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Governor's Newsletter, August 1999

Chapter Meeting

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

  • Programs Are In The Mail
  • Register Early
  • 11 Category I CME Credits
  • 9th Annual Infectious Diseases Society of Oregon Meeting November 4

Associates' Council

The Associates' Council would like to congratulate all of the Oregon residents who participated in the ACP-ASIM Annual Session in New Orleans. Thanks to you, Oregon was well represented!

Dr. Jane Dunham of Providence Portland Hospital - Clinical Vignette Poster Winner - Fever of Unknown Origin in the Returning Traveler: Bad Cheese or Fleas?

Dr. Anthony VanHo of Legacy Portland Hospitals - Oral Presentation - Severe Tricuspid Regurgitation: Classic Feature of a Rare Malignancy and Consideration of the Differential Diagnosis

Research Poster Finalist - Are We on the Same Wavelength: Are Resident Physicians Using Medical Terminology That Patients Misunderstand?

Drs. Lisa Els, Mark Harrington, and Rhonda Tetz of Legacy Portland Hospitals - Research Poster Finalist - An Educational Intervention and Resident Drug Prescribing Behaviors

Dr. Karen Wesenberg of Providence Portland Hospital - Clinical Vignette Poster Winner - Atorvastatin: Cure for the "Protease Paunch?"

The Associates' Council is busily planning events for the 1999-2000 academic year. Look for a social event in July to welcome the new interns and a series of Career Preparation Workshops in the Fall. Also, residents will be receiving information over the summer regarding the Associates' Competition at the Oregon ACP-ASIM meeting in Eugene, November 4-6 (mark your calendars!).

The Associates' Council would like to acknowledge all its outgoing members: Drs. Guy Delorifice and Frederick Mitchell from Providence St. Vincent Hospital; Dr. Tom Steele from Providence Portland Hospital; Dr. Maria Silveira from OHS; and Drs. Rick Hongo and Lisa Els from Legacy Portland Hospitals. We appreciate all your hard work!

Current Associates' Council members are:

Amy Chaumeton
Legacy Portland Hospitals
833-3812

Peter Embi
Oregon Health Sciences University
494-4799

Karen Englund
Providence St. Vincent Hospital
301-4570

Julie Henery
Legacy Portland Hospitals
833-3112

Craig Kunz
Providence St. Vincent Hospital
301-4843

Jim Nachiondo
Oregon Health Sciences University
494-4799

Teresa Ramirez
Providence Portland Hospital
215-0067

Rebecca Sunenshine
Oregon Health Sciences University
494-4799

Tim Thunder
Providence Portland Hospital
215-3878

Jim Nachiondo will represent the Associates' Council on the Chapter Council. Please feel free to contact us any time with questions or if you would like to volunteer to help with one of our upcoming events!

Medical Student Activities

As reported in the last newsletter, a student component of the Chapter is taking form. Here is the exciting update:

  • Three students attended the March Council meeting.
  • Students are developing an ongoing community service project to be linked with Loaves & Fishes, Inc./Meals on Wheels and launched in the Fall of 1999.
  • The Chapter's Annual Scientific Session in Eugene will be "advertised" to students; the Chapter will plan to provide free lodging, either at the hotel or in the homes of Chapter members from the Eugene area.
  • The Chapter will be developing a "mentorship program" for medical students, linking with the Associates' Council and members around the state.
  • Student membership in the Chapter continues to grow!

Any Chapter member who is interested in becoming involved in any of these student projects, please contact Jim Reuler.

The first Chair of the National ACP-ASIM Council of Student Members, Kavita Patel, MD, a 1999 graduate of the University of Texas-San Antonio School of Medicine, has joined the Medicine residency program at OHSU. Kavita was the national President of the American Medical Student Association and has represented AMSA and ACP-ASIM on numerous national executive and advisory committees. We are looking forward to tapping Kavita's energy, contacts and perspective as our student and Associate programs grow!

Many thanks to Adam Williams, MD, Medicine resident at UC-San Diego, and Ian deBoer, MD, Medicine resident at UCSF, both AOA graduates of the 1999 class, School of Medicine, OHSU, for all of their work in helping to launch the Chapter's Student program over the past two years, and to Ryan Peterson, MS-IV, and Amy Schmitt, MS-III, for providing the continuity of leadership this year!

Career Corner

This edition's Career Corner is authored by Mark Leavitt, MD, Ph.D. Mark initially trained and worked in electrical engineering, but decided to switch to Medicine. He attended the Ph.D. to MD program at the University of Miami School of Medicine, and served his residency in Internal Medicine at OHSU. After ten years in private practice, he left medicine to devote himself full-time to chief executive duties at his fast-growing electronic medical records company, MedicaLogic, Inc. MedicaLogic now employs nearly 200 people, with development centers in Hillsboro and San Francisco, and provides EMR systems for major healthcare systems around the country.

(Editors Note: MedicaLogic and Mark were featured in the Oregonian Business Section June 8 when it was announced that a venture capital infusion of $35 million into the company set a record for investment in a Portland area private company).

My career path probably ranks as an unusual one for a physician. In looking back, I'm quite amazed how random, seemingly minor events have influenced my career trajectory in major ways. In retrospect, somehow it fits together logically. In telling my story, my hope is that a colleague debating his or her own future may find a nugget of insight. The major shifts in my career choices may be more understandable if you look back at a similar pat-tern in my early aspirations. I had decided I wanted to be a doctor sometime before I entered grade school. I had a moderately bad case of childhood asthma, and one particular episode complicated by a pneumomediastinum led to a hospitalization, during which I met quite a few doctors. They seemed intelligent, respected, and powerful - desirable role models for a young boy - and it seemed to be a career that would harness my already apparent loveof science and technology.

This career aspiration lasted until I was ten. Tinkering with a crystal radio, I picked up the transmissions of a ham radio operator across the street. I knocked on his door and showed him my contraption - housed in a cigar box, it used a razor blade, safety pin, toilet paper tube, and salvaged wire - and soon I had a mentor who wanted to teach me all about radio and electronics. He had severe rheumatoid arthritis and had never married or had children; in retrospect, I can see that the relationship fulfilled a need for both of us.

As I became more involved and skilled in radio technology, it seemed natural that I should become an electrical engineer, and there was lots of reinforcement for this decision. I passed examinations for every federal radio license obtainable, enabling me to earn spending money throughout high school by moonlighting as a technician at radio broadcasting stations. In college, EE courses proved simple thanks to the hands-on experience I'd already gained.

At graduation in 1971, the best jobs were in the defense industry, so I accepted one in the San Francisco bay area that promised tuition payments for graduate work at Stanford, where I completed work for the Ph.D. At that company, my job was to design sophisticated antenna systems for reconnaissance. I have souvenir photographs of a U-2 spy plane with my antennas on it and other bizarre antenna designs that were actually disguised as trees! I was pleased with my advancement in this career, but once I had a child, I started to question the value and relevance of my work to society as a whole. This is a personal growth passage that most people experience, but perhaps I reached it a bit early at 27. I met a fellow quite randomly, at a party, who had been an engineer but had then attended the Ph.D-to-MD program at the University of Miami to become a doctor. That sounded like an incredible adventure and a challenge, besides giving me the chance to find more relevance in my career, so I applied. When I was accepted, I had to make the difficult decision to give up my engineering career, sell my house and car, and uproot my wife and 1-year old baby from their comfortable home to live like poor students at the opposite end of the country for two years. I did it because I was convinced I would regret it all my life if I let the opportunity pass. In retrospect, I am thankful that I made that decision.

Five years later, after the accelerated two year Ph.D.-to-MD program and three years of internal medicine residency at OHSU, I hung out my shingle to start a solo practice in Portland in 1982. I had bought an Apple II+ computer to tinker with and created a basic program to manage patient clinical records. As each patient left, I handed them a large computer printout with perforations that could be separated into their prescription slips, their instructions, and their next appointment reminder. Patients liked it and fewer mis-takes were made. Of course, once I reached a population of fifty patients, they wouldn't fit on a single Apple floppy disk any more! As computers advanced in capability, I upgraded the program, and eventually started selling a few copies to physicians around town, strictly as a side business. I incorporated MedicaLogic in 1985 mainly so I'd have clear tax deductibility for the computer toys I liked to buy. The patient database proved very powerful; for example, when the L-tryptophan/myositis outbreak occurred (caused by a contaminated batch of product), I was able to quickly search my population and call up all the patients who had mentioned using the supplement.

My practice grew to a typical full internal medicine population. For my computer business, I added a few employees and rented out a small office nearby to house them. As it grew, I tried to take a day or two off from practice each week to work at MedicaLogic, but as you can imagine, that doesn't work, even with a pretty understanding associate in the practice. Finally, in 1992, I was forced to decide between the two. Once more, I took the more chal-lenging path, feeling I had to give it a try or I'd regret missing the opportunity. Fortunately, I was able to ease the transition in two ways. First, I took a two-day-a-week consulting position with Providence as their Medical Director of Information Systems, so I knew I wouldn't starve (although not meeting house payments was a real possibility). Second, the St. Vincent Department of Medicine purchased my practice, making it their official Faculty Practice and residency teaching clinic, where it continues in operation today. I continued to see patients for a half day a week for a few years, and finally stopped all patient care activities in 1996 when my business travel schedule made that impractical.

Since then, MedicaLogic has grown beyond my wildest anticipations and I've had to learn new skills at every stage of the company's growth: going from doing everything myself to managing a small group, to becoming a part of an executive team, to leading a large organi-zation, to articulating a vision for the future of medical informatics. I come into contact with hundreds of physicians every year, and am frequently asked if I miss taking care of patients. My answer is that I'm finding even greater satisfaction now by working to allow my fellow physicians to stay more focused on their own patients. If I succeed, I'll be helping, albeit indirectly, many more patients than I could ever have seen myself in practice.

Is there a message to my story? Well, if you are considering a career change that uses your skills and experience as a physician in a new way, and you're still up for an adventure, my advice is to take the chance. You have the right, and, in fact, an obligation to employ your talents and gifts to their fullest extent.

Initiatives in Community Service

Community service is an important aspect of citizenship and physicianhood. Several College/ Chapter developments have put new focus on this component of our social contract with society:

  • Increased emphasis on voluntary provision of medical care as an aspect of community service in Fellowship advancement requirements of the College.
  • The National Council of Associates Community Service Award established two years ago.
  • Establishment by the College this year of the Oscar E. Edwards Memorial Award to recognize College members engaged in voluntarism and community service.
  • Our Chapter's Community Service Column begun in 1997.
  • Our Chapter's new medical student Community Service project.
  • Establishment of Community Service Awards in all of the College's Chapters, a project of the Board of Governors Class of 2001 of which Jim Reuler and Andrea Keilich are members.

More information about this initiative for our Chapter will be forthcoming.

Community Service

This edition's column highlighting community service is written by Steven J. Mandelblatt, MD. A graduate of Hahneman Medical School in Philadelphia, Steve spent two years in the National Health Service Corps in rural Wisconsin, after completing internal medicine residency at OHSU. Certified in both Internal Medicine and Addiction Medicine, Steve has been affiliated with Kaiser Permanente in the Portland area for over twelve years. Earlier this year, Steve traveled to Honduras to help with relief work in the wake of Hurricane Mitch.

In mid-January, 1999, I was part of a medical relief team that went to Honduras to provide medical care in the aftermath of Hurricane Mitch, which devastated essentially the entire country in the Fall of 1998. The hurricane dumped about four years worth of rain in 5 days into a country whose population of 6 million (approximately half rural, half urban) already lived a life such that 2/3 of the people lived below the poverty level. I went with two nurses who had been to Honduras in November on a different mission, both under the auspices of Operation Shoebox based in Newberg, Oregon, which has been involved in relief work in Honduras for about 8 years. We flew into the capitol city of Tegucigalpa and coordinated our supplies and itinerary through an existing relief agency located there which has worked with Operation Shoebox prior to the hurricane and with the previous medical teams from both Shoebox and Northwest Medical Teams.

Our supplies consisted of medications left over from the November teams' efforts, pre-dominately antimicrobials, topical antifungals and topical steroids. There was also a smattering of H2 blockers, analgesics, antiasthmatics, ear and eye preparations, electrolyte replacement solutions, bandages, and some suturing materials. Most of these had been provided from the offices and ER's of the prior and current teams, although we ultimately also purchased $400 worth of vitamins, antihelminthics, and more analgesics throughout our stay from local pharmacies.

We traveled from Tegucigalpa to a small town in north-central Honduras called Morazan which served as our base for 4 days. We then traveled to 3 separate small villages of between 1500 and 3000 people to deliver care. The countryside is spectacular - high mountain valleys, lush forests, bananas/mangos/papayas/oranges/coconuts growing in groves and in people's yards. In spite of this richness, the rural population in the smaller villages live in what was to me an astounding degree of deprivation - homes were typically 20 x 40 feet in size with fowl or swine running about, no plumbing, no electricity or phone service (Morazan itself has 2 phones, one in the mayor's office and one for collect, out-going calls to the US only; the surrounding towns had no phone or electricity), roads and bridges that had been either totally washed away from the flooding associated with Mitch or that were in great disrepair, and sporadic running water. The devastation from the flooding was unbelievable: huge landslides, homes totally washed away or destroyed beyond repair, and swaths of destruction 150 years wide where what had been a placid 15 foot wide wadeable stream became a torrent that scoured topsoil, vegetation, buildings, and people into a wasteland.

We traveled into these towns unannounced, as there was no way to communicate our presence widely other than to call out from our pickup truck that an American medical team was in the village and would see patients. We used the local schoolhouse as a clinic: one corner became the intake area, one corner was the pharmacy, and one corner was the "exam room" for the clinical visit itself. Our presence seemed to be the event of the year for many of the people; I believe that most of the rural folks had not seen either an MD or an Anglo in their lives. (There is a national health service in Honduras that is predominantly based in the larger cities and does provide for free medical visits; however, there is no lab or medication benefit and the closest hospital to where we were was 1.5 hours away). We tried to see the children first, then the elders, and lastly the rest of whomever wanted to be seen. I saw over 200 patients each day, with some people waiting many hours to get seen. I did no documentation, had no lab facility, and wrote "prescriptions" on notebook paper. At one point, I was suturing by illumination provided by a penlight.

The bulk of what I saw clinically was respiratory and diarrheal illnesses, along with a lot of back pain and arthralgias due to subsistence lifestyle. The water supply is contaminated, and although the population both before and after Mitch was instructed on the necessity of either boiling their water or adding Chorox (provided free of charge from the Government to anyone who wanted it), the reality was that boiling used about 1/3 of a wood supply that was otherwise needed for heat and cooking, and chlorination was not accepted due to taste reasons. Consequently, the status quo was to have diarrhea and obvious parasites in the adults, and the same along with marked malnutrition in the children. Basically everybody I saw, therefore, received some dysentry and antihelminth treatment, along with as many vita-mins as our supply allowed. I knew nothing about tropical medicine until this trip was arranged, and if I saw my patients with the exotica like malaria or dengue or leptospirosis, I did not recognize it as such. I was told that there were some of these diseases diagnosed by the November team, however.

The sense of futility was great, both that what we were doing for the people was temporary at best, and that there seemed little hope among the people that they could achieve a different lifestyle even if the tragedy of Mitch had not affected them. There was much sadness due to the loss of family and property, and some of the children reportedly had a PTSD-type fear that each rainstorm would bring further destruction. Regardless of these prevailing attitudes, we were warmly received and extemporaneously fed home cooking of soup or eggs, tortillas, and coffee in each village. The people were genuinely grateful and their thanks was uplifting.

Our last clinic day was spent in the worst of the slums of Tegucigalpa. I was prepared for more misery after having seen the state of existence in the rural areas, but surprisingly the slum residents had much better nutrition, sanitation, and clothing than the people seen at the first three villages.

My most lasting memories will be numerous. The countryside is beautiful, even if it hides such suffering. The scope of the destruction remains beyond my ability to fathom. The smiles of the kids to whom we gave a piece of candy at the end of their visit; the thanks of the 65 year old midwife of one of the villages for a handful of latex gloves for her use in her healthcare role; and the oxcart ride into one of the villages after our pickup got swamped in a failed attempt to ford a stream will remain with me always. And the realization that we have so many advantages in our lives in Oregon is very sobering.

There will be future medical teams traveling to Honduras through Operation Shoebox. If anyone is interested in exploring these opportunities, contact Dr. David Krier, Medical Director, PO Box 1210, Newberg, OR 97132. Cell phone: (503) 703-4745.

Board of Medical Examiners

The Oregon Board of Medical Examiners is now the first Oregon licensing board web site to provide information which is available to the public about licensees. The home page (www.bme.state.or.us) contains information about BME programs, licensure requirements and links to other related web sites. BME plans annual license renewal fee increases this year, the first in a decade. George A. Porter, MD, FACP, is Vice-Chair of the BME.

Public Policy

Get involved - Be an advocate for your patients and the profession. The Health and Public Policy Committee of the ACP-ASIM, Oregon Chapter, is a standing committee of the College linked directly to the National Committee on Health and Public Policy. As its title implies, the Committee focuses on pertinent issues of health care policy affecting both physicians and the public. Within Oregon, the Committee serves as a bi-directional conduit for information going from the state to the national organization and the reverse.

We internists are more influential than we might imagine. The public in general and the legislature in particular pay attention to our opinions. There are many issues where we can be advocates for the good health of our patients. From seat belts to motorcycle helmets. From immunizations to mental health parity, and from tobacco taxes to providing health care for our less affluent citizens to a gun law that will include gun show background checks and a child access prevention clause - our efforts - the efforts of so many of you - have furthered the health and well-being of our patients and all Oregonians.

Your statewide Public Policy Committee is profiling our membership as to what health/safety/ medical/political issues each of you is particularly interested in. That way, you can be kept informed and updated about issues in a timely way so that your voice may be heard: to write or call legislators, to notify your own contacts or networks of friends, and to let your Chapter's Committee know your position on important matters. There is strength in numbers! Legislators do respond to public pressure, and physicians' opinions are respected - especially in areas that affect the health and well-being of our patients and our communities.

Thank you for taking a moment to let us know what areas interest you and be added to our list to receive timely information on these important issues. Please respond to the contact information listed below and let us know your Name, Address, E-mail, Fax and/or Phone Numbers, and Areas of Interest.

Areas of Interest

Tobacco
Gun Control
Toxics
Gambling
Assisted Suicide
End of Life Care
Nuclear Weapons
Universal Health Coverage
Domestic Violence
Genetic Engineering
Media Violence
Pollution
Other

Contact:

Martin L. Jones, MD, Chair, Public Policy Committee
2300 Parkside Lane
Eugene, OR 97403
Phone: (541) 484-2911 (office); (541) 485-5762 (home)
FAX:(541) 345-3211
E-mail: martin.jones1@worldnet.att.net

Membership

The Oregon Chapter continues to grow! Here is a breakdown:

Category September 1, 1997 June 1, 1998 June 1, 1999
Students 36 104 127
Associates 183 217 238
Members 533 524 642
Fellows 179 182 191
Masters 2 2 2
TOTAL 933 1,029 1,200

Tell your friends about ACP-ASIM. For more information, contact ACP-ASIM Customer Service at (800) 523-1546, ext 2600 or Mary Olhausen at (503) 494-8676.

Internists and the Media

This edition's Internists And The Media column is authored by John A. Benson, Jr., MD, MACP. Dr. Benson, one of the senior leaders in modern American Internal Medicine, is President-Emeritus of the American Board of Internal Medicine and Dean Emeritus of the School of Medicine, OHSU. Recently, Dr. Benson chaired the Institute of Medicine's Review Committee "Medical Use of Marijuana: Assessment of the Science Base," which published its report in March, 1999, with much press coverage and debate.

In the April Governor's Newsletter of the Oregon Chapter, Ed Rosenbaum captures the enor-mous shift in the attitude of our profession toward the media. This sea change accompanied societal phenomena such as consumerism, informed consent, the educated public's thirst for medical knowledge, as well as the development of really effective medications. Girded with that information, our patients now want a role in decision-making about management of their illnesses. And they learn about breakthroughs from coverage on nightly network news of articles from The New England Journal of Medicine, Nature, and the JAMA just as soon as we do.

Therefore an accountable profession must help the public get the story straight. This is the Age of Information, after all. By relying on scientific fact and evidence-based medicine, physicians can blunt accusations of self-aggrandizement and publicity mongering while increasing the public's understanding. As a member of a faculty, medical association, or health system one has the additional burden when "going public" of not embarrassing col-leagues or the organization, because outsiders perceive you as representing the organization's views or policy. Public displays rub off on colleagues.

For me there have been two striking media experiences. The first began in 1983 when the American Board of Internal Medicine decided that the demonstration of humanistic qualities is an essential component of certifiable clinical competence. This was picked up by The New York Times as a call for renewed "bedside manner" in a technologically driven era. As the Board's executive, I was challenged by reporters' skepticism and, I might add, that of colleagues in academic medicine. "How does the Board define humanistic qualities?" Compassion, personal integrity, and respect for patients and colleagues. "Can they be measured?" No, but one knows them when one sees them; they can be evaluated. "Have doctors abandoned the bedside manner?" Not the good ones. "Don't physicians adopt such behaviors at their mothers' knees, long before going to medical school?" Often, but such values frequently aren't exhibited in the behavior of busy, frustrated, tired, or thoughtless doctors. "Can such skills be taught?" Definitely. Coping skills, simple strategies for better interpersonal communication, and a willingness to listen can be modeled and enhanced by constructive criticism.

The New York Times News Service triggered hundreds of letters and calls, mostly approving. From my desk in downtown Portland there were a dozen or so radio talk show appearances in Tampa, Texas, California, and elsewhere. The public wasn't skeptical. I remember one lady in Florida who complained of the inhospitable environment of her physician's examining room -- details that mean something to patients, ones my thinking had not included as humanistic.

Humanistic behavior struck a responsive chord in the public, and ABIM enjoyed praise. Metastases rapidly followed -- a presidential address to the American College of Surgeons, the requirements of other certifying specialty boards, and seminars for residency directors on dealing with "problem residents." This "notoriety" was pleasant and largely driven by the public.

A second experience with the media was nearly overwhelming. As a co-Principal Investigator on an Institute of Medicine study of medical marijuana, I accepted the risks of a sensitive subject and unorthodoxy. But at age 76, retired, reliant on the respect in which the IOM's impartiality and independence are held, and confident that a rigorous scientific approach would protect me, I undertook the 18-month task. The study was commissioned by the White House Office of National Drug Control Policy, directed by General Barry McCaffery, whose approaches have been "to wage war on drug abuse."

But our report was not influenced or tampered with by the ONDCP, and by contract was first presented to the Director only seven days before it was made public. The subject matter was politically very touchy, so tremendous care was taken to understand the prevailing biases

of scientists and to select expert advisors and confirmed scientific data such as double blinded, controlled clinical trials.

The study team decided to hold three public workshops, the first in California where a state initiative had already endorsed medical use. Because we respectfully listened to the anecdotes of patients whose opinions previous studies had excluded, the patients and their advocacy groups trusted IOM. Those opposed to liberalization of marijuana use regarded us as dupes of scheming proponents of decriminalization. It was true that a pro-legalization group, the Marijuana Policy Project, organized the attendance of many of the patients. The media tended to feature public interest stories of personal illness, incarceration, and unlawfulness, and one felt some responsibility for such one-sidedness. But the workshops also included basic and clinical scientists, and the two political camps heard their unvarnished data as well. Surprisingly few opposed to marijuana accepted the team's invitations to present their points of view at the workshops, preferring instead internet-borne criticisms of the drug culture and the federal dollars "wasted" on the study.

IOM practice is to announce major studies at a press conference, where only credentialed media are permitted to ask questions. Ours was on March 17th. Two days earlier a press release was circulated, embargoed until the hour of the press conference. The afternoon before, the IOM staff heard of a possible break in that embargo by the executive director of the Marijuana Policy Project on a nationally televised evening news hour. Veiled threats to dissuade him from breaking the news followed, and the study team and IOM public affairs group nervously watched. Our fall-back would be about 100 calls that evening to release other media from the embargo. He desisted, and we retired after pizza.

Another IOM practice is the "murder session." Senior IOM people asked the two of us on the study team tough questions we might expect from the Beltway's media. "Had we ever inhaled?" "Why did you allow limited use of marijuana for terminal patients even while warning of the hazards of smoking?" "Aren't more effective approved drugs far more expensive than the plant?" "Would we move marijuana to a Schedule II controlled sub-stance?" Our answers were honed, not changed, our fears reduced, and our focus strength-ened. We were scientists, not policy wonks; we relied only on solid evidence. After 100 minutes we survived.

Then into the press conference. What an overwhelming site! About 100 people, badges for the media, 17 television cameras and their cables, bright lighting, a few patients identified by emblazoned t-shirts, and two very exposed chairs for the co-PIs. After about 15 minutes of prepared text the questions began, the first to me from ABC News and the TIMES. Some were rhetorical, most sought clarification. We were well prepared, and in another 45 minutes done. The subject matter made it the largest IOM press conference ever. Again the saving grace came from factual knowledge, sensible opinion, and no-nonsense responses. We avoided trying to be cute or political.

Then the IOM public affairs team split the team to maximize accessibility by telephone. In the next three hours I talked to perhaps 12-15, including the BBC, a taping for the Brokaw NBC News, and a Portland radio station, before flying home. There I found myself on CNN. That was only the beginning. Over the next six weeks calls connected me to several newspapers, USA Today, the Rolling Stone, many radio stations, an on-line ABC "talk" show, NPR, among others -- repeating the same story, the same conclusions, the same reluctance to enter into possible political solutions. I preferred careful conversations with writers to the sound bytes TV wants. Calls came from patients and attorneys. An OHSU newspaper clipping service has forwarded at least 200 items, many with inaccuracies. Later the team prepared an OpEd piece which reemphasized our contention that medical marijuana is a different matter than drug abuse. Its publication stimulated even more calls. The team still communicates regularly by e-mail. During the concurrent legislative session in Salem, a prudent OHSU hasn't publicized the participation of its emeritus faculty, the doobie doctor.

Lessons regarding media exposure for me have been to stick to the facts, avoid over-answering leading questions, protect one's own credentials and school's reputation, and behave as a compassionate physician and credible scientist. Then the circus atmosphere is manageable. Second, physicians should be involved in public education, even the education of populations. That usually starts with the reporter. We should not shy from the media's interest. Their understanding of issues is critical. After all, they teach a very broad con-stituency, our patients and their families.

Preceptorship Opportunities

Precepting young professionals is one of the most rewarding aspects of physicianhood and a critical building block in the foundation for the future of our profession. ACP-ASIM has emphasized this role through its Community Based Teaching (CBT) Program. If you are interested in learning about the resources of the CBT Center, receiving the CBT newsletter, or applying for a CBT Certificate of Recognition (requires at least one year of office based teaching), please contact Patrick Alguire, MD, FACP, at the CBT office within the Department of Education and Career Development at ACP-ASIM national office, (215) 351-2400, ext 2845, or see the CBT section of ACP-ASIM Online.

Chapter members who served as preceptors for first or second-year medical students at OHSU in the Principles of Clinical Medicine course during 1998-99 include:

Susan Bagby
Donald Girard
Anthony Montanaro
Ian Barr
Steven Hashiguchi
David Nardone
John Bauer
Mari Kai
Rebecca Orwoll
Katie Bensching
Andrea Kielich
Steven Redmond
Phillip Buckley
Kelly Krohn
James Reuler
Thomas Cooney
Kusum Kumar
Scott Sallay
Brian Cox
David Labby
Melanie Scurry
Richard Craft
Roger Leverette
Ellen Singer
Theo deBruin
Linda Lucas
David Smith
Thomas DeLoughery
Nancy MacNeal
Steven Spindel
Leigh Dolin
Scott Mader
Carol Sprague
Martin Donohoe
Daniel Mangum
Richard Wise
Diane Elliot
Mary Meyer

If you wish to learn more about PCM Preceptor opportunities, please contact Ms. Pam Tise at OHSU, (503) 494-6617.

Through the Area Health Education Centers (AHEC) Program and the Primary Care Clerkship at OHSU, primary care practitioners from around the state serve as preceptors for third-year medical students. Chapter members who served as AHEC preceptors during 1998-99 include:

Steven Delashmutt Baker City
Andrew Gilchrist Newport
Charles E. Hoffman Baker City
Susan Mark Newport
Jeffrey McDonald Coos Bay
William Moriarity Coos Bay
George Potter Coos Bay
Jerry Robbins Newport
Albert Tsien Coos Bay

If you are interested in learning about preceptorship opportunities in the AHEC Program, please contact Ms. Becki Anderson at OHSU, (503 494-1165.

Kudos

  • Steven A. Hashiguci, MD, ACP-ASIM Member. Recipient of the College's Community Based Teaching Award.
  • Joseph J. Thaler, MD, FACP. Recipient of the College's Community Based Teaching Award.
  • Elizabeth A. Allen, MD, ACP-ASIM Member. Recipient of the David W.E. Baird Award for "Excellence In A Junior Faculty Member" awarded by the 1999 graduating class, OHSU, School of Medicine.
  • Stephen M. Campbell, MD, ACP-ASIM Member. Recipient of the Allan J. Hill, Jr., Award for "Excellence In Teaching" awarded by the 1999 graduating class, OHSU, School of Medicine.
  • D. Lynn Loriaux, MD, Ph.D., FACP. Recipient of the J. David Bristow Award for "Exemplifies The Ideals of a True Physician" awarded by the 1999 graduating class, OHSU, School of Medicine.
  • Oregon Chapter, ACP-ASIM. Recipient of an Evergreen Award from the College's Chapters Sub-Committee for Innovation in Education/Communication represented by the Chapter Newsletter. Many thanks to all Chapter members who have contributed to the newsletters over the past two years.

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

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:

Arlene D. Bradley, MD, FACP, Roseburg
Martin L. Donohoe, MD, FACP, Portland
Linda L. Humphrey, MD, MPH, FACP, Portland
Charles M. Wood, 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, please contact Jim or Mary or the ACP-ASIM National Office at (800) 523-1546, ext. 2694.

Upcoming Dates

June 1, 1999 - Fellowship Applications due at ACP-ASIM
November 4, 1999 - 9th Annual IDSO Meeting, Eugene
November 4-6, 1999 - Oregon Chapter ACP-ASIM Annual Meeting, Eugene
December 1, 1999 - Fellowship Applications due at ACP-ASIM
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 - Oregon Chapter ACP-ASIM Annual Meeting, Eugene

How to Reach Us

James B. Reuler, MD, FACP
Section of General Medicine
Veterans Affairs Medical Center (P-3-MED)
PO Box 10343181
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
SW Sam Jackson Park Road, OP30
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