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Governor's Newsletter, December 1999

Governor Election

One of the most important events in the cycle of Chapter activities is the election of the next Governor, occurring every four years. Many thanks to Kathleen M. Weaver, MD, FACP, Chair of this year's Nominating Committee and Committee members Donald E. Girard, MD, FACP, and Curtis R. Holzgang, MD, FACP, for all their work in reviewing credentials and contacting potential candidates. The two nominees chosen are:

  • Stephen R. Jones, MD, FACP, Legacy Health Systems, Portland
  • Andrea M. Kielich, MD, FACP, The Portland Clinic, Portland

Biosketches and vision statements are posted on the Chapter web page. Ballots have been mailed to all Masters, Fellows and Members of the Chapter. The candidate elected will serve a one-year term as Governor-Elect and will become Governor on April 1, 2001. Please exercise your voting privileges.

2000 Meeting

On the heels of a very successful 1999 Chapter meeting, plans have already begun for the 2000 meeting in Eugene, November 2-4. Linda L. Humphrey, MD, MPH, FACP, will chair the Program Planning Committee. Daniel Federman, MD, MACP, of Harvard Medical School, will be the Howard P. Lewis Visiting Professor. Mark your calendars now!

Medical Student Activities

  • 12 students attended the Chapter meeting in Eugene, November 4-6.
  • Jennifer Keam, second-year student, coordinated an ACP-ASIM booth/display at an all campus OHSU Student Activities Faire, September 16.
  • On October 8, the Community Service project, in conjunction with Loaves and Fishes/Meals on Wheels, Inc., was launched with coordination by Sarah Cassell, third-year student. Ryan Petersen, fourth-year and Beatrice Brooks, Michael Oh and Wynn Tom, second-year students, provided screening for, and education about, high blood pressure for 74 people participating in a health fair at the Neighborhood House Senior Center at Multnomah Center in Portland.
  • Richard W. Wise, MD, ACP-ASIM Member, of Kaiser Permanente Beaverton Medical Clinic, will be working with the Chapter's student group to develop a mentorship program. Any Chapter member interested in being involved, please contact Rick at (503) 520-4879.

Career Corner

This edition's Career Corner is authored by Ellen L. Singer, MD, FAAP, ACP-ASIM Member. A graduate of the University of Rochester School of Medicine, where she continued residency training in internal medicine and pediatrics, Ellen is a Diplomate of both the ABIM and the American Board of Pediatrics. An Assistant Professor in the Departments of Medicine and Pediatrics at OHSU, Dr. Singer practices "Med/Peds" at OHSU's Beaverton Clinic and is an Executive Committee member of the Section on Medicine/Pediatrics of the American Academy of Pediatrics.

Editors Note: The "Medical Students Guide to Evaluation of Combined Med-Peds Residency Programs" can be found at www.apdim.med.edu/publications.

When I sat down to write this piece, I realized that it has been exactly ten years since I wrote my personal statement for my residency applications. At that time, I was applying to medicine/pediatrics programs after several months spent debating about what type of residency I'd apply for. Ten years later I can say that I have had no regrets whatsoever!

I was fortunate to attend a medical school that had a well-established, primary care based medicine/pediatrics ("med/peds") program. I learned about the University of Rochester program during my medical school interview. At the time I applied to medical school, I was working in a UCSF infectious disease research laboratory and was intrigued by the clinical correlations of the vaccine research we were doing. I had already had extensive experience working with children as a teacher, child life volunteer and science educator. I was naturally interested in pediatrics, but had little experience in adult medicine. However, the possibility of training in both fields was new and exciting to me.

When I was a third-year student the University of Rochester, I had an eight-week required pre-clerk-ship course. We spent five weeks on the wards doing interviews, physicals and detailed case write ups. I was fortunate to be on the medicine service in a community hospital and to have exceptional faculty and house staff preceptors and mentors. Although it was easy to be overwhelmed with the complexity of illness in adult patients, I enjoyed the relationships I developed with my patients and their families and the challenge of problem based clinical reasoning.

My first "real" clinical rotation was pediatrics and I enjoyed the mix of inpatient and outpatient work. I discovered that I knew less about infants and young children than I thought! I loved the challenge of assessing children developmentally and learning to do an exam in a "kid friendly" fashion. And it was a relief to not have to wade through thick charts and write up 6 pages of past medical history (most of the time)!

As my clinical year progressed, I found that I enjoyed all of my clerkships. I particularly loved the intensity of my surgical rotation and spent several months considering a career in surgery. My medicine rotation was the last twelve weeks of my third year. I started in the university hospital and I hated it. I had a wonderful resident team, but I felt overwhelmed again. I was on the steep learning curve that all students struggle with as they master clinical exam and reasoning skills. As many of my classmates began to decide which residencies they were going to apply for, I felt less and less able to make this decision. I began to collect applications from family practice, internal medicine, pediatrics and med/peds programs. The faster these arrived in the mail, the more anxious I became.

I was very fortunate to participate in an outpatient medicine pilot program for the last six weeks of my medicine rotation. I worked with a family practitioner in an outpatient office, rounded on the inpatients for his practice and also worked in several medicine subspecialty practices. I enjoyed the variety in this rotation. I saw patients with acute outpatient problems as well those patients in a continuity practice with ongoing chronic illnesses. I opted to do my required fourth year medicine sub-internship at the university hospital immediately following this rotation. During this final month, I found that I really enjoyed the challenges of internal medicine and decided to look at both medicine and med/peds programs for residency. I decided that as much as I respected and believed in the philosophy of family medicine training, I did not expect to do Ob-Gyn and I wanted more in depth training in medicine.

I had the opportunity to do a sub-internship in outpatient pediatrics and an emergency room rotation in the fall of my fourth year and it was during this rotation that I realized that I didn't want to give up pediatrics. I had several med/peds trained mentors - both house staff and faculty - in Rochester and began applying to programs with a clear understanding of what the residency entailed and what was possible after training. Med/Peds is a four-year commitment with 3-4 months blocks of time spent on either service fully integrated as either a medicine or pediatrics resident. I applied to fifteen programs, interviewed at eight and ranked five. At that time, the Rochester program did not have a med/peds clinic, but there was strong commitment to primary care and general medicine and pediatrics; this strength was a big factor in my decision to stay in Rochester for my residency. The program was intense with multiple ward, ICU and ER blocks in both disciplines. I also had weekly busy continuity clinics in both medicine and pediatrics. During my third and fourth years of training and my chief residency year I did a lot of moonlighting including multiple emergency room shifts, outpatient pediatric clinics and call at a large HMO, internal medicine consults on inpatient psychiatric patients, delivery room management of sick newborns, and attending coverage in a large outpatient geriatric PACE program.

At present, my current practice is in an OHSU affiliated outpatient clinic. I also precept in internal medicine residency clinics 2-3 half days per week. On average about 60-70% of my practice is adult patients, but that varies from week to week. I enjoy the variety of patients that I care for and the opportunity to take care of entire families. In several families, I care for three generations! I typically take call for both components of my practice together; usually this is one night a week and every 4-5th weekend. We admit patients both to OHSU and Providence St. Vincent's.

Many people find it daunting to consider mastering two disciplines in clinical medicine. What I value most is how medicine and pediatrics overlap and how the skills I've learned in one discipline help me in another. I believe that I am a better internist because of my training in developmental pediatrics and because I have had the unique opportunity to learn about how children and families grow. I am a better pediatrician because I've had the training to handle complex inpatient and outpatient illnesses and was taught explicit clinical reasoning and evidence based medicine skills in my medicine residency. I've found it relatively easy to stay current in both fields although as my current practice is about 60-70% internal medicine, I find that I need to be more disciplined about how I keep current in pediatrics. I am very interested in communication issues in medical practice and know that as a med/peds doctor I've been well trained to look at clinical situations from multiple points of view.

In the past five years, med/peds training programs experienced a rapid growth in residency slots and applicants. This stabilized recently with about 250 graduating med/peds trainees per year. Most graduates have found work in primary care settings and most continue to work in both disciplines. Med/peds also allows one to apply for subspecialty training in most disciplines although some fellowships (notably intensive care, cardiology, pulmonary) will not allow applicants to sit for both medicine and pediatrics certification. The challenges most med/peds practitioners face include finding a setting in which to practice both disciplines with adequate call coverage, obtaining dual listings in managed call panels, minimizing the costs of CME and, in the academic setting, finding a niche that allows equal participation in two departments. As residency training programs are primarily concentrated in the Midwest, South and East, there are typically more job opportunities in these areas.

I serve on the Executive Committee of the combined AAP and ACP-ASIM med/peds section. This group works nationally to provide mentoring to med/peds practitioners, residents and students, and to tackle the work force, CME, partnership and practice issues med/peds practitioners face. The section sponsors yearly programs at the national Fall AAP meeting and Spring ACP-ASIM meeting and publishes a quarterly newsletter. Two other organizations - a national Med/Peds program directors' association (MPPDA) and grass roots residents' organization (the NMPRA) - also lobby for med/peds house staff with a particular emphasis on curricular issues and work force issues as they relate to house staff training. Together the NMPRA and the med/peds section convened a transition work group to assist new residency graduates as they enter practice.

Would I do it again? Absolutely! I feel I had the best opportunities of both the medicine and pediatrics residency that I trained in. I highly value the perspective and insight I gained by training in two closely related disciplines. The workplace has changed dramatically in the past 4-5 years and although there are some additional challenges in finding a "med/peds" friendly workplace, I am confident that med/peds practitioners will always be able to find work. Please feel free to contact me at singere@ohsu.edu if you have questions about med/peds training or practice.

Leadership Day

On May 25-27, 1999, Andrea M. Kielich, MD, FACP, was the Oregon delegate to ACP-ASIM Leadership Day. Below is her report.

This is an annual event whose purpose is to advocate for ACP-ASIM policy on a number of legislative issues. This is done in a personal way by scheduling meetings with members of congress from each state. This year there are a number of important issues:

  • Patient Protection legislation.
  • Bills to help MD's control pain and conversely to prohibit use of drugs in assisted suicide.
  • ACP-ASIM proposal to use 12% of budget surplus to increase access to affordable insurance.
  • Medicare Fraud & Abuse issues.

Prior to the meeting we were sent comprehensive briefing materials on all these issues. The first day of the meeting we also heard several briefings on the legislative process and updates on various versions of the bills before congress. Role-playing the following morning we heard from Congressman Ganske from Iowa (a plastic surgeon) and others; they gave us valuable insights on how to be effective, and their perspectives on the political process affecting the legislation we hoped to influence.

We also had a workshop with role-playing the congressional visits so we could "practice" and gain skills and confidence.

Then we were off to the Hill. I had scheduled three meetings with Senator Ron Wyden and Representatives Darlene Hooley and Earl Blumenauer. Senator Wyden has developed the Conquering Pain Act and Congresswoman Hooley has introduced it in the House. This has already been formally endorsed by ACP-ASIM. This bill has particular importance in Oregon. It's intent is to increase the availability of information about adequate pain management, especially at the end of life; to increase research, and to protect MDs from inappropriate sanctions for providing adequate pain relief. The implication is that the better the end-of-life care available, presumably fewer patients will be desirous of assisted suicide.

When I met with Senator Wyden's Health Affairs aide, she was already quite familiar with ACP-ASIM, as Hal Sox, MD, MACP, has testified in favor of the Conquering Pain Act. Consequently, we had a long and productive meeting and were able to discuss a number of health care issues. The Senator himself only stopped by for a few minutes, but I felt his staff was very well versed on the issues.

I had a very nice meeting with Representative Darlene Hooley. She was co-sponsoring the Pain Control Act (in the House) so was working with Senator Wyden on this issue. She was able to meet with me personally and her health affairs aide was also present. I learned that Ms. Hooley's mother had died of cancer and had benefitted from hospice care, so the Congresswoman was able to personally relate to issues of end of life care. I felt she was really interested and knowledgeable in this area and not just making a courtesy visit with me. As an aside, in conversation with her aide before meeting with the Congresswoman, I learned that their office was interested in monitoring Oregon HMO's and would be interested in hearing from us about abuse of care given to patients by HMO decisions.

My third meeting was with Earl Blumenauer's aide. In this meeting I did more briefing and education on our issues. I encouraged them to support the delegation on the pain control bill and was told they planned to endorse it.

Decision 2000

The ACP-ASIM has stepped up its call for, and activity toward, universal access to health care by joining with the American Academy of Family Practice, American Academy of Pediatrics, American College of Emergency Physicians, American College of Obstetrics and Gynecology, American College of Surgeons and American Medical Association to make this a key issue in the upcoming presidential and congressional campaigns. Decision 2000 supports three important concepts:

  1. All Americans must have health care coverage.
  2. Health care coverage will contain at least a basic benefits package.
  3. Medical necessity determinations made under the benefit package should reflect generally accepted standards of medical practice, supported by outcomes-based evidence, where available.

For more information, check the College's D2K Site. To get involved locally in pushing this message, contact Martin L. Jones, MD, Chair of the Chapter's Public Policy Committee (541-484-2911; martin.jones@worldnet.att.net).

Community Service

This edition's column highlighting community service is authored by Karl D. Ordelheide, MD, ACP-ASIM Member from Lincoln City. A graduate of the Loma Linda University School of Medicine, where he served his residency and chief residency in internal medicine, Dr. Ordelheide is Chair of the Department of Medicine at North Lincoln Hospital and Director of its ICU. Beyond the busy practice and community activities Karl outlines in this piece, he serves as a Board Member of Cascade Head Music Festival and has been to Guam, Mexico and Nepal as a volunteer physician in the past four years.

Neither discouragement nor boredom with my practice prompted me to accept the nomination. My five year old practice, having 20 plus outpatients every weekday with a busy hospital service, provided challenge and enough affirmation to counterbalance the humbling experiences that inevitably punctuate the life of a physician. Nor was guilt over insufficient hospital or medical staff contributions a reason for saying yes. In addition to teaching frequent classes for ICU nurses and cardiac rehab patients, I had just finished a two-year term of Medical staff presidency. This, in my view, satisfied any societal obligation stemming from my privileged status. Nor was I trying to escape family responsibilities. My children, being raised by two outdoor enthusiasts, were becoming hopelessly addicted to snow skiing, water sports and mountain biking, all of which required their father's participation. My wife's devotion to running was soon to lure me into time-intensive training for several marathons. Then there was our 45-year old home acquired with a time commitment to its modernization.

So it was in 1985, when all my time was so apportioned, that I agreed to run for a position on the newly formed lake improvement district board. I rationalized that the health of our lake, shallow and weed choked more resembling a swamp at summer's end, was somehow a symbol of the health of the community built on it's shores. I reasoned, therefore, that this contribution would be in keeping with my professional mission. My carefully crafted explanation to my wife was that the one meeting per month would happen mostly after the kids' bedtime. Furthermore, any task dealing with this, our children's favorite playground, would be family oriented. Somehow that speech didn't sound very convincing. The truth is that I said yes against my better judgment because of my congenital inability to say no.

For the next 7 years I devoted one Wednesday evening a month to debating the merits of various strategies to restore balance to this fragile resource lost by years of human carelessness. Time commitments increased, especially during the last two years when I served as chairperson. My partners, who encouraged my participation, seemed happy enough to take call during those times. They remained gracious when it became my responsibility to attend the odd day workshops and on three occasions, the annual national meeting of lake managers.

My remuneration for this effort was a multi-faceted education. First, and probably most fascinating, was the opportunity to learn the language and tenants of limnology. Somewhat surprising were the lessons in political "science." For example, I witnessed the "bulldozers effect" of a town hall meeting to utterly squelch an idea from materializing. Maybe this shouldn't have been surprising considering the fact that the word herbicide appeared on the agenda of a public meeting in rural Oregon. Equally impressive was the demonstration of political pressure exerted by a (small) town hall meeting on agency officials, people I thought to be invulnerable to an unknown lake improvement district. In this case, state and federal agencies rolled over, allowing an exception to a long-standing prohibition of a locally acceptable strategy - the introduction of vegetarian fish to graze on the unwanted weeds. I learned how a community develops traditions that celebrate successful endeavors around which large segments of the community have rallied. In this case, it was an annual Grass Carp Festival observed for the next several years. I also made the discovery that my rationalizations for taking the job in the first place were pretty naive and, finally, that I could actually say no when asked to run for a 3rd term.

That ability to decline faded within a couple of years when the principal from a private high school, where by now one of my children was attending, approached me about teaching biology lab. My internist partner and I had just agreed that we could afford a full day off every other week. So when this teacher suggested twice a month lab, I had no excuse. Equipped with a recent education in fresh water ecology, the availability of a marvelous supply of biological specimens and a colleague, who would also help, this job figured to be a snap. The invitation, I would later discover, was only to bait my interest in the school. As of this writing, I have spent lunch hours during three different spring quarters teaching personal and public health issues to 11th and 12th graders in addition to numerous biology lab sessions. The exposure to inquisitive kids, coupled with my interest in teaching, has made this a light burden.

There was more turmoil than usual on the local hospital front in 1997. Declining reimbursements, coupled with poor administrative decisions, were threatening its financial viability. The corporate wisdom of the medical staff was that many of the poor decisions could have been averted had the board been more receptive to medical staff concerns. It had been 12 years since an active medical staff member had served on the board. Several of my colleagues, recalling better communication during that era, urged that my winning a board position might help the current dilemma. My partners were once again all too happy to offer their help with call coverage should that be necessary. They had not missed the fact that the board just happened to meet on the two days in the month I was already out of the office. Ignoring the wise council of my wife's to "just say no," I agreed to run.

The current board viewed my bid for election as a hostile intrusion, making it clear from the outset that I would be in a political hot seat. At the time I could never have guessed the source and intensity of that heat. I was relieved when the incumbent, whose seat I would be seeking, kindly withdrew leaving me unopposed on the ballot. My comfort with the prospects of this job grew further when the vice-chair, one who had publicly discouraged my bid for office, pulled me aside before my first meeting and outlined his plan to remodel the board process into that of policy making. This would diverge significantly from the micro-management to which the board had heretofore been accustomed. His surprise at my positive reception to his ideas marked a perceptible change in attitude that spread to the remaining board members. My optimism grew about the reuniting of medical staff and hospital governance. This tempered my impatience with the inordinate number of hours the board wanted to meet. Each of the other six members, living comfortably on their pensions, seemingly had nothing more interesting to do than hospital business. So this rehabilitating of medical staff-board communication came at a cost of two 4-hour sessions per month in addition to the regular 2-hour board meeting.

Less than halfway through my four-year term, just when positive change seemed imminent, a petition filed for my recall jarred me out of any semblance of complacency. The petitioners, veterans of several other recall initiatives in our community, soon had the necessary signatures forcing the election. The bewildering list of reasons for recall confused everyone except the medical staff, board and a very few citizens who were familiar with the work of the board. Championed by a handful of poorly informed citizens, the reasons resonated with volatile issues that have plagued our town for years. Their early success raised considerable uncertainty as to the probable outcome of the election. So my efforts to dispel misunderstandings during the next two months more than made up for the campaigning I had missed during my initial bid for office. The tide took a decisive turn in my favor, however, when the supporters of recall resorted to vicious personal attacks. Their campaign backfired spurring a surprisingly high voter turnout and convincing defeat of the recall.

Discovering a positive spin has become a little easier with the passing of time. Trying to be objective, I concluded that this was probably another example of the quirkiness of small town politics where struggling news media deem small agendas newsworthy. Fortunately the adversity of the moment was softened by unanimous support from my fellow board members who, two years earlier, had discouraged my participation on the board. All but two of the medical staff rose to my defense. A further consolation was the overwhelming support from a large segment of the community galvanized to action by a perceived injustice. As a result of the hospital sharing the spotlight in the recall election, many more citizens are now aware of the problems facing the hospital. Its base of support has built on that publicity and there are promising changes on the horizon for the hospital. A welcome spin-off has been a 50% drop in hours the board is spending in session. My suspicion is that my fellow board members, feeling a bit more vulnerable, were happy to limit the hours of public scrutiny.

In reviewing these forays into community life over the last 19 years, it occurs to me that the benefits have been mostly my own. It has been a privilege to share in the successes and struggles of this small community; to observe developing youngsters from the vantage point of the teacher; and even to experience the harsher side of American politics if for no other reason than to discover just how plentiful and loyal are my friends. I am particularly grateful for the opportunity to return each day to a stimulating medical practice with long-time, supportive partners, and most of all for an intact and helpful family having given me permission to be so involved.

Chapter Finances

As presented at the September 21 Council meeting, the Chapter is healthy and stable financially. For the fiscal year ending June 30, the Chapter's balance was $52,798. At the time of the Council meeting, the balance was $61,680. For the 1998-99 fiscal year, it cost $47,777 to run the Chapter. The 1998 Chapter meeting cost $32,399 with revenues of $29,655.

The Chapter Council set a goal of having the Chapter meeting "break even." The Chapter has taken advantage of every opportunity to apply to the national office for Chapter subsidies and development grants (e.g., to launch the Associates Council.) With approval of the merger of Oregon ACP and OSIM and filings with the State of Oregon submitted, the Council plans to commission an independent audit of Chapter finances prior to merger of OSIM's accounts and in anticipation of the transition of Governors.

Any Chapter member who has questions about the Chapter finances is encouraged to contact Jim Reuler.

Associates' Competition

The Associates' Competition at the 1999 Chapter meeting, again completely organized by the Associates' Council, set new standards for quality. Twenty six posters and six oral presentations filled a wonderful evening of learning and comradeship. Awards were presented to the following Associates:

First Place, Oral Presentation: Soraya Abbassian, MD, Providence Portland. "A Case of Relentless Headache: Can Headache Cause Hepatitis?"

Second Place, Oral Presentation: Julie Henery, MD, Legacy, Portland. "The Fates Collide: Occult Thrombophilia and Cerebral Sinus Thrombosis".

First Place, Research Poster: Judy Zerzan, MD, OHSU. "Economic and Policy Barriers for Use of Hospice in Nursing Homes".

First Place, Clinical Vignette Poster: Heather Brown, MD, Providence Portland. "Polyglandular Failure in Trisomy 21".

Second Place, Clinical Vignette Poster: Timothy Jacobson, MD, OHSU. "Case Report of a Spontaneous Hemothorax in a Patient Undergoing High Dose Chemotherapy for Small Non-Cleaved Cell Lymphoma".

Third Place, Clinical Vignette Poster: Lisa Miura, MD, OHSU. "Apathetic Hyperthyroidism Presenting as Worsening Heart Failure".

Internists and the Media

This edition's Media Column is authored by Craig R. Nichols, MD, FACP, of Portland. A graduate of OHSU School of Medicine, Craig did his internal medicine residency at Alton Ochsner Medical Foundation in New Orleans and Hematology-Oncology fellowship training at the University of Miami, Miami, FL, and Indiana University. Dr. Nichols was a Professor of Medicine at Indiana until returning to OHSU in 1997 as Head of the Division of Hematology and Medical Oncology. Specializing in testicular cancer therapy, Craig has been in the media related to care for Lance Armstrong and, more recently, Josh Bidwell, rookie kicker for the Green Bay Packers.

Editor's Note: Read an exclusive interview with Craig on the Testicular Cancer Resource Center on the Lance Armstrong Web page.

For 15 years, I've been learning more and more about less and less until I and a few colleagues captured an infinitesimally small fraction of medicine, testicular cancer. And, it was in this context that I became fully enmeshed in a dazzling all American story. It is a story so grand, I thought it impossible to sully or dilute. This misdirection and the negative spin that enveloped the story was instructive for anyone in the melee between celebrity and media.

The medical facts are straight forward and well chronicled. Lance Armstrong, a very promising young cyclist, developed testicular cancer. When it became apparent that he had poor risk metastatic disease with lung and brain metastases, he sought experienced input. In evaluating him, it was clear that his chance of survival was less than 50%. I recommended resection of his two brain metastases and chemotherapy that was a bit harsher than standard therapy, but a treatment that would not include bleomycin and the attendant risk of minor pulmonary damage.

My end of things unfolded nicely with rapid normalization of his elevated blood markers and disappearance of his pulmonary and abdominal metastases. He obtained and remains in remission. Lance's end unfolded spectacularly. The cancer diagnosis, the very realistic threat to his invulnerability and the rigorous treatment quickly reoriented this brash young man. He achieved new focus and balance. He became aware of the possibilities and responsibilities of representing the cancer community; the community of patients and survivors. He married, he remade his body, and he became a smarter and more focused athlete. And then, less than 2 1/2 years after his treatment, he dominated the most grueling test of endurance imaginable, the 2,900 mile/3 week Tour de France.

This story alone seemed sufficient, but at this point, the agenda of the media, the facts and some subtext that I felt obliged to inject became impossibly jumbled. The European press, sensitized by the prior year's drug scandal at the tour, became focused on the near impossibility of the feat and began to dig for negative angles. In addition, the cultural stigma attached to cancer and cancer treatment in Europe entered the mix. Lance's success must have been due to secret undetectable-performance enhancing substances (despite the fact that he passed daily blood and urine screens) or that something related to the cancer treatment had been "additive." I was queried relentlessly regarding the details of his treatment and as to what I attributed the "miracle" of his victory. I wryly suggested to a French reporter that we had put in an extra lung and, after no recognition of the sarcasm, became vaguely concerned that this would be the banner headline the next day.

My puny hope was to use this spectacular demonstration of recovery and resolve to highlight cancer survivorship, the value of cancer research and the fact that modern cancer therapy frequently is followed by full, productive, unimpeded life. I may as well have been trying to squeeze a second opinion out of an HMO director. Very few of the media representatives were interested. Fewer still wrote anything about this aspect of the story. I became progressively more frustrated with the writers and eventually lapsed into "just the facts" mode.

So what are the lessons here and what would I have done differently? I unfortunately came away with the impression that the media agenda is pre-formed. The reporters came not so much for information, but confirmation. My role, since I was unable to confirm the negative speculation, was reduced to filler. I was egobound enough to think that they would automatically care about my thoughts, my opinion and my agenda. That was naive.

Suggestions... My experience was a corollary of the adage that you shouldn't fight a war of words with people who buy ink by the barrel. Accept the fact that you are not the story and likely will not influence the telling. Be forceful in your relating of the medical facts. Avoid speculation. Be concrete and never try cynicism or sarcasm. It may come back to bite you.


  • Robert A. Gluckman, MD, FACP - Recipient of the Chapter's 1999 Howard P. Lewis Distinguished Service Award
  • Thomas G. Cooney, MD, FACP - Recipient of the Chapter's 1999 Howard P. Lewis Distinguished Teacher Award
  • Marina Brush, fourth-year medical student, OHSU and Chapter student member - Election to Alpha Omega Alpha Honor Medical Society, September, 1999
  • Annette Matthews, third-year medical student, OHSU and Chapter student member - Appointment by Oregon Governor John Kitzhaber to the OHSU Board of Directors
  • Emil J. Bardana, Jr., MD, FACP, of Portland, Past-Governor, Oregon Chapter ACP-ASIM - Nomination as President-Elect, American College of Allergy, Asthma and Immunology, 1999-00
  • Arlene D. Bradley, MD, FACP, of Roseburg - Appointment as the ACP-ASIM representative to the American Medical Association National Advisory Council on Family Violence, 1999-02
  • Gary Regalbuto, MD, FACP, of Hood River - Appointment as the Chapter's representative to the Medicare Advisory Committee. Ruth E. Medak, MD, ACP-ASIM Member and Clinical Coordinator, OMPRO, who has represented the Chapter the past two years, will continue service on the Committee as OMPRO's representative. Thanks, Ruth!
  • Gregory J. Magarian, MD, FACP, of Portland - Recipient of the 1999 Distinguished Service Award of the Clerkship Directors in Internal Medicine. Greg was the founding President of the national organization
  • David Gilbert, MD, FACP, of Portland - Elected Vice-President, Infectious Diseases Society of America
  • John A. Benson, Jr., MD, MACP, of Portland - Recipient of the John Phillip's Memorial Award, ACP-ASIM, for "outstanding work in clinical medicine" to be presented at the National meeting, April, 2000

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

Upcoming Dates

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, 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
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

Contact Information

Thomas G Cooney, MD, MACP
Oregon Chapter Governor

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