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November 2011 Nancy A. Hasenfus, MD, FACP, ACP Governor

On Being Governor

Dr. Hasenfus

(Autumn -season of mists and mellow fruitfulness; close bosomed friend of the maturing sun- Keats)

Gait disorders, a penis update, and a remarkable view surrounded by nature and autumnal leaves gave us a memorable Maine Annual ACP meeting this year. It took place at Point Lookout, a lovely resort on a hill north of Camden. Point Lookout has hundreds of acres of grounds and trails, cozy and tasteful cabins and good food. The scientific program was outstanding. In the interest of space I will just comment on a few of the talks. Sal Mangione, our featured speaker, gave a two hour talk on gait disorder which held everyoneís attention. He made many of these gait disorders memorable by connecting them to famous personalities with video clips. He demonstrated that Pope John Paul was diagnosable as having Parkinsonís as early as 1991 by looking at his gait. The current Popeís gait demonstrates Marche a` Petit Pas which is a gait involving very small steps and an upright posture characteristic of aging. Several doctors told me this was probably the best educational lecture they had ever heard and definitely the best lecture on neurological gait problems.

As for the talk about the penis that Sal gave Sunday morning --- well you just had to be there.

Many excellent speakers were present. One of the highlights of the conference was the clinical vignettes given by residents Saturday morning. Myra Ross presented a case of a 24 year old Iraqi woman with severe liver disease which turned out to be celiac disease. Andrew Jones described an unusual case of postop hypoxia in a woman with a history of hepatitis C with cirrhosis. Her oxygenation was much worse sitting up than supine and she was eventually diagnosed as having hepatopulmonary syndrome. Karen Bascom presented a man with a numb chin and prostate problems who had a b-cell lymphoma found on biopsy and whose numb chin was due to a metastasis affecting a branch of the trigeminal nerve. The final case was by Curt Senita who described an uncommon complication of bacteremia . The patient had neck pain and was found to have a thyroid abscess. Our judges chose Karen Bascom to receive the award for the best presentation, a stipend of 1200$ to attend the National Meeting of the ACP held this year in New Orleans.

Friday afternoon during the reception 9 posters gave us all something to study and discuss. They were presented by: Mike Nielsen, Bethany Roy, Bert Hootsman, Christina de Matteo, Eric Mogyoros, Dwight Pringle, Jack Rusley, Leslie Fernow, and George Davis.

In all we had 75 attendees. We had more medical students attending the conference than in recent memory. We had 6 from both UNE and Tufts/ MMC. MMC residents were also well represented. There as a lot of discussion and interaction with each other and I believe our residents and students could sense the feeling of congeniality in our group. We are planning to have our chapter meeting at Point Lookout again next fall on September 14-16 2012. I hope you can be there.


Ideas about Ways to Decrease the Cost of Healthcare in America

October 23, 2011

To stimulate discussion at the Town Meeting I passed out a questionnaire asking people to list three ways to decrease the cost of healthcare in America since we are currently spending almost 18% of our gross national product on medical care.

8 people responded and there were some very interesting ideas. Unfortunately we did not have time to discuss them at the town meeting and so I am listing them here.

    Member #1:
  1. 20% of healthcare is spent on nonhealthcare administrative costs so I would continue to advocate for a national health service.
  2. Reducing variations in care across specialities (subspecialities) for example screening ultrasounds.
  3. Invest in primary care.
  4. Outlaw tobacco products
    Member #2:
  1. Provide coverage for everyone
  2. Develop a consensus about what is to be paid for and what is optional and not paid for under a basic health plan
  3. Separate coverage for experimental therapies from standard coverage
    Member #3:
  1. Adopt the Alaskan Native Health Center Model
  2. Get rid of RVUís and the SGR in favor of a nonproductivity model
  3. Medicine needs to use less of a business model
    Member #4:
  1. PCP/Primary care based system which means more PCPs and fewer subspecialists
    • Reward PCPs
    • Support training of PCPs
    • Support med students who choose to become PCPs
  2. Better end of life planning
    • Better support of PCPs
    • Better support of palliative care
  3. Access to primary care for all
    • Support PCPs (as above)
    • Healthcare coverage for all
    Member #5:
  1. Gain a better understanding of the need and frequency for follow-up and laboratory monitoring
  2. Work towards a more defined accountability of roles and shared care
  3. Work toward more integration with community resources
    Member #6:
  1. Single payer healthcare
  2. Increase ratio of primary care docs to specialists
  3. Eliminate direct to consumer advertising
  4. Increase government control over pharmaceutical pricing
    Member #7:
  1. National single payer system
  2. Nonpolitical careful evidence based process to decide whether treatments are FDA approved, with cost a part of the consideration
  3. National Medicare formulary with governmental power to negotiate with pharmaceutical companies for competitive pricing
    Member #8:
  1. Put a surgeon generalís warning on servings of French fries and limit all servings of soda to 8 ounces
  2. Make health records available on a universal electronic record to minimize repeat testing
  3. Create a reliable source of information that would fully address issues that might otherwise end up with expensive or inappropriate interventions (treatment of URIís without antibiotics, limited benefit of coronary interventions, use of PSA, etc)


Call for Resolutions

Please send me any resolutions that you are interested in submitting to the National ACP. I will take them to the next Governor's Advisory Council (GAC) and see if the chapter can support them. I truly believe that resolutions are the backbone and the life blood of the ACP and they are why it is such an outstanding organization.


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Contact Information

Maine Chapter Governor:
John E Erickson, MD, FACP

Chapter Staff:
Warene Chase-Eldridge
Chapter Coordinator
10835 Ani Circle
Estero, FL 33928
Phone: 207-215-7118
Email: MaineChapterACP@gmail.com