Governor's Newsletter, Winter 2001
Rolf R. Paulson, MD, FACP
Governor, North Dakota Chapter
From the Desk of the Governor
The events of September 11 took me, like many, by surprise. We in the USA now join the rest of the world, looking over our shoulder at where the next threat is coming from. The current "war on terrorism" and the war in Afghanistan bring further uncertainties. I don't think we really know what this will all mean but I have confidence that it will all work out. The USA will persevere and prevail as a society defending freedoms such as freedom of religion and free speech. It is so special that there is a place where people can disagree and yet work peaceably together. That concept must persist and spread. Without question, our world has changed both as citizens and as doctors. Society's priorities will be more toward security than services (such as medical care) but we'll have to see how this turns out.
The Annual ACP Governor's meeting had to be canceled amid the airline crisis of that week. We proceeded with our North Dakota ACP Chapter meeting the following week in the spirit that we were not going to let the terrorists control our every action. I felt it was a lively and successful meeting.
A highlight for me was to present the ACP Laureate Award (a lifetime achievement award in Internal Medicine) to one of my Grand Forks colleagues Dr. Jim Brosseau. As I said at the meeting, I think these awards often bring greater honor to the donors of the award (in this case the N. Dakota ACP ) than to the recipient. Dr. Brosseau has a tremendously loyal and large practice here. He has been an innovator and leader regarding Diabetes Care and Quality Management. He has been active over the years in the ACP. He has been very involved at the North Dakota School of Medicine and at UND in general. He was recently named the chair of the Department of Rural Health. He is currently president of the UND Alumni Association. This is the first Laureate we have awarded in five years. We are allowed one or occasionally two a year so I'd encourage you to consider nominees for this honor.
The meeting started with a lively "Professor in Action" session. Dr. Velinski of our Fargo based Internal Medicine residency presented the case of a young man with acute multiple organ failure. He was miraculously "pulled through" by the expert care of the residents and the Meritcare staff. The courageous and equally expert Dr. Mahendr Kochar "solved" the case of hemochromatosis through careful questioning. Dr. Kochar is from the Medical College of Wisconsin and was our ACP College Representative.
Dr. David Theige, Grand Forks, and a UND Faculty member talked about teaching medical students in the office. The ACP is involved in this project and this is very important, as this is where many of us make our contributions. Dave promised more help will be available in this area through the medical school and the Department of Internal Medicine.
Dr. Jon Nelson, co-founder of NAIP (the National Association of Inpatient Physicians, an ACP affiliate) gave a polished "state of the art" presentation regarding the "hospitalist Movement". This was close to home as several variations are going on in North Dakota at this time.
Dr. Kochar acknowledged our Chapter's winning of the prestigious "Evergreen Award" during his College Report. This has to do with Chapter activities, in our case with medical students to stimulate interest in Internal Medicine as a career. Thanks to Casey Ryan, Dawn Drotar, and Lavaun McCaan as well as our student leaders regarding the Internal Medicine Club. Thanks to Jim Hanley and Bill Newman of Fargo as well as the IM Department staff and the preceptors who helped with the Summer Externship program. Dr. Kochar represented the college well explaining its many programs and other areas we might become more involved with as a Chapter.
Dr. Heather Gantzer, an internist from Park-Nicolet in Minneapolis represented the American Board of Internal Medicine (ABIM) at our meeting. She spoke about the new recertification system. Many of you (younger) internists still don't realize that if you certified after 1991 in either IM or a specialty, you will need to recertify or lose your "Board Certified" qualification! Furthermore, recertification is a process that will soon take several years to complete! Dr. Gantzer did a nice job of presenting both the process and the rationale for recertification. I think "North Dakota nice" took over however and we let her off the hook without asking more tough questions. I think there are some real problems ahead regarding practitioners and the ABIM. Stay tuned.
UND Medical students Robyn Hape, Doug Renton, and Chad Theil presented research papers. UND IM residents Apar Ganti and Azhar Malik presented cases.
Dr Roberto Patron of Fargo was the penultimate presenter discussing a case of rabies here in North Dakota. My take home message was BATS BATS BATS BATS BATS.
We wound up with Dr. Hanley, the UND Chair of Internal Medicine from Fargo and Dr. Bruce Pitts of Meritcare in Fargo. The discussion was about the Department of Internal Medicine and the direction in which it should go. This is especially timely as Dr. Hanley is soon stepping down. He has done such a good job that it has been decided to replace him with two people! (a separate Chair and Program Director). I serve on the search committee and am excited by the caliber of people applying to try to follow his fine example.
A new FACP announced last January was Dr. Akindolapo Akinwande of Fargo. In July Paul Freiberg and Manor Skukla of Minot and James Hargreaves of Grand Forks followed. I am aware of several more in the application process but this still leaves many highly qualified North Dakota Internists who have not advanced to FACP who should do so. Pam Heisler and I have applications. Again, this is a flexible process.
I need volunteers for the Governor's Council. This is painless. If volunteers are not forthcoming, I'll come looking. We have tried to keep this a diverse group representing the Chapter regarding age, gender, location, and practice style. I'm hoping to have a Council event, this spring in Fargo, which will focus on our Associate (resident) members.
The National Meeting this year is in Philadelphia April 11 to 14. I would encourage people to attend, especially the new Fellows and Laureate.
I appreciate the work Bob Tight did regarding the recent Governor election. Thanks to Dr. Abel Tello of Bismark and Sr. Steve Mattson of Minot for being candidates for our next Governor. Congratulations to Dr. Tello as the Governor-elect. He will begin his official term after the national meeting in spring 2003 in San Diego. The college does a nice job of helping prepare one for position. One of the events is the Fall Governor's Meeting, which next year conflicts with the NDMA date. We are discussing moving the ACP meeting in Minot to avoid this conflict.
Last, I erred in my financial report at our meeting. Our assets are closer to $30,000 than $40,000. Nonetheless, this is good. We have taken on an additional $5,000 per year expense for our Externship program on top of our other expenses. We need to keep a balanced budget or we will go broke in a few years. We get some from the ACP but the rest comes from grants I have solicited from the pharmaceutical companies. I'd like to thank Pfizer, Merk, Aventis, Glaxo Wellcome, Ortho-McNeil, Dupont, and Pharmacia & Upjohn for their help this year.
Bioterrorism Resource Center
The September 11 terrorist attacks precipitated a wave of concern about the possibility of bioterrorism-the use of germs and chemicals as weapons of mass taking of lives. In recent weeks, the concerns have become a reality with the onslaught of Anthrax cases. In an effort to educate physicians and provide up-to-date information on biological terrorism, ACP has developed the Bioterrorism Resource Center on the College website.
The information featured in the Bioterrorism Resource Center is broken down into the following sections:
- Therapeutic Recommendations for Exposure to or Disease Caused by Biological Weapons - Up-to-date recommendations from the CDC and other organizations regarding treatment, exposure, research, etc.
- Essential Medical Knowledge - General medical knowledge on biological and chemical weapons
- News - Current events and news releases regarding bioterrorism.
- Additional Resources - Helpful resources to assist in the gathering of information on bioterrorism; websites, journals, recordings, speakers.
- College Activities - ACP initiatives and efforts to aid physicians in the battle against biological and chemical threats.
ACP encourages all physicians to visit the Bioterrorism Resource Center often, as physicians are the first line of defense against bioterrorism. It is the intent of the College to be a comprehensive resource for the medical community on biological and chemical threats in an effort to prevent the sense of alarm and panic.
Education and preparation are key components in promoting an efficient, expeditious approach to bioterrorism. Visit the Bioterrorism Resource Center and join ACP in the campaign to promote a "Don't panic, prepare" campaign against bioterrorism.
End of Life Care Patient Education Brochures and Doctors Tip Sheet Available
In September, the Center for Ethics and Professionalism inaugurated its Patient Education and Caring: End-of-Life (PEACE) Series by releasing three patient education brochures designed to guide patients through various stages of palliative and end-of-life care. The brochures offer clearly worded advice for patients and caregivers and are suitable for distribution in doctor's offices. The available brochures are:
- "When You Have Pain at the End of Life"
- "Living with a Serious Illness: Talking to your Doctor When the Future is Uncertain"
- "Making Medical Decisions for a Loved One at the End of Life"
Also available is "Improving Your End of Life Care Practice," a tip sheet for doctors, with suggestions on how to identify patients who would benefit from the brochures and tips on how to "break the ice" in face-to-face discussions about sensitive end-of-life issues.
What Can the Practice Management Center Do For You?
The Practice Management Center (PMC), located in the Washington office, is a valuable benefit of College membership. It supplies free assistance to members on how to handle the business issues associated with running or working in a practice. Internists are provided with timely information to succeed in today's health care environment through three different means.
First, PMC offers over forty practical written guides on various. These publications can be downloaded via PMC's web page, or ordered through the College's customer service desk. The first copy of each publication is complimentary as a part of your College membership. These guides cover everything from starting a practice to negotiating an employment contract and complying with Medicare regulations. Laminated pocket reference sheets on coding, documentation, and preventive services are some of the most popular items.
Second, PMC's management and regulatory experts respond to individual member inquiries via e-mail and telephone calls within 24 to 48 hours. If PMC experts cannot answer your question, then they may research the question, refer to another source, or, as needed, offer a list of qualified consultants. It is important to note that Center specialists do not address clinical questions nor do they provide legal advice.
And finally, PMC offers management tools for members to use in assessing and improving their practices "Check Ups." The Patient Satisfaction Check Up (PSCU) provides a survey instrument developed by internists for internists. After you survey your patients, PMC supplies customized comparison patient satisfaction assessment reports. The Office Laboratory Check Up (OLCU) is a spreadsheet program enabling you to evaluate and optimize the profitability of your office laboratory. The Practice Management Check Up (PMCU) is a benchmarking tool for conducting an overall assessment of the practice and identifying opportunities for improvement. Each of the three "Check Up" tools comes with a guide to help improve the practice and can be downloaded free of charge from the PMC web page.
Under the umbrella of the Practice Management Center, members receive one-stop service from two organizations. PMC's own professional staff has years of experience managing medical practices and this expertise is augmented by that of the Managed Care and Regulatory Affairs Department, whose staff write guides and respond to inquiries in their respective fields. This expertise combination enables PMC to offer a remarkable range and depth of knowledge to assist College members.
In addition, PMC supports the Young Physicians Subcommittee (YPS) in developing products and educational programs of interest to young physicians. Together, YPS and PMC have begun to assist chapters interested in developing their own practice management programming and young physician committees.
What is the best way to access the Center's services and resources? Go to the PMC web page where everything is right at your fingertips - downloads, e-mail questions, links, tools, and a host of other resources. The PMC web page offers members access to the various guides for the topic of concern to them. If still more specific information is needed, the next step is to e-mail a question directly from the web page to the PMC specialist in that field.
With all of its services instantly available on the web page, PMC represents a rich and valuable resource for College members. Visit (PMC) to explore it yourself. For more information, please contact Margo Williams at (firstname.lastname@example.org).
Experience Annual Session-Philadelphia Style
Join the College April 11-14, 2002 and be a part of Annual Session 2002 in Philadelphia. Experience over 275 sessions covering the spectrum of internal medicine and the subspecialties. Upholding tradition, ACP promises to offer a rich educational experience with an emphasis placed on content that is clinically relevant and practice oriented. Be Sure Not to Miss...
Clinical Pearls -
Remember those words of wisdom from your most respected clinical teachers? Those Pearls were based on an experience of depth and knowledge of medical literature of remarkable scope. Pearls are noteworthy for their clarity, timelessness, and clinical applicability.
Introduced at the 2001 Annual Session and an instant hit, Clinical Pearls rekindles the joy of bedside learning, using a highly engaging, case-based format. With the audience-response keypad-system, you'll have a chance to test the depth of your clinical acumen. You'll leave each session with a rich collection of Pearls, ready to be applied directly to the patients.
Multiple Small Feedings of the Mind -
Rated by many as the best of Annual Session, Multiple Small Feedings of the Mind uses a creative format to address some of the most common, yet challenging or controversial, patient-management issues. In these highly focused, fast-paced sessions, faculty offers answers to some of the most frequently faced dilemmas in patient care.
The Learning Center -
Experience the excitement of the Learning Center. Refine your techniques in a variety of office-based examination and procedural skills. Take advantage of small group or individual tutorials with experts in the field. The Learning Center is unique to Annual Session and offers a wide range of opportunities for closely supervised, hands-on practice. Become familiar with procedures and examinations you don't perform on a routine basis. Try out the latest software for clinical information management and patient care. The Learning Center is a dynamic collection of hands-on activities, which you can immediately apply to your clinical practice.
Keep up to date on the year's most important published papers in the subspecialty areas. Learn significant findings and their impact on patient care. Nationally recognized faculty reviews the literature and presents the year's highlights.
Experience Annual Session...
ACP Annual Session 2002, April 11 - 14, 2002, Philadelphia, PA
ACP Email Campaign
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