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Governor's Newsletter

April 1998

CHAPTER MEETING

MARK YOUR CALENDAR FOR THE 1998 OREGON ACP-ASIM MEETING NOVEMBER 5-7, IN EUGENE.

The Program Planning Committee is finalizing the program for this year's meeting, which will include:

  • Associates' Competition and Activities
  • Briefing Breakfast for Women
  • Clinical Updates - Heparin, Angina, Geriatrics, Impotence, Wound Care, Menopause, Factor V Leiden
  • Generalist and Hypertension Panels
  • Risa Lavizzo-Mourey, MD, FACP, Director, Institute on Aging, University of Pennsylvania and ACP Trustee; College Representative
  • John T. Potts, Jr., MD, FACP, Jackson Professor of Medicine, MGH/Harvard; Lewis Visiting Lecturer
  • Robert Doherty, Ph.D., VP for Governmental Affairs and Public Policy, ASIM

Don't miss this important CME event and the opportunity to see your colleagues and friends from around the state!

IN MEMORIAM

J. David Bristow, MD, FACP, died of cancer at his home on December 30, 1997. A native of Pittsburgh, Dr. Bristow served as Governor for OR-ACP 1976-77 and as a mentor for many Chapter members.

A graduate of OHSU's School of Medicine, Dr. Bristow served as Chair, Department of Medicine, OHSU, 1971-75, and as Director of the Cardiology Fellowship Program 1981-92. Dr. Bristow was an internationally recognized investigator and teacher who was a Professor of Medicine at UCSF 1977-81 and a Visiting Professor at the Radcliffe Infirmary at Oxford, England, during sabbaticals in 1967 and 1987.

Dr. Bristow chaired the Cardiology Advisory Council of the National Heart, Lung, and Blood Institute of the NIH and was Past-President of the Western Association of Physicians. A critical thinker whose radiant smile and boundless energy served as a beacon for many young physicians, Dr. Bristow was an avid mountaineer, cyclist and marathon runner who epitomized the highest ideals of physicianhood and the ACP. We will miss Dave greatly.

ACP-ASIM MERGER

Leaders of OR-ACP and OSIM met January 9 and February 26 to lay the foundation for the merger to take effect this summer. As well, the National Merger Task Force has provided logistical and legal guidance.

The 1998-99 Interim OR ACP-ASIM Council members are:

  • Elizabeth Eckstrom, MD, MPH, ACP Member, Chair, Associates' Council
  • Lisa Els, MD, ACP Associate, Legacy Portland Program
  • Steve Gordon, MD, ACP Member, Providence St. Vincent Medical Center
  • Bob Gluckman, MD, FACP, Chair, Scientific Program Committee
  • Martin Jones, MD, ACP Member, Chair, Public Policy Committee
  • Andrea Kielich, MD, FACP, ASIM Trustee and Interim Governor
  • Dan Mangum, DO, ACP Member, President OSIM
  • Jim Reuler, MD, FACP, Governor, OR-ACP
  • Jocelyn White, MD, FACP, Chair, Chapter Women's Committee

At the 1998 OR ACP-ASIM meeting, the Council plans to conduct a Chapter business meeting to inform members of plans/initiatives and to hear from members about how they feel the Chapter can better serve their needs. Please contact any Council member at any time to discuss issues on your mind.

CAREER CORNER

This edition's column related to career paths taken by internists is written by Michael F. Bonazzola, MD, FACP, of Portland. A graduate of OHSU's School of Medicine and Internal Medicine Residency, Mike served as Chief Resident in the Department of Medicine at Providence St Vincent Medical Center in Portland before joining the Medford Clinic where he served as Medical Director 1991-96. A member of OMPRO and the Oregon Health Council, Mike is the Senior Vice-President and Chief Medical Officer of Physician Partners, Inc.

I finished my chief residency at St. Vincent Hospital and Medical Center in Portland and relocated to Medford where I joined the Medford Clinic and began my general internal medicine practice. Within two years I was completely busy and very happy. At that point one of the senior internists asked me to represent the internal medicine department on the board of directors. I agreed and was elected to that post. I've not been out of management since. I progressed from board member to clinic president to medical director to chief medical officer of Physician Partners, Inc., a physician practice management company, over a period of 13 years.

My education included Medical Group Management Association and American Medical Group Association conferences, a number of American College of Physicians Executives courses, trial, error and lots of listening.

American medicine at the end of the 20th century is undergoing a sea change. Care models, diagnosis and treatment modalities and delivery systems all are being revolutionized. Physicians and patients, as primary care givers and recipients, need to be integrally involved in the design of the new care.

American physicians at the end of the 20th century are a beleaguered bunch. Working as hard or harder than we've ever worked for the same or less income, having our autonomy compromised at every turn, we are not particularly amenable to the tremendous changes being required of us. But change we must. I believe physicians need to be actively involved at every level of change now occurring, to make sure the change happens with us and our patients rather than to us. It was for this reason I became a full-time physician administrator.

Why a physician practice management company? The only way for doctors to ensure our place at the table of change with health plans and hospital systems is to be large enough and organized enough so we can't be marginalized or ignored. A PPM is a vehicle for that consolidation.

What does the future hold? Information systems on a scale which will dwarf those existing today. Large organized groups of physicians who have driven much of the system change, who are committed to providing quality care based on evidence and outcomes, who can demonstrate their quality of care, and who are dedicated to bringing back caring and service to the most important people in the health care system, patients.

Do I find the changes occurring in medicine today stimulating? Absolutely. Does it concern me that many in our profession are disheartened and burned out? Very much. Can I play a role in the change, hopefully addressing also some of the stress issues? I certainly hope so. I am working full time to make the future as physician friendly as possible.

Hospital systems, health plans and physician organizations will all continue to get bigger. Acquisitions and mergers will be the rule. Though the nature of the encounter may change, the interaction between a doctor and a patient will remain at the core of health care.

Do I miss seeing patients? Very much. The intimacy of the examination room, of knowing patients and families over time, is unmatched in our society and is one of the great privileges we enjoy as physicians. I hope to get back to seeing patients as a primary care provider at some point in the future. For now, however, I will remain in the arena of change, striving to make the new health care system better and more effective for both patients and doctors.

FINANCES

At the conclusion of my first year as Governor, I want to report to you about our financial status. Mary Olhausen and I have worked during our tenure to develop a budget, identify new revenue sources and opportunities for cost savings, computerize our financial reporting and cost-account the time and money that is required to support the Chapter.

The major expense for the Chapter each year is the Annual Meeting. The 1997 meeting cost was $29,449.00. Our revenues for the meeting matched expenditures exactly.

As of March 15, 1998, we have $36,089 in our account. Because of our financial health, the Chapter will not increase dues for 1998-99.

To help with some Chapter organizational and accounting issues, and to plan for the merger, Mary and I have contracted for the intermittent services of a Certified Public Accountant. If you have any questions about Chapter finances, please contact me.

Jim Reuler, MD, FACP

INTERNISTS/MEDIA

This edition's Media column is written by Charles E. Hofmann, MD, FACP, a general internist in Baker City since 1981. A graduate of OHSU's School of Medicine and the Internal Medicine Program at Maricopa County Hospital in Phoenix, Chuck has been the Mayor of Baker City and is the President of the OMA 1997-98. In 1990, Chuck was the recipient of the OMA's "Doctor-Citizen of the Year" award.

First, let me make it clear that I am not a media relations expert. I know people who say they are and who make a living talking about such things as "putting on the right spin", "how to manipulate the media", and the like. I'm not sure, however, that these people are always correct in their assessments. I've developed my own policy regarding the media and Jim asked me to share it with you. Remember, though, that what follows is just one person's opinion!

Over the past ten years, I have had the opportunity to be quizzed by reporters more often that I care to (or can) remember. Sometimes, I have been successful in making my point. Other times, I have fallen flat on my face. As a matter of fact, I think I've been misquoted so many times that now even I sometimes believe what they say I said.

Reporters first began to care about what I had to say when I entered local politics. At first, I was surprised that they cared and then I began to like the attention. This infatuation soon led me to break RULE NUMBER ONE: Never become enamored with seeing your name in print.

Depending on what the reporter has to say, it can be a curse. Break Rule Number One, and it won't be long before you'll experience that unique malaise that comes from seeing something really stupid attached with quotes to your name.

I'm sure it will come as no surprise to those of you who know me, but it wasn't long after I took office that some of my opinions about things began to become controversial among the electorate. In attempting to clarify my thoughts to the media, I frequently broke RULE NUMBER TWO: Never assume you can convince someone with the facts. Don't get me wrong - the press clearly respects the dedication and knowledge of physicians. It's just that our dedication and knowledge can be of little use when we find ourselves right in the middle of a controversial and emotional issue. What we may consider to be the facts likely will not have much bearing on someone who vigorously disagrees with us.

Sometimes, I felt that I had been unjustly criticized. Thus, I began writing explanatory letters to the Editor. By so doing, I broke RULE NUMBER THREE: Never argue with someone who buys ink by the barrel. Believe me, that's a battle you cannot win. Now, when I feel that I have been wronged and that I must respond, I simply talk directly with the reporter. It makes me feel even better than I did when I wrote a letter. And there's no paper trace of what I said! Just make sure there's no tape recorder nearby!

These days I have a different attitude toward the media than I used to. I consider my relationship with them to be more of a partnership than a supervisory one. I am now of the opinion that, by and large, reporters are intelligent, intrinsically fair, and are primarily interested in informing their readers of the facts. Sure, there are always occasionally "hot dog" reporters who are trying to make a name for themselves, but I think they are a rare breed. And they are very easy to deal with: Just don't talk to them and instead give the story to one of their associates! In fact, I now treat reporters with respect. And to my delight, they usually return the favor.

Finally, two last rules. You must never break RULE NUMBER FOUR: Be honest! Reporters possess a unique ability to know when you are avoiding the truth, or, even worse, when you are lying. I suggest that rather than dodging the question or making something up off the top of your head, you try these two little words: "No comment." Reporters may not like that response but there is no rule that says they have to like what you have to say. And then there is my favorite, RULE NUMBER FIVE: Never be afraid to say you don't know. As doctors, we don't like to say we don't know, but the rest of the world is used to not knowing. Furthermore, reporters hardly ever talk to someone who admits they don't know the answers. I have frequently stunned reporters into silence by admitting that I don't know. Here's a great line: "Hey, I don't know, but I'll get back to you when I do!" Try it if you want. It's guaranteed.

Well, good luck in your dealings with the media. Try to remember the "Five Rules of Hofmann." I hope they work for you, but if they don't, don't blame me. I'll just claim I've been misquoted!

MKSAP 11

The ACP's Medical Knowledge Self-Assessment Program (MKSAP) 11 is published in four parts during 1997-98 and will be available on CD-Rom this spring. The home study program allows you to earn 144 Category 1 CME credits, and you can take until June, 2000, to complete the examination portion of the program. For more information, call 1-800-523-1546, ext. 2600.

COMMUNITY SERVICE

This edition's Community Service column is authored by Charles M. Wood, MD, ACP Member, of Portland. A graduate of Columbia University College of Physicians and Surgeons and the OHSU Internal Medicine Residency, Chuck is the lead internist at the Kaiser-Rockwood Clinic and the Physician Advisor for Quality Improvement at Kaiser Sunnyside Medical Center in Clackamas.

For the last twelve years I have been a volunteer physician at Neighborhood Health Clinics of Portland. Formerly known as the Health Help Clinics, it is funded by donations from United Way, Multnomah County funds and local foundations, and permits free access to the medically indigent. The clinic initially was located in someone's house in North Portland, but it quickly outgrew this space and is now split into two services out of the NE and SE County clinics. Staffed by volunteer nurses, pharmacists, lab techs, physicians, and clerks, each clinic sees about 350 patients a month.

Patients make appointments in advance and are able to get free medications from the "all donation" pharmacy or go outside the clinic pharmacy with a $25.00 coupon for outside prescriptions if they are necessary. The clinic is staffed usually by a combination of family practitioners, internists, emergency physicians and pediatricians, but many medical and surgical sub-specialists from all over town also volunteer their time. Patients often have little or no insurance, represent multiple ethnic backgrounds, and are very appreciative of our care. Sub-specialty referrals into the community for X-rays, physician services and special lab tests are available as well.

I find the two to three hours a month that I give to the clinic not only fun, but personally satisfying. I make sure I have had a chance to change into casual clothes prior to arrival, because wearing jeans allows me to let down my professional guard to a certain extent and enjoy myself while I see patients.

The evening usually passes very quickly with good "bread and butter" primary care medicine: colorful rashes, influenza, UTI's, and hypertension, but I have also seen secondary syphilis, an occasional surgical belly and ectopic pregnancy! Afterwards, I feel like I have given of myself, both as a physician and a human being and made a contribution to people who are underprivileged. If you are interested, please contact Sheila Thomas or Mary Stillwell at 503-288-5995.

ASSOCIATES' COUNCIL

Portland residents lend support and enthusiasm for new ACP-OSIM Associates' Council - November, 1997. The newly formed OR ACP-ASIM Associates' Council held its first event at the Oregon ACP meeting this fall in Eugene. Members of the Council displayed the ACP Associates' Web Page and explained the function of the Council. Many residents present at the meeting signed up on the spot to contribute to activities supported by the Council, including an expanded forum to present research and a career faire. One resident noted, "This is just what we need to increase collaboration and friendship between residents in the Portland Programs." The next social/educational event will be held at the Bridgeport Brew Pub on April 22, 1998. For more information about the Council or our next event, please contact Elizabeth Eckstrom, MD, MPH, at eeckstro@lhs.org or 503-833-3554.

PUBLIC POLICY

The ACP's Public Policy office in Washington DC, has installed a wide range of public policy "links" on the OR-ACP Web Page. These include:

  • OR ACP-ASIM Public Policy Committee
  • Oregon State Legislature Web Site
  • Link to the web sites of each member of the Oregon Federal Congressional delegation
  • Link to the ACP Department of Public Policy's Public Page, including position papers
  • Link to the Member Advocacy page, including bi-weekly Washington Report and connections to legislative information on the Internet

Check out that page and let us know what you think about these new services!

KUDOS
  • Gordon L. Noel, MD, FACP—Recipient of the 1998 National Award for Career Achievements in Medical Education, given by the Society of General Internal Medicine
  • Martha S. Gerrity, MD, MPH, Ph.D., FACP—Election to the National Council, Society of General Internal Medicine
  • Walter J. McDonald, MD, FACP, ACP Executive Vice-President and former Governor, OR-ACP—Delivery of the 1st Annual Gilbert Lipshultz, MD, Memorial Lecture at Providence Portland Medical Center entitled, "A Historical Perspective of American Medicine: Trade or Profession?", March 18, 1998
  • The late J. David Bristow, MD, FACP—Recipient of the 1998 Discovery Award of the Oregon Health Sciences Foundation
  • Jonathan Darer, MD, ACP Associate, OHSU—Oral presentation in the clinical vignette competition at the 1998 National ACP meeting entitled, "Syncope in a Patient With Variant High Oxygen Affinity Hemoglobin"
  • Melinda J. Muller, MD, ACP Associate, Legacy Portland Program—Research poster presentation at the 1998 National ACP meeting entitled, "Medical Student Attitudes Toward Homosexuality"
  • Douglas A. Shumaker, MD, ACP Associate, Providence St. Vincent Medical Center—Clinical poster presentation at the 1998 National ACP meeting entitled, "A Solitary Pulmonary Nodule"
  • Marjorie J. Hrbek, MD, ACP Associate, OHSU—Clinical poster presentation at the 1998 National ACP meeting entitled, "The Woman With Rapid Neurologic Decline"
  • Sheila Jhansale, MD, ACP Associate, Legacy Portland Program—Clinical poster presentation at the 1998 National ACP meeting entitled, "Reversible Dementia With Antibiotic Treatment"
  • Elizabeth N. Eckstrom, MD, MPH, ACP Member, and Chair of the Chapter Associates' Council—Recipient of a Chapter Development Fund award of $3,570 from the ACP Chapters Sub-Committee to support the activities of the newly created Council during 1998
  • Andrea M. Kielich, MD, FACP, of Portland, an ASIM Trustee - Appointed for a one-year term to the transitional ACP-ASIM Board of Governors and to the ACP-ASIM Internists of Today Campaign Steering Committee
  • William Hersh, MD, FACP, and Paul Gorman, MD, FACP—Co-directing the "Using Computer Tools to Solve Clinical Problems" track at the 1998 National ACP meeting. Bill and Paul are also authoring three chapters in a new ACP book on using computer tools to manage medical knowledge.
  • Grover Bagby, Jr., MD, FACP—Membership on the ABIM's Subspecialty Board on Hematology which writes the subspecialty certifying examination in hematology

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

CALL FOR AWARDS NOMINATIONS

At the annual meeting each year, the Chapter presents a Distinguished Teacher Award and a Distinguished Service Award, both named in honor of the late Howard P. Lewis, MD, MACP. Please refer to the August and December, 1997, editions of the Newsletter for the names of past recipients. Please contact Jim Reuler if you wish to nominate a colleague for one of the 1998 awards.

PHYSICIAN-ASSISTED SUICIDE

As reaffirmed by voters last November, and reported in the ACP Observer in December, Measure 16, Oregon's law legalizing physician-assisted suicide and passed in 1994, will be implemented during 1998. This legislation touches the lives of many of our patients and their families and the practices of many of our Chapter members. Several Chapter members have been very involved at the state level in framing issues related to implementation. In the August, 1998, newsletter, we plan to devote a column to this important policy issue. If you have specific aspects of Measure 16 you would like addressed, please contact Jim Reuler.

UPCOMING DATES

June 1, 1998—Fellowship Applications due at ACP
June 3-6, 1998—Biennial ACP Internal Medicine Review Course, Vancouver, BC
July 28 - August 1, 1998—ACP Board Review Course, Seattle, WA
November 5, 1998—Infectious Diseases Society of Oregon Meeting, Eugene, OR
November 5-7, 1998—OR ACP/OSIM Chapter Annual Meeting, Eugene, OR
December 1, 1998—Fellowship Applications due at ACP
April 22-25, 1999—ACP Annual Session, New Orleans, LA
June 1, 1999—Fellowship Applications due at ACP
November 4-6, 1999—OR ACP-ASIM Chapter Annual Meeting, Eugene, OR
April 13-16, 2000—ACP Annual Session, Philadelphia, PA

HOW TO REACH US

James B. Reuler, MD, FACP
Section of General Medicine
Veterans Affairs Medical Center (111)
PO Box 1034
Portland, OR 97207
503-220-8262, ext 55582
FAX: 503-721-7807
E-mail: reuler@ohsu.edu or reuler.james@portland.va.gov

Mary A. Olhausen
Department of Medicine
Oregon Health Sciences University
3181 SW Sam Jackson Park Road, L-455
Portland, OR 97201-3098
503-494-8676
FAX: 503-494-5636
E-mail: olhausen@ohsu.edu or omary@teleport.com

Contact Information

Thomas G Cooney, MD, MACP
Oregon Chapter Governor

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