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November 2012 Nancy A. Hasenfus, MD, FACP, ACP Governor


From the Governor

Dr. Hasenfus
Maine Annual Chapter Meeting

We had the Annual Chapter Meeting of the Maine ACP at Point Lookout September 14th through the 16th. Point Lookout is a lovely location near Camden on a hill overlooking the ocean. The first speaker of Friday afternoon was Dr. Rines who spoke about Leadership Day. This is one of the most important events of the ACP year. Dr. Rines, Dr. Currie, Dr. DeMatteo and a med student Rebecca Dyer met with Representative Chellie Pingree, Senator Susan Collins and Representative Mike Michaud to discuss ACP issues including getting rid of the sustainable growth rate and ensuring an adequate supply of internal medicine physicians. This was followed by Gordon Smith, the CEO of the Maine Medical Association, who gave a legislative update. He emphasized the new program put forth by Mainecare to control narcotic prescriptions. He explained how it evolved and what will happen when it is instituted. He explained that Maine has the highest rate of prescription narcotic drug abuse in the country.

The rest of the afternoon dealt with issues of PET scanning and the immense complexity of chemotherapy. This was followed by an informal cocktail hour with three excellent posters.

The Saturday morning session started with the residentsí Clinical Vignettes. These are diagnostic dilemmas that the residents present and then question the audience. They are always fascinating and this year they really outdid themselves. Dr. DeMatteo spoke about the Takotsubo syndrome (broken heart) and the association with SAM (systolic anterior motion) of the mitral valve causing outflow problems. Next Dr. Desmarais gave a case of a man with a painful right arm . There was no sign of infection and blood clots were ruled out. The diagnosis was eventually arrived at through a MRI showing diabetic ischemic muscle. Dr. Andrew Romanowsky presented a case of Crohnís disease with abscess which originally seemed to have been misdiagnosed. The workup was described in detail and eventually it became clear that it was Crohnís with an unusual type of abscess. The last case presented by Elizabeth Herrle was the case of a woman who felt slightly short of breath and turned out to have a massive pericardial effusion causing tamponade. The pericardial effusion tamponade was the result of severe hypothyroidism. Dr. Elizabeth Herrle was the vignette winner and will present her cast at IM2013.

Following this was a panel discussion by Dr. Evans, Dr. Meisfeldt, and Dr. Woloshin regarding the value of cancer screening and how best to go about it. This panel responded to questions from the audience concerning lung cancer screening and the new recommendations for prostate screening and the whole PSA controversy. In the abstract everyone doubted how much good we achieve with all this screening but when it came down to specific cases it was clear that decisions are much harder.

The evening banquet was well attended and very animated. It was in a gorgeous dining room overlooking the ocean and islands. Dr. James Van Kirk was honored as the Laureate. Dr. Van Kirk told attendees that the ACP has been integral to his practice of medicine since his residency. Dr. Van Kirk reminded everyone what his parents taught him: Be Proud, Be Thankful, Serve.

Dr. John Tooker gave the Leonard Keilson, MD, FACP Memorial Presentation about Civil War medicine. He focused on the Battle of Antietam and we learned interesting facts such as there were only a few hundred surgeons at the beginning of the Civil War and this increased to 10,000 by the end. The Civil War was also when ambulances corps were invented. Prior to that wounded soldiers just died on the battlefields or were pulled off by friends with no place to take them. In the question and answer section many other facts emerged such as the main treatment for rifle wounds to the limbs was amputation. Surgeons focused on gunshot wounds to the extremities because this was what they were able to treat. They essentially did no abdominal or chest surgery since patients did not survive such surgery. Occasionally they would operate on a brain without much success. There was very little antiseptic technique during the Civil War but there was Morphine and Chloroform although in the major battles the surgeons ran out of supplies very quickly. The whole audience was enthralled by this lecture and asked many questions.

Sunday morning broke with a beautiful day. Once again there was a gorgeous view of the ocean from the conference room. John Tooker led the town meeting and told us about the politics behind the Affordable Care Act. He pointed out that it most likely will stand unless a Republican president and a Republican Senate are both elected. If itís just one or the other they wonít be able to destroy it. Dr. Tookerís talk was followed by Dr. Medd speaking about medical malpractice cases from his work with Medical Mutual Insurance Company of Maine. Interestingly, he says that most cases they see are either systemís problems or thinking issues. In the latter case the doctors donít think through the case enough. He says heís never seen a case where a doctor got sued for missing a very obscure diagnosis. Itís more that they didnít pay attention to the clues or that they did not rethink the problem when the preliminary diagnosis did not fit the evolving course of the disease.

Following the break there were talks about how statistics are used to make us think that cancer screening is much more effective than it is. It can often look like screening is saving lives when it is not decreasing the mortality at all because cancer is discovered at an earlier stage. Also some cancers are not lethal if undiscovered. Dr. Tracy Weisberg followed with an impassioned talk about how to take care of the long-term cancer survivor and how these patients suffer.

All in all the weekend was fascinating and intellectual. It involved a discussion of the big concepts. The usual way we view preventive medicine was challenged strongly by Drs. Steven Woloshin and Lisa Schwartz. Interestingly, during the panel discussion Saturday morning it was clear that the oncologists had all thought of and appreciated such issues as well and also were not convinced that screening recommendations as currently promulgated are helpful. It was a weekend of big ideas, controversy, discussion, history and beautiful views. The camaraderie was palpable. I hope to see you at the Chapter meeting next year.

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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 Governorís Advisory Council (GAC) and see if the chapter can support them. I truly believe that resolutions are the backbone and the strength of the ACP and why it is such an outstanding clinician driven organization.

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Board of Governors (BOG) Meeting

At the BOG meeting in September, 5-6 resolutions were accepted. One of these resolutions came from the Maine Chapter. It was a resolution to fight the acceptance of ICD-10 codes which are due to become effective in October of 2014. It asks the ACP to try to get the government to wait for the more modern ICD-11 codes that should be ready in 2015.

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Awards

The Maine Chapter would like to present a Chapter Volunteerism and Community Service Award and a Laureate Award at the 2013 Chapter Meeting. We are requesting nominees for the awards. Below are descriptions/criteriaís for the awards. Please review and submit a nominee for either or both awards. If your nominee is selected we may contact you for additional information. If you have questions please contact Roger Renfrew, MD, FACP, Awards Chair (rrenfrew@rfgh.net) or Warene Eldridge, Executive Director (warene54@yahoo.com).

Chapter Volunteerism and Community Service Award

Award Description

The Chapter Volunteerism and Community Service Award was developed by the ACPís Chapters' Subcommittee to recognize the work of members who are involved in volunteerism and community service activities. This award also enables chapters to raise the level of awareness and promote dialogue and action in volunteerism within their regions. Volunteerism, like a commitment to continuing education, is an established tradition for internists.

Eligibility

The following criteria must be met:

  • Nominees must be Masters, Fellows, Members, or Associates of ACP and must have provided volunteer service post-training. Self-nominations are not permitted.
  • The services must have been performed on a voluntary basis and not required for the completion of teaching, training, or position requirements.
  • Volunteer work must have been done as a physician and be medically related.

Nominations

Materials to consider in the selection process include the following:

  • Brief biographical sketch and contact information
  • Detailed description of the program or activity for which the person is being nominated
  • Description of the impact the program or activity has had on the target group or general community
  • Letters of support, which may strengthen the nomination
Laureate Award

Award Description

The Laureate Award honors those Fellows and Masters or the American College of Physicians who have demonstrated by their example and conduct an abiding commitment to excellence in medical care, education or research and in service to their community, their Chapter and the American College of Physicians.

Awardees generally are senior physicians who have been Fellows for at least 15 to 20 years, with a long history of excellence and peer approval in the specialty of Internal Medicine. Additionally they should have served their chapter with distinction or in some clearly definable manner. Exceptional circumstances may modify these requirements.

The Maine chapter is pleased to honor Fellows and Masters who have been long-standing and loyal supporters of the American College of Physicians, have rendered distinguished service to the Chapter, and have upheld the high ideals and professional standards for which the American College of Physicians is known.

Nominations should be sent to Roger Renfrew, MD, FACP, Awards Chair or Warene Eldridge, Executive Director.

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Photo Gallery

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Enjoying free time at Chapter Meeting

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James VanKirk, MD, FACP receiving Laureate Award from Dr. Allan Currie

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Panel discussants

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Dr. Douglas Couper (Program Chair) giving introductions

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Dr. William Medd

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Moose enjoying the poster session

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Dr. Elizabeth Herrle, Clinical Vignette Winner

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John Tooker, MD, MACP giving the Leonard Keilson, MD, FACP Memorial Presentation

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Attendees enjoying the poster session

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Announcements

Governor-Elect

The ACP - Maine Chapter is pleased to announce John E. Erickson, MD, FACP has been elected as Governor-Elect. Dr. Erickson will be the Governor-Elect for a year prior to being the Governor. Dr. Erickson will become the Governor in 2014

Dr. Erickson completed his residency at Strong Memorial Hospital in Rochester, NY. He also spent seven years in New York with National Health Service Corps. He currently practices at Intermed in Portland. In addition to caring for patients at Maine Medical Center he has been a Teaching Attending for residents at MMC for more than 20 years and has been Associate Program Director in the Department of Medicine for the last few years.

Dr. Erickson was a member of the Governorís Advisory Committee from 1997 to 2002. He was the Chair of the Program Committee in 1997 and a member of the committee in 2004.

Congratulations to Dr. Erickson.

Maine House of Representative

Congratulations to Jane Pringle, MD for her election as the Representative for Maine House District 11, Windham.

Dr. Pringle is the Chair of the Maine Chapter Health and Public Policy Committee.

Maine Chapter Governorís Advisory Council

We welcome Dr. Daniel Meyer to the GAC. Dr. Meyer is an Assistant Professor, Department of Medicine, MMC, Tufts University School of Medicine. Dr. Meyer is also a Hospitalist for Maine Hospitalist Service.

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Save the Date

2013 Maine Annual Chapter Meeting
September 27 Ė 29, 2013
Atlantic Oceanside
119 Eden Street
Bar Harbor, ME

barharbormainehotel.com

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Contact Information

Maine Chapter Governor:
Nancy A. Hasenfus, MD, FACP

Chapter Staff:
Warene Chase-Eldridge
Chapter Coordinator
10835 Ani Circle
Estero, FL 33928
Phone: 207-215-7118
Email: warene54@yahoo.com