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Governor's Newsletter December 2000

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

Governor's Farewell

As I sit at my kitchen table to prepare my last newsletter, I still feel the pulsating energy from the wonderful annual Chapter meeting, which concluded yesterday. The opportunities to connect with so many friends, to hear from outstanding and inspiring speakers and to host, as a Chapter, the fabulous group of residents and students, as young colleagues, make for wonderful memories. Many thanks to Linda L. Humphrey, MD, MPH, FACP, and the Program Planning Committee for a spectacular job!

Over the past four years, the Chapter has grown in depth and breadth. Expansion of the Council, continued refinement of the annual meeting, new student and Associate programs, public policy initiatives and guest columns in the newsletter all represent the involvement and commitment of many Chapter members. For all of those contributions, I am very grateful.

However, we cannot become complacent. Sustaining present programs and nurturing further growth will require new energies and the support of Chapter members like you. The futures of the College and our profession of internal medicine are dependent on "giving back." Consider how you might help. Governor-Elect, Stephen R. Jones, MD, FACP, will be anxious to hear from you (sjones@lhs.org).

Finally, I want to thank Mary Olhausen, Chapter Administrative Assistant, for all that she has done for me, you and the Chapter over the past four years. The fact that our Chapter received an Excellence in Management Award this year from the Board of Governors is a direct tribute to Mary's energy, organizational skill and commitment. Mary's work has translated nascent ideas from many of us into "business plans" and functioning programs. For everything Mary has done for our Chapter, many, many thanks!

ACP-ASIM Becomes More Involved in Violence Prevention

By Arlene Bradley, MD, FACP

Every day we hear about incidents of interpersonal violence. Increasingly, however, we are also learning from research studies that interpersonal violence, including gun violence, media violence, school violence, workplace violence, sporadic community violence, child abuse and neglect, intimate partner violence, and elder violence significantly affects people's health and their utilization of healthcare services. Some studies suggest that up to 1/3 of primary care visits are directly or indirectly related to traumatic experiences, especially repetitive traumas. The American College of Physicians- American Society of Internal Medicine, working with the AMA's Councils on Violence and Youth Violence, has joined with over 45 other professional organizations to address the spectrum of violence in a more comprehensive, coordinated public health manner. Such partners include other healthcare disciplines (e.g. Family Practice, Pediatrics, Surgeons), the American Bar Association, the Center for Disease Control and Prevention, the American Association of Medical Curriculum, the Family Violence Prevention Fund to name just a few.

I am the national ACP-ASIM representative to the AMA Council on Violence. Some of the Council's current activities include: 1) Reducing physician workplace violence, emphasizing professionalism; 2) Standardizing guidelines for medical school curriculum addressing interpersonal violence; 3) Promoting the mentoring of violence-inclusive care throughout training and continuing education; 4) Supporting faculty development in the area of violence; 5) Networking among medical, legal, social, advocacy and community agencies to more effectively reduce the risks of violence occurring; and 6) Recommending changes in CPT and ICD-9 coding to improve reimbursement for violence screening and intervention efforts. If you would like to be more involved in some of these activities, please contact me at VA Roseburg Healthcare System (A209), Roseburg, OR 97470; Phone: (541) 440-1000, ext. 45828; or E-mail: mabrad@wizzards.net.

Chapter Council

Many thanks to the following Chapter Council Members who have completed their terms:

Elizabeth Eckstrom, MD, MPH
Andrea Kielich, MD, FACP
Steve Gordon, MD, MPP
Dan Mangum, DO, FACP

Thanks so much for all of your contributions to the growth and development of the Chapter.

Welcome to the following Chapter members who were elected to the Council at the Annual Business Meeting, November 3 in Eugene:

Robin H. Miller, MD, Medford
Karl D. Ordelheide, MD, FACP Lincoln City
Mark D. Sternfeld, MD, La Grande
Frances M. Yuhas, MD, The Dalles

Career Corner

This edition's Career Corner is authored by Kelly O'Brien-Falls, MD, FACP, Governor-Elect of the Colorado ACP-ASIM Chapter. A native of Colorado and graduate of The University of Colorado HSC School of Medicine, Kelly was a resident, Chief Resident, faculty member and Program Director at Exempla St. Joseph Hospital in Denver until she went to jail last year. Certified in Geriatrics as well as Internal Medicine, Dr. O'Brien-Falls melds her part-time career with volunteer time at her children's (11 & 8 yr) school, other family activities and many roles within the Colorado Chapter.

"When I heard I had to do my medicine rotation at the jail, I started to cry."
A dubious start with our current PA student.

A year ago I left my position as Associate Program Director with a training program to work in "Correctional Care." I work at several county jails with short term inmates, no budget for preventive care, varying medical capabilities (me and the deputy at one, 24-hour infirmary and IV therapy capabilities at another.) I'm still not sure what led me here, but I know what keeps me here and why more internists are joining this field.

There are different aspects of Correctional Care, each with its own rules, formularies, funding and policies, as well as varying benefits. Physicians may be employed by the state, the federal government, or by counties. Others contract hourly with an institution, or with a private correctional care company. From my own experience, you might consider Correctional Care if:

1)You enjoy teaching. Many of these patients are under-educated and are very grateful when we review labs, prognoses, follow-up on the outside, etc. For many, recent experiences with health care providers have been antagonistic or limited, so it is a new experience for them to freely ask questions of their provider "Don't hurry for me, Doc. I've got a lot of time." The nurses and deputies, too, appreciate the educational efforts. Many of them require Continuing Education hours so teaching time can be arranged. Though not sentimental about the inmates, most take seriously their professional responsibilities and want to understand what is happening with the patients.

2) You enjoy providing a service. In the past, jails and prisons were the practice sites of providers who couldn't work elsewhere. Changing standards of healthcare for prisoners, arigorous accreditation process for jail/prison infirmaries and required CME has changed that. Well-trained physicians, nurse practitioners and physician assistants can help maintain better relationships with the prisoners and safeguard both the prisoners and the institution. This is a service to patients also. While caution and adherence to the rules is always important, many patients will relax with you more than they can in the rest of the facility. "Hey, Doc, I told my homies they shouldn't be nervous, you went over that blood stuff real good. They gonna come see you."

3)You like innovation and new opportunities. Because Correctional Care is an expanding field, there are many opportunities to develop your own programs. You may design your institution's protocols or formulary, develop a collaborative project with the county or state health department, or delve into the use of telemedicine. The latter is especially appealing to many facilities because it reduces the need for patient transfer, with its inherent cost and risk.

4) You choose to limit your work hours. In my institution, the inmates are kept in their cells for meal times. Except for emergencies, I am unable to see patients during lunch and after 4:30 pm. Non-urgent patients are easily re-scheduled, as their social situation means they'll be readily available. I have call responsibilities, though I'm called by a nurse who's already initiated the evaluation. Night coverage for patients who must be seen is provided by the county emergency room.

5)You're still waiting to hear the words, "I hurt my back, Doc, but I want to go to work. Can you clear me to return?" Inmate-workers get time-off for each day worked. Since I've been here, no one has asked me for a work excuse due to back pain. On the rare occasion someone does request a work excuse, they are really hurting.

6) You want variety in your practice. This last year I have worked with heart transplants, dialysis, cystic fibrosis with nebulized tobramycin, sleep apnea, baggie ingestion, psychosis, depression, end-stage liver disease, acute grief, boxer's fractures, tongue lacerations, kidney transplants, dog bites (police), human bites (not the police), ankle sprains, drug withdrawal, jaw fractures, pregnancy with and without thrombocytopenia, dental abscesses, chronic urticaria, B12 deficiency, pneumonia, hepatitis due to B, C, alcohol and isoniazid, finger amputation, handcuff neuropathies, joint effusions, many of the initials (IDDM, NIDDM, CHF, CAD, RAD, COPD, HTN, HIV, URI, BPH) and the usual somatic concerns seen with stress. I see both men and women, and the age range has been 14 to 68. A CAQ in Geriatrics has been rather handy, given many inmates are physiologically older than their stated age. Spanish has been useful, and I also wish I understood Russian, Polish, Serbian, Vietnamese, British accents and American Sign Language.

As in any field, there are also disadvantages. As an employee, I cannot hire or fire. Many institutions have significant budget constraints. Most settings don't allow long-term patient relationships, and it is frustrating to be in a system that currently doesn't emphasize prevention. Overall, however, I find the clinics fascinating and I love going to work. I feel valued, I do far less paperwork than I did before and I have more time with patients.

Finally, there's that special feeling that comes when a patient says "Hey, Doc, can I have your card? I want to see you when I get out."

Addendum: The PA student has started to enjoy her rotation. This is good. Now we'll get another one next month.

Fellowship

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

Charles D. Blanke, MD, FACP Portland
John T. Neilson, MD, FACP Astoria
David H. Panossian, MD, FACP Klamath Falls
Richard A. Parker, MD, FACP Portland
Ellen L. Singer, MD, FACP Portland
Robin A. Yurk, MD, MPH, FACP Albany

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 call the ACP-ASIM National Office at 800-523-1546, ext 2694.

Upcoming Dates

February 9, 2001
NW-SGIM Meeting, Portland

March 29-April 1, 2001
ACP-ASIM Annual Session, Atlanta, GA

June 1, 2001
Fellowship Applications Due at ACP-ASIM

November 1, 2001
11th Annual IDSO Meeting, Eugene

November 1-3, 2001
OR Chapter ACP-ASIM Meeting, Eugene

December 1, 2001
Fellowship Applications Due at ACP-ASIM

April 11-14, 2002
ACP-ASIM Annual Session, Philadelphia, PA

Kudos

Kenneth E. Melvin, MD, FACP - Recipient of the Chapter's 2000 Howard P. Lewis Distinguished Teaching Award.

Patrick M. Dunn, MD, FACP - Recipient of the Chapter's 2000 Howard P. Lewis Distinguished Service Award.

Keith W. Harless, MD, FACP, of Bend, for election as Secretary/Treasurer for the North Pacific Society of
Internal Medicine.

Peter Bonafede, MD, FACP, of Portland, Chair, Board of Directors, Arthritis Foundation-Oregon Chapter.

Kent G. Benner, MD, College Member, and Thomas G. Cooney, MD, FACP, both of Portland, for serving on
GI and Ambulatory Medicine Writing Committees, respectively, for MKSAP 12.

Donald E. Girard, MD, FACP, of Portland, elected Trustee-at-Large to the Oregon Medical Association's
Executive Committee.

Gil Porat, MD, Associate Member, of Legacy Portland Training Program, for 1st Place Award, at the Associates'
Oral Competition, November 3.

Tonia Jenson, DO, Associate Member, of Legacy Portland Training Program, for 1st Place Award, Clinical
Vignettes, at the Associates' Poster Competition, November 2.

Addie Onsanit, MD, Associate Member, of OHSU Training Program, for 1st Place Award, Research Category, at the Associates' Poster Competition, November 2.

Vivian Kwan, MD, Associate Member, of Legacy Portland Training Program, for 2nd Place Award, at the
Associates' Oral Competition, November 2.

Elizabeth VanderVeer, MD, Associate Member, of Providence St. Vincent Training Program, for 2nd Place
Award, Clinical Vignettes, at the Associates' Poster Competition, November 2.

Kooros Samadzadeh, DO, Associate Member, of Legacy Portland Training Program, for 3rd Place Award,
Clinical Vignettes, at the Associates' Poster Competition, November 2.

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

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
Phone: (503) 220-8262, ext 55582
Fax: (503) 721-7807
E-Mail: reulerj@ohsu.edu
E-Mail: reuler.james@portland.va.gov

Mary A. Olhausen
Department of Medicine
Oregon Health Sciences University
3181 SW Sam Jackson Park Road, OP-30
Portland, OR 97201-3098
Phone: (503) 494-8676
Fax: (503) 494-5636
E-Mail: omary@teleport.com
E-Mail: olhausen@ohsu.edu

Chapter Web Site:

http://www.acponline.org/chapters/or

Contact Information

Thomas G Cooney, MD, MACP
Oregon Chapter Governor

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