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November 2012 Kenneth E. Olive, MD, FACP, ACP Governor


From the Governor

Dr. Olive

Major League Baseball knows the World Series as the Fall Classic. This year’s four game sweep by the San Francisco Giants left Giants fans ecstatic and Tigers fans despondent. The Tennessee Chapter ACP celebrated its own version of the Fall Classic one week before the World Series with our chapter scientific meeting in Chattanooga October 18-20, 2012. Unlike a significant number of Tigers fans who paid much more to attend the World Series than our members paid to attend the chapter meeting, no one left the Tennessee Chapter meeting despondent. This year’s program was organized by Daphne Norwood, MD, MPH, FACP of Knoxville who served as program director. She was assisted by the program planning committee (Monique Bennerman, MD, FACP, Sonal Gupta MD, Jason Hayes, MD, FACP, Steve Hegedus, MD, FACP, Lisa Staton, MD, FACP, Catherine Womack, MD, FACP, and Wilma Cooley, Executive Director ).

The Thursday evening program which focused on Associates and Student members featured clinical vignette and research posters. While posters were being judged, students and residents from programs across the state had the opportunity to network and share experiences. For many participants, this was the first opportunity to make a formal scientific presentation at a professional meeting. The Council of Young Physicians organized the poster judging. Many of the judges were young physicians, providing students and residents the opportunity to interact with those a few years further along in their careers. A spirited medical jeopardy competition among the residency programs followed the poster presentation and judging. This competition narrowed the field down to the teams from the University of Tennessee – Nashville (Baptist Hospital program) and Vanderbilt University. A high risk final jeopardy question left the Vanderbilt team as the victors.

Vanderbilt Jeopardy

The Vanderbilt University Jeopardy Champions

Cooley Lewis

Wilma Cooley, Executive Director and Dr. Jim Lewis share a light moment during the Associates program

The scientific program on Friday and Saturday featured state of the art presentations on a variety of topics commonly seen by internists including COPD, atrial fibrillation, lupus, CHF, new cervical cancer screening guidelines, and perioperative evaluation. A panel of physicians experienced in both practical and administrative aspects of the Medicare Shared Savings Program discussed Accountable Care Organizations. Charlene Dewey, MD, FACP helped participants meet the Tennessee Board of Medical Examiners CME requirement on prescribing practices. The option to complete two ABIM self-evaluation modules for maintenance of certification was available Saturday afternoon in sessions led by Jim Lewis, MD, FACP and Catherine Clarke-Bateman, MD, FACP. Susan Hingle, MD, FACP, chair-elect of the ACP Board of Governor served as College representative and spoke on the ACP initiative on High-Value Cost-Conscious Care.

Olive, Lane, Mire and Hingle

Drs. Ken Olive, Governor, Richard Lane, Governor-elect, Ryan Mire, Treasurer, and Susan Hingle, Chair- Elect, ACP Board of Governors

While the scientific program is one important aspect of the meeting, the opportunity to see friends and colleagues from across the state is equally important. Many discussions involved the future of internal medicine. The changing face of clinical practice and the variety of factors influencing it were common topics of discussion. Likewise, evolving practice patterns including the relationships between our members in ambulatory practice and those who are hospitalists evoked many passionate conversations. A wide range of members participated in the meeting encompassing medical students, retired physicians, general internists, subspecialtists, active duty military physicians, and physicians from other states.

Vegors, Lane, Ralston

Drs. Bob Vegors, Richard Lane, and Fred Ralston enjoying time together during a break

The social highlight of the meeting was the Friday evening reception at the Tennessee Aquarium. This year the chapter sponsored a narrative medicine competition sponsored by Ron Lands, MD, FACP of Knoxville. The winners of the competition were recognized at the reception where their work was available for members to enjoy. Having the aquarium open for our group provided an uncrowded, family friendly event which everyone seemed to enjoy. The aquarium’s evening ambience differs from that during the day making some of the displays seem a bit more mystical.

Aquarium

Dr. Catherine Womack, Dr. Laurie Spraberry, Mrs. Katherine Lewis, Dr. Jim Lewis, and Dr. Mary Nell Ford enjoying time together at the reception.

One of the significant events of the chapter meeting is the presentation of the two major awards presented annually by the chapter – the Laureate Award and the Community Service and Volunteerism Award. Recipients of these awards were nominated by their peers and were selected by a committee consisting of former chapter Governors and a member of the Council of Young Physicians. The Laureate Award was presented to Paul McNabb, MD, FACP of Nashville. Dr. McNabb has had a distinguished career as a practicing infectious disease physician and serves as the Assistant Dean for Graduate Medical Education at Baptist Hospital in Nashville. He is currently serving as Chair of the Board for State Volunteer Mutual Insurance Company. He has served the chapter with distinction. His wife and daughter were present to share in the occasion with him. Robert Miller, MD of Nashville was recognized with the Volunteerism and Community Service Award. Dr. Miller has volunteered numerous hours working with the Shade Tree Clinic in Nashville providing care to underserved patients.

McNabb Laureate

Dr. Paul McNabb receiving Laureate from Dr. Tracey Doering, a prior Laureate award recipient.

Chapter meetings are the local lifeblood of the ACP. Later in this newsletter an article discusses the importance of chapter meetings from a national perspective. If you have never participated in the chapter meeting, I strongly encourage you to do so. You will discover commaraderie and excellent continuing medical education. The 2013 chapter meeting will be held at the Marriott Hotel in Franklin, TN, October 18-19, 2013.

Lane and Olive

Dr. Richard Lane presents Dr. Ken Olive with letter of appreciation from ACP leadership

Medical Student Research Poster Winner

Ayeetin Azah- P2X4R Knockout Mice Exhibit Modified Alcohol Intake When Compared to Littermate Controls. Meharry Medical College, Nashville.

Azah

Ayeetin Azah, MS3, Meharry Medical College, Nashville

Medical Student Clinical Vignette Poster Winners

First place: Elizabeth Rutter- Abdominal aortic aneurysm with inferior vena cava compression: an unusual cause of deep venous thrombosis. University of Tennessee Health Science Center, Chattanooga.

Rutter

Elizabeth Rutter MS3, UTHSC – Chattanooga

Second Place: Michelle Tanner- Lupus Myocarditis Presenting as Heart Failure: Rare but Still Around. Quillen College of Medicine, East Tennessee State University, Johnson City.

Tanner

Michelle Tanner MS3 discussing her poster with judges

Associates Research Poster Winners

First place: Jeremy Pollack- Implementation of a Standardized Pathway for the Treatment of Survivors of Caardiac Arrest Using Therapeutic Hypothermia: “Code Ice”. Vanderbilt University, Nashville

Pollock

Jeremy Pollock MD, Vanderbilt University, Nashville

Second place: Burcu Gül- The Qualitative Assessment of Biodegradable Coronary Stents with the Use of Intravascular Ultrasound, Optical Coherence Tomography and Histology. Vanderbilt University, Nashville.

Gul

Burcu Gül, MD Vanderbilt University, Nashville

Associates Clinical Vignette Poster Winners

First place: Scott Duncan- A 41 year old female with a lung mass and multiple lung nodules. University of Tennessee Health Science Center, Memphis.

Duncan

Scott Duncan MD, UTHSC - Memphis

Second place: Brittany Ragan- A Cunning Use of Iron: A Rare Case of Cunninghamella Endocarditis. Vanderbilt University, Nashville.

Ragan

Brittany Ragan MD, Vanderbilt University, Nashville

Associates Oral Presentation Winner

Mathew Edwards- A Strange Case of Massive Hemoptysis. University of Tennessee, Knoxvillle.

I Edwards

Matt Edwards DO, University of Tennessee Knoxville.

Narrative Medicine Competition Winners

First Place: “Thanksgiving” by Matt Neal, 4th year medical student

Second Place: “Still Kickin’ ” by Andrew W. Dake MD, Associate

Third Place: “My First Clinical Rotation” by Calvin M. Smith, III MD, Associate

Thanks to the following who served as judges of the resident and student competitions at the chapter meeting Haytham Adada, MBBS, Ammar Almehmi, MD, FACP, Christopher Burress, DO, Roger DeVersa, MD, Sonal Gupta, MD, Steve Hegedus, MD, FACP, Gena Kluwe, MD, FACP, Victor Kolade, MD, FACP, Philip Kuo, MD, FACP, Reena Kuriacos, MD, FACP, Mack Land, MD, MACP, Ryan Mire, MD, FACP, Ayodeji Oso, MD, FACP, Ed Palmer, MD, FACP, Mihir Patel, MD, Bheerendra Prasad, MD, Richard Reed, MD, FACP, Laurie Spraberry, MD, FACP, Bob Vegors, MD, FACP, and Catherine Womack, MD, FACP.

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Recently one of our long time distinguished chapter members died. Winston P. Caine, Jr., MD, FACP was a member of the Tennessee Chapter Governor’s Council for several years, served the chapter by allowing his name to be place in nomination for the position of Governor-elect, received the Laureate Award from the Tennessee Chapter, and the American College of Physicians National Volunteer Teacher of the Year Award. The following reflection by Clif Cleaveland, former Tennessee Chapter Governor and ACP President was published in the Chattanooga Times Free Press on November 1, 2012.

How Medicine Should be Practiced

Clif Cleaveland, MD
1 November 2012

At a medical conference last week, I learned of a patient with a very complex illness. He had been seen by nine consultants, none of whom had actually touched him. The tenth consultant sat at the bedside and listened carefully to the man before examining him. This led to a rational plan of analysis and treatment of his life-threatening disorder.

Listening and seeing with deliberation are ancient diagnostic tools at risk of being forgotten in an era of high-tech medicine.

I thought of the man with many doctors as I reflected upon the career of Doctor Winston Caine who died last week.

I met Winston in medical school in Baltimore in 1961. Subsequently, we shared years on the medical house-staff at Vanderbilt Hospital. After separate stints of military service, we were members of a medical partnership for 33 years.

At the outset of a shared, professional journey, technology was in its infancy. Medications for high blood pressure, diabetes, and many infectious diseases were limited and often associated with unpleasant and, sometimes, dangerous side-effects. Cancer chemotherapy was limited. In a breakthrough, an engineer and a heart surgeon collaborated to produce the first heart defibrillator. CAT scans, MRIs, and systems of life-support remained on the distant horizon.

At Vanderbilt, kidney dialysis began. A four-bed intensive care unit opened. Research provided new treatment options for leukemia, heart disease, and organ transplantation. Collaborative research between pharmaceutical companies and academic labs led to a rapidly expanding menu of medications for almost all diseases.

HIV-AIDS exploded on the scene in the 1980s to remind us of our vulnerabilities to new, epidemic diseases.

New technologies were introduced faster than we could comprehend how to employ them most efficiently. Associated costs sky-rocketed. Medical ethics struggled to keep up with all the new choices in therapy. Harmon Smith, a distinguished professor of ethics at Duke, summarized the dilemma with a question: “Who gets how much of what when there is not enough to go around?” WE have yet to answer this inquiry.

Winston chose the field of hematology for specialty training and practice. Leukemias and lymphomas, malignant diseases involving lymph nodes and related tissues, fall within this branch of medicine. When Winston began his work in this discipline, treatment was often limited, and many patients died.

Hodgkin’s disease, one of the lymphomas, carried with it a bleak outlook. Near the end of our Vanderbilt years, a new therapy involving high-dose radiation offered fresh hope for victims of the disease. Subsequently, we learned that the radiation could severely damage other organs, such as the heart. Expanding options of chemotherapy presented double-edged swords of benefit and risk of side-effects, including the generation of new malignancies.

Basic scientists progressively informed clinicians of the biology of malignant cells in bone marrow and lymph nodes. Treatment became more precise. Rates of remission and survival steadily rose. New insights into the DNA of malignant cells point to even more individualized treatment for people who suffer from these diseases.

To keep abreast of changes in therapy, Winston exemplified the clinical scholar, reading, directing and attending seminars, always alert to something that would offer hope to his patients. He exemplified the clinical teacher, sharing this complex information with medical students and residents whom he cherished as colleagues.

A disease, whether acute leukemia or Hodgkin’s disease, occurs in a unique human being, a person whose aspirations, relationships, and identity are suddenly placed in unexpected jeopardy. And this is a basic premise of clinical medicine that Winston Caine never forgot.

He listened soulfully to learn of the person who had the illness. He examined meticulously the person and then her diagnostic data. He did not hesitate to involve local or regional experts if he had uncertainties as to how best to restore health to this individual. Years on high school and college football teams had ingrained in him the value of teamwork. He quietly celebrated success in battles against disease. He comforted the dying and their loved ones when disease could not be conquered.

The proper practice of medicine is deeply personal. It is focused, respectful, tireless, and above all compassionate. I celebrate Winston P. Caine, Jr., Physician.

Contact Clif Cleaveland at cleaveland1000@comcast.net.

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Strategic Planning for the Tennessee Chapter of ACP 2013-2017

Dr. Lane

When I submitted my biography for Governor-elect I indicated my vision was to serve as the conduit of membership concerns of the Tennessee Chapter to national ACP. In order for me to achieve this goal as your Governor during my four year term (2013-2017) I will need to know what the chapter wants and needs to have happen over the next four years. The logical approach is to develop a strategic plan with input from the membership and your representatives on the Council. With that in mind, I presented a brief outline of what would be needed to achieve a strategic plan and received approval from the Council to move ahead with setting a Strategic Planning Retreat shortly after the ACP Annual Meeting in April 2013. Ammar Almehmi, MD, FACP from Germantown, who has assumed chairmanship of the Tennessee Council of Young Physicians, and Randall Curnow, MD, MBA, FACP Medical Director with a large physician group in Knoxville (Summitt Medical Group) who has just been through strategic planning for this group, along with myself will form the Steering Committee for this endeavor. The charge to this Steering Committee will be to choose a facilitator, a meeting time, and a meeting site for the Strategic Planning retreat as well as to lay the groundwork for the agenda of this meeting. The intent is to set aside time other than the annual meeting for the council to meet as a whole and focus on developing a strategic plan appropriate to the needs of our chapter. ACP in some of their resource materials indicated:

Strategic Planning is a well-organized approach to defining what an organization is, what it does, and why it does it, with a focus on the desired future. A completed strategic plan can reflect both short-term and long-term goals and serve as a roadmap to success.”

In anticipation of the meeting a survey will be sent out to you, the general membership, soliciting your assessment of what the strengths and weakness of our Chapter is and what you feel needs to be done to improve its value to you. Your input will serve as a guide to help your Council representatives in the development of the Chapter’s roadmap for the next four years. The final duty of this Steering Committee along with the Council will be to revisit the plan annually to be sure I, as your Governor, am staying on track as well as to update the plan to adapt to the rapidly changing landscape of medical practice and your needs as practicing Internists.

Richard G. Lane, MD, FACP Governor-elect
November 4, 2012

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2012 Chapter Excellence Award

Chapter Excellence Award

I am pleased to announce that our chapter is in receipt of the 2012 Chapter Excellence Award! The award recognizes chapters which successfully meet the standards for managing a chapter. In order to achieve the Chapter Excellence Award, chapters must meet all basic criteria and seven optional criteria. Criteria include such activities as formulating an effective Governor’s Council and committees, communicating frequently with membership, providing educational opportunities, recruiting and advancing members and celebrating membership through local awards. I would like to extend a special thanks to those chapter members who assisted me in all of these endeavors! For their hard work and dedication, we received this award.

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Tennessee Council of Young Physicians

The Tennessee Council of Young Physicians (TCYP) was organized in 2008 with a Chair and six members- two each from the Eastern, Central and Western zones. Its first Chair Ryan Mire MD, FACP became the National Council of Young Physicians Chair after one year. Since its inception various members served the council for 1 to 4 years. This year four members (Jason Hayes, MD, FACP; Sonal Gupta, MD; Gena Kluwe, MD, FACP; Victor Kolade, MD, FACP) complete their 2 year tenure, one member resigned after a year on the council and the Chair (Reena Kuriacose, MD, FACP) completed her 2 year Chair tenure, leaving only the new Chair-elect (Ammar Almehmi, MD, FACP, Memphis) remaining in the council. The remaining six positions were open for election. Strong applications from interested young physicians from a wide variety of backgrounds were submitted and the election resulted in a new group of members to join Dr. Almehmi including a cardiologist (Yasmine Ali, MD, FACC, FACP, Nashville), a nephrologist (Omar Siddique, MD), a gastroenterologist (Chakradhar Reddy, MD, Johnson City), two hospitalists (Philip Kuo, MD, FACP, Nashville and Mihir Patel, MD, Johnson City) and an internist/pediatrician (Christopher Burress, DO, Dickson).

The year began with a dinner talk organized by Jason Hayes, MD, FACP in Nashville on coding. A Spring Fling was organized by Sonal Gupta, MD also in the Central region. Ammar Almehmi, MD, FACP and Jason Hayes, MD, FACP represented the council at Leadership Day on Capital Hill in June. The Council helped to write the questions for Jeopardy conducted by Victor Kolade, MD, FACP during Medical Students and Associates evening at the Chapter meeting on the 18th of October this year. At the same meeting the Council also organized the poster and oral presentation judging.

Various members of the Council actively participated in the Program planning committee, awards committee and membership committee and were also active members of the Governor’s Council.

Kolade, Kuriacose

Drs. Victor Kolade and Reena Kuriacose with a colleague during the Associates Program

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Importance of Chapter Meetings

2011-2012 ACP Chapter Meeting Attendance Overview

Membership attendance at chapter meetings across the country demonstrated continued member engagement at the local level. Chapters were responsible for promoting meetings and events without marketing and promotional dollars from the College’s budget and successfully did so using electronic resources as well as social media. During the 2011-2012 year, 60 chapter meetings were held.

Attendance at chapter meetings surpassed attendance at the annual Internal Medicine Meeting; 5,900 members attended Internal Medicine 2012 in New Orleans while 7,358 members attended chapter meetings in 2011-2012. Chapters also attracted more than 2,500 attendees to additional local events, such as Associates meetings, dinner meetings, and reading retreats. Several chapters reported an increase in member attendance during 2011-12 compared to 2010-11, and an average of 6.9 percent of chapter members attended their chapter meeting in 2011-12.

Other statistics to note in 2011-2012 regarding chapter meeting attendance:

  • Total attendance at chapter events was 11,938!
  • Overall 2011-12 attendance at the 47 meetings held in both 2011-2012 and 2010-2011 increased 3.6 percent.
  • Total membership attendance at chapter meetings in 2011-2012 increased 16% compared to 9 years earlier in 2002-2003, although overall attendance decreased in some years. (The variable number of meetings held each year may account for some year-to-year variability in total attendance.)
  • 670 medical student members attended chapter meetings.
  • More chapters incorporated Associate and Medical Student programs, Maintenance of Certification sessions, and hospitalist breakouts at their meetings.
  • 10 chapters saw an increase of 10% or more in their meeting attendance from 2010-2011.
  • There were over 2,000 nonmember attendees at chapter meetings.

Chapter meetings continue to provide members with an excellent opportunity to network with fellow internists, obtain local CME often without extensive travel costs or time out of the office, keep up to date with College news and activities, as well as hear from the Governor about topics that are important to them.

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TN Chapter, ACP Reading Retreat XXVI

Fall Creek Falls State Park Resort; Pikeville, TN
March 1-3, 2013

Guest faculty: Gregory O’Dea, PhD
UC Foundation Professor of English
Director of University Honors
University of Tennessee at Chattanooga

This is the twenty-sixth annual Tennessee Chapter ACP reading retreat will consist of two and one-half hour sessions will take place on Friday evening, March 1 (begins at 7:00 PM Central Time); Saturday morning and afternoon; and Sunday morning. A Saturday evening session will be devoted to original works, be they poetry, memoir, fiction, drama or music.

The theme for this conference will be “Food Matters”. We in medicine spend inordinate amounts of time with the problems in our patients caused by overeating or poor eating. Obesity is rampant in our society and leads to many medical problems including diabetes, spine and joint stress/destruction, and poor self image. It is important that we not just fuss at our patients about their weight but help educate them in healthy eating. Our works this year will celebrate good eating, demonstrate ways to do it, point out the pitfalls of misguided advice and help us help our patients be better informed consumers.

The works we will examine include: We Are What We Ate: 24 Memories of Food (anthology of short memoirs of food by great writers); In Defense of Food by Michael Pollan; The Road to Wellville by T.C. Boyle; Babette’s Feast by Isak Dinesen; and An Everlasting Meal by Tamar Adler.

For further information contact Mark Anderson, MD, FACP: maidpc@epbinternet.com.

Thanks to Dr. Catherine Womack for contributing the better quality photos in this newsletter.

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Contact Information

Richard G. Lane, MD, FACP,
Governor, Tennessee Chapter

Renee Arnott
Executive Director
Ph: 615-460-1657
E-mail: renee.arnott@tnmed.org