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Governor's Newsletter, April 2000

James B. Reuler, MD, FACP
Governor, Oregon Chapter

Governor Election

It is with great pleasure that we announce that Stephen R. Jones, MD, FACP, of Portland, has been elected as the next Governor for the Chapter. Chief of Medicine of Legacy Health System, Steve will serve as Governor-Elect for one year and take over as Governor on April 1, 2001. Steve and Jim Reuler will work closely this year to assure a smooth transition and continued Chapter growth.

2000 Meeting

The Program Planning Committee is completing work on the content of this year's meeting, November 2-4, 2000, in Eugene. Daniel Federman, MD, MACP, an endocrinologist and master teacher from Harvard Medical School, will be the Lewis Visiting Professor, and William J. Hall, MD, FACP, Chief of General Medicine and Geriatrics at The University of Rochester School of Medicine and President-Elect, ACP-ASIM, will be the College Representative. Topics will include updates in General Medicine and Geriatrics, and Women's Health, hemochromatosis and obesity. Watch your mail for registration materials.

Awards Committee

The Chapter is forming an Awards Committee under the leadership of Robert A. Gluckman, MD, FACP. The goals of the committee will be:

  • Solicit nominations for, and recipients of, the established Chapter Awards for Teaching and Service.
  • Launch the new Community Service Award as part of a national Board of Governors initiative.
  • Identify candidates/prepare nomination packets for national College awards and Masterships.
  • Launch Chapter Laureate Awards, a national program recognizing distinguished local members.
  • Field suggestions for/develop guidelines for new Chapter awards.

If you have suggestions or nominations, please contact Bob at rgluckmanmd@providence.org.

Chapter Council

The following are members of the 1999-2000 Council:

Sima Desai, MD; Portland
Associates Council Coordinator

Stephen Jones, MD, FACP; Portland
Governor-Elect

Elizabeth Eckstrom, MD, MPH; Portland

Lynn Keenan, MD, FACP; Eugene

Robert Gluckman, MD, FACP; Portland
Chair, Awards Committee

Andrea Kielich, MD, FACP; Portland
Past Transitional Governor

Steven Gordon, MD; Portland

James Leggett, MD; Portland

Arthur Hayward, MD, FACP; Beaverton
Past-President, OSIM

Dan Mangum, DO, FACP; Portland

Charles Hofmann, MD, FACP; Baker City

Linda Humphrey, MD, FACP; Portland
Chair, Program Planning Committee

James Nachiondo, MD; Portland
Associates Council Representative

Martin Jones, MD; Eugene
Chair, Public Policy Committee

James Reuler, MD, FACP; Portland
Governor

At the February 28 Council meeting (conference call), the following decisions were made:

  • Keep Chapter dues at $40 for 2000-2001, an amount unchanged for the past three years.
  • Keep registration fees for the 2000 Chapter meeting at the same level as the 1999 meeting.
  • Send a letter to the OMA, supporting the statewide coalition supporting referral of Measure 81 to voters, a constitutional amendment permitting the legislature to establish limits on jury awards in civil actions, including medical malpractice. The Council voted to contribute $2,500 to this effort and to encourage Chapter members to support Measure 81.
  • Endorsed the Tobacco Free Coalition efforts to decrease teen access to cigarettes; develop 100% smokefree workplaces; decrease advertising of tobacco products to teens; assist smokers who wish to quit.

Internists and the Media

This edition's Internists and the Media column is authored by John H. McAnulty, MD, of Portland. After graduating from Tufts University School of Medicine and residency at the University of Michigan, Jack completed a cardiology Fellowship at OHSU where he is Professor and Head of the Division of Cardiology. One of the most popular faculty at the Chapter's Annual Meeting, Jack is a frequent "expert" for local media.

Like it or not, the media is involved with medical issues, and readers, listeners, and viewers seem interested. Many of us, probably more from OHSU than from other medical systems, have the opportunity to provide comment. By suggesting that I could write these words reflecting experience as an "expert commentator for the media" in this column, Internists and the Media, Dr. Reuler has sensitized me to the fact that being one has not gone all that well.

Why?

Probably first is personal discomfort - wondering if I've been one (an "expert") too often, if others are thinking, "Oh, there he is again," "Always seeking attention" and, of course being somewhat worried that this may be true. See, even now, here I am again! There are other reasons that it doesn't seem to always work well. Comment is most often requested from me when a cardiovascular event has occurred in a public figure, often a sports figure. As far as I can tell, there's no increase in events related to either being public or a sports figure than there is in the general population. We know, of course, that this is the nature of media - and, it does keep us more interested - but it's uncomfortable to contribute to the idea that something medical is somehow more important when those characteristics are involved.

Another uncomfortable part is of course that all of us know that we're not truly experts. So, how did we get there - how did we become "expert?" One reason, it seems, is that somehow we were available. The media often has deadlines - they need to talk to someone now - it seems they are often willing to talk to anyone who will give them the time. Secondly, a list of experts is often "crafted" - often by institutional public relations offices (that certainly occurs at OHSU). Sometimes that might be appropriate but institutions clearly have vested interests - often just plain publicity. There's a discomfort in being part of that as well.

Enough lamenting. This system in some way will go on. Can we do anything about it? At the least, when approached by the media, we can hope that our responses do not reflect self-interest, but openly and fairly address the issues. We do have an obligation to fulfill our role as teachers - the situation in which this occurs can't always be controlled by us so hopefully we can do the best with the opportunities that present themselves. We can then hope that our thoughts have been repeated fairly (it seems this is usually the case) and that the writing (hmmm, why am I never a television expert?) is clear and informative.

Career Tumult

The Chapter has received funding from the national office to explore ways in which ACP-ASIM can help members experiencing career change/dissatisfaction. Katherine Bensching, MD, Chapter Member, and Jim Reuler will be collaborating on a survey being developed by investigators in Seattle, as well as exploring a pilot launch of Physician Development Group Programs, small groups of 6-8 physicians sharing experiences and self-awareness techniques, as originated by John Wynn, MD, of Seattle.

The Chapter will be a co-sponsor of the Northwest Regional Symposium, "Physician Well-Being," October 14, 2000, at Skamania Lodge (a brochure will be mailed to all Oregon physicians), a program of The Foundation for Medical Excellence's Northwest Center for Physician Well-Being. The Chapter will include this topic on the program for the 2000 Chapter meeting.

If you are interested in becoming involved in this initiative, please contact Jim Reuler.

Hepatitis C

Screening for Hepatitis C infection and related diagnostic and treatment strategies represent important public health issues, which are evolving and are often confusing for patients and physicians. Some resources include:

Student Mentorship Program

The Oregon Chapter of the American College of Physicians - American Society of Internal Medicine is developing a mentorship program, which would allow students from OHSU to interact with practicing internists in Oregon and to learn more about the medical practice and lifestyle of the internist. The idea for this program originated from the students who feel that, though they get some experience and exposure to medical practice "off the hill," such as in the preceptorship program in first and second years, they would value a more informal and casual relationship with a practicing internist, or internists, to learn more about what it is really like to practice internal medicine.

I have been asked to help organize this program and I've met with several students who have outlined their goals or needs for this program, which include a desire to develop an ongoing relationship with a physician, possibly over several years of medical school where there isn't the structure or pressure of being graded. Through this relationship, the ability to get a sense of not just the day-to-day clinical practice of medicine, but also other aspects of the life of a physician, including issues around lifestyle, family pressures, non-clinical medical work such as committee work, volunteer work, etc. The ongoing relationship with a mentor outside of school who would be available to provide advice and answer questions as the student progresses through medical school and faces decisions about future training or practice.

Mentor/student interactions might occur monthly (or more or less often), might occur in a clinical setting such as in the office or on rounds or meetings, or might involve getting together for lunch or dinner, or by phone or e-mail. Students are hopeful that there would be a broad range of mentors available, including practicing clinicians in small practices, HMO's, hospitalists, generalists and subspecialists and in both metropolitan and rural areas.

From the physician's standpoint, this can be a wonderful and rewarding opportunity to share your knowledge and experience with a very eager and motivated medical student or students specifically interested in internal medicine and to have a significant positive impact on their development into well-rounded physicians.

If you are interested in participating in the program, please contact me.

Rick W. Wise, MD, Chapter Member
2419 SW Richardson Street
Portland, OR 97201
hdub@spiritone.com
(503) 520-4879

Fellowships

Fellowship in ACP-ASIM is an honor awarded to those recognized by colleagues for clinical competence, professional accomplishments, personal integrity, scholarship and community service. In recent months, the following Chapter members have been advanced to Fellowship:

  • Mark E. Bradley, MD, FACP; Roseburg
  • Karl D. Ordelheide, MD, FACP; Lincoln City
  • Geoffrey S. Sewell, MD, FACP; Portland

Congratulations!

Anyone who has been an ACP-ASIM member for at least two years is eligible to be considered for Fellowship advancement. For more information, contact Jim or Mary, or the ACP-ASIM national office at 800-523-1546, ext 2694.

Community Service

This edition's Community Service column is authored by Richard Hartoch, MD, an internist certified by the ABIM and the ABEM. After internal medicine training at the University of Pennsylvania, Rick practiced in a variety of locums tenens positions around the country before joining the staff at VA/OHSU. Rick shares with us his experience as a volunteer in Kosovo.

Kosovo Medical Journal

The Islamic camp today, a sea of canvas tents floating across a dusty plain... smiling children's faces contrast cruelly with the sadness and desperation of their parents... soccer and tag, sitters and smokers, the waiting, the worrying, the dazed and the stunned. All have lost their homes, their land and their pride. All have seen death and senseless destruction. All have walked here from scattered points in Kosovo - tossed together in a way they had never imagined life could demand. Dehydration, intense anguish, pneumonia, violent coughs, interminable diarrhea, tuberculosis, chest pain, mangled feet, fever, nausea, vomiting, asthma, backaches, panic attacks and broken hearts all find us.

"A young woman who couldn't control her trembling hands seeks our help. She blames her cup of coffee and dismisses with a shaken glance the import of all she has lost, all she has seen, all she has endured. I take blood pressures and reassure the refugees they are 'OK'... their hearts are strong they "will live 100 years." One patient gives me a small candy, another offers a cigarette, most give a beautiful fleeting smile and a deep, warm handshake. They then leave our fragile medical tent to return to the harsh reality of their shaky, vulnerable lives, totally at the mercy of the kindness of strangers.

"They are gracious. They are polite, sincere, and dignified. None appears bitter. All muster the strength to maintain their humanity against all odds. A true tribute to the human condi-tion, it's adaptability and resilience. Yet, we know the scars will last a lifetime and beyond. None of these lives will return to their former trajectory. The physicist now washes tables. The economist makes sandwiches. The basic need to survive disables all of society's artificial distinctions. Escaping with the clothes on their backs, the "lucky" ones are merely alive. This nation was "cleansed." A brutality. A sin to the core."

The paragraph above represents a selection of my journal writings for May 31, 1999. I am a physician boarded in Emergency and Internal Medicine practicing at the Portland VA Medical Center and Oregon Health Sciences University. I spent three weeks in and around Shkodre, Albania in late May and early June 1999. I was part of a medical relief team organized by Northwest Medical Teams, International (NWMTI) based in Portland, OR.

In the spring of 1999, I was closely following and deeply moved by the Serbian invasion of Kosovo. My parents are Jewish refugees of Nazi persecution and the Balkan massacre struck a deep chord. Having not acted during the horrific tragedy in Rwanda, I felt my continued "silence" must end. I called NWMTI and volunteered my services. To my surprise, I was quickly accepted to be a part of a team of seven health care providers. NWMTI was sending a similarly structured group each week for 3-week assignments.

After orientation in Seattle, we flew to Bari, Italy, via Milan and then took a hydrofoil across the Adriatic since the airport in Tirana, Albania was closed. Following a brief orientation, we were driven to Shkodre, a small, ancient town in Northern Albania near the Kosovo (Yugoslavian) border.

We lived with Albanian nationals and each day were assigned to different sites. The "Islamic camp" described above was a vast grouping of tents which stretched across in arid plain. The tents were furnished by Islamic relief organization, which also supplied food and toilets. NWMTI provided medical support.

Our other assignments included the "tobacco factory," an abandoned conglomeration of pre-World-War-II brick structure, a makeshift clinic on the front porch of a home in a small fishing village and finally a decrepit train depot in a small town called Mjeda.

Mjeda, the first Albanian entry point for refugees leaving Kosovo was heavily fortified with NATO troops and armor. My journal entry for June 4, 1999 describes the scene as we waited for the daily arrival of yet another convoy.

"In a few minutes the dusty caravan is spotted in the distance. From the silence and the antic-ipation of an expected event, the scene is immediately transformed into wild activity. Trucks arrive in rapid sequence, loaded with men, women, and children. They have been sardined into the bare trucks on simple benches with all their possessions stuffed into corners. The refugees are encouraged to disembark as rapidly as possible. The result is overwhelming. Old men with their traditional wool caps are often the first off, loaded with bundles of blankets and a few torn cardboard boxes. The children are wide eyed, fear and excitement turn to big smiles as the hugs and handshakes of soldiers, volunteers and medical personnel warmly greet them. The oldest women have the most difficulty. Many are wearing several layers of sweaters, scarves and long dresses, despite the sweltering heat. Several are holding small plastic bags, which have collected the vomit of the journey. They are exhausted and dehydrated.

They enter the long dark hall and quickly re-form into family groups. A few settle on the rickety benches lining the wall. Most end up on the floor surrounded by the bundles of their few salvaged possessions. They are now safe from the terrors of the Serbian police. The long, long journey from the horrors of their often tiny villages to this remote site in Albania takes its toll. All have suffered greatly. The stunned expressions and profound sadness are evident every-where. The hall filled now with hundreds of people is extra ordinarily quiet. Most are eating and drinking vigorously, others are too emotionally and physically spent to even move.

Our medical team slowly canvasses the crowds. The sad faces immediately open to genuine smiles as we extend our hands for the ubiquitous warm, firm handshake. We are each accom-panied by our translators. Now comes the hard part. We offer our medical aid. The stories begin. At times, we can only offer our ear, a hug and word of support and hope, but we are usually shaken. At times, even our own experienced 20-year old translators can not hold back their tears. The cruelty, the brutality, the utter inhumanity these people have endured is beyond any comprehension. One old man tells us his eyes are "infected" because they are tear-ing continuously. This started shortly after his four sons were murdered. He is actually crying. We offer "high touch, low tech" treatments. We examine his eyes and instill a few antibiotic drops. He states he feels better and hugs us. We tell him to return in two hours for another treatment (he does.) A young woman appears haggard and distraught. She clutches her beautiful bright-eyed blond son who captures our hearts immediately. Her eyes are swollen with tears, her face tired beyond emotion. The boy's father (her husband) was murdered last week. Another middle-aged man quietly walks to the clinic and apologizes for bothering us with an irritating rash on his legs and arms. It is the result of the intense heat and poor sanitary con-dition of the prison where he was beaten. He silently cries as we examine his rash. His long time next door neighbor was a Serbian police officer who knew that our patient had only one son. He waited for the son to return home one night and killed him in front of the father. Their house was then destroyed. My tough translator today, Flamur, a Kosovoar who was also expelled can not hold back the tears. One of our nurses overhears the story and later I see her crying almost uncontrollably in the corner of the clinic. I give the man an antibiotic for his skin, phenergan for pruritus and a big hug from one human to another. It is so difficult to look into his eyes. He desperately clings to his dignity and slowly walks back to his spot in the crowd. I check on him often and see him staring blankly into the hall. His loss is immense and so tragically common. The stories don't end. Children beheaded, pregnant women shot. Men carved by knives. A man tells how a Serb tried to steal his daughter's wedding ring after murdering her husband. Having trouble, he cut off her finger to steal the ring."

I realize that my political perspective has been skewed towards the stories of my patients and am fully aware that Albanians have committed and now continue to commit atrocities against their Serbian neighbors. The cycle of violence tragically is not disrupted.

My experiences in Albania will resonate with me for the rest of my life. It was an honor and privilege to serve. NWMTI along with other local relief agencies provide care which would just not exist were it not for private donations and general public support. I encourage all medical providers to consider volunteering what you can donate to aid in catastrophic and ongoing relief projects. In the end you probably will feel you received more than you actually gave, but your impact will be profound, meaningful and sincerely appreciated. I would be happy to advise any interested person. I can be reached at (503) 293-6566.

Kudos

  • Robert A. Gluckman, MD, FACP, of Portland - appointment to the national ACP- ASIM Managed Care Subcommittee.
  • Frances M. Yuhas, MD, ACP-ASIM Member, of the Dalles - recipient of the Rural Provider of the Year Award, Oregon Primary Care Association, 1999.
  • Elizabeth A. Allen, MD, of Portland - recipient of the 2000 Clinician-Teacher Excellence Award of the Society of General Internal Medicine, Northwest Region.

Please keep us informed of your activities and accomplishments. We want to recognize your good work!

Upcoming Dates

June 1, 2000 Fellowship Applications Due at ACP-ASIM
July 25-29, 2000 ACP-ASIM Board Review Course, Seattle, WA
August 22-23, 2000 ABIM Certification Examination in Internal Medicine
November 2, 2000 10th Annual IDSO Meeting, Eugene, OR
November 2-4, 2000 Oregon Chapter ACP-ASIM Annual Meeting, Eugene, OR
December 1, 2000 Fellowship Applications due at ACP-ASIM
March 29-April 1, 2001 ACP-ASIM Annual Session, Atlanta, GA

How to Reach Us

James B. Reuler, MD, FACP
Section of General Medicine
Veterans Affairs Medical Center (P-3-MED)
PO Box 1034
Portland, OR 97207
(503) 220-8262, ext. 55582
FAX: (503) 721-7807
E-Mail: reulerj@ohsu.edu
reuler.james@portland.va.gov
Mary A. Olhausen
Department of Medicine
Oregon Health Sciences University
3181 SW Sam Jackson Park Road, OP-30
Portland, OR 97201-3098
(503) 494-8676
FAX: (503) 494-5636
E-Mail: omary@teleport.com
olhausen@ohsu.edu

Contact Information

Thomas G Cooney, MD, MACP
Oregon Chapter Governor

Mary Olhausen
Phone: 360-892-1814
Fax: 360-326-1844