Virginia Chapter Governor'sNewsletter

Summer 2000

GOVERNOR'S COLUMN

In recent weeks a few Virginia internists, housestaff and medical students, have been recognized for their outstanding achievements. At the Virginia Chapter's Annual Clinical Program in Roanoke, March 10-11, Laureate Awards were presented to Munsey S. Wheby, MD, FACP, Professor of Medicine and Senior Associate Dean at UVA, former Virginia Chapter Governor and current Chair of the Board of Governors of the ACP-ASIM; H. Verdain Barnes, MD, MACP, former Chair of Medicine at Eastern Virginia Medical School, who was twice a Governor of the College and subsequently a member of the Board of Regents; and Kenneth Hyatt, MD, FACP, Director of Medical Education at Eastern Virginia Medical School. Each of these men was recognized with a Laureate Award for the accomplishments of his career and his contributions to the College.

At the Annual Session in Philadelphia, April 13-16, 2000, the College awarded Masterships to two Virginia internists. Robert M. Carey, MD, Professor and Dean of UVA School of Medicine and H. Verdain Barnes, MD, were recognized for their outstanding contributions to medical teaching and research as each was made a Master of the ACP-ASIM.

Two of our Associate members won the abstract competition among entries from the state's five teaching programs. Kendra Good, MD, a PGY-3 at the University of Virginia ("The Effect of Alendronate on Bone Mineral Density in Patients With Primary Biliary Cirrhosis and Following Liver Transplant") and Edward Pak, MD, a PGY-2 from Portsmouth Naval Medical Center ("Is Focal Glomerulosclerosis a Systemic Disease?"), were selected in competition from among the 78 abstracts which were submitted. Each won an expense paid trip to the Annual Session in Philadelphia for the National Competition. Lisa Ellis is a 3rd year student at the Medical College of Virginia, who represents the state's medical students on the Virginia Chapter ACP-ASIM Council. Her synopsis of the "Club Med" program with particular emphasis on the community volunteer work performed by MCV students, garnered an Evergreen Award for the Chapter. This award recognizes new programs which the College feels to be so outstanding that other chapters are encouraged to emulate them. From among the 66 chapters in the United States, Canada, Central and South America, only 10 were recipients of an Evergreen Award this year.

Recognition is also due to the Virginia internists who organized some other wonderfully successful programs. Hal Cragun, MD, FACP, as Chair, along with Paul Dallas, MD, FACP, Neil Dorsey, MD, FACP, John Pendleton, MD and Michael Basile, MD, devoted almost a year to the preparation of the Virginia Chapter's Annual Scientific Program. Thanks to their efforts, 155 attendees from all about the Commonwealth enjoyed the richly diverse program with its variety of educational formats and political updates (see pages 8-9 for a more detailed review of the meeting.)

Included for the first time in a state meeting was "Internists As Artists." Thanks to the enormous effort of a committee chaired by Dugan Maddux, MD, from Danville, the Awards Dinner was preceded by cocktails served in a "gallery" of paintings, photographs and poetry by Virginia internists and internal medicine housestaff. Additionally, we were entertained by Rob Mayo, MD, from South Boston, with wonderful renditions of a number of popular songs; by Jonna Bernstein, MD, from Danville, with delightfully amusing Medieval ballads; and by Hamidreza Aliabadi, a medical student from MCV, who entertained us beautifully at his piano with 3 classical pieces.

Dugan is an artist in her own right. She has given readings of her short stories on National Public Radio (NPR). Joining her in encouraging internists throughout the state to share their work at the Virginia Chapter meeting were Julia Connelly, MD, FACP, of the University of Virginia, a poet and co-director of the Literature in Medicine series; G. Watson James, MD, Professor Emeritus from MCV and editor of "Between Rounds," a periodic compilation of work by MCV faculty; Stephen Beuttel, MD, FACP, Portsmouth Naval Hospital; Thomas Manser, MD, FACP, from EVMS; Mark Kasari, MD, chief resident from the Roanoke-Salem program and Chair of the Virginia Council of Associates; and Lisa Ellis, Chair of the Virginia Council of Students.

Lastly, I am eager to also recognize the contributions of five individuals who have graciously given of their time as members of the Governor's Council. Geoffrey Viol, MD, FACP, Richmond; Larry Stein, MD, FACP, Arlington; John Cary, MD, FACP, Manassas; Tom Scott, MD, FACP, Virginia Beach; and Bill Powers, MD, FACP, Marion, have recently completed their terms on the Council. Each has brought to the Council energy and invaluable advice. Each has helped ensure that the Virginia Chapter of the ACP-ASIM continues to foster a rich array of programs for Virginia internists, housestaff and medical students.

Jeff Harris, MD, FACP
Governor for Virginia

LAUREATE AWARD WINNERS

(With her kind permission, a brief piece by Dugan Maddux, MD, is reproduced here. I thought it was delightful. Scratch an internist and you will often find an artist. If you would like to share your artistic work with the 2,600 members of the College who receive this newsletter, or perhaps with next year's "Internists As Artists," please let me know at jharris@shentel.net —JPH)

As I take care of chronically ill patients everyday who have end stage renal disease and are on dialysis, I am reminded that this is it. This is the main show. Every day must count. I write in part to capture those moments thatgo by so fast never to return. For instance, at our house now with 2 children every sentence begins with Mama... Mama-Mama where are my shoes? Mama-Mama did you sign my homework folder? Mama-Mama what happened to the dinosaurs?

Mama-Mama how come they let that big guy skate in the Olympics if he keeps falling down? Mama-Mama how do they make those tires that can run over nails and not go flat? Mama-Mama what are we having for dinner? I answer all clothing and food questions, but I sometimes pass on those that involve Olympic Committee policy or polymer chemistry. I'm not above expounding on creative theories about the extinction of the dinosaurs with something like, "Tyrannosaurus rex refused to bathe for a week and all the dinosaurs around him keeled over dead. Now go take your bath!"

Mama-Mama has reinforced my sense of being at the center of the universe for my children. I am their pivot point. They send out the Mama ping and when my reply bounces back to them they feel secure in their location in life. Mama-Mama can answer all questions, perform all tasks, meet all needs. Mama-Mama is the center of knowledge, the hero of the planet.

I knew that my children would eventually mature enough to see beyond the Mama-Mama universe, but it had been our accepted world for so long that I was not prepared when my seven year old slipped out of Mama-Mama orbit. It was near Martin Luther King's birthday and he and I were driving home from an evening celebration of music and dance in honor of the civil rights leader. From the backseat Cabell was planning his future as either a soccer player or professional football star. "I like football," he said, "But I cannot decide which position I should play, Mama. Mama, if you played football what position would you play?"

"Well, you know, Cabell," came my words of Mama wisdom, "I loved football when I was your age. I thought it was the world's greatest game. I watched college games and professional games and at night I would dream of being a football player. I would dream of being a quarterback in charge of calling the plays, taking the snap and rolling back to pass the perfect spiral. I would dream of being a tight end sprinting out long for the pass and making the perfect catch with my fingertips. I would dream of being a linebacker, agile and quick, breaking through the line and sacking the quarterback with awesome power."

There was silence for a moment in the backseat. Then Cabell said, "That's not the same dream Martin Luther King had."

In that moment he was out of the Mama-Mama universe and I knew it. It was bound to happen, but who would have thought I would get ousted over football. Of course, at bedtime Dr. King wasn't there to scratch his back and Mama-Mama worked a little gravitational magic.

Sometimes raising children is like knowing the natural history of diabetic nephropathy.

You can see that the renal function is normal, but once the proteinuria is there what can you do? You pull out all your tricks like tight blood sugar control, blood pressure control, ace inhibitors, but you know the future. Raising children is like that for me, too. You see the prognosis, but do whatever it takes to slow it down.....

Last September on a Saturday afternoon off, my husband and I were hauling rocks from a pile near my garden to the road bed by the pond. These were the same smooth pebbles that two years before we had moved from a pile near our house out to cover the walking paths of my garden. We have a long tradition of doing the same work time and again.

As sometimes it happens in southside Virginia, the September air was still summertime warm. Frank and I worked in tandem shoveling the rocks onto the tractor lift. We wore shorts and tee shirts and Frank had begun to drip sweat from his brow. We were ready for a rest when our son Cabell called us to "Come see" what he had found in the backyard. As we walked over to where he was crouched in the grass he said, "Look at this spider."

Actually, in the previous two weeks we had looked at a lot of spiders. Cabell's second grade class had finished the unit on frogs and toads several weeks before and since then we had switched from hopping after amphibians to peering at arachnids. We had identified sheet webs on the window sills and found a funnel web in the privet hedge. We had observed the spider that lived in the giant web outside his bedroom window tocatch bugs attracted by his light at night. We could identify the spider cephalothorax and we knew that the sticky silk was dispensed from the spider's abdomen by the spinnerets.

That day Cabell had a new spider lesson for us. We hunkered down beside him and followed the beam of his index finger to the tan and black spider making her way among the stalks of grass. At first she looked like an ordinary spider and then Cabell pointed out the cargo of tiny spiders she carted on her back."See," he said, "She's a mother spider. Maybe she's a wood spider or a jumping spider, but she's carrying all of her babies. They are called spiderlings."

I loved that word, spiderlings, and sure enough there must have been a hundred very tiny baby spiders clinging to the back of the mother spider. We watched her labor along and Cabell continued, "She'll carry them until they get big enough to be on their own. Then one day they'll leave her back and crawl to the top of a blade of grass. Then they'll send out a string of silk." Cabell swept his hand from the top of the grass out into the open air. "The wind will catch the strand and send them flying off. It's called ballooning." The three of us sat for a moment gazing over the field imagining the troops of spiderlings sailing off into the world away from the mother who had carried them on her back.

My husband looked at Cabell and asked, "Will you ever go ballooning away from us?"

"Nope, never," Cabell replied with an honest heart and he grabbed his soccer ball and ran off to play leaving us there in the grass.

Frank and I stood and watched Cabell dribble the soccer ball in the far yard. I crossed my arms, squinted my eyes and leaned toward my husband, "I don't believe him," I grumbled. "He'll be ballooning off before we know it. With no warning one day he'll just leave. I say we stock up on scissors and any sign of a silk strand we snip it at the abdomen."

"It's a deal," Frank nodded. "His cephalothorax is grounded."

CANDIDATES SOUGHT FOR ACP-ASIM GOVERNOR'S COUNCIL

With the merger of the Virginia Chapter of the American College of Physicians and the Virginia Society of Internal Medicine the new bylaws call for election of representatives from each of four regions into which the state was divided based upon fairly equal numbers of ACP-ASIM members. The members in each region will receive ballots with the two candidates for the position from his/her region. The term is for three years. There will eventually be three representatives from each region serving rotating terms. Those elected will join the Governor; Immediate Past Governor; Treasurer; Chairs of the Departments of Internal Medicine at UVA, MCV and EVMS; Internal Medicine Program Directors for UVA, MCV, EVMS, UVA/ Roanoke-Salem and Portsmouth Naval Medical Center; Chair of the Associates' Committee; Chair of the Council of Medical Students; and up to four other members appointed by the Governor.

The Governor's Council plans all ACP-ASIM activities in Virginia for internists, housestaff and medical students. The Council meets three times per year, including a two-day Summer Retreat for long range planning, a one day meeting in the Fall for project follow-up and on the afternoon before the Chapter's Annual Scientific Program, which is usually held in March or April. Remuneration is limited to one night's lodging for each meeting.

If you are interested in being a candidate for the Council, please send your Curriculum Vitae by July 14, 2000, to:

Mo Nadkarni, MD, FACP
University Medical Associates
Box 800744, Room 4506 PCC
University of Virginia Health System
Jefferson Park Ave.
Charlottesville, VA 22908

The Nominations Committee will select the two candidates for the election in each region. Ballots will be mailed from the national office in Philadelphia in early August.

The Council is a wonderful opportunity to work with a talented group of physicians from all across the Commonwealth. They share an abiding interest in fostering educational opportunities which keep Internists current on the scientific advances and socioeconomic issues, which affect the care our patients receive and the quality of our practice lives. JPH

VIRGINIA CHAPTER'S ANNUAL CLINICAL MEETING PROVES QUITE A SUCCESS

By Paul Dallas, MD, FACP

On March 10-11, the Hotel Roanoke and Conference Center played host to our annual Va Chapter ACP-ASIM Clinical Meeting. And again this year, the meeting generated much enthusiasm and garnered many accolades for its substantive educational offerings as well as its entertainment interludes.

One hundred and fifty-five participants, practitioners, attendings, residents and medical students sampled the broad variety of educational material. Lectures centered around major themes: antibiotic resistance, geriatrics and orthopedics, while the breakout sessions provided excellent hands-on experiences in skin biopsy, arthrocentesis, the pelvic exam featuring live models and computers in medicine. While evaluations are sifting in from the national headquarters, early responses (from the skin biopsy session for instance) show that participants took home much that they thought was helpful for their practice of medicine. Four lecturers for the Multiple Small Feedings of the Mind series, a concept which won our chapter an Evergreen Award,
previewed the talks they would later give at the College's Annual Session in Philadelphia.

The Associates' abstracts, posters as well as oral presentations, highlighted the hard work, research and clinical acumen of the residents in our internal medicine programs. The winners of our state competition later represented their programs, themselves and Virginia at the national level. To Ron Clark, the Associate's program chairman, and his committee, much thanks for generating another top-notch program. We were delighted to host our guests, Alan Nelson, who inaugurated our first "Last Lecture," Bill Hall, President-Elect of the College and Bob Doherty, our man-in-the-know in Washington. Their updates on medicine, the state of the College and the political and socio-economic issues which affect us, were especially enlightening.

This year marked the unveiling of the "Internists as Artists" exhibit where internists showcased their artistic talents as painters, photographers, pianists and minstrels. One individual commented that, given the now not-so-hidden talents, perhaps the clinical meeting should henceforth be called the "Artists as Internists" meeting! Our hope would be that other ACP-ASIM chapters could eventually reproduce similar events at their meetings.

Laureate Awards went to well-deserved clinicians ­ Munsey Wheby, Chair of the Board of Governors, Verdain Barnes and Kenneth Hyatt.

Special thanks go to Hal Cragun and the planning committee; the faculty; our guests; the associates; our pharmaceutical companies for their support (Ben Lewis, great job gathering their financial support!); our caricaturist; Ann Tennett for her attention to details, which made this meeting so successful; and to Jeff Harris for his vision and leadership!

Hope to see you next year!

NEW PRODUCTS FOR YOUNG PHYSICIANS

The Young Physicians Subcommittee (YPS) of the ACP-ASIM was formed just over a year ago to meet the needs of young physicians under the age of 40 and to facilitate their passage from Associateship to Membership. The YPS has developed two new products for young physicians ­ the Young Physician Practice Management Survival Packet and the "Evaluation and Management Coding Card."

Aimed at the young physician who is beginning his/her practice, the Young Physician Practice Management Survival Packet provides information about the resources that the College has to offer the young physician in the early stage of his/her career. In addition, the booklet contains information from a variety of sources that can help you successfully launch a career. The information provided contains references to Internet sites and telephone numbers. It also contains a checklist for getting started.

The "Evaluation and Management Coding Card" is a laminated, pocket sized sheet designed to help the young physician select appropriate levels of service for history, exam and medical decision making. It presents a great deal of information from a variety of sources in one easy to read card.

If you would like copies of the survival packet and/or coding card, please contact Jean Elliott, Staff Liaison, Young Physicians Subcommittee, at (800) 523-1546, ext. 2692.

MKSAP FOR STUDENTS

By Patrick C. Alguire, MD, FACP Director, Education and Career Development

The Education and Career Development Department is pleased to announce the release of MKSAP for Students. In creating this product, the College has partnered with the Clerkship Directors in Internal Medicine to create a useful educational tool for 3rd and 4th year medical students. We have chosen to model it after the highly successful Medical Knowledge Self-Assessment Program (MKSAP) for internal medicine physicians. MKSAP for Students consists of a printed collection of nearly 400 patient-centered, self-assessment questions and their answers.The questions begin with a clinical vignette, and the vignettes are organized into 28 different categories that correspond to the Core Medicine Clerkship Curriculum Guide "Training Problems."

The retail price for MKSAP for Students is $32.50, making the publication very competitive against other, lower quality books of this type. It can be purchased at medical school bookstores or by ordering through the ACP-ASIM Customer Service at 800 523-1546, ext. 2600.

SUPPORTING YOUR CHAPTER THROUGH CHAPTER DUES

Chapter dues are the backbone of local activities and vital to the success of our chapter. While we are provided some financial support from the national office, the chapter dues collected provide the majority of financial support for local activities. Educational meetings, mentoring programs for medical students, local Associates' research competitions, advocacy with state legislators, and participation by chapter leaders in Leadership Day on Capitol Hill are just some of the activities supported by your chapter dues. Many of these activities are orchestrated by unpaid volunteer leaders in our chapter. However, the increase in activities at the local level has created the need for additional staff support to help manage the day to day operation of the chapter. Your chapter dues help support the cost of local staff and provide funding for new and existing chapter initiatives. When you receive your dues notice, please remember to include the chapter dues in your payment. You will be contributing to the success of many grass roots activities happening right here at home.

CONTACT YOUR LEGISLATORS THROUGH THE LEGISLATIVE ACTION CENTER

To make participation in grassroots advocacy easier for its members, ACP-ASIM established a Legislative Action Center (LAC), which may be accessed from ACP-ASIM Online. The LAC allows you as an ACP-ASIM member to view the most current ACP-ASIM Legislative Alerts, find out who your federal legislators are, and send e-mails or faxes to your members of Congress. It also provides you with the status of key legislative issues of concern to ACP-ASIM, Congress' schedule, and tips on communicating with your legislators. ACP-ASIM encourages you to try the LAC by sending an e-mail to your members of Congress in response to the current Legislative Alert posted on the LAC.

You can access the Legislative Action Center through the "Where We Stand", or by going straight to the LAC at. To send a message to Congress, you are prompted for your zipcode and are zip-matched to your federal legislators. You will then be asked for your name and address (so that congressional offices can identify you as a constituent). ACP-ASIM encourages you to send a message based on the sample message posted for you, with your own personal anecdotes added. If you have any questions about the LAC or ACP-ASIM's Key Contact program, please contact Jenn Jenkins, Associate for Grassroots Advocacy, at jjenkins@acponline.org or at 1-800-338-2746, ext. 4536.

Munsey S. Wheby, MD, FACPH. Verdain Barnes, MD, MACPKenneth Hyatt, MD, FACP

 

HOW TO REACH US

Jeffrey P. Harris, MD, FACP
190 Campus Boulevard,
Suite 310
Winchester, VA 22601
Phone: (540) 636-6900
Fax: (540) 636-9299
E-mail: jharris@shentel.net

or

Ann Tennett
E-mail: atennett@shentel.net