Bulletin
Physician Advocacy Since 1873
SEPT/OCT 2020 VOLUME 50, NO. 5
Editors: Maureen Padden, M.D. | Erica Huffman, Executive Director www.escambiacms.org
President’s Message Wow! I can't believe it is already mid-September. Time just refuses to slow down and seems to go faster the older I get. I know I have talked about the many challenges we face today trying to practice medicine, but I can't examine what it is like being a resident or medical student trying to learn the art of medicine during a pandemic. I have had conversations with some of our residents and medical students at our Escambia County Medical Society meetings and have been fascinated by some of the challenges they face today trying to complete their clinical rotations and get experience in the various specialties of medicine. I asked one of our "star" medical student's, Maurice Inkel, to describe what it is like trying to be a medical professional in training in the year 2020. I hope you will enjoy his perspective and thoughts as much as I have. I hope to see everyone at our next Escambia Count Medical Society function celebrating Halloween at the Wahoo stadium on October 29, 2020.
Do you remember what it was like to go to the movies? What about the pleasure of having dinner with family or a group of friends? And, how about that reassuring feeling of a face-toface appointment with your family physician? Without a doubt this pandemic has affected each of us in any number of ways. As a medical student it has seemed an eternity since the beginning of the COVID-19 pandemic. In addition, Zoom has become all too comfortable for me and my peers. Our 3rd and 4th year education, as we all know, is built on our ability to integrate into the physical practice of medicine within the community. Each patient interaction and hands-on experience builds our mental rolodex for our future careers as physicians. However, when the pandemic took hold, medical students quickly became endangered species at most every hospital. The cancellation of rotations put finishing 3rd year on hold and postponed scheduled board exams until undetermined dates and locations. My USMLE STEP 2 was postponed four months with the closest available location being Gainesville, FL over five hours away. As my test date approached, other students shared stories of scheduling exams only to find out they had been cancelled within a couple weeks or even days of their date due to Prometric’s test center being over-booked. They of course were left scrambling for a testing center. I considered myself lucky to test on my rescheduled date even if I was wearing my mask for eight hours.
Continued on page 4
Contents Page 4 - President’s Letter Ctd. Page 6 - Medical/Legal Page 10 - Foundation Page 15 - Community
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HURRICANE SALLY RESOURCES FEMA 1-800-621-3362 or 1-800-462-7585 for the speech/hearing-impaired. Apply for disaster aid online at www.fema.gov or www.disasterassistance.gov. Small Business Administration (SBA) Disaster Assistance Center 1-800-659-2955; online at www.sba.gov/content/disaster-assistance Emergency Management Florida Department of Emergency Management Florida Division of Emergency Management 2555 Shumard Oak Boulevard Tallahassee, Florida 32399-2100 Phone: 850-815-4000 or 1-800-342-3557
Northwest Florida’s leading brain and spine care specialists Ascension Sacred Heart specialists provide leading care for adults and children with brain, spine, nerve and muscle conditions in Northwest Florida. With the most advanced technology in the area and the region’s only nationally certified Comprehensive Stroke Center, we diagnose and treat your patients’ specific needs, so they receive the care needed, close to home.
American Red Cross Disaster and Emergency Assistance: www.redcross.org/find-help National Number: 1-800-733-2767 Volunteer Information www.volunteerflorida.org Beware of Fraud and Scams For more information, please call (866) 966-7226 or visit www.myfloridalegal.com/Contact.nsf/PriceGouging!OpenForm
ECMS FOUNDATION Go Seniors Voucher Transportation
A grant funded program thanks to the Fellows Foundation. In partnership with ZTrip Pensacola
We want your patients to attend their regular scheduled appointments and have access to reliable transportation. Eligble patients: 60 years and older 2 vouchers per trip Continuity of care Regular scheduled appointment
Visit us at ascension.org/pensacolaneuro Or call 850-416-2250 to get the care that’s right for your patients.
© Ascension 2020. All rights reserved.
For more information email Erica Huffman director@escambiacms.org
New Members E.C.M.S. Bulletin The Bulletin is a publication for and by the members of the Escambia County Medical Society. The Bulletin publishes six times a year: Jan/Feb, Mar/ Apr, May/Jun, Jul/Aug, Sept/ Oct, Nov/Dec. We will consider for publication articles relating to medical science, photos, book reviews, memorials, medical/ legal articles, and practice management.
Vision for the Bulletin: • Appeal to the family of medicine in Escambia and Santa Rosa County and to the world beyond. • A powerful instrument to attract and induct members to organized medicine.
Mission:
Advancing physicians’ practice of medicine in our community.
NEW MEMBERS Anz M.D., Adam
Puente M.D., Jairo
Andrews Institute Orthopaedic Surgery 1040 Gulf Breeze Parkway Suite 203 Gulf Breeze, FL 32561
Baptist Medical Group Family Medicine 1000 W Moreno Street Pensacola, FL 32501
Barker M.D., Vincenet
Bosarge M.D., Christopher
Baptist Medical Group Primary Care-Gulf Breeze Family Medicine 1200 Gulf Breeze Parkway Suite B Gulf Breeze, FL 32561
Coastal Vascular & Interventional 5149 N 9th Avenue #120 Pensacola, FL 32504
Boyd D.O., Marc
Coastal Vascular & Interventional 5149 N 9th Avenue #120 Pensacola, FL 32504
Baptist Medical Group Ladies First OBGYN Gynecology 3417 North 12th Avenue Pensacola, FL 32503
Brooks D.O., Tristan Baptist Medical Park- Airport Family Medicine 5100 North 12th Avenue Suite 201 Pensacola, FL 32504
Foust M.D., Joe Editor Maureen Padden, M.D. Executive Director Erica Huffman 4771 Bayou Blvd. # 157 Pensacola, FL 32503 Ph: 850-478-0706 Fx: 850-474-9783 Email: info@escambiacms.org www.escambiacms.org
Baptist Medical Group Family Medicine & Walk-In Care – Navarre Family Medicine 8888 Navarre Parkway Navarre, FL 32566
Hahn M.D., John West Florida General Surgery General Surgery 2130 E Johnson Ave Suite 130 Pensacola, FL 32514
Hlavacek M.D., James Ad placement Contact Erica Huffman at 478-0706 Ad rates 1/2 page: $350 · 1/4 page: $200 · 1/8 page: $150
Montgomery M.D., Aaron
Risley M.D., Geoffrey Coastal Vascular & Interventional 5149 N 9th Avenue #120 Pensacola, FL 32504
Patel M.D., Shonak Coastal Vascular & Interventional 5149 N 9th Avenue #120 Pensacola, FL 32504
Ronson M.D., Russell Thoracic Surgery Cardiology Consultants 1717 North “E” Street Suite 331 Pensacola, FL 32501
Hannah M.D., Dawn OBGYN West Florida Obstetrics and Gynecology – MFM 8333 North Davis Highway 2nd Fl. Pensacola, FL 32514
Andrews Institute Orthopaedic Trauma 1040 Gulf Breeze Parkway Gulf Breeze, FL 32561
View and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the board of directors, staff or advertisers. The editorial staff reserves the right to edit or reject any submission. www.escambiacms.org | 3
President's Letter Cont'd
I was probably most affected in seeking an externship in my desired specialty. Students now use the Visiting Student Application Service (VSAS) to apply for spots at residency programs across the country. Originally delayed, then reopened with stipulations regarding who can be accepted or from how far away, the VSAS restrictions caused significant adverse impact for students whose home institutions did not have residency programs for their desired specialty. Having overcome the obstacles so far, we medical students soon learned, COVID-19 was not about to leave our residency interviews unaffected. Every interview is a chance to talk with current residents and visit possible residency programs. Most importantly, it was our chance to let the doctors and residents at the programs we might
wish to attend get to know us and for us to let them know why we thought their program was where we were meant to be. Now we get an hour interview over Zoom with almost no exposure to the program and very little chance for them to meet the person who wants to join their team. How all this will change in the coming months is unknown, but as a 4th year medical student, and future physician, the quickly changing environment has taught me to plan the best you can, but be ready to adapt to whatever may come. Fortunately, my classmates and I have an amazing faculty and staff at Florida State University College of Medicine that are with us every step of the way. Maurice Inkel III, MS4
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4 | Escambia County Medical Society in conjunction with Santa Rosa County
Calendar
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www.escambiacms.org | 5
Header Medical/Legal
Informed Consent: Substance and Signature By Robert Morton, CPHRM, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management
For decades, consent documents have helped protect physicians against the claims of dissatisfied patients. Times have changed, however, and modern medicine requires a more complex and complete acknowledgment of both the patient’s and the physician’s rights and responsibilities to each other. True informed consent is a process of managing a patient’s expectations; it is not just a signature on a document. Achieving an accurate diagnosis requires the patient to provide accurate information to the physician. The physician must then provide sufficient information to the patient so that he or she can make a reasonable and informed decision regarding a comprehensive plan for medical or surgical 6 | Escambia County Medical Society in conjunction with Santa Rosa County
treatment. This physician responsibility cannot be delegated. A successful exchange of information between the doctor and the patient accomplishes two things. First, when the physician explains diagnoses, treatment alternatives, expected outcomes, and potential risks to the patient, it demonstrates that the physician recognizes the patient’s rights and will remain responsive to them. Second, it shifts the decisionmaking responsibility from the physician alone to a mutual responsibility of both physician and patient. At its best, informed consent should protect and inform the patient and the doctor. Litigation often results from a discrepancy between the patient’s expectations and the outcome of treatment. Informed consent cannot eliminate malpractice claims, but an established rapport between the patient and the physician based on robust exchanges of information can prevent patient disappointment from ripening into a claim.
Medical/Legal Physician-Patient Dialogue Avoid medical jargon when discussing diagnoses, treatment plans, risks, and expected outcomes with the patient. Define and explain medical words and concepts using simple pictures and analogies. If there are alternative treatment options, discuss them in detail. Also, outline the recovery process and the expected short- and long-term effects on the patient. Identify any uncertainty and risk involved with a specific treatment plan, including the probability factors, if possible. Discuss reasonable assumptions the patient may make about the treatment plan. Whenever possible, supply reading materials and the consent document for the patient to take home and discuss with his or her family. Encourage questions. Questions provide a better understanding of the patient’s comprehension of the information and facilitate the dialogue between the patient and the physician. If time permits, consider scheduling a second visit with the patient to review the consent form, clarify expectations, and ensure patient comprehension of the proposed treatment—especially with elective procedures.
Documentation Documentation is another key component of the informed consent process that cannot be entirely delegated to a nurse or another member of the healthcare team. If the doctor-patient discussion proceeds successfully and the patient requests treatment, the doctor is required in some jurisdictions to write a note in the patient’s record. Additionally, the consent document must include the patient’s name, doctor’s name, diagnosis, proposed treatment plan, alternatives, potential risks, complications, and benefits. To some extent, physicians who use an informed consent document can protect themselves further by including a statement to the effect that the form only covers information that applies generally and that the physician has personally discussed specific factors with the patient. The consent document must be signed and dated by the patient (or the patient’s legal guardian or representative). Many consent forms also require a physician signature. Consent forms should include statements to be signed by the patient and the physician. The patient attests that he or she understands the information in the treatment agreement. The physician attests that he or she has answered all questions fully and believes that the patient/
legal representative fully understands the information. These statements help defend against any claim that the patient did not understand the information. Some states have specific requirements for informed consent forms, procedure-specific disclosures, and legal standards for disclosure of risks. For example, Texas maintains lists of procedures and attendant risks and hazards through the Texas Medical Disclosure Panel. Check your state for requirements.
Informed Consent in Special Situations The informed consent process for same-day surgery patients may occur in the physician’s office before scheduling the procedure. That will allow the patient time to think about the information, ask questions, and make an informed decision. Hospitalized patients must be informed as far in advance of the procedure as practicable. If time permits in an emergency in which the patient is unable to provide consent, the physician must contact a legally authorized representative to obtain an informed consent. If the nature of the emergency does not permit time to contact a legally authorized representative, consent is implied. Consent may be waived under emergent conditions that threaten life, limb, eyes, and the central nervous system. If the patient is incompetent or otherwise cannot consent, the physician is legally bound to obtain informed consent from the incompetent patient’s authorized representative, except in an emergency. This type of consent should be thoroughly documented in the medical record.
Additional Tips and Suggestions • Develop and use procedure-specific forms that the patient can sign when the informed consent discussion takes place. • Obtaining consent from the patient after a sedative or sleepinducing medication is administered is not recommended. However, when a change in the patient’s condition requires a change in treatment, secure the patient’s consent. Thoroughly document in the medical record the facts and conditions surrounding the need for the revised consent. • Additions or corrections to the consent form must be dated, timed, and signed by both parties. • Any member of the healthcare team may sign as a witness to the patient’s signature, although this serves only to verify that it was the patient who signed the form. The witness does not obtain consent or verify the patient’s competency to give consent. • A patient’s questions or obvious lack of understanding www.escambiacms.org | 7
Medical/Legal about the procedure should be referred to the attending physician as soon as possible. • Translate consent forms to the most common nonEnglish languages that you encounter in your practice, and verify that the form is translated correctly.
Patient Safety Measures Every physician should develop his or her own style and system for the informed consent process, making it easier to avoid omissions and—more importantly—ensuring consistency of application. Do not speed through the process. Give the patient and the family time to absorb and comprehend the information. Preprinted materials are extremely helpful for patient understanding and will serve as a trigger for other questions.
understanding of the information you have communicated. This will increase the likelihood that you will be able to manage the patient’s expectations effectively. If you and your patient have completed the informed consent process and your patient declines your recommendations, see our article on “Informed Refusal” for further guidance. You can also contact the Department of Patient Safety and Risk Management for assistance. Contact us at patientsafety@thedoctors.com or (800) 421-2368. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
Assess the patient’s level of understanding just before documenting the process. One way of doing this is to ask the patient to repeat back to you his or her
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ECMS Foundation Physician Wellness Program Helping Healers Heal
TELEMEDICINE APPOINTMENTS NOW AVAILABLE To schedule an appointment 1) Email patrick@psyassociates.com or call (850) 434-5033 x8 2) Identify yourself as a member of Escambia County Medical Society and that you wish to utilize the Physician Wellness Program
FREE & CONFIDENTIAL MEMBER BENEFIT
Foundation
#maskedhero contest
#maskedheroescambia
We asked local school children to draw what they felt a masked hero looked like. We selected a winner in grades K-5, 6-8, and 9-12. We received many submissions and it was a tough decision to make so we asked our 3rd year Florida State University College of Medicine medical student representatives to select our winners.
Contest Judges
Georgia Huffman
I'm Georgia Huffman, a third year student at FSU College of Medicine. I'm from Milton, FL and went to UWF for my undergraduate degree in Biology. I want to be a physician because I love problem solving and empowering others, and I think medicine is a great way to do both of those things in a meaningful way. I'm grateful to be entering a profession where I can make real differences in bettering the lives of others.
My name is Mohsan Khan, I am a thirdyear medical student at FSU College of Medicine. My choice to become a doctor arose after I was diagnosed with Acute Lymphoblastic Leukemia shortly after graduating high school. I went through treatment here in Pensacola and have always wanted to be a part of this community of Moshan Khan excellent physicians. I received my bachelor's degree in pre-professional biology from the University of West Florida and was a volunteer research assistant for multiple research projects and my work on Copper(I) and Gold(I) bimetallic nano-particles was published. At UWF, I served as president of the American Medical Student Association (AMSA). After graduating I began working as a scribe for the emergency department at Baptist Hospital with branches in Pensacola and Gulf Breeze. 10 | Escambia County Medical Society in conjunction with Santa Rosa County
Marissa, 7th grade
Janavian, 5th grade
Foundation #maskedherosantarosa
Faith, 12th grade
Parker, 6th grade
Kessa, 4th grade www.escambiacms.org | 11
Foundation
ESCAMBIA COUNTY MEDICAL SOCIETY FOUNDATION To my medical society physician colleagues, This is my first newsletter as President of the Escambia County Medical Society Foundation. I am so happy for the opportunity to continue working with thededicated foundation board members, Dr. Miley, Dr. Snow, Dr. Willis, DrBujnoski, and Dr. Krueger. I look forward to working with Dr. Brandhorst, who is joining as a new board member. I am thankful to Dr. Krueger whose leadership has left the Foundation stronger, better positioned to continue and expand the outreach programs which have been the staple of the ECMS Foundation. I would like to acknowledge the service of Dr. John Lanza for his many years of participation on the boards of both the medical society and foundation. His knowledge of public health and the workings of the state medical system is unrivaled. I am very happy to be working closely with Erica Huffman again. Her experience and energy is indispensable to the board members as we try to manage practicing medicine and being involved in organized medicine. Please mark your calendar for a special Halloween fundraiser scheduled for October 29, 2020. This is a family friendly event to be held at the Wahoo’s stadium. The ECMS Foundation board felt it was important to open this event to all healthcare workers. At this time, everyone involved in patient care needs an evening of fun and frivolity. There will be trick or treating and a mask contest, so be creative and decorate your face covering. In addition, be on the lookout for information about our holiday wreath fundraiser. A great opportunity to add some holiday cheer while benefitting the ECMS Foundation. Thank you Fiore for partnering with the ECMS Foundation again this year. The ECMS Foundation is also sponsoring the #MaskedHeroes art contest. Students in Escambia and Santa Rosa Counties will submit an original piece of art work illustrating what a mask-wearing hero looks like. The FSU medical students, who participate on our boards, will judge and pick the winner who will receive a $100 gift card in grade levels K-5, 6-8, and 9-12. I want to highlight one of the newer initiatives of the foundation, the SMART program. SMART stands for Stress Management and Resiliency Training. Our physician instructor is Dr. Rohit Amin who will teach a 90 minute class each week over nine weeks. Most physicians would benefit from learning 12 | Escambia County Medical Society in conjunction with Santa Rosa County
skills which may help them to handle stress more appropriately and be more resilient when meeting life’s challenges. If you are wondering if you could benefit from such a course, ask your spouse or significant other. They will give you the correct answer. As always, we are supporting and growing the following programs: Blood Pressure Cuff Program: dedicated to helping patients monitor their blood pressure at home by providing free blood pressure cuffs. We Care Program: dedicated to helping the indigent and uninsured patients access care. This is only achievable because of our member physicians who generously donate their time and skill. Please consider joining this effort. Go Seniors Program: dedicated to helping the elderly poor see their doctor on a regular basis by covering transportation expenses. Pensacola State College Endowment: dedicated to funding scholarships of students attending Pensacola State College who are interested in health-related fields of study. 1873 Society: dedicated to funding all of the initiatives/ programs of the ECMS Foundation. This is made possible through the generous donations of our physician colleagues. Please consider becoming a member of the 1873 society. We need you! Physician Wellness Program: dedicated to helping our physician colleagues who may be suffering personal and professional angst. Member physicians may access three private sessions with a highly skilled psychologist. It is my honor to serve as your ECMS Foundation President. I am dedicated to working closely with the Medical Society and will commit to insuring that the philanthropic mission of the foundation continues to be fulfilled. Thank you for this opportunity. Ellen W. McKnight, M.D.
Foundation
THE 1873 SOCIETY Since 1873, Escambia and Santa Rosa County Medical Society physicians have dedicated themselves to their patients and the people of Escambia/Santa Rosa County. To further our mission and build on the loyal support of our members, the Board of Directors approved the formation of The 1873 Society, a special recognition opportunity to formally honor physicians who contribute to our organization and have demonstrated a long-term commitment to the quality of health care and well-being of our community. As a member of The 1873 Society your good name as a physician will be honored in our community
forever – entwined with the good works of the medical society in a cherished legacy. Membership in The 1873 Society is for physicians who have chosen to pledge $3,000 to Escambia County Medical Society Foundation, Inc. This can be accomplished through a single gift or a recurring gift of $1,000 over three years, THREE IN THREE! The 1873 Society members are recognized and awarded with their names permanently engraved on a traveling Wall of Honor to be displayed in the ECMS office and at ECMS and ECMSF events.
THE 1873 SOCIETY MEMBERS
The individuals listed below are both founding members as well as others who have joined The 1873 Society since its founding. We thank you for joining their distinguished ranks.
Joanne Bujnoski, D.O.
Jennifer Miley, M.D.
Robert Sackheim, M.D.
Kurt Krueger, M.D.
Jack Kotlarz, M.D.
Michelle Brandhorst, M.D.
Ken Long, M.D.
Hillary Hultstrand, M.D.
Steve Ziller, M.D.
Ellen W. McKnight, M.D.
Brett Parra, M.D.
Who is the Escambia County Medical Society Foundation? The Escambia County Medical Society Foundation is a non-profit organization dedicated to providing healthcare services on a volunteer and funding basis through its members. The Foundation was created in 1994. The primary goal is to assure access to adequate healthcare for the medically indigent citizens of the area, to study and promote improved methods and facilities for healthcare, to pursue the protection of public health, implement the means of financing healthcare at reasonable costs to cooperate with other organizations and institutions interested in pursuing these goals, and disseminate information concerning healthcare in general. Current Foundation programs include “We Care” and “Go Seniors!” Contact the ECMS Foundation for more information | 850.478.0706 or info@escambiaCMS.org
www.escambiacms.org | 13
Foundation Escambia County Medical Society Foundation
HOLIDAY WREATH FUNDRAISER Holiday or Corporate Gifts . Home or Office Decor
Cost is $90 for artificial $50 for fresh and fragrant.
Orders must be placed by November 26th through the ECMS Office. Wreaths will be available for pick up after December 1st at Fiore. Orders of 20 or more to one location can be delivered Mail your check made payable to the "ECMS Foundation" 4771 Bayou Blvd. #157 Pensacola, FL 32503 https://secure.affinipay.com/pages/ecms/wreaths Name: ____________________________________________________________ # of wreaths ($90) ________________ # of wreaths ($50) __________________ The Escambia County Medical Society Foundation, Inc. is a 501(c) (3) organization. EIN # 59-1514947 The ECMS Foundation has teamed up with Fiore to offer holiday wreaths to friends and family of medicine. A portion of the proceeds will benefit the ECMS Foundation
14 | Escambia County Medical Society in conjunction with Santa Rosa County
Community
Escambia/Santa Rosa County Medical Society donates 6000 childrens face masks to Studer Family Childrens Hospital Ascension at Sacred Heart Pensacola thanks to SHI Medical Supply Frank Francone, M.D., returns to Baptist as medical director for Baptist Occupational Health at Baptist Medical Park – Nine Mile. He earned his medical degree from
the University of Ottawa School of Medicine in Ontario, Canada and completed his residency in family medicine at Florida Hospital in Orlando, Florida.
Board-certified otolaryngologist Alan Grimm, M.D., has joined Baptist Medical Group – ENT & Audiology.
Baptist Medical Group – Neurosurgery welcomes William Dillen, M.D. Dr. Dillen earned his medical degree at
West Virginia University School of Medicine in Morgantown, West Virginia and completed his residency at the University of Kentucky Department of Neurosurgery in Lexington, Kentucky.
Fellowship-trained oncologist Syed Imran Jafri, M.D., has joined Baptist Medical Group – Hematology and
He earned his medical degree at Ohio State University School of Medicine in Columbus, Ohio and completed his residency and internship in head and neck surgery at the University of Mississippi Medical Center in Jackson, Mississippi. He will work in partnership with Drs. Botts, White and Dixon.
Oncology. Dr. Jafri earned his medical degree at King Edward Medical University in Lahore, Pakistan. He completed his internal medicine residency training as chief resident at Abington Hospital Jefferson Health in Abington, Pennsylvania. He completed a fellowship in hematology and oncology at the University of Connecticut in Farmington, Connecticut.
Double fellowship-trained, double board-certified gastroenterologist Jermaine Ralph, M.D., has joined Baptist Medical Group – Gastroenterology. Dr. Ralph earned
Family medicine physician Alisha Scott, M.D., earned her medical degree at the University of Nebraska Medical Center in Omaha, Nebraska and completed her
his medical degree at The State University of New York (SUNY) Downstate College of Medicine in Brooklyn, New York. He completed his residency in internal medicine from North Shore University Hospital – Long Island Jewish Medical Center in Manhasset, New York and returned to SUNY-Downstate Medical Center to complete fellowships in hepatology and gastroenterology.
residency in family medicine at the University of Nebraska Medical Center Department of Family Medicine in Omaha. She welcomes new patients at Baptist Medical Group Primary Care – Live Oak.
www.escambiacms.org | 15
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