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Governor's Newsletter, April 1999

Mark Your Calendar for the 1999 Oregon ACP-ASIM Meeting, November 4-6, In Eugene

The Program will include:

  • "Update in Infectious Diseases" by John G. Bartlett, MD, FACP, Chief, Infectious Disease Division, John Hopkins University School of Medicine and President, Infectious Disease Society of America; Howard P. Lewis Visiting Professor.
  • "Controversies in Screening" by Harold C. Sox, Jr., MD, MACP, Chair, Department of Medicine, Dartmouth-Hitchcock Medical Center; Immediate Past-President, ACP-ASIM
  • "Update in General Internal Medicine" by Robert G. Gluckman, MD, FACP, Director, Department of Medicine Faculty Practice, Providence St. Vincent Medical Center, Portland; Program Chair, 1999 Chapter Meeting.

The program is being finalized now. Watch your mail for announcements and registration materials. And, don't forget the 9th Annual Infectious Disease Society of Oregon Meeting, on November 4th, just preceding the Chapter meeting.

Call For Awards Nominations

At the annual Chapter meeting each year, the Chapter presents a Distinguished Teaching Award and a Distinguished Service Award, both named in honor of the late Howard P. Lewis, MD, MACP. If you would like to nominate someone for either award, please contact Jim Reuler.

Medical Student Activities

In November 1998, the Chapter received a $2,500 grant from the College to support student participation in our annual Chapter meeting, as well as the development of community service and other educational and professional development initiatives. On February 22, Adam Williams (MS-IV), Ian deBoer (MS-IV), Ryan Peterson (MS-III), Amy Schmitt (MS-II) and Sarah Cassell (MS-II), met to develop these concepts and to launch several projects in the coming months. More information about this new component of our Chapter will be contained in the August Newsletter. If you wish to become involved in these student programs, please contact Jim Reuler.

Associates' Council

The ACP-ASIM Associates' Council is pleased to report the successful completion of the first annual series in Career Planning for all Oregon residents. This series began in the fall with a panel discussion by general internists in various types of practice in the community, as well as a discussion of how to write a CV and cover letter. The second workshop included a panel discussion of how to interview for potential job choices, with input from medical directors of practices and third-year residents and recent graduates who had recently completed the interview process. In the third workshop, a contract lawyer reviewed some of the legal aspects of signing a contract, including no-compete clauses and malpractice insurance coverage. All workshops were well-received and very informative. We plan to repeat the workshops next year, so please give us feedback about changes you would like to see!

Career Corner

This edition's Career Column is authored by Leesa M. Azar, MD. A graduate of Portland State University, Leesa received a Master's degree in Nutritional Biochemistry from Cornell University and her medical degree from OHSU. Since completing residency training at Legacy Portland Hospitals, Dr. Azar has held a number of locums tenens positions in the Portland area and served as a member of a Career Options panel organized by the Chapter's Associates' Council.

As I gazed down upon Nepal's Khumbu valley from the 19,000' Teschi Lapcha pass, I realized that my life had never been better. Working as a locum tenens physician has provided the free time to pursue my passion of travel and outdoor sports, while still offering a rewarding and challenging career. I have been working as a locum tenens and moonlighter physician in the Portland area since completing my residency in primary care internal medicine 2 1/2 years ago at Legacy Portland Hospitals. My medical school training took place at OHSU. I initially planned to work as a "locums" for only six months, while seeking permanent work in Portland, but found that it suited my lifestyle so well that I've since decided to continue in this type of practice indefinitely. I have no dependents and have always valued travel and outdoor adventure over material wealth. Working part-time and for relatively short periods allows me to engage in many recreational activities. In the last 3 years, I have been trekking in Nepal, mountain climbing in the North Cascades and Canadian Rockies, ice climbing in Canada and Alaska and rock climbing all around the U.S. I have also done a lot of local whitewater kayaking, hiking, camping and snowboarding. I will be participating in Cycle Oregon for the second time this year, and will be spending 3 weeks in Australia.

From my perspective, the greatest advantage of being a locum tenens provider is that my schedule on a daily or weekly basis is much more flexible than it would be if I had my own patient panel.

The downside, of course, is that nearly every patient is new to me, and I miss the occasion to establish long-term rapport, and to learn from the continuity that a traditional practice provides. Furthermore, as locum tenens work is usually in a clinic setting, there is no requirement to do overnight or hospital call, and this may lead to the gradual erosion of inpatient skills.

Other factors to bear in mind when considering practice as a locums provider include the lack of employee benefits and the inconvenience of frequently changing offices. This involves not only physically transporting books and files, etc., but also of getting to know new staff, EMR systems, paperwork, local subspecialists, etc. The benefits lost include not only those such as life and health insurance, paid time off, disability coverage, retirement benefits, etc., but also of such "perks" as the financing of pagers, cell phones, medical books, or CME conference expenses, and there is, of course, no "signing bonus." Malpractice coverage, however, is usually provided by the employer for the duration of the contract. The national locum tenens companies typically provide not only malpractice insurance, but also attorney's fees, as needed (the latter is not necessarily provided if one is a so-called "independent" like me). They also furnish all travel and housing expenses (including rental cars), and pay fees for licensing in different states, as applicable. In addition, they will confine assignments to particular geographic areas, if requested.

As a native of Portland, OR, I have always loved the scenic beauty and unique lifestyle of the Pacific Northwest. During medical school and residency, I was worried about finding employment in the area, which was reputed to be a tight market for health care providers. Surprisingly, however, I have found that there is plenty of demand for the services of "temp" physicians. Personally, I have never found it necessary to seek employment through one of the locum tenens companies because I have found more than enough work locally, by simple word of mouth.

For those who ultimately intend to join a traditional practice, doing locum tenens work provides a way to introduce yourself to a particular clinic and improves the chance of selecting one in which you are most comfortable and compatible. It also offers the advantage of experiencing many different practice settings, from large HMO's to small private clinics, from urgent care centers to solo rural practices. During the past two years, I have found that working in a locums capacity often leads to offers of permanent employment. I've had several tempting offers, and regretfully turned them down only because practicing as a locums suits me so well.

When seeking employment as a locum tenens physician, one should carefully compare possible advantages offered by different groups. These may even be negotiable. For example, Kaiser Permanente, which frequently utilizes locums physicians, offers the advantage of treating them as permanent employees to the extent that the employer pays of the FICA withholding, paid time off is accrued, and a 100% health benefit is provided if one's contract is for a minimum of 20 hrs/wk for 6 months. Most other groups consider locum tenens physicians as independent contractors and only pay a straight hourly wage. Therefore, the employee is responsible for all of the FICA tax, and is also required to make estimated quarterly federal income tax payments or face a penalty.

Kaiser is also a source of urgent care or inpatient moonlighting. Moonlighting differs from locum tenens work in that there is no contract term, so the working hours are even more flexible. This type of employment is available not only in urgent care clinics, but also through health care staffing companies, for example, doing life insurance physicals on healthy clients applying for expensive coverage. The Legacy St. Helens' urgent care center is often in need of moonlighters, and a colleague who works for an urgent care unit in Salem informs me that benefits are provided if one works at least 10 shifts per month.

There are a few other important points to keep in mind while working as a locum tenens or moonlighter physician. First, be sure to inform the DEA of all practice address changes. They require updates whenever you begin work at a new location. Also, while most locum tenens positions require a board-certified MD, many moonlighting situations do not.

This sums up most of what I've learned as a locums physician, and I would be happy to provide further information to anyone interested in pursuing this type of experience. To inquire about available positions with any group, one simply contacts the person in charge of physician recruitment. Please feel free to contact me for names of contacts, phone numbers, or other particulars. I may be reached at (503) 224-8664 or by e-mail at lane.brown@cwix.com.

Chapter Meeting Sites

As discussed at the Chapter business meeting in Eugene, November 6, 1998, the Council initiated a process for exploring/evaluating alternate sites for the Chapter's annual meeting. A number of members expressed opinions at the meeting and via e-mail. After considering sites in Bend, Portland and on the Oregon Coast, specific information (space/logistics/costs) was obtained from Skamnia Lodge, Stevenson, WA, and Valley River Inn and the Hilton Hotel in Eugene.

After considering all factors, and because many dates are already booked two years in advance, the Council decided in November 1998, to hold the 2000 Chapter meeting at the Eugene Hilton Hotel, from November 2-4. A departure from past meeting dates, there will not be an Oregon football game played in Eugene that weekend. This fact may permit alteration/expansion of the meeting format.

If you have ideas about future meetings, please let Jim Reuler know. We will need to "book" the meeting for 2001 by November 1999.

Governor/Council Elections

Every four years, the Chapter holds an election to choose the next Governor. We are approaching that election cycle this year. The individual elected serves one year as Governor-Elect (2000-2001) and four years as Governor (2001-2005). The timetable for the election is:

a) Governor appoints a Nominations Committee, all members of which must be Fellows or Masters in the College;

b) The Committee reviews the position description and responsibilities of the Governor, solicits names of potential candidates and analyzes the qualifications of those individuals nominated for consideration;

c) Two candidates are chosen from the list of nominees to stand for election. Their names will be forwarded to the College's national office in July 1999;

d) In early November 1999, ballots will be mailed to all Chapter members from the national office. Ballots will be due back in Philadelphia in mid-January 2000; and

e) The Governor-Elect Designee will be announced in early February 2000, will assume office as Governor-Elect, April 16, 2000, and as Governor at the annual National College meeting in 2001.

Any Chapter Fellow or Master interested in being considered a candidate, or anyone interested in nominating a colleague, should contact Jim Reuler.

As outlined in the new Chapter Bylaws and discussed at the business meeting, a portion of the Council must be elected each year by a vote of the membership. The Council is developing the mechanism for conducting such an election this year. Anyone interested in serving on the Council should contact Jim Reuler.

Finances

Over the past year, the Chapter has continued to refine its accounting practices, explore new revenue sources and identify cost-savings while holding the line on annual Chapter dues.

The major expense for the Chapter each year is the annual meeting. The 1998 meeting cost $32,398.75. Our revenues for the meeting were $29,655.00

As of March 15, 1999, we have $47,520 in our accounts. This compares to $36,089 on March 15, 1998. This balance does not include financial reserves of OSIM. These monies will be deposited in Chapter accounts after the merger of OR-ACP and OSIM has been "officially" sanctioned by the State of Oregon Attorney General's office.

At the September 1998 Chapter Council meeting, industry support for Chapter activities, especially the annual scientific session, was discussed. It was felt by the Council that the Scientific meeting could run with continued support from industry without undue influence on the content of the program. Given the proportion of revenues for the annual meeting that comes from exhibitor booths purchased by various organizations (43.5%), the Council agreed that a more detailed analysis of the issue would need to be completed before the Chapter proposed eliminating all forms of industry support for education activities.

During the coming year, the Council will address the concept of developing an "investment strategy" vis a vis our financial reserves/resources. This will include examination of ways we can maximize interest or dividend income from monies the Chapter has in the bank to support development of new Chapter projects/expansion of ongoing projects.

If you have questions, comments or ideas about any of the above financial issues, please contact Jim Reuler.

Internists/Media

This edition's Internists and the Media column is authored by Edward E. Rosenbaum, MD, MACR, Emeritus Professor of Medicine, OHSU. A graduate of the University of Nebraska Medical School, Dr. Rosenbaum's fellowship in internal medicine at the Mayo Clinic was interrupted by WWII, during which he served as a shock officer in a MASH unit in North Africa, Sicily and Normandy, and for which he received the Bronze Star. Ed began practice in Portland in 1946 and, as a volunteer faculty member, founded the Rheumatology Clinic at OHSU. Dr. Rosenbaum is a Master in the American College of Rheumatology. Several years ago, Dr. Rosenbaum became a world-famous celebrity (editor's note).

When I was in medical school (1934-38), doctors avoided the press. Good doctors did not seek or grant interviews to announce a new drug or to publicize a medical advance. It was considered unethical to receive any notoriety. Medical students knew that if they received any newspaper publicity, they would be accused of unethical conduct and expelled.

When I was a Fellow at the Mayo Clinic (1940), one of the fellows in our group wrote two books, Huber The Tuber, the story of tuberculosis and Corky The Killer, the story of syphilis. The books were reviewed in Time magazine. The fellow was warned that further publicity would not be tolerated.

When I received my license to practice medicine in the State of Oregon in 1948, I was given a directive by the Board of Medical Examiners advising me as to the exact size and placement of my nameplate on my office door and was warned against advertising. A dentist friend of mine had difficulty getting malpractice insurance through the dental society because he advertised in the newspapers. He was able to purchase insurance only after he threatened a lawsuit.

In 1960, I was asked to appear before a committee of the county medical society to explain my unethical conduct. What had I done? I had given a newspaper reporter an interview on the use of DMSO in the treatment of acute bursitis. The committee forgave me.

At that time, the medical profession was slowly changing its attitude toward the press. Doctors started to actively seek publicity. Clinics, medical schools and individual doctors actually began to hire public relation experts to court the media.

In 1985, I developed cancer of the vocal cords. After fifty years of being a doctor, I became a patient. I no longer gave orders; I now received them. It was my first major illness and I quickly learned that there was a vast difference between a patient and being a doctor. To a patient his illness is a major crisis; to the doctor it's all a routine event.

As a result of that experience I wrote a book, A Taste of My Own Medicine, describing my experience as a patient. A division of Walt Disney Pictures made the book into a movie, The Doctor, starring William Hurt. The movie was a success. The book was renamed The Doctor and published as a paperback. It made the New York Times bestseller list, and I was thrown into contact with the media.

I was flooded with requests for interviews and personal appearances. The movie's producer arranged an agent for me at William Morris, one of the finest agencies in the world. Because the book was critical of the medical profession, I expected scorn from my colleagues, but times had changed. Instead of criticism I received praise. Most of the requests for personal appearances and lectures were from medical groups. Some hospitals and medical schools today use the book as a training manual to teach about doctor-patient relationships. A Japanese Medical school uses the book as a text to teach English to Japanese medical students. Some hospitals ask all their employees to read the book before starting their employment.

So, our profession has changed. Yesterdays' taboos strike us as artificial and overblown. We no longer shun the media. After all, an informed public is better able to take advantage of the wonders of modern medicine. At least, that is what we tell ourselves. Bur our real motives are probably more complex. Doctors are only human. We have egos and bills to pay. Publicity can be altruistic and self-serving at the same time.

I do not advocate going back to the old system, but the present system has its flaws. The publicity at times may be premature and untested. It may raise false hopes and actually do harm. Note the current craze and promotion of untested herbal remedies. In 1994, Congress authorized herbs and vitamins to be sold as foods, and hence they can be marketed and promoted without FDA approval. Promoters of these products take full advantage of publicity using advertising and stories in newspapers and on radio and television. Today, for example, I heard an advertisement on the radio describing an herbal remedy to strengthen blood vessels. How the manufacture proved that herbs could strengthen blood vessels I do not know. The ad is careful to state that these claims have not been presented to the FDA. Manufacturers would not have dared to advertise unproven claims prior to 1994; in the "old" days that would have been illegal. Doctors who participated in such promotion would have lost their standing and the FDA would have prosecuted the manufacturers.

We are aware when we treat the individual patient of the dictum, "above all do no harm." Let us not forget that warning when we deal with the media. When we give incorrect information to the press we are not harming one, we are harming many. I agree that we are now married to the media. I do not advocate divorce. Publicity can be beneficial, but remember that it can cut two ways.

Public Policy
"Your Action Needed NOW on Gun Safety Legislation"
By Martin Jones, MD, Public Policy Committee

Currently, there are three bills before the legislature that have a direct impact on the health and safety of our patients and our communities. All are endorsed by the ACP-ASIM, the OMA, the American College of Pediatrics, the Oregon Association of Chiefs of Police, the Oregon District Attorneys Association, the Oregon State Sheriffs Association, the Oregon State Police and many other organizations. Not surprisingly, they are opposed by the NRA.

Gun violence and injury are epidemic - with more firearm deaths every two years in the US than all Americans who died in Vietnam (over 58,000)! Half of these deaths are suicides, and everyday, 16 American children are killed with guns. Practicing preventative medicine includes advocating in the political arena for our patients safety - just as we have for seat belts, motorcycle helmets, immunizations, etc.

A description of each bill follows:

Gun Show Background Checks (Senate Bill 700) — This bill is sponsored by Senator Ginny Burdick. It requires that anyone buying a handgun at a gun show or flea market go through a criminal background check. Non-licensed sellers may still display and sell guns, but gun show operators must provide licensed dealer services at gun shows to assume that a background check is completed for each sale. This bill does not change the sales procedures for licensed dealers and does not affect the procedures of the State Police Identification Services background check.

Children's Access Prevention (CAP) — This bill is also sponsored by Senator Ginny Burdick. It holds gun owners criminally liable if children obtain access to their firearms. Gun owners are protected from liability if their guns are obtained by children, but were locked up or disabled by trigger locks. It does not hold gun owners criminally liable for unlocked firearms unless a child actually obtains access to those firearms. It does not authorize law enforcement agencies to search people's homes for unlocked weapons.

Prohibition of Youths on Probation Having Access to Guns — This bill is sponsored by Representative Bill Morisette at the request of the Community Action Forum. It prohibits youth offenders from accessing guns while they are on probation for any criminal offense. Specific elements of the bill require that all guns must have trigger locks and that parents or legal guardians must store all guns in locked boxes in the home, property or vehicle while the youth is on probation. It requires parents or legal guardians not use guns in the house, property, or vehicle in the presence of the youth while he or she is on probation. It prohibits the offending youth from being in a place where guns are not properly stored and prohibits the youth from handling a gun while on probation.

You'd think these common sense measures would be "slam dunks". However, after lobbying on March 9th, I found there is a widespread fear in Salem about bucking the NRA. Many legislators are not aware of the survey commissioned by the OMA and completed a few weeks ago that shows that 86% of Oregonians favor background checks on gun sales at gun shows, and similar majorities favor trigger lock.

Legislators are impressed with the volume of communications about an issue. Please call, e-mail, or write your legislator today about these matters - and encourage your friends and associates to do the same. I have sample letters available and legislator contacts can be accessed through the Chapter web page. If you have any questions, please call me at (541) 484-2911.

Chapter Committee Representation

The Chapter has been asked to designate members to serve on two OMPRO-coordinated Medicare Quality Improvement Advisory Committees, one for hospital-based and another for office-based projects. A number of specialty societies will have representation. These committees will advise OMPRO in development of projects in six areas which will be implemented statewide.

Over recent years, the Chapter has had representation on the State Breast and Cervical Cancer and Diabetes Coalitions. These activities are important for our patients and provide Chapter member opportunities to meet others from around the state and learn about policy development. Please contact Jim Reuler if you are interested in more information about these committee assignments.

Kudos

  • Martha S. Gerrity, MD, Ph.D., MPH, FACP - Recipient of the 1999 Excellence in Research Award of the NW Region - Society of General Internal Medicine.
  • Thomas G. Cooney, MD, FACP - Profiled in the ABIM newsletter column, "Influential and Inspirational Men and Women in the Community of Internal Medicine Today."
  • Jocelyn C. White, MD, FACP - Featured in the Oregonian, February 17, for her leadership roles, including Presidency in the national Gay and Lesbian Medical Association and for spearheading the development of the Lesbian Health Research Institute.

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

Community Service

This edition's column highlighting community service, is written by Charles M. Grossman, MD. A graduate of the New York University College of Medicine and a former faculty member at NYU, Yale and OHSU, Charlie has practiced internal medicine in Portland since 1950. An activist throughout his career, Dr. Grossman has served as the President of the Oregon Chapter of Physicians for Social Responsibility and has been the recipient of the Citizen of the Year Award of the Oregon Chapter, National Association of Social Workers and the Albert Schweitzer Peace Achievement Award from the International Physicians for the Prevention of Nuclear War.

It is not easy to conceive of a unified whole for the many and varied activities in which I have been involved in the past 60 years. Having been raised in poverty, and having difficulty with finances at medical school, I always appreciated poverty and its horrible consequences, especially as seen in the clinics at Bellevue Hospital. For me medical school was a bit of a shelter, and except for occasionally wondering where my next bed would be, or my next meal, I recognized I was approaching a professional status that would remove me from the ranks of the poor. In 1938 a profound experience moved me. I happened to read Edgar Snow's "Red Star Over China"- a story of poor peasants halfway around the world trying to solve some of their problems. I hasten to add that my respect for poor people as human beings has ever since been a dominant part of my life.

In the beginning of my professional career, I found very few doctors to whom I could relate. Issues of peace, poverty and justice interested very few of them. One of my role models in the 1940's was Dr. John P. Peters at Yale. He was always concerned about every little thing that bothered his patients, whether it was his or her diabetes, heart failure, or a painful corn. He was actually a very famous doctor and scientist, well known for his scientific publications and the famous text of Clinical Biochemistry, which he co-authored with Van Slyke of Rockefeller Institute. He was outspoken in his criticism of the organized medical profession, and became secretary of the "Committee of 400," a group of very prominent academic physicians, which publicly fought the AMA in recommending better medical care for the poor.

Undoubtedly related to these activities was his removal in 1952 from a study section of the National Institutes of Health as a disloyal American. He took to the courts, with the help of Yale Law Professor, Tom Ermerson, and fought back. He prevailed, and was reinstated in 1955. Why do I relate this bit of history? I was proud to have played a very small part in the fight. I was asked to sign an Amicus Curiae brief to the Supreme Court, and a petition to President Eisenhower, together with many famous American doctors White, Butler, Castle, Holman, Janeway, Wood, Gamble - to mention a few. Why was I as a young doctor included? My guess was that my magic address of Portland, Oregon, made the document more national in scope. Many of my good friends across the country, who had also studied with Peters and who had far more important names in academic positions in various medical schools did not appear. I assumed that as academics they were a bit uneasy taking an unpopular public position. The one notable exception was Dr. Russell Elkinton (a Quaker), who did lend his name. He later served for many years as the distinguished Editor of Annals of Internal Medicine.

For a short time in the sixties, some of my activities again focused on medicine. Dr. Morton Goodman and I were asked on a number of occasions to appear and debate with the leadership of the Oregon Medical Association on the subject of Medicare. This was easier than either of us anticipated since popular sentiment for Medicare was way ahead of the conservative position of the OMA. The 60's were also positive in that I was elected by the Black Community to help represent their interests in the Albina Citizens War on Poverty Committee, and was also elected as an alternate delegate to the Portland Metropolitan Steering Committee, part of the national OEO program.

The decade of the 70's was devoted primarily to welfare problems and trying to help build friendship with the Peoples Republic of China. Several achievements we can take pride in. Our Interagency Welfare Crisis Committee succeeded in persuading the state legislature to adopt the federal WIC program after the Oregon Board of Health turned it down. For this we were very grateful to Senator (later Judge) Betty Roberts. We also succeeded in establishing a lunch program for poor children during the summer months when they participated in schoolyard play activities. While only a few hundreds of free lunches were available in the 70's, it is our understanding that it is now a program that feeds thousands of hungry children.

A chance meeting in 1980, standing with each other in a candlelight parade for the poor, I introduced myself to Karen Steingart. She had just returned from an exciting meeting in Boston where she had heard Helen Caldicott.

Together with other young, outspoken stalwarts like Chris Cassell and Mike McCally, a new chapter of Physicians for Social Responsibility was organized, and I have remained an active member since, including membership on the National Board as well as President of the Oregon Chapter.

What can I say about doctors and their participation in community activities? Obviously the decision must be a personal one, made by each individual. One of the rewards for me has been meeting a number of medical students in PSR and watching them "grow." Some seem to leave community activities, but increasing numbers have remained interested in the problems of nuclear destruction, the environment we live in, and gun violence.

The 1990's are a bit different medical world than in the 50's. Witness the editorial in the British Medical Journal, Dec. 19-26, 1998, p. 1669, entitled "Can Medicine Prevent War?" It was indeed positive thinking, and paid tribute to the International Physicians for the Prevention of Nuclear War, awarded the Nobel Peace Prize in 1985. PSR is the US affiliate of IPPNW. Perhaps the small efforts of community activities of doctors throughout the world will add up eventually to a more logical and peaceful world.

One of the most rewarding community activities has occurred in the past five years. In 1993, downwinders from the plutonium manufacturing plant in Hanford came to PSR and requested help. Together with several other board members, they formed the Northwest Radiation Health Alliance. A medical questionnaire was designed, and distributed by them to their friends and neighbors. A total of 801 were evaluated and entered as a database into our computer. Hopefully we are helping downwinders by listening with a sympathetic ear. From a scientific point of view, this activity has resulted in two peer review publications, a published letter in another journal, and an invitation to be a guest speaker and present the preliminary data at a meeting of the Society for Radiation Protection in Berlin, Germany on the occasion of the 100th Anniversary of the discovery of x-ray by William Roentgen. This report was subsequently published in the proceedings of the meeting.

Perhaps my greatest compliment came from a young internist friend. She introduced me to a new hospital staff member, and said "Dr. Grossman is our Resident Activist".

Pneumococcal Vaccine Awareness Campaign Starts in May

Oregon's Adult Immunization Coalition and the Oregon Health Division will sponsor an intensive public campaign titled "It's Worth A Shot" in May. This campaign, targeted at those 65 and older or who have a chronic illness, will raise awareness of pneumococcal disease and increase demand for the pneumococcal vaccine. A major message of this campaign will be to "ask your provider about the pneumococcal vaccine," so health providers may want to prepare for increased demand for information and the vaccine through the summer and fall.

Pneumococcal Disease and the Pneumococcal Vaccine

Pneumococcal disease is responsible for approximately 500,000 cases of pneumonia, 50,000 cases of bacteremia, and 3,000 cases of meningitis each year in the United States. The disease accounts for billions of dollars in healthcare costs and around 40,000 deaths annually. (Jernigan, 1996). The pneumococcal vaccine has been shown to reduce the overall incidence of invasive pneumococcal disease, although similar evidence remains elusive for prevention of pneumococcal pneumonia. Case control studies have generally shown effectiveness against invasive pneumococcal disease in the range of 56% to 81% for the 23 serotypes included in the vaccine (CDC 1997). About half of vaccine recipients develop mild, local side effects but moderate and severe systemic reactions are very rare. (CDC, 1997). And a cost-effectiveness model develop by Sisk et al. (1997) showed the vaccine to be cost saving for those 65 and older based on reduced medical expenses and improved health.

Guidelines for the Pneumococcal Vaccine

The Centers for Disease Control, through their Advisory Committee on Immunization Practices (ACIP), provide a simple algorithm to represent current recommendations. Particularly, this group recommends that "when in doubt, vaccinate and document".

Compromised health creates the other criteria for vaccine candidacy besides age, and ACIP recommends the pneumococcal vaccine for all patients over age 2 if they have a chronic health condition (such as cardiovascular disease, pulmonary disease, liver disease, and diabetes mellitus) or are immunocompromised.

Remember: provider recommendations have a strong positive impact on most patients' decisions to get the pneumococcal vaccine. Systematic changes in office procedures, such as standing orders, computer reminders, or inclusion of pneumococcal vaccine with fall flu clinics can help boost coverage rates for your at-risk clinic population.

For more information about the upcoming campaign, or to review materials that will be sent to clinics and facilities during the campaign, contact Jennifer Kelly (503-731-4342) or David Dowler (503-731-4291, ext 576) at the Oregon Health Division.

Fellowship

Fellowship in ACP-ASIM is an honor awarded by 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:

Paul Bascom, MD, FACP Portland
Paula F. Ciesielski, MD, FACP Eugene
Linda M. Farris, MD, FACP Portland
Alexander M. Kositch, MD, FACP Portland
Jennifer C. Neahring, MD, FACP Salem

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, please contact Jim or Mary or the ACP-ASIM National Office at (800) 523-1546, ext. 2694.

Upcoming Dates

  • April 22-25, 1999, ACP-ASIM Annual Session - New Orleans, LA
  • June 1, 1999, Fellowship Applications due at ACP-ASIM
  • November 4, 1999, 9th Annual IDSO Meeting, Eugene
  • November 4-6, 1999, OR ACP-ASIM Chapter Annual Meeting, Eugene
  • April 13-16, 2000, ACP-ASIM Annual Session, Philadelphia, PA
  • June 1, 2000, Fellowship Applications Due at ACP-ASIM
  • August 22-23, 2000, ABIM Certification Examination in Internal Medicine
  • November 2-4, 2000, OR ACP-ASIM Chapter Annual Meeting, Eugene, OR

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 or
reuler.james@portland.va.gov
Mary A. Olhausen
Department of Medicine
Oregon Health Sciences University
3181 SW Sam Jackson Park Road, OP30
Portland, OR 97201-3098
(503) 494-8676
FAX: (503) 494-5636
E-Mail: omary@teleport.com or
olhausen@ohsu.edu

Contact Information

Thomas G Cooney, MD, MACP
Oregon Chapter Governor

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