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Governor's Newsletter, August 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:

  • Expanded Associates Program
  • 10 Category 1 CME Credits
  • Clinical Updates
  • Panel Discussions

Brochures have been mailed. Register early. For questions, contact: 503-494-4898 or 1-800-452-1048

IDSO Meeting

The 8th annual meeting of the Infectious Diseases Society of Oregon will be held at the Eugene Hilton Hotel, November 5, just preceding the ACP-ASIM meeting. Updates include endocarditis, gastroenteritis, community-acquired pneumonia and the diabetic foot. For registration information, contact Elizabeth Kerl at 503-215-6088.

Career Corner

This edition's column related to career paths taken by internists is authored by a physician on the cutting edge. Maureen Wright, MD, ACP-ASIM Member from Portland, completed both her medical school and internal medicine residency training at OHSU. In 1990, Maureen began work for Kaiser Permanente Northwest as one of the first hospitalists in the country. In addition to her role as a hospitalist, Dr. Wright is chairperson for Kaiser's Cardiovascular Steering Committee, which functions to promote and maintain high quality care by the prevention and treatment of cardiovascular disease. Recently, Dr. Wright was appointed acting Chief of Northwest Permanente's Medical Legal Division.

During my last year of residency training, I became aware of the concept of an internal medicine practice based exclusively in a hospital setting. This was a fairly new idea at the time, and felt by some to be experimental, or possibly a job that an internist might do until they decided to settle down and have their own practice. To me, this was a definite career path, and I jumped at the opportunity.

The term "hospitalist" had not been coined when two other physicians and I started our inpatient practice. The duties of an inpatient physician vary from hospital to hospital, but the focus is to provide timely care in an efficient manner to patients that require hospital admission. We have evolved over time, and now believe we meet the needs of patients, other physicians and hospital staff.

One of our roles is to act as consultant for the Emergency Room physicians. Because our internists and family practitioners have clinics that are spread throughout the Portland metropolitan area, it is usually not feasible for primary physicians to see their patients in the Emergency Room. We evaluate patients with medical problems in the ER and either admit them or expedite an outpatient work-up. When the patients are admitted, their primary physicians will assume care the next day. Patients whose physicians have elected to discontinue their hospital practice will be admitted to our service and cared for by us throughout their stay. Communication with the patients' primary physician is key to making the process as seamless as possible, and Kaiser's computer-based medical record system ensures that they will have a full record of our care when they see the patient in follow up.

We currently rotate duties among our team of five physicians. In order to maintain as much continuity as possible, we take turns rounding on the inpatient service for a span of nine days. We overlap the rotations by several days so that the physician coming on service will be assuming the care of patients while the physician going off service is still rounding. Since length of stay is usually two to three days, this system works quite well, and we have found that the vast majority of patients are very comfortable with this process. They understand that we are managing only their inpatient care, and that they will return to their own physician after discharge.

The advantage of this system from a patient perspective is that we are available in the hospital when problems or questions arise. We can make frequent evaluations and tailor workup and therapy on a timely basis. Communication with the patients' loved ones can occur as frequently as needed. The hospital nursing staff has ready access to us for patient questions and concerns, and surgical specialties can consult us for urgent medical problems. We can respond as needed to any emergencies.

What I find most rewarding is that I have the opportunity to practice the kind of medicine for which I was trained. I diagnose and treat bread and butter internal medicine problems and emergencies, as well as the occasional "zebras". I enjoy the pulse of the hospital experience and the daily challenges that accompany it. The hospitalist experience has also given me the chance to become involved in other areas related to continued quality improvement.

My roles in medical-legal matters and the cardiovascular steering committee serve to enhance my effectiveness as an inpatient physician. The future of hospital based medicine looks bright, and I feel very fortunate to be a part of it.

Editors Note: ACP-ASIM is providing administrative support for the newly created National Association of Inpatient Physicians (NAIP). For information about NAIP, contact 215-351-2740.

Death With Dignity Act

Oregon's Death With Dignity Act, permitting physician aid-in-dying (known as physician assisted suicide) is being implemented. This legislation touches the lives of many of our patients and their families and the practices of many of our members. A number of Chapter members have provided state-wide and national leadership in end of life issues.

At this juncture, the Oregon Board of Medical Examiners is adopting administrative rules (public hearing June 3; Board review July 16-17) and the Oregon Health Division is developing a questionnaire for physicians involved in physician assisted suicide. More information will be forthcoming. In order to help Chapter members and their patients frame the issues (regardless of your willingness to participate in prescribing), the following perspective is offered. Also, please refer to the ACP-ASIM Ethics Manual, 4th Edition, published in Annals (April 1, 1998).

This column is authored by Nancy S. Crumpacker, MD, medical oncologist, and ACP-ASIM member of Portland. A graduate of University of Kansas School of Medicine, Dr. Crumpacker did her internal medicine training at Truman Medical Center in Kansas City, Missouri, and Hematology-Oncology Fellowship at OHSU. Dr. Crumpacker is currently in private practice in Tualatin.

Since voters passed the Death With Dignity Act, physician aid-in-dying is currently available in Oregon to mentally competent, terminally ill adults who request the option of hastening their inevitable death. Patients will be asking you about this option and this column is written as a brief guide.

Your first goal is to decide how you will respond to a patient who requests physician aid-in-dying. In making this decision, it is important to realize that requesting, and even completing the process to obtain the option does not mean the option will be exercised. Most patients - even those who complete a request under the Death With Dignity Act - will die naturally. If you are not willing to participate in any of this process, then you do not have to proceed any further.

Your only legal obligation is to release copies of the patient's medical records to the patient or the new attending physician. If you support your patient's discussion of this option but object to writing the prescription, you may refer to another physician who will then act as the "attending physician". In this case, you may act as the "consulting physician".

The third option is to be the attending physician for the patient who requests physician aid-in-dying. If a patient approaches me with the desire to talk about this option, I ask his/her permission to schedule a special visit exclusively for this purpose. I schedule these visits at the end of my day to allow an open-ended discussion and request that my staff not interrupt us.

Your primary job is to listen. These individuals have given careful thought to this request before coming to see you. This listening process is very important and rewarding and may remind you why you chose to become a physician. When you have an opportunity to ask questions, explore all of the patient's physical, psychological, and spiritual symptoms. Discuss all options of symptom control, especially hospice care, so that patients fully understand that terminal care is best delivered in the patient's home.

Your patients will most likely confide that a loss of independence is the primary motivating factor for having this discussion. These individuals desire to regain a sense of control, which has been lost because of their terminal illness. Also, explore the social and financial issues that may influence this request. Do not forget to consider possible coercion.

During the conversation, it is important to ask how other family members and friends view this request for aid-in-dying. It is also important to stress that family members and friends could possibly obstruct the process if not fully aware of the patient's desires. This is an excellent opportunity to discuss the existence of an Advanced Directive to Physicians and to consider filling out a Physician Orders for Life-Sustaining Treatment (POLST) form. This form is a portable DNR order signed by the physician. The POLST form is available from the Center for Ethics in Health Care at OHSU (503-494-4466).

Physician responsibilities include first and foremost establishing that this adult, Oregon resident is capable of making an informed decision, the request is voluntary, and he/she has a terminal illness (less than six months to live).

The law states we must then inform the patient of the following:

  1. His/her medical diagnosis,
  2. His/her prognosis,
  3. The potential risks associated with taking the medication to be prescribed,
  4. The probable result of taking the medication to be prescribed, and
  5. The feasible alternatives including, but not limited to, comfort care, hospice care, and pain control.

If you have detected symptoms that must be controlled before proceeding with the request for aid-in-dying, then you should address these symptoms and have the patient return for follow-up.

The attending physician should consider whether there is any psychiatric disorder, including depression, causing impaired judgment. If a psychiatric/psychological referral is necessary, it is important to make one early in the process.

The patient and his/her attending physician will need to find a consulting physician to verify the patient's capability and terminal diagnosis. The consulting physician must also convey to the patient all the necessary elements of the "informed decision" outlined above. The consulting physician may make a recommendation for a psychiatric/psychological referral. It is suggested that the consulting physician should not have a financial or other relationship with the attending physician that has the potential for a conflict of interest, such as a capitated managed care situation.

If the patient wishes to proceed, then he/she needs to be informed of the time constraints. The attending physician cannot write a prescription until 15 calendar days have elapsed from the first oral request and 48 hours have elapsed from the written request. The attending physician should obtain the written request from the patient only after the consulting physician has confirmed and documented the patient's terminal disease. When the patient returns to make his/her second oral request, the prescription can be written if the above requirements are met. Ask the patient if he/she wishes to rescind his/her request at the time of the oral requests and the writing of the prescription.

Locate a cooperative pharmacist and discuss by phone the intent of the prescription. To avoid patient trauma, the patient should arrange to pick up the prescription directly from the informed pharmacist. Alternatively, the physician may pick up the medication and deliver it personally to the patient.

The Act requires the Oregon Health Division (OHD) to collect information about individuals exercising the option of physician aid-in-dying and to assure that the safeguards are being followed. The necessary forms are available from the OHD at 503-731-4027. There is a two page form for the attending physician to complete, which is relatively simple. However, you may sign a one-page form, which states that you "elect to make available to the Health Division the relevant portions of the patient's medical record to determine compliance with the Death With Dignity Act". I urge you to use the two-page form to protect your patient's confidentiality. You must also send in a form filled out by the consulting physician, a copy of the written request by the patient for medication to end life, and if obtained, a copy of the psychiatric/psychological consultation.

Mark the envelope: "CONFIDENTIAL" and mail the forms to:

Oregon Health Division, Attention: State Registrar
Center for Health Statistics
PO Box 14050
Portland, OR 97293-0050

The OHD would like us to fill out the death certificate "as accurately as possible". I suggest you fill out "Cause of Death" (Part 36) with the actual terminal medical condition. Then, in the box labeled "Manner of Death" (Part 40), check "Other". The OHD does not rely on the cause of death written on the death certificate to determine who opts for aid-in-dying.

Physicians may wish to contact Compassion in Dying (503-525-1956) in Portland. They will assist with mental health and clergy referrals, with finding volunteers to visit the patient in the home, and in assessing the request and reassuring that any decision made is the result of a careful and deliberate process. They will also provide specific information for patient education and information about procedures and drugs. They can help a physician contact other physicians who have participated in this process.

Oregon Death With Dignity Legal Defense and Education Center (503-228-6079) in Portland will provide professional referrals to physicians and pharmacists. They also provide educational seminars on the procedures outlined in the Act.

Physicians may also wish to obtain the Oregon Death With Dignity Act: A Guidebook for Health Care Providers developed by the Task Force to Improve the Care of Terminally-Ill Oregonians. This can be obtained from the Center for Ethics in Health Care at OHSU in Portland (503-494-4466). It is a discussion of the issues involved and I highly recommend purchasing it.

I believe that the law is working as it should, quietly and effectively for a small number of patients. The U.S. Department of Justice is neither prosecuting nor investigating cases of aid-in-dying in spite of threats from the Drug Enforcement Administration. The Oregon Health Division is maintaining confidentiality.

Finally, in my experience, patients who receive the lethal prescription may never take the drugs. Simply by regaining some element of control over their lives, they find peace. For them, this process represents not a prescription for suicide, but a prescription for compassionate care at the end of life.

Associates' Council

New ACP-ASIM Associates' Council Members
Tim Thunder, MD, and Tom Steele, MD, both of Providence Portland Medical Center training program, have joined the Associates' Council for the 1998/99 year. We welcome their enthusiasm and ideas!

Associates' Competition
The ACP-ASIM Associates' Council is gearing up to run the Associates' Competition at the Oregon ACP-ASIM meeting, November 5, 1998, in Eugene. Details on submitting oral and poster presentations will be mailed to all residents in early August and will be available in each Program office. Start pulling together those cases!

Fun and Productive Social Event
The first major event sponsored by the ACP-ASIM Associates' Council was held in the conference room at the Bridgeport Brewing Company on April 22, 1998. There were approximately 74 residents in attendance, representing all four Internal Medicine training programs in Portland.

The purpose of the meeting was for residents from each program to interact with residents from other programs within the city, sharing ideas and interests in an unstructured social environment. The pleasant atmosphere of the Bridgeport offered ample opportunity for interaction, and members of the Associates' Council were able to discuss goals and plans for future activities. They also received feedback from residents regarding events that would be useful to further their medical careers.

Career Fair
The Associates' Council will sponsor a Career Fair this fall for all senior residents. This will be held at the Bridgeport and will include seminars on how to write a CV, what questions to ask in an interview, how to determine what type of practice is right for you, and several other topics relating to careers after residency. We encourage residents from all programs to participate in the Fair. For more information, contact Elizabeth Eckstrom (503-833-3554 or eeckstro@lhs.org) or visit the Oregon ACP-ASIM Associates' Council on the web page.

Community Service

This edition's Community Service column is authored by Richard Bayer, MD, FACP, of Portland. A graduate of The University of Missouri - Kansas City School of Medicine and the OHSU Internal Medicine Residency, Rick had to leave his primary care internal medicine practice in 1996 because of complications of an ilio-femoral deep venous thrombosis. However, he has become very active in medical, public health, and political efforts in Oregon.

After my disability forced me to leave my practice, I had to decide how I could contribute to our community even though I could not be on my feet for the 12+ hours daily that I had put into my practice for 15 years. I had been a member of Physicians for Social Responsibility (PSR) since the early 1980's when a certain president had the foolish notion that anyone could "win" a nuclear war. In 1997, I joined the PSR - Oregon Board of Directors.

PSR, the US affiliate of International Physicians for the Prevention of Nuclear War (IPPNW) and a recipient of the 1985 Nobel Peace Prize, had expanded their mission statement beyond "elimination of nuclear weapons" to "other weapons of mass destruction, the achievement of a sustainable environment, and the reduction of violence and its causes".

One of the first presentations I heard as a PSR - Oregon Board Member was from the Urban League of Portland describing the "lead poisoning epidemic" among poor urban children. They had just released a study called, "Portland's Silent Epidemic: Lead Poisoned African American & Latino Children". The Center for Disease Control (CDC) had just revised their lower limit for "acceptable" lead levels in children to 10 mcg/dl and the report stated that nearly 1 in 10 Latino, Native American, and African American children in Oregon had lead concentrations in their blood that exceeded this level.

Although many physicians are familiar with acute lead toxicity from very high levels, new data suggested that a decrease in IQ and associated learning problems, behavior problems, and possibly problems such as Attention Deficit Disorder could be related to chronic lead poisoning (see the CDC booklet "Screening Young Children for Lead Poisoning: Guidance for State and Local Public Health Officials" published November 1997).

As an internist, I had often managed the ravages of poor health choices and environmental toxin exposures (including tobacco, alcohol, pesticides, etc.) but this public health opportunity offered a chance to participate in a "front end/preventive" solution rather than the more traditional "see me when you get sick" solution. It seemed obvious that children at risk needed to be tested, data needed to be collected, and novel solutions were needed.

Our current President of PSR - Oregon is Josiah Hill, who is a Physician Assistant. He and I were interested in working with Multnomah County Health Department and the Oregon Health Division to provide the volunteer work needed to screen children. The Oregon Health Division had lost the grant from the CDC and could not afford to use paid employees to actually do the screening (see "Willamette Week" of January 14, 1998 on line at http://www.wweek.com/html/cover011498.html).

Josiah and I decided to tag onto the "SKIP" (Screen Kids, Inform Parents) Health and Developmental Screening Program, which is part of the Child Services Center (503-916-5840, ext 208). SKIP provides infants, toddlers, and preschool-age children in Multnomah County with free screening in areas of general and dental health, hearing, vision, speech/language and motor skill development. In the Spring of 1998, we added lead screening to SKIP.

We draw the blood via finger sticks and heel sticks (not as easy as we adult medicine specialists may think) and educate the parents about lead. There are good brochures from the EPA and from the Portland Bureau of Water Works. Once the results from the state labs are available, we discuss the results by phone with the parents. Children with high levels are referred to their regular doctors for repeat venous lead levels and follow-up.

We do this because children are not being screened in their doctor's office. Many practitioners presume that there is no longer a lead problem. That may be true in wealthy areas of Oregon, but is not true in poor neighborhoods. Medicaid providers are supposed to do lead screening at 12 and 24 months. Although nearly 25,000 children should be screened annually by OMAP providers, only 1,410 billings for lead screenings were submitted to OMAP in 1995. Lead was banned from house paint in 1978, pipe solder in 1986, and gasoline in 1996.

The primary source of lead poisoning of children is now from lead-based paint chips and the subsequent lead dust. Oregon has many older homes where peeling paint can be a hazard.

Although the grant money had dried up from the CDC, the EPA has agreed to let some money be shifted from the Portland Water Bureau budget to Multnomah County's "Community Lead Education and Reduction Corps" (CLEARCorps). CLEARCorps, a branch of Americorps, specializes in cleaning up lead hazards. If a child with an elevated lead level needs help with lead removal from their home, CLEARCorps is available. It may be as simple as covering the old lead paint with a fresh coat of latex paint, thus eliminating the health hazard of the lead dust. I never had this much "power" in private practice using my prescription pad and an ink pen.

Josiah Hill, PA, who is also on the executive committee of the Coalition of Black Men (COBM), has just found a location at Common Bond on NE Alberta Street and 9th Avenue, behind St. Andrew's Catholic Church, that we plan to turn into a permanent lead screening site. Common Bond is a day-care/parent-education site for residents of N/NE Portland, mostly African American and Latino clients. It is funded primarily by Volunteers of America and the Urban League of Portland. We also have OHSU medical students working with us (who also serve on the board of PSR - Oregon) and wonderful volunteers from COBM and CLEARCorps who help us with the administrative complexities. We plan to have our permanent site up and running this summer and are always looking for more volunteers.

PSR - Oregon can be reached at 274-2720 and our board meetings are open to the public, so feel free to show up at the PSR office on the 5th floor of the Galleria (10th & Morrison) at 7:30 pm on the first Tuesday of the month. Please consider joining PSR. Josiah (503-282-6118 or hillmajo@webtv.net) and I (503-292-1035 or ricbayer@teleport.com) are the "Co-Directors" of the "PSR - COBM Lead Screening Project" and would be happy to discuss our project with anyone.

Josiah and I hope to generate data from our project for further research and help providers screen for lead problems, but primarily this is a long-term project for the kids, who are, of course, the future of our community. I enjoy the chance of being part of a "front-end/preventive medicine" solution and believe that we can make a difference in our community. As I have changed from exam room and hospital based internal medicine to community public health medicine, I have become impressed with the need for strong coalitions among health care providers, community activists, and government health bureaus. One of the best consequences of my community service are the friendships I have made with others and the good feeling that comes from serving our community.

Chapter Council Activities

The Interim Chapter Council, announced in the last newsletter, met May 29. Projects include:

  • Preparing new Chapter by-laws to be approved at the national office facilitating "formal" merger of OR-ACP and OSIM into OR ACP-ASIM.
  • Investigating alternate sites for the annual Chapter meeting.
  • Preparing for the November 6 Chapter business meeting in Eugene.
  • Developing a strategy for representation within the OMA's decision-making process.
  • Identifying Public Policy priorities for the Chapter.

The ACP-ASIM merger was "official" July 1. Many Chapter members have received dues notices for 1998-99 for the new organization. Chapter dues were not raised and remain at $40.00.

Welcome to all OSIM members who were not previously members of ACP. This is your first newsletter. Please let us know what you think, and if you would like to contribute. Valorie Burns, Administrative Coordinator for OSIM, has stepped down from her position recently. For the past years, Val has been a great support of internists from around the state. Over the past ten months, Val has supported the discussions and meetings between ACP and OSIM leadership culminating in our merger. We, collectively, thank Valorie for all of her work on our behalf and wish her well in her new pursuits.

Internists/Media

This edition's Media column is written by Susan W. Tolle, MD, FACP, of Portland. After medical school at OHSU, residency and Chief-Residency in the Department of Medicine at the University of California-San Diego School of Medicine, and a sabbatical year at the Center for Ethics at the University of Chicago, Dr. Tolle founded the Center for Ethics in Health Care at OHSU, where she is Director of the Center, Professor of Medicine, and a practicing general internist.

Time spent educating reporters can have a variety of very positive outcomes. The media has the power to encourage better informed health policy, to educate the public about health issues and to even enhance cultural change in the practice of medicine. My most frequent interactions with the media are about medicine's shortcomings and successes in care of the dying.

National media continue to portray physicians as inattentive to the pain and suffering of the terminally ill, and overly zealous in the use of machines in life's final months. What the national media has missed is that these problems are primarily due to systems issues, not hard-hearted doctors.

Because of our successes in removing systems barriers, Oregon physicians are very fortunate not to have as many obstacles as our colleagues face in other states. For example, physicians in California are hampered in writing narcotic prescriptions by the required use of triplicate forms, and our counterparts in New York have great difficulty withdrawing life support unless the patient has completed a written advance directive (because they do not have a surrogate law). We do not have these types of barriers in Oregon and part of the reason we don't is that many of us have spent time educating Oregon reporters, which in turn has facilitated policy and systems change.

Can you get burned working with the press? Absolutely and I certainly have! Sometimes my comments are taken totally out of context. Sometimes I sound as if I didn't finish high school or that I have a point of view I do not hold. Many times what is printed is a quote, which while accurate, fits the reporter's story rather than the message I most wanted to make.

Even with these frustrations, is it worth spending time with the media? I believe it is. Medicine is troubled in many ways. We continue to have many uninsured Oregonians. Incentives in medicine are changing and, at times, finances and the bottom line are getting more attention than quality. Each of us has a concern and something to share. Physicians need to speak out and to be heard about the many tough issues facing medicine today. One effective, though at times frustrating, means to bring about change is through the public press.

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, www.acponline.org/cme/cbt, of ACP-ASIM web page, www.acponline.org.

Chapter members who served as preceptors for first or second-year medical students at OHSU in the Principles of Clinical Medicine course during 1997-98 include:

Elizabeth Allen
Susan Bagby
Ian Barr
John Bauer
Steven Beeson
Phillip Buckley
Thomas Cooney
Brian Cox
Richard Craft
Theo deBruin
Thomas DeLoughery
Leigh Dolin
Martin Donohoe
Diane Elliot
Martha Gerrity
Donald Girard
Andrea Kielich
Steven Hashiguchi
Kusum Kumar
David Labby
James Leggett
Roger Leverette
Mark Loveless
Linda Lucas
Nancy MacNeal
Scott Mader
Daniel Mangum
Kenneth Martin
Ellen Michaelson
David Nardone
Rebecca Orwoll
Steven Redmond
James Reuler
Wayne Rogers
Scott Sallay
Melanie Scurry
Ellen Singer
David Smith
Steven Spindel
Carol Sprague
Richard Wise

If you wish to learn more about PCM Preceptor opportunities, contact Ms. Pam Marshall 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 1997-98 include:

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

If you are interested in learning about preceptor opportunities in the AHEC Program, please contact Ms. Rebecca Landau at OHSU, 503-494-1165.

Membership

The Oregon Chapter continues to grow! Here is a breakdown (figures are before merger of ACP and ASIM):

Category

Students
Associates
Members
Fellows
Masters

Total

September 1, 1997

36
183
533
179
2

933

June 1, 1998

104
217
524
182
2

1,029

Tell your friends about ACP-ASIM. For more information, contact Michelle George at 1-800-523-1546, ext 2716, or Mary Olhausen at 503-494-8676.

Fellowship

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

Richard E. Bayer, MD, FACP
Joji Kappes, MD, FACP
Daniel K. Mangum, DO, FACP
Portland
Portland
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 1-800-523-1546, ext 2694.

Kudos

  • Jay R. McDonald, MD, ACP-ASIM Student Member - Recipient of the 1998 Edward S. Hayes Gold-Headed Cane Award, "in recognition of compassionate devotion and effective service to the sick", the highest award given to a graduating student, School of Medicine, OHSU
  • Don Venes, MSJ, MD, ACP-ASIM Member - Named Medical Editor of the 19th Edition of Taber's Cyclopedic Medical Dictionary. Don practices general internal medicine in Brookings.
  • Melinda J. Muller, MD, Legacy Portland Program (Research Poster), Sheila Jhansale, MD, Legacy Portland Program (Clinical Poster), and Jonathan Darer, MD, OHSU Program (Oral Clinical Vignette), ACP-ASIM Associates who each received $750.00 award for their presentations at the National Associates' Competition, San Diego, April, 1998.
  • Thomas G. DeLoughery, MD, ACP-ASIM Member - Recipient of the Allan J. Hill, Jr., Award for "excellence in teaching in the clinical sciences" by the 1998 graduating class, School of Medicine, OHSU; and election to Alpha Omega Alpha (AOA) Honor Medical Society, Alpha Chapter, OHSU, as the honored faculty member for 1998.
  • Peter K. Black, M. Erik Gilbert and Matthew R. Riley, ACP-ASIM Student Members and members of the class of 1999, School of Medicine, OHSU, for induction into AOA at the Spring Banquet, June 2, 1998.
  • Elizabeth S. Allen, MD, ACP-ASIM Member - Recipient of the David W.E. Baird Award for "excellence in a junior faculty member" given by the 1998 graduating class, School of Medicine, OHSU.
  • Anthony L. McCall, MD, Ph.D., FACP - Serving as the official representative of Oregon ACP-ASIM to the Oregon Diabetes Coalition, convened by the Oregon Health Division, June, 1998.
  • Robin Miller, MD, ACP-ASIM Member, of Medford - Represented the Chapter in the National ACP-ASIM Doctors for Adults Campaign, with TV and newspaper interviews and features in Medford, Eugene and Portland over the past six months.
  • Andrea M. Kielich, MD, FACP, of Portland, a Transitional Governor for 1998-99 - Appointed to the Executive Committee, Board of Governors, ACP-ASIM.
  • Mark Helfand, MD, MPH, and Craig Redfern, DO, OR ACP-ASIM Members, of Portland - Authoring a paper for the ACP-ASIM Clinical Efficacy Assessment Project entitled "Screening for thyroid disease: An Update" in the July 15, 1998, Annals. This paper served as the new foundation for the ACP-ASIM position paper on screening for thyroid disease published in the same edition and featured in TIME magazine July 27 edition.

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.

Upcoming Dates

September 1-December 1, 1998 Registration Period for 1999 ABIM Certification Examination. 1-800-441-2246.
November 5, 1998 Infectious Diseases Society of Oregon Meeting
Eugene, OR
November 5-7, 1998 OR ACP-ASIM Chapter Annual Meeting
Eugene, OR
December 1, 1998 Fellowship Applications due at ACP-ASIM
April 22-25, 1999 ACP-ASIM Annual Session
New Orleans, LA
June 1, 1999 Fellowship Applications due at ACP-ASIM
August 24-25, 1999 ABIM Certification Examination in Internal Medicine
November 4-6, 1999 OR ACP-ASIM Chapter Annual Meeting
Eugene, OR
April 13-16, 2000 ACP-ASIM Annual Session, Philadelphia, PA

How to Reach Us

James B. Reuler, MD, FACP
Section of General Medicine
Veterans Affairs Medical Center (P-3-MED)
PO Box 1034
Portland, OR 97207
503-220-8262, ext 55582
FAX: 503-721-7807
E-Mail: reulerj@ohsu.edu or
reuler.james@portland.va.gov
Mary A. Olhausen
Department of Medicine
Oregon Health Sciences University
3181 SW Sam Jackson Park Road, L-455
Portland, OR 97201-3098
503-494-8676
FAX: 503-494-5636
E-Mail: omary@teleport.com or
olhausen@ohsu.edu

 

Chapter Web Site: 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