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June 2012 Alan D. Forker, MD, MACP, Governor

Message from the Governor

Dr. Fleming

Hello to all physicians in Missouri, but especially to the 2,400 Members, Fellows, and Masters of the Missouri Chapter, ACP. If I didn’t see you at the Annual ACP Meeting, New Orleans, April 18-21, 2012, I’m sorry I missed you. It was a “whale” of an Annual Meeting. If you didn’t attend, let me tell you some highlights that will show how much you missed.

First, I want to congratulate the 46 new ACP Fellows, from Missouri listed in the Thursday Convocation program. The sad part is only four showed up to walk in the procession into the auditorium with me, your Governor. I remember when I did this is a new Fellow in 1973—what a high! “I am now a Fellow of the American College of Physicians, an organization that stands for excellence in all aspects of medicine.” Almost 40 years later now, I got the same high as I walked in with the four new Missouri Fellows.

And especially we all need to congratulate Dr. Aubrey Morrison, Professor of Medicine, Washington University, for his election to not only Mastership, but also the winner of the ACP Award for Science. Dr Morrison’s research is credited with providing the seminal insight into the role of cyclooxygenases and prostaglandins in hypertension and kidney failure. CONGRATULATIONS, AUBREY.

That same evening we had an enjoyable Missouri Chapter reception, including fabulous food. One new FACP, Dr. Steve Halpin from Hannibal, and I discussed how we could recruit more members into ACP, plus how many of his partners were eligible for FACP, who like Steve had never gotten around to completing the application. How many of your partners are eligible and are not FACPs? That is a challenge to me and all of you to re-energize our recruiting efforts.

I just have to point out Dr. David Bronson’s editorial in the May issue of ACP Internist. David is our new ACP President. “For me, the strongest reason to be a member of ACP is we care about the profession and its future, and we want to make a difference.” If you are not involved with ACP, you will “miss the opportunity to work closely with like-minded physicians who share a passion for the betterment of our profession and improved patient care.” Thank you, David, for summarizing why I have volunteered my time over the past 39 years for ACP.

At the reception Dr. David Fleming and I had an additional pleasure meeting five female medical students from Washington University. How many other schools have sent that many medical students to the annual meeting? Of course, they do have an unbelievable mentor in Elizabeth Davlantes, one of their/our own, who was Chair of the national Student Committee this past year.

Elizabeth has taken a year off from Wash U to do a legislative internship with a senator in her home state of Florida. We are so proud of her, a state and national leader, a role model for involvement in advocacy at this early stage in her career. If we are to impact the decision process at the Capitol in both Jefferson City and Washington DC, we have to try harder, not with personal biases, but with unbiased data, such as provided by our Washington DC ACP office, led by Bob Doherty. And this leads me to say I hope to see you at a future ACP Leadership Day in Washington DC. This year it was June 6-7, 2012.

Think it is beneath you to be involved in the political process? That is what I used to think before I was involved in Leadership Day. You have to experience it to believe it, plus walk around the Capitol and feel all that history of the United States. As a reminder, nicely discussed by Dr. Greg Hood, ACP Governor from Kentucky, in the recent The Capital Key from ACP Services: “You may still feel that physicians should not be involved in politics.” Remember the name of “Dr. Benjamin Rush, the only physician to sign the Declaration of Independence, who was also a member of the first Continental Congress.” Now that’s a role model of over 200 years ago.

The IM12 Annual Scientific Program included all fields of internal medicine, including multiple opportunities to meet in small group sessions with an expert. Plus, for those of you, like me, who were looking for something beyond just science, but a mind-opening/broadening experience, I found Dr. Mimi Guarneri, FACC, a former interventional cardiologist, who is now head of Integrative Medicine at the Scripps Clinic in San Diego. Discussing her personal journey and awakening into a wider scope of healing was heart opening, especially with an emphasis on meditation. Now is a time for confession: my wife, Susie, and I spent a week with Dr. Deepak Chopra in a meditation retreat several years ago. How many of you can say you have done nothing but sit still and meditate for up to two hours a day ? I didn’t think it was possible for the ‘ol Fork’ to do that, but I did it, and never felt better in my whole life. Wish I had learned this technique in my 30s! Now, I try to meditate about 20 minutes daily, which is enough to keep me centered most days. Try it—you will be surprised how easy and rewarding it is. Or do meditation in motion—Tai chi, which is also totally relaxing. But maybe you don’t have any emotional stress in your life and don’t need it?

And I can’t fail to mention Dr. Jock Murray, MACP, a Professor of Medicine from Dalhousie University, Halifax, Nova Scotia, who gave a life enhancing lecture entitled “The History of Medicine Through 100 Great Works of Art.” Talk about an emotional, stress-relieving experience--it almost made me cry to see those paintings and the emotion I felt, plus the electricity I felt with the 1500 other attendees. A standing ovation followed. Now see what you missed!

Two new ACP position papers were announced in April, 2012: Reforming Medicare in the Age of Deficit Reduction and Strengthening the Public Health Infrastructure. The 2nd topic is pertinent to Missouri after the Joplin tornado, i.e. the public and professional response. How ready are we nationwide to respond in an organized manner to such tragedies? How many of our safety net clinics are in jeopardy of losing funding and closing with the proposed budget cuts? Worth your time reading.

And that reminds me: how many of you have ever visited the ACP Web site? If not, there are six headings across the top you can sample: Clinical information, Running a Practice, Education and Recertification, Residents and Fellows, Medical Students, and Patients and Families. Loaded with good information., including the expanded, remodeled Medical Home Builder (re: Patient Centered Medical Home and application to your practice); new PQRIwizard, a Web-based registry designed to help collect and report quality measures for the Centers for Medicare & Medicaid Services PQRS incentive payment program; the free AmericanEHR Partners Program for EHR product ratings and readiness tools; and announcement of the new edition MKSAP 16, first part A available July 31, 2012; part B on December 31, 2012 with the digital edition available January 31, 2013.

ACP just launched ACP JournalWise in April, 2012. It replaces ACP Journal Club Plus. For those who don’t use it, I look at it daily, since it provides updates from over 120 journals, and can be transmitted to your computer, also to your smart phone and tablet. And can you believe it—it is free (well, OK, it is part of your annual membership dues).

Have you ordered any of the ACP Foundation free patient information pamphlets? If not, you’re missing very timely, easily readable, accurate information for your waiting room, such as the most recent one on atrial fibrillation, especially as related to stroke. Patients like them.

Finally, the ACP support for High Value Cost Conscious Care (HVCCC) is rapidly gaining momentum, both in the medical literature, especially the Annals of Internal Medicine, but also the lay press with a new collaboration with Consumer Reports. The leading editorial by Drs. Cassel and Guest in May 2, 2012 edition of JAMA is entitled “Choosing Wisely: Helping Physicians and Patients Make Smart Decisions About Their Care,” is worthy of emphasis since nine medical organizations, including ACP, have now created a partnership to educate patients, and try to raise the consciousness of physicians for the need to examine more closely why we are ordering specific, especially more expensive tests. Are they really needed? Will the results change the treatment of this patient? Can we be better stewards of medical resources? Can we change the paradigm/culture of medicine from volume to value?

Yes, we definitely need to consider the needs of each individual patient; but we also need to think as part of a team, a nationwide/worldwide team of physicians with renewed concern over total population health and resources at risk. It is up to us, my friends. Not the time to say, “doesn’t affect me, so I will ignore it.” Lets “dig our heels” in to home plate and not strike out, but punch out some good solid singles and even doubles (that’s baseball talk for you non-baseball fans). If we hit an occasional home run, whoopee, let’s enjoy it, but don’t expect one every day or week. Our profession is depending on us not to give up, but try, try, and try again to do our best, and you are the best. Join us in our renewed passion for the future of internal medicine and ACP. Good Luck.

Alan Forker, MD, MACP


ACP Leadership Day

Pictured in Washington DC on June 7 are Frank Xing – UMKC School of Medicine; Peggy Barjenbruch, MD, FACP – Mexico – Chair of HPPC; Alan Forker, MD, MACP - Governor; and Ruchi Bhatia, MD – SLU IM Program.


Missouri Hospitalists News

Robert Folzenlogen, MD of Columbia has published a Missouri Hospitalist newsletter for the past few years. Sadly the June issue was the final edition. Thank you Dr. Folzenlogen for your time and contributions.

The Missouri Chapter meeting will have topics of interest to hospitalists and non-hospitalists on Saturday, September 15. In addition to CME lectures, there will be a panel discussion on transition of care. In the afternoon there will be a non-CME session discussing administrative issues in this new profession.


Congratulations to New Fellows and New Master

Shakeel Ahmed, MBBS, FACP
John F. DiPersio, MD, FACP
Tarek M. El-Achkar, MD, FACP
Robert J. Ellis, MD, FACP
Morey Gardner, MD, FACP
Mark W. Greenwell, MD, FACP
Vinay G. Kamat, MD, FACP
Wilson P. Pais, MD, MBA, FACP
New Master: Aubrey R. Morrison, MD, MACP


Web Sites for Physicians



Missouri Chapter Web Site

The Chapter has developed a new Web site: www.missouriacp.org. Let us know what you want posted and watch it grow.



Updates in Internal Medicine – 22.25 hours of CME
September 13 – 16, 2012 at Tan Tar A

  1. ABIM SEP Module – Hospital Based 2012 Update (83-M) - Kyle Moylan, MD, FACP and Kevin Clary, MD
  2. ABIM SEP Module- Internal Medicine 2012 Update (C0-M) - Melvin Blanchard, MD, FACP and Ernie-Paul Barrette, MD, FACP
  3. Making Sense of Medical Homes, ACOs and Meaningful Use – Michael Barr, MD, MBA, FACP
  4. Pneumonia Guidelines - William Roland, MD, FACP
  5. The Use of Biomarkers in Diagnosing Dementia - David B. Carr, MD
  6. The Adventure of Domestic Volunteer Medicine - Bridget McCandless, MD
  7. Non-Alcoholic Fatty Liver Disease, recent updates and current management - Ghassan M. Hammond, MD, MPH
  8. Management of Acute Low Back Pain - Thomas M. De Fer, MD, FACP
  9. Chapter Business Meeting & Town Hall
  10. Doctors Dilemma™
  11. DNR-Time to Resusciate the Code Blue Discussion - Richard E. Butin, MD
  12. Stress Cardiomyopathy-An update on Broken Heart Syndrome-Kevin Bybee, MD
  13. Management of Pressure Ulcers - David R. Thomas, MD, FACP, AGSF, GSAF
  14. Vascular Embolization by Interventional Radiology. Clinical applications: Present and Future - Nasir H. Siddiqi, MD
  15. Hospitalist Lunch: Transitions of Care: From the Office to the Hospital and Back - James Duff, MD; Marc Merbaum, MD; James T. Rogers, MD, FACP; and Stephen Wen, MD
  16. Open Forum on Hospitalist Issues (No CME) - Andrew Evans, MD, FACP
  17. Workshop 1-Diabetes Management - David W. Gardner, MD, FACE
  18. Workshop 2-EKG Reading - Richard B. Whiting, MD, MACP, FACC
  19. ABIM SEP Module – Hospital Based 2012 Update (83-M) - Kyle Moylan, MD, FACP and Kevin Clary, MD (repeat of Sept 13 talk)
  20. Everything You Need to Know About Headache, but Were Afraid to Ask - Richard Sohn, MD
  21. Thyroid Disorders: Too Hot, Too Cold or Just Right? Uzma Khan, MD
  22. Management of Dementia-Use of Medications and Non-pharmacologic Management - John Morley, MB, B.Ch.
  23. RA versus OA: Diagnosis and Treatment - Anne Winkler, MD, PhD, MACP
  24. Fellowship Tutorial
  25. IMG Meeting
  26. Poster Contest


Doctors Dilemma™

Internal medicine training programs will again compete against each other in this quiz bowl format during our chapter meeting. The winner will be entered in the IM 13 competition in San Francisco. Last year’s winner, MU Internal Medicine, competed at IM 12 in New Orleans.



The Chapter will host a poster contest for Associate members and Student members on Friday, September 14. Details are available at our new Web site: www.missouriacp.org.


Leadership Day

Submitted by: Nathan Moore, Washington Univ. School of Medicine

This was my second time at Leadership Day and I thought it was even better than last year. It was really great to hear directly from the leaders of the government health agencies that are developing new payment structures and health care delivery systems; even better, the staff at ACP prepared us to take that information and discuss it with our representatives. One of the congressmen we spoke to wasn't familiar with value based purchasing but after a short discussion seemed to really come around to the idea and see the potential benefits. If you consider the 300+ congressional visits by ACP physicians and students on Leadership Day, I hope and think we made a positive difference in the development of sensible health policy for this upcoming year.



Richard W. Burns, MD, FACP will be recognized as the Laureate Award winner by the Missouri Chapter of the ACP during the annual meeting in September. Dr. Burns has served on the Council and as the Education Committee Chair for four years.



Many if not most physicians find a way to volunteer their services both locally and internationally. The following are a few examples of some of the good work that is being done close to home. If you have a story to share, please e-mail it to pmills@msma.org and we will publish it in the next newsletter.

Shared Care Free Clinic - Independence

Submitted by: Bridget McCandless, MD, MBA, FACP
The Shared Care Free Clinic serves low-income, uninsured adults who have chronic medical illnesses. The Clinic is located in Independence, MO but serves patients from several surrounding counties. Patients are treated for diseases like diabetes, hypertension, depression, asthma and COPD. The clinic is able to provide medications, lab services, vaccinations, diabetes supplies, disease education and primary care. Care is provided by volunteer physicians and other health care providers. More information is available at sharedcarefree.org.

Casa de Salud

Submitted by: William M. Fogarty, Jr., MD, FACP
In 2009, a volunteer clinic for immigrants, La Clinica closed because of funding issues. Father Biondi, President of St. Louis University, graciously offered a building on the medical campus, paid for its renovation and leased it to the new Casa de Salud for $1 per year. With that support and the leadership of many civic and medical leaders the clinic opened in January 2010.

Since that time, it has grown in size and now serves almost 200 patients per week and has the services of more than 25 volunteer physicians, many nurses, social workers, mental health professionals, dieticians and translators. Many of the translators are undergraduate students from Saint Louis and Washington Universities. Medical students from those universities also rotate through.

The role of Casa is to serve the immigrant and indigent communities, especially Hispanics, and to integrate them into community medical services. Care for episodic and acute illness is emphasized and referrals are made for long term care whenever possible. Counseling for mental health, diet, smoking cessation and social service needs is offered.

The need for free/low cost services is huge and growing. It is a pleasure to serve the immigrants who are so important to our communities. I urge anyone who is able to consider volunteering. You will be richly rewarded. casadesaludstl.org

Kansas City Free Health Clinic

The Kansas City Free Health Clinic is one of the oldest and largest free clinics in the nation. Since the founding in 1971, the Kansas City Free Health Clinic has responded to the changing needs of the community, providing free-of-charge multi-faceted health care, wellness, prevention and supportive services for uninsured and underinsured adults. Clinical services are adult general medicine, HIV primary care, oral health care and behavioral health services.

The Clinic’s services are made possible by a team of more than 1200 volunteers working in partnership with just over 100 paid staff. Missouri-licensed professionals are continually needed to provide care for KC Free Health Clinic patients. Interested volunteers can access an application on the Clinic’s Web site, www.kcfree.org.


Helping to keep the "medical" in medical learning

Physicians learning from their peers helps to ensure healthcare quality. Comprehensive and impartial reviews of medical cases by physicians -- as opposed to non-medical professionals -- works for safer patients and healthier Missourians. By joining the physician-reviewer team at Primaris, the Medicare Quality Improvement Organization for the state, physicians can join this effort.

All reviewing - and training for reviewing - can be done remotely, from the comfort of your home or office. Physician reviewers are paid and covered by Primaris' liability insurance. To get started, contact Primaris Medical Director Sharon Hoffarth, MD, MPH, FACPM, at shoffarth@primaris.org or 800-735-6776 ext. 170.