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Governor's Newsletter, Summer 2000

Chapter Meeting

Mark Your Calendar for the 2000 Missouri Chapter ACP-ASIM Meeting - September 22-24, 2000, at Marriott's Tan Tar A in Osage Beach. Some of the highlights include:

  • Infectious Disease Updates
  • 11.5 Category 1 CME Credits
  • Chapter Business Meeting
  • Women's Health Updates
  • Fellowship Advancement Workshop
  • College Update
  • Managing Stress Update
  • Associates Poster Contest
  • Casual Attire

The complete program is available at http://www.acp-asim-missouri.org/meetings/acm.htm, or in the registration booklet that was mailed in July. You may also get a registration form online, or fax a request to (573) 636-8552. See you there.

Missouri Poster Captures First Place

Karan Singh, MD, of the University of Missouri - Columbia, won first place at the College Poster Competition in Philadelphia. Dr Singh received an all-expense paid trip to the competition by placing first in the Clinical Vignette poster competition at the 1999 Missouri Chapter meeting. His poster may be seen at http://www.acponline.org/chapters/mo/99abstracts/41-c31.htm.

Hatim Hassan, MD, of Saint Louis University, also participated in the College Poster Competition by placing first in the Research category at the 1999 Missouri Chapter meeting. His poster may be seen at http://www.acponline.org/chapters/mo/99abstracts/22-r6.htm.

All of the 1999 posters are viewable at http://www.acponline.org/chapters/mo/99abstracts/.

Current year entrants may enter online at http://www.acp-asim-missouri.org/posters/flyer.htm. Watch this same site for a link to view the current year entrants before the Fall Meeting. Best of luck to the Associates in this year's competition, which will be held Friday, September 22, 2000, at 5:15 p.m. at Tan Tar A.

The Missouri Chapter is the lucky recipient of a great deal of work that went into building our website by our Chapter web experts - Steve Atwood, MD, FACP and Terry Nye, MD, both of Springfield. Thanks.

Internal Medicine Interest Group

At St. Louis University School of Medicine, an Internal Medicine Club was organized in 1994. The group is now called the Internal Medicine Interest Group. It was developed to increase awareness among students about internal medicine and its subspecialties and to attract them to a career in this area.

Active student participation has been an essential component of the group since inception. Each year two second year medical students coordinate activities with a faculty advisor. A student organization fair during orientation week lets incoming students know about the interest group and provides an opportunity to invite them to the first meeting of the year.

The meetings, scheduled over a lunch hour, bring faculty, community practitioners and students together in a collegial atmosphere. The student coordinators invite speakers and post notices and sign-up sheets for lunch that is provided by the Internal Medicine residency program. Typically 50 to 100 students attend. Speakers have included educators, deans, internist-pediatricians, family practitioners and representatives of ACP-ASIM. Other speakers have discussed managed care, cardiology and gastroenterology procedures, stress management and medical education. A highlight of each year is the session at which ACP-ASIM summer externs report back to the group on their summer activities. This has stimulated a great deal of interest in the externship program. More than 20 students each year apply for the 5 funded positions. The last meeting of each year is a panel discussion with an upper level resident, a first year resident, a fourth year student and a third year student (usually one of the previous interest group coordinators.) This group discusses daily life in the hospital on rounds, on call and with patients.

Internal Medicine Interest Groups can offer students an opportunity to expand their knowledge of internal medicine, to meet faculty and community mentors and to learn more about ACP-ASIM membership and activities.

The Meaning of Fellowship

Source: ACP-ASIM Credentials Subcommittee

Fellowship in the College is an honor. It is a mark of esteem from colleagues who recognize accomplishments and achievements over and above the practice of medicine.

A physician's achievements and accomplishments could be limited by the area where he or she practices, and by the available resources. The most important considerations for Fellowship are excellence and contributions made to both medicine and to the broader community in which the internist lives and practices.

Candidates for Fellowship should be recognized for exemplifying in their professional lives the Mission and Goals of the American College of Physicians-American Society of Internal Medicine. The items listed below are considered important in indicating that individuals are ready for advancement:

  • Upholding and practicing the highest clinical standards and ethical ideals.
  • Providing leadership at the community, regional, or national level in matters relating to health, citizenship, and social improvement.
  • Providing education and information to others, including students, residents, fellows in training, other practicing Physicians, or allied health professionals.
  • Advocating responsible positions in health and public policy through work on committees, in hospitals, in other medical societies, and in the community.
  • Providing voluntary medical care and working on community service projects related to medicine, or in a broader arena.
  • Serving on hospital and medical school committees that serve the professional needs of the membership and advance internal medicine as a career.
  • Doing research in science and medicine, in enhancing the quality, of practice, education, and continuing education of internists; in attractiveness of internal medicine to physicians and the public; and in scholarly activities in medicine.
  • Keeping up-to-date in continuing medical education.
  • Participating in ACP-ASIM activities.

Volunteerism

One of the fairly recent areas of emphasis for the College is volunteerism. This is a concept that I personally have found very rewarding, and I know many of you have, as well. I was offered an opportunity to help set up a medical clinic in an under-served area within the city of St. Louis. That was a very good experience, primarily, with the realization that a lot of good, particularly in the area of preventive care, could come out from a relatively minor amount of effort. That particular clinic grew and became popular enough that it ultimately was taken over by a larger ambulatory facility, so that it continues to serve that particular population.

I was subsequently approached to do the same thing again, in this case, to help initiate a clinic service for the large number of Vietnamese who have immigrated to the St. Louis area. Because of language barriers and their reticence to become involved with regulatory bodies, our medical community was overlooking them. With the help of several volunteers, we started the Vietnamese Health Center in South St. Louis. This gradually increased in its size, and took on a fair number of Vietnamese to serve as volunteers. Eventually, through the help of Catholic Charities in St. Louis, we were able to submit grants to several organizations for the support needed to hire and maintain a full time community nurse. This clinic has now become self-sufficient, and continues to serve the Vietnamese community. This particular activity was unique in that the clinic served as access to health care by identifying existing other clinic facilities and practicing physicians who where willing to accept these patients into a continued care program, as long as a method of interpretation was also involved.

Thus, within St. Louis, two very different clinical facilities were started from nothing, and built up to provide a level of ongoing care in each case, to an under-served group. Once again, I was struck by the feeling that what we did was of real value, and was also very much appreciated by the patients. I have often thought that I am incredibly fortunate in what God has given me, and it seems appropriate to give something back. I know many physicians within Missouri that share similar feelings. There is a vast variety of need within Missouri for all forms of health related volunteer work. Many of you already do this in the form of actual care, educational efforts, sitting on various boards, and similar groups to aid in long-term care, or preventative management, etc.

The College has recently put together a booklet that highlights physicians as volunteers. Anyone interested could receive a copy by calling 800-523-1546. In addition, ACP-ASIM has created a national award for volunteerism and community service - Oscar E. Edwards Memorial Award. Dr. Edwards was a remarkably warm and friendly, very bright Internist, who often gave considerable amounts of his own personal time to various projects. It was appropriate to name this award in his memory.

Members, Fellows and Masters in the Missouri Chapter could help us consider whether there are suitable candidates for such an award. I know there are many of you who take volunteerism for granted. I think the Missouri Chapter should set up our own recognition, and would consider recommendations concerning a Missouri Chapter Volunteerism Award. At least five chapters of the College have already set up such a program. Please contact me with your thoughts on this subject at richard.whiting@medcast.com, or (314) 768-8778.

Richard B. Whiting, MD, FACP
Governor, Missouri Chapter

Online CME Available from the College

Clinical Problem-Solving Cases (CPSC) is a new and innovative educational program from American College of Physicians-American Society of Internal Medicine. Two cases published monthly, present interactive, clinically based patient care scenarios addressing differential diagnosis, treatment, and follow-up. Written and reviewed by respected physicians, who are well known for their expertise in the fields of Internal Medicine and its subspecialties, CPSC offers state-of-the-art, focused problem-solving at the click of a button. Learn more at Annual Book Awards Presented

The Missouri Chapter Book Awards are presented to graduating seniors who meet the following criteria:

  1. achieves the highest cumulative grades in all General Internal Medicine rotations and any required written examinations covering the general field of Internal Medicine in the third and fourth year of medical school;
  2. has outstanding ethical and humanitarian qualities; and
  3. is committed to a career in General Internal Medicine, or one of the subspecialties of Internal Medicine.

The Book Awards are given in the name of an ACP-ASIM member of the faculty. This year's awards were presented to:

Awardee School Honoree
Ali Husain, MD Washington University Alison J. Whelan, MD
Michael O. Barry, MD University of Missouri, Columbia Richard W. Burns, MD, FACP
Smitha Chadaga, MD University of Missouri, Kansas City Loretta S. Loftus, MD, FACP
Anna Chang, MD Saint Louis University Adrian M. DiBisceglie, MD, FACP

Missouri Chapter Sponsors Visiting Professor

Norton J. Greenburger, MD, MACP, Senior Associate Dean for Medicine at the University of Kansas Medical Center, was the ACP-ASIM Missouri Chapter 2000 Visiting Professor at the University of Missouri - Columbia, on August 3. Dr Greenburger made rounds with residents, gave a noon lecture Gastroenterology Update: 2000 and then had lunch with some of the residents.

This program is put on by the Chapter's Education Committee and has over the last few years brought some outstanding physicians to Missouri medical schools.

Internal Medicine Residency Applications

Each year in late Fall, the cycle begins to match applicants for Residency programs, with positions to be filled. This year 370 Internal Medicine Programs in the United States, offered 4,810 positions for categorical Internal Medicine applicants. Each applicant selects those programs that he or she would like to receive their application. Each residency program then reviews a large number of applications and selects those candidates to be interviewed. Part of this selection process involves reading a personal statement from each applicant. This is, of course, a definite privilege, and it also is very insightful, since it provides a concise view of individual motivation and enthusiasm for medicine. Reading over such material serves a secondary purpose, albeit, unintended. It reminds the reader of the "pure" values for a career in Internal Medicine, and in many cases, recalls some of the reader's personal motivation to pursue medicine as a career. I believe these comments have something to say to all of us involved in Internal Medicine, and therefore, I have decided to share a few of them with the readers of this newsletter. For obvious reasons, these are all presented in an anonymous fashion, in no particular order, and in some cases, I have altered wording very slightly, for the purposes of this presentation. I think readers of the newsletter will enjoy these comments from young bright, enthusiastic people just starting a career in Internal Medicine.

  • From the time I was a little girl, I wanted to become a doctor. At that time, though, a doctor was just someone who took care of sick people. Now that I am older and looking toward my future as a physician, I realize there is a difference between a doctor and a physician. A physician does everything possible to prevent illness. When sickness cannot be avoided, a physician treats the disease process with compassion.
  • In Internal Medicine, a physician has the opportunity to take care of patients as a whole, rather than just parts of the body.
  • I have found that the practice of medicine demands an individual's best. Each experience requires intuitive evaluation and analysis.
  • Internal Medicine provides the opportunity for long term patient care, and the wide variety of health issues that I enjoy solving.
  • What attracts me to Internal Medicine? In my opinion Internal Medicine represents the most challenging field of medicine. To be an Internist, requires an intimate understanding of a broad spectrum of medical conditions. This intellectually demanding process is further complicated by the need to remain current with new information. The prospect of dealing with these challenges is very exciting.
  • My clinical rotations in medical school provided me with an excellent opportunity to explore options in medicine. Internal Medicine was the rotation that made me feel that I had found my place in medicine. I enjoyed the patient contact immensely. It was not enough to see the patient once, I had to follow up on every lab report or test ordered, and I usually accompanied the patient during this process. Up until this time, I had always thought the patient thought the doctor patient relationship was unidirectional. Instead, it is an interrelationship. I have been motivated, encouraged, and my spiritual strength nurtured, from my interactions with patients.
  • I like reading mystery novels. The keen sense of observation, analytical skill, and logical thinking displayed by the investigator fascinates me. My interest in analyzing and problem solving motivated me to pursue the field of medicine, where I think a physician is a keen detective with a caring heart for fellow human beings.
  • Especially one patient reinforced my dedication to Internal Medicine, an intellectually challenging field. It was a young man with a brief medical history and a negative physical exam. Before a minor surgery, he showed me a lesion under a band aid on his chest. It was an advanced malignant melanoma with two satellite moles nearby. I am grateful to him for teaching me an invaluable lesson early in my career. First, that the healthiest looking patient may hide the most serious pathology. Second, that however busy you are, take the time to look under any dressing or clothing, and always examine the whole patient. Above all, I will remember that the patient who keeps on talking may have something important to tell.
  • I learned in my experiences both in counseling and also on clinical rotations that one of the greatest comforts that can be offered to a patient is a listening ear. It has been my honor to have helped patients in the course of grave illness to vent anger, cry, and laugh.
  • Internal Medicine requires an understanding of a broad spectrum of disease processes, and is truly the basis for all fields. I want to care for all types of patients and problems, from simple outpatient visits to the most complex patients in the Intensive Care Unit. I love the idea of treating "the whole patient" and interacting with them for a long period of time. The diagnoses and treatments encompassed by Internal Medicine fascinate me, even the so called "routine" problems like hypertension and diabetes. Advances in these areas keeps the "routine" exciting. Medicine is a fascinating specialty because it demands mastery of both medical knowledge, and compassionate understanding of patients.

FACP Promotion Continues

Your Missouri Chapter is making a concerted effort to promote as many qualified members as possible to Fellowship in the College. The Council members have been working with the Governor of the Missouri Chapter, Richard B. Whiting, MD, FACP, Transitional Governor, Warren C. Lovinger, Jr., MD, FACP, and the new chair of the Chapter's Credentials Committee, Carl F. Strauss, MD, FACP.

The initial push for more Fellows came from the Missouri Chapter's regional meetings. Over the past year, in addition to the Chapter's Annual Meeting at Tan Tar A, meetings have been held in Kansas City, Springfield, St Louis and Cape Girardeau.

In May, Sara Walker, MD, MACP, assisted four long-time members with their Fellowship applications. Dr Walker, Immediate Past Chair of the College's Credentials Committee and a member of the College's Board of Regents, was able to give insight into what should be emphasized in completion of the Fellowship application. A few overlooked areas that will assist you in qualifying for Fellowship include: teaching, service on hospital committees, attendance at Chapter or College meetings and community volunteerism.

Fellowship Tutorial Available at Chapter Meeting

For those interested in learning more about Fellowship, Sara Walker, MD, MACP, will be conducting a noon meeting on September 22, at the Chapter Meeting. If this appeals to you, bring an updated copy of your CV and plan on being part of the College Convocation soon.

Dr. Walker is widely recognized as one of the leading authorities on the Fellowship application. Not only is she the Immediate Past Chair of the Credentials Committee, but she has also discussed Fellowship with the many Chapters she has visited as a member of the Board of Regents.

Isabel Hoverman, MD, FACP, ACP-ASIM Regent from Austin, TX, will also be on hand to discuss how the College has recently modified the process to make it easier for private practice physicians to advance to Fellowship.

Don't forget to bring your CV for some personalized guidance on completing your Fellowship application. Applications will be available, so that you may get started on the Fellowship process.

Legislative Review

The 2000 General Assembly was one of the most unproductive legislative sessions ever. Partisan quarreling and election year posturing brought the entire lawmaking process to a standstill. Of the more than 1600 bills introduced this year, only 82 managed to survive.

For medicine, the most important bill this year was Rep. Tim Harlan's prompt pay/managed care reform package. The bill passed the House, but was killed in the Senate by a one-man filibuster on the last day of the session. Countless other bills died as well, many of which were opposed by medicine. For example, the pharmacists pushed legislation that would have allowed them to modify or prescribe drug therapies. The nurse anesthetists sought independent practice authority. The psychologists fought for prescriptive authority, and the naturopaths tried to pass legislation that would have granted them medical licensure in Missouri. The General Assembly also failed to address the tobacco settlement issue, and came up short on a big push to lower the state's DWI threshold to .08% BAC.

Of the few bills that did pass, one was of significant importance to medicine. Senate Bill 921, unfortunately vetoed by the Governor, would provide basic civil immunity for the Physicians' Health Program, an outstanding early intervention program that helps physicians with substance abuse problems and emotional illness. Liability issues threatened to shut the program down. Another bill that passed creates an Office on Women's Health within the Department of Health. And one other new law establishes new whistle-blower protections for health care workers in hospitals and ambulatory surgical centers, and requires those facilities to maintain adequate staffing levels of nurses and ancillary personnel to meet the needs of patients.

The 2001 General Assembly will convene on January 3, 2001. Although that seems a long way off, legislative plans are already being made. Rep. Harlan has promised to renew his effort to require health plans to pay claims in a timely manner. House and Senate leaders are working to reach an accord on the tobacco settlement issue. And most of the bills that died this year - good and bad alike - will be back for another run.

Missouri Chapter Meeting Exhibitors

Abbott Laboratories
Aventis
Bayer
BCBSKC
Carnrick Laboratories
Express Scripts Infusion Services
Forrest T. Jones
Janssen Pharmaceutical
Lilly
Merck & Co.
Missouri PRO
Ortho McNeil Pharmaceutical
Pfizer
Pharmacia
Roche
SmithKline Beecham Pharmaceuticals
Tap Pharmaceutical
Wyeth Ayerst