parents were raised on dairy farms nearby. The family farm was a BIG part of my youth. I spent most all weekends, vacations and holidays doing daily chores, milking and haying. Frank Lloyd Wright was born and raised just down the road. My grandparents met him on the train when they were going to Chicago for their honeymoon in 1914. I'm a great admirer of Frank Lloyd Wright, a Wisconsin farm boy, who dominated American architecture in the 20th Century. My wife Penny and I, with our two children, Katlin and Patrick, live in the F.B. Henderson House designed in 1901 by Wright. He was 33 years old at the time and our house is one of his initial three Prairie Style homes. Penny has been on the faculty at Northwestern for 15 years and teaches Spanish language and literature. My leisure loves include squash, kite flying, sailing, golf and being on Washington Island anytime."

Dr. Patrick Fahey attended Loras College in Dubuque, Iowa and the University of Wisconsin School of Medicine in Madison. His Residency and Pulmonary Fellowship were at St. Elizabeth's Hospital of Boston, Tufts University School of Medicine and Strong Memorial Hospital, University of Rochester, Rochester, New York. Pat came to Loyola in 1980 and is boarded in Pulmonary Medicine and Critical Care. He was Chief of Medicine at the Edward Hines VA Hospital from 1992 to 1997 and appointed Chair of Medicine at Loyola in 1997. Dr. Fahey has been Teacher of the Year and Attending of the Year on seven occasions. He has served the ACP-ASIM since 1993 as our representative to the Residency Review Committee of the American Council on Graduate Medical Education. He has been on numerous committees of the American College of Chest Physicians. Pat Fahey can be seen at the annual session of the ACP-ASIM surrounded by his house staff. Kevin Simpson, Program Director at Loyola said the following about Pat:

" In an era of diminishing reimbursement, ever present legal issues and restricted physician autonomy, Pat Fahey rises above these issues demonstrating to his colleagues that being a physician is a vocation. The joy Pat experiences in his everyday work with his patients, trainees and his fellow attendings is obvious to all and inspires them to a higher degree of professionalism."

Michael B. Graham, MD, FACP

Dr. Michael Graham graduated from Marquette University in 1965 with a degree in electrical engineering. He spent two years as a graduate student in biomedical engineering at Marquette and worked for Baxter-Travenol Laboratories from 1968 to 1972. With his biomedical engineering background, Dr. Graham entered medical school and graduated from Loyola University Stritch School of Medicine in 1975. He went to Evanston Hospital for his internship and medicine residency. He was the Medical Intern of the Year in 1976 and finally a Chief Resident in Medicine at Evanston. He has remained on the Evanston Staff since that time and has been very active in the Medicine Residency Program. Dr. Graham is in private practice at his Glenview office, but has never lost touch with academic medicine, medical education, his teaching institution, and the medical school. He has served as a tutor for the Junior Student Medicine Program for many years. He was on the Dean's task force for the future of Northwestern University Medical School Library. At the community level, he has worked avidly for the American Heart Association and the American Cancer Society and has given freely of his time in fund raising activities and in raising public awareness of the importance of prevention and early diagnosis of disease. At Evanston Hospital, in addition to his duties as an excellent teaching attending physician, he has been the coordinator of the Visiting Professor Program and Grand Rounds for the past twenty years. He has attended virtually every annual session of the American College of Physicians and many of the Meet the Professor workshops where he has personally recruited these excellent speakers to come to Evanston as visiting lecturers. Dr. Graham met his wife, Rita Piasecki, at Marquette, and they have three children, Jennifer MacDonell, John and Jessica. Perhaps, no one could describe Dr. Graham's activities better than Dr. Bernie Adelson did in his letter of recommendation:

"In his skills, his attitude, his integrity, his devotion to his patients, his loyalty to his profession and in his constant demonstration of altruism over self-interest, Dr. Graham serves as an inspiration for each of us. In short, Dr. Graham typifies the compleat physician who, by example of his own life, demonstrates that the profession of medicine is an ethical enterprise in the truest meaning of the term."

Community-Based Teaching Program

Program goals:

1) Increase the availability of excellent CBT experiences for students, residents and fellows; 2) Improve the teaching of CBT preceptors; 3) Provide the necessary educational resources to support CBT; and 4) Recognize and reward CBT preceptors. Several initiatives have been implemented. Faculty development skills will be taught at the 1999 Annual Session in New Orleans at the Learning Center. Two publications supporting CBT are currently available. Community-Based Teaching. A Guide to Developing Educational Programs for Medical Students and Residents in the Practitioner's Office is a 238 page soft-cover book and is available through ACP-ASIM Customer Service (1-800 423-1546, ext. 2600). The CBT News is a free, quarterly newsletter for CBT practitioners and administrators featuring educational resources for CBT. Physicians wishing free copies can obtain them by calling 1-800-523-1546, ext. 2588. The major CBT related service is the Clearinghouse Database. This database contains over 350 individual educational items for CBT including curricula, descriptions of model programs, evaluation schemes, lectures, and faculty development videotapes. Members can have the database searched by staff (1-800-523-1546, ext. 2588), or they can individually search it online, in the CBT web site. Like CBT News, the web site lists and reviews new resource acquisitions into the Clearinghouse Database, and provides timely information on grants, training programs, faculty development, teaching tips, and award programs and recipients.

Awards

Two awards are available to internal medicine preceptors who teach students, residents or fellows in an office-based practice. Eligible preceptors may be either full-time or volunteer faculty, provided they teach in a practice located in the community, separate from the hospital or hospital clinic.

The Participation Recognition Award is available to office-based internists who have taught in an office setting for two or more years. There is no specified amount of contact time mandated during the two years of teaching in order to be eligible for the award. Self-nomination for the award is allowed, but one of our local CBT program administrators, Dr. John Skosey or Dr. Janet Riddle must sign the application attesting to its accuracy. Applications are then forwarded to the CBT Program at ACP-ASIM. The awarded certificates can be displayed in the practitioner's office.

We wish to thank and congratulate the following physicians for their recent participation.

Illinois Downstate

Kathleen Collins, MD, Urbana,
Sami Zabaneh, MD, Champaign

Illinois Northern

Richard Abrams, MD, Chicago,
Sanjay J. Amin, MD, Chicago,
David Baldwin, Jr., MD, Chicago,
Ahsan M. Basha, MD, Chicago,
Barbara J. Brotine, MD, Skokie,
George Demos, MD, Chicago,
Danuta K. Hoyer, MD, Chicago,
Saeed A. Khan, MD, MM, Chicago
Claudia Nugent, MD, Urbana
Morris Papernik, MD, Chicago
Robert D. Passovoy, MD, Chicago
Janet M. Riddle, MD, Chicago
Morry Rotenberg, MD, Arli. Hghts
Syed H. Shah, MD, Chicago
Mervin Shalowitz,MD,FACP, Skokie
Vesna V. Skul, MD, FACP, Chicago
John A. Wiley, MD, Chicago
Robert J. Wolf, MD, Skokie

The CBT Excellence in Teaching Award is available to office-based internists who have taught for at least 7 of the last 10 years, and who can document at least 50 hours of direct contact time with trainees for each of those years. In order to receive the award, the preceptor must meet specified criteria. Additionally, a letter of support is required from someone knowledgeable about the preceptor's teaching and the local CBT administrator must sign the application. The award consists of a red, marble apple on a black ebonite base, and is inscribed with the name of the award and the recipient's name.

Each award is available to preceptors only once. That is, a preceptor may receive one Participation Award, and one CBT Excellence Award, but not more than one award from each category. Award applications are available online or call CBT Program at (800) 523-1546, ext. 2588.

CBT Coordinators

Chairs: CA Hedberg, John Skosey, Janet Riddle
Chicago Medical School: Lori Siegel, Laurie Broutman
Loyola: Paul Hering, Kevin Simpson, Ann Dean(resident)
Northwestern: Ray Curry, Marianne Green
Rush: Janet Riddle, CA Hedberg
So. Illinois University: Robert Bussing
U. of Chicago: Holly Humphrey, David Liebovitz
U. of Illinois: Mel Lopata, Linda Lesky

On Nov. 8, 1998, representatives from four of our seven medical schools met at Rush to share what their schools were doing in CBT and to learn how the ACP-ASIM could help them plan and coordinate activities. Dr. Broutman felt that the ACP publications had been helpful as a guide to her CBT faculty. She was interested in planning a future meeting to train her teachers and also inquired about CBT teaching as a pathway to fellowship for members of the College. Dr. Dean said that the CBT program at Loyola has been very popular. Drs. Green and Riddle discussed the strengths of their respective programs. There was a consensus that another meeting should be held in the spring with two or three members of each school present to specifically plan a Saturday morning seminar this summer for the area medical schools. The purpose of the seminar would be to teach community based teacher facilitators new skills and effective methods of teaching.

Volunteers Are Needed To Help Revise The College CBT Publication: Learning From Practitioners. Office-Based Teaching of Internal Medicine Residents.

The major strength of the book is its focus on the community-based preceptor and precepting rather than the academic administration of CBT programs. Most of the weaknesses are related to its age; it has been almost 4 years since the initial publication. More information has become available regarding precepting costs in both lost charges and time and on teaching efficiency and effectiveness that could supplement the section on teaching tips. The book could be expanded to address office-based teaching of medical students as well as residents. Members who volunteer to help with this project can select from several jobs, ranging from the actual writing or editing to serving as a reviewer. If you are interested in helping with this revision please contact Francine Martin or Patrick Alguire at 800-523-1546 #2615

Associates Corner

Steven Potts, DO, FACP

ACP-ASIM Associates Meeting
October 14, 1998
Chicago Historical Society

The theme for this Silver Anniversary Session was Alternative Medicine. The program opened with a discussion by Dr. Mark Micozzi illustrating the controversies surrounding Complimentary Medicine. His presentations was followed by small group presentations and a panel discussion. This year marked a record attendance with 428 Associates, Medical Students and Faculty participating in the day's events. All Illinois programs were represented. Our downstate colleagues proudly arrived by bus with a lot of enthusiasm.

Many thanks to the Loyola University Department of Medicine for helping make the 1998 Associates Meeting a success. Special thanks to Drs. Ann Dean, Dan Newton, Pat Towne, Jim Morgan, Mike Radzienda, Kevin Simpson, Leah Hopkins and the Department of Medicine Administrative Staff! Your hard work, creativity and enthusiasm helped to make our 25th year celebration the greatest!

1998 Clinical Vignette Winners

First Place
Judit Pulai, MD
Ravenswood Hospital and Medical Center
Report: A Case of a Normotensive Primary Aldosteronism Leading to Rhabdomyolysis

Second Place
Jennifer Moore, MD
Loyola University Medical Center
"An Enlarging Left Breast"

Third Place
Anil Bhogaraju MD
U. of Illinois College of Medicine at Urbana-Champaign
"Recurrent Neurological Deficits in an Elderly Woman with Diabetes"

Fourth Place
Fiona Gibbons, MD
University of Chicago
"Intoxicated in the Emerald City"

Council Of Associates

The goal of the Council of Associates is to help address the needs of the Associates in the state by improved communication and the development of new programs. If you are interested in joining us please contact Steve Potts at 312-567-6070 or Ann Dean at 708-763-1447.

Medical Schools & Community Hospital Programs

Loyola:

Ann Dean adean@luc.edu
Dan Dilling ddilling@luc.edu
Helena Wang hwang@luc.edu

Northwestern:

Dan Milton dmilton@nwu.edu
Jeremy Smith jsmith@nwu.edu

Associates needed from:Chicago Med, Rush, U. of Chicago, U. of Illinois, Christ, Cook County, Evanston, Illinois Masonic, Lutheran General, MacNeal, Mercy, Michael Reese, St. Francis, St. Joseph, Ravenswood, Weiss, West Suburban.

Medical Students Corner

Ray Curry, MD, FACP

Internal Medicine Interest Groups: Club Meds

Chicago Medical School:Ann Chen*
Loyola: Kevin Owen* kowen@luc.edu
Northwestern: Peter Tonui, ptonui@hotmail.com
U. of Chicago: Brian Gelbach
U. of Illinois: Ray Helms, Dave Dobesh, Tim Lewan,Hakan Tunca

The medical students at the six medical schools in the Chicago area are planning internal medicine club meetings to share their interests and to learn more about being an internist. If you would like to join them please let the leaders (see above) know how to contact you for their upcoming programs. There is the beginning of a National Council of Medical Students. This will be modeled after our National Council of Associates.

Resident and Fellow Career Counseling Program

The Departments of Education and Career Development and Advertising Services have created an online career counseling program. This program is valuable to residents as they prepare to enter the job market during their last year of training and to program directors who wish to create a career counseling curriculum for their trainees. The Career Counseling web page consists of a series of articles that addresses tasks that need to be completed during the last training year. The articles are presented on the time line at those points when the resident should be performing the task, or when the information is most likely to be useful in making career decisions.

Community Service
Serafino Garella, MD,FACP

The ACP has been at the forefront of all medical organizations in promoting a social change that would result in granting universal access to health care. We are still a long way from achieving that goal. However, one avenue to demonstrate our organization's commitment to providing care for the uninsured is to join one of the existing volunteer-based institutions whose main mission is to provide such care.

CommunityHealth is one such institution. Presently located at 1309 North Ashland and operated mainly by volunteers, it provides free service to those people in our community who have no other access to health care. In 1998, approximately 10.000 free visits were provided by CommunityHealth volunteers. Because of the increasing demand for health services, linked to the progressive tightening of access, CommunityHealth has recently decided to acquire a new and larger facility. We are in need of your help and support. If you are interested in helping in any capacity please call CommunityHealth at 773-395-9808 or call directly Dr. Garella at 847-723-7194. Working as a volunteer physician at CommunityHealth will remind you of the original reason why you wanted to be a healer in the first place.

Health Care Reform Committee
James Webster, MD, MACP

In its collaborative efforts to push for health care reform, the Illinois Ad Hoc Committee to Defend Health Care has had an active 18 months. A number of activities have furthered our mission, goals and objectives. We undertook a Health Care Summit where Dr. Arnold Relman talked about his vision for the health care system and Dr. Linda Peno gave us insights into her life as a former medical director in the for-profit system. Our petition drive to support the Bernardin Amendment has garnered over 11,000 signatures, predominately from patients. We would like to think that we had some minor role in having the Bernardin non-binding Amendment passed in Cook County with an approval rate of 83%. Thanks to Drs. Stuart Levin and Gordon Schiff, a monthly M & M conference on clinical quality and delivery is under study. We have arranged multiple presentations to physician and nursing groups over the past year and have delineated criteria for what we believe should be the important aspects for the reinvention of health care delivery. For 1999, our goals include developing a public partnership, an informational package about our organization, student recruitment and undertaking legal initiatives on behalf of patients. We would like to convene a broad-based working group to recommend specifics regarding there invention of health care as the for profit systems implode upon themselves and collapse. The latter event is happening and it is now incumbent on the medical establishment to provide leadership that will give true meaning to our slogan of "Patients Not Profits."

Political Action Committeee

The issue of whether or not the ACP-ASIM should form a Political Action Committee (PAC) is being hotly debated by the Board of Regents, Board of Governors, Health and Public Policy, and the Ethics and Human Rights Committee.

Potential Benefits: A PAC might serve to further the agenda of the medical profession and more specifically of internal medicine by providing an effective avenue for members to be politically active and enhance access to members of Congress, strengthen the Association's grassroots program and raise visibility of the Association and its issues.

Concerns: 1. The public may have an unfavorable perception of PACs and establishing an ACP-ASIM Service's PAC might tarnish the reputation of the College. 2. Conflicts of interest could arise in supporting political candidates who may advocate political issues not in line with those of the College. 3. Although a PAC bears the name of the organization, the number of members who contribute to the PAC may comprise only a small percentage of that organization. 4. What impact would a PAC have on membership?

Springfield Legislative Update
John Schneider, MD, FACP

A major legislative issue this year will be the patient's rights legislation. The Illinois State Medical Society, ISMS has reintroduced its Managed Care Patient Right Act. Some of the provisions follow: 1. New enrollees in HMOs should be able to receive ongoing treatment from previous providers outside of the plan network for at least 90 days to assure continuity of care. 2. Plan members when set up by their PCP should have standing referrals to plan specialists for ongoing care of complex medical needs such as malignancy, multiple sclerosis, rheumatoid arthritis. 3. Plans should not be able to deny care for emergency service under the "prudent layperson" standard. 4. Plans must have a quality assurance program and utilization review plan that meets national standards. 5. Patient must have clear understandable information about the plan. This would include coverage limitations, how the grievance process works and the limitations that they have for accessing physicians and hospitals.

Because of the increasing numbers of complaints about health care plans, the Illinois Attorney General's Office has established a hotline. The hotline accepts calls from physicians and patients. Complaints may relate to denial of care, often for reasons other than medical necessity such as lack of PCP approval, emergency care, and specialty access. Possible misleading marketing is one area for further investigation by the Bureau. This is one of the more common reasons for Medicaid and Medicare covered individuals disenrolling from a plan. Public statewide forums to increase awareness of this hotline and service are being held. The toll-free hotline number is 1-877-305-5145.

Some other items on the ISMS legislative agenda include:

1. Legislation to prevent denial of payment for medically necessary services solely because the patient or physician is unsuccessful in promptly notifying the payer. 2. Legislation to prohibit contracts with any incentives to deny, reduce, limit or delay care. 3. Proposal for payment of interest when payment is late for clean claims. 4. Prohibition on insurers requiring physicians from being required to participate in all of the company's plans in order to participate in one or more.

Mark Your Calendar

Illinois ACP-ASIM Regional Meeting
Fri-Sat October 8-9. 1999
The Lodge At Mc Donald's Office Campus
Hamburger University
Oak Brook, Illinois

Public Health Committee
Disease Prevention
John Scott, MD, FACP

The right thing to do or just more frustration?

In primary care medicine prevention is no longer a good idea, but a fact. It is part of our job description. Ultimately we are Doctors of priority setting and behaviors.

Your life-Your health-Your behavior-Your responsibility

Levels Of Prevention

  • Primary prevention; prevent the behavior before it starts-do not smoke or drink and drive
  • Secondary prevention; prevent the behavior after it has started but before it has done irreversible damage.
  • Tertiary prevention; prevent the behavior after it has done damage but before further damage or death.

Putting Prevention Into Practice

Identify the leading causes of death and those you can prevent

  • Heart attacks
  • Strokes
  • COPD
  • Pneumonia
  • Lung cancer
  • Breast cancer
  • Colon cancer
  • Prostate cancer
  • Diabetes
  • Cirrhosis
  • Motor
  • Vehicles
  • Suicide
  • Homicide
  • Fires
  • Poisoning
  • Falls
  • Domestic Violence

Identify Risk Factors and Chart

This can be done on the initial history/physical or a routine appointment. The key is to chart! Give the list to the patient.

Behavioral Modification

  • Discuss stages of change, empower and set realistic goals.
  • Remember Life is an Evolution not a Revolution.
  • Set your patient up to win.
  • Dr. Prochaska and Dr. Clemente's stages of behavioral change.

    Precontemplation-" doctor get off of my case, I don't want to hear about it." Advise to change behavior, offer information and state you are there. Do not waste time.

    Contemplation-" yes, I think I should change, but I'm not ready." Advise to change behavior, offer information and state you are there. Encourage, do not waste time!

    Action-"I am ready to make a change. What should I do? Help." Help them change their behavior. Make follow up appointment.

    Maintenance-staying off or on the old behavior until it becomes extinct and the new behavior becomes the norm. Make follow up and encourage

    Relapse-behavior change is like riding a bicycle, you must keep trying until you learn enough to get it right. Tell them it is a success to try and help them to learn it. Start over with modifications.

  • Mark Twain-" To cease smoking is the easiest thing I ever did; I ought to know because I've done it a thousand times."

Northern Illinois Advisory Committees

Health And Public Policy/ ACP-ASIM Position Papers:
Chair: Serafino Garella

Public Health:
Chairs: Lee Francis, Quentin Young
Domestic Violence: Carole Warshaw, John Scott
Disease Prevention: John Scott
Gun Violence: James Webster, Lee Francis

Health Care Reform:
Chairs: James Webster, Rolf Gunnar

Legislative Affairs:
Chair: John Schneider

Community Service:
Chairs: K. Neely, L. Francis, S. Garella, S. Erhlenbaum

Membership Enhancement:
Chair: Vesna Skul
African Americans: Wayne Williamson, Sonja Boone
Asian-Pacific: Manuel Claudio
Hispanic: Evelyn Diaz, Pedro Lopez
IMG: Ashutosh Gupta
Women: Janet Riddle

Associates:
Chair: Steven Potts
Chief Resident Training Course: Steven Potts
Job Fair: Michael Silver

Medical Students:
Chair: Ray Curry

Community Based Teaching:
Chairs: CA. Hedberg, Janet Riddle, J.Skosey

Ethics, Professionalism:
Chair: Rolf Gunnar

Resolutions:
Chair: Warren Furey

Newsletter:
Chairs: Nancy Furey, Carlotta Rinke

Web Page:
Chairs: Robert Kapicka, David Liebovitz

Awards:
Chairs: Warren Furey, Joan Mullan

Finance:
Chair: Rolf Gunnar

Mark Your Calander

Annual Meeting
Society Of General Internal Medicine
Career Paths In Internal Medicine
San Francisco, April 29-May 1, 1999

Congratulations

Our New Governor For Northern Illinois: Dr. Serafino Garella is our Governor elect and will take office in April 2000.

Our New Masters: Dr. Stephen Kurtides and Dr. James Webster.

Our New Regent: Dr. C. Anderson Hedberg

Dear Fellow Illinois ACP-ASIM Member:

Being given the opportunity to serve as President of our newly formed organization is the highest honor and greatest responsibility I can imagine. It is an honor because I profoundly respect the values and accomplishments of the American College of Physicians-American Society of Internal Medicine and I greatly admire the current and previous leaders of both these organizations.

The role of President brings with it tremendous responsibility because of the difficult and compelling issues facing the practice of internal medicine and the health of all Americans. To do this job, I will need the help of every member. Please feel free to contact me at any time. I may be reached by telephone at 312-942-3567, by fax at 312-666-5709 and by e-mail at waddingt@rush.edu.

I pledge you my very best.

Best wishes,

Whitney W. Addington, MD,FACP, President-elect, ACP-ASIM