March 2013 • Vol. 43, No. 3
Mecklenburg Medicine A Publication of the Mecklenburg County Medical Society | www.meckmed.org
Thanks for the
e c n e r e f you make … dif
with our gratitude on National Doctors Day. Mecklenburg County Medical Society
Mecklenburg County Medical Society • Mecklenburg Medical Alliance and Endowment Mecklenburg County Medical Society
Founders of: Bioethics Resource Group, Ltd., Hospitality House of Charlotte, Teen Health Connection, N.C. MedAssist, Physicians Reach Out
Small incisions
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novant-presby-1250-01 Print 2013 Gyn Ad Revisions_V2.indd 1
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Contents
March 2013 Vol. 43 No. 3
Features 7 Fixing Health Care – Right Here at Home 8 Fighting for More Funding for School Nurses in Charlotte
13 The Other Side of the Stethoscope Understanding challenges as a Community Intern
In This Issue ------------------------------------------------------------------------------------------------------------- 4 Committee Highlight: Meck PAC Board Summary for 2012 5 President’s Letter: With Snow, Go Slow 9 Member News 10 New Members 10 Upcoming Meetings & Events 10 National Health & Wellness Observances 10 AHEC Course Offerings 11 At the Hospitals 15 Advertising Acknowledgement
Mecklenburg County Medical Society
OFFICERS Janice E. Huff, MD President James B. Hall, MD President-Elect Simon V. Ward III, MD Secretary Stephen J. Ezzo, MD Treasurer Maeve E. O’Connor, MD Immediate Past President BOARD MEMBERS Lloyd L. Bridges, MD Raymond E. Brown, PA Scott L. Furney, MD Harold R. Howe, Jr., MD Scott L. Lindblom, MD A. Miller Wilson Maxwell, MD John P. McBryde, MD Paras H. Mehta, MD Cheryl L. Walker-McGill, MD Thomas N. Zweng, MD EX-OFFICIO BOARD MEMBERS Tammy Bridges President, Mecklenburg Medical Alliance & Endowment Keia V. R. Hewitt, MD President, Charlotte Medical Society Docia E. Hickey, MD NCMS Speaker of the House Stephen R. Keener, MD, MPH Medical Director, Mecklenburg County Health Department Darlyne Menscer, MD NCMS Delegate to the AMA Douglas R. Swanson, MD, FACEP Medical Director, Mecklenburg EMS Agency
1112 Harding Place, #200, Charlotte, NC 28204 704-376-3688 • FAX 704-376-3173 meckmed@meckmed.org Copyright 2013 Mecklenburg County Medical Society
Mecklenburg Medicine is published 10 times per year by the Mecklenburg County Medical Society, 1112 Harding Place, Suite 200, Charlotte, NC 28204. Opinions expressed by authors are their own, and not necessarily those of Mecklenburg Medicine or the Mecklenburg County Medical Society. Mecklenburg Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Mecklenburg Medicine is not responsible for unsolicited manuscripts. Non-members may subscribe to Mecklenburg Medicine at a cost of $30 per year, or $3.50 per issue, if extra copies are available. Classified Ads: Open to members, nonprofits and non-member individuals only; advance approval of the Managing Editor and advance payment required. Member rate is 0, non-members $20 for the first 30 words; $.75 each additional word. Display Ads: Open to professional entities or commercial businesses. For specifications and rate information, call Mark Ethridge at 704-344-1980. Acceptance of advertising for this publication in no way constitutes professional approval or endorsement of products or services advertised herein. We welcome your comments and suggestions: Call 704-376-3688 or write Mecklenburg Medicine, c/o Mecklenburg County Medical Society, 1112 Harding Place, Suite 200, Charlotte, NC 28204.
EXECUTIVE STAFF Sandi D. Buchanan Executive Director Trisha G. Herndon Director, Meetings & Special Events Stephanie D. Smith Executive Assistant MECKLENBURG MEDICINE STAFF Editor Mark E. Romanoff, MD Managing Editor Sandi D. Buchanan Copy Editor Lee McCracken Advertising Mark Ethridge 704-344-1980 Editorial Board N. Neil Howell, MD Janice E. Huff, MD Jessica Schorr Saxe, MD Graphic Design — Wade Baker
Mecklenburg Medicine • March 2013 | 3
Committee Highlight
Meck PAC Board Summary for 2012 By John K. Williford, Jr., MD, co-chair Meck PAC Board The elections of 2012 are over, and our re-elected President has administered his second oath of office. Our 2013 N.C. General Assembly will soon take its seat in Raleigh to tackle the difficult issues that affect the citizens of North Carolina. Your Meck PAC is a state PAC, and by law can only financially support those candidates seeking election to county or state offices. Throughout 2012, members of your Meck PAC Board sought to identify, educate and support those candidates who have a real understanding of the issues physicians face in caring for their patients, and who support legislation that positively impacts the practice of medicine. These issues include but are not limited to, medical malpractice reform, payment and contract negotiations, pay for performance and scope of practice. Our Meck PAC Board, along with MCMS Legislative Committee members, the N.C. Medical Society and other physician leaders across our
state, decide who to support for election for state offices. We look at voting records, sponsorship of bills favorable to doctors and campaign promises. In 2012 we supported Democrats and Republicans, incumbents and challengers. Most of these individuals were seeking office representing the citizens of Mecklenburg County. We contributed $4,000 in PAC money before the primary, and $12,500 before the general election. Including the Governor and Lt. Governor, we contributed to the election campaigns of 24 individuals. All but three were successful in their bid for office. Our Meck PAC Board continues to work with elected officials and watch for any legislation that may impact the practice of medicine. Please continue to support our efforts on behalf of all doctors. As you renew your membership to the Mecklenburg County Medical Society, consider making a separate contribution to Meck PAC for 2013.
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4 | March 2013 • Mecklenburg Medicine
9129 Monroe Rd., Suite 100-105 Charlotte, NC 28270
President’s Letter
With Snow, Go Slow By Janice E. Huff, MD President
“Running everywhere at such a speed till they find there’s no need …” — John Lennon
O
f the various duties that are required of me as president of your medical society, the one that causes me the greatest angst is writing the monthly column. I strive to be informative, but not tedious, original (keeping in mind what my predecessors have written about), and display just enough pithiness to keep your attention. So it was as I faced another deadline and the struggles that accompanied it when nature intervened and presented to me a topic begging to be written. All I had to do was look and listen. It snowed. Not a paralyzing amount, but enough to alter my daily routine. A few very early morning meetings — what I refer to as “what I did before I went to work” — were canceled. And for once, I did not immediately fill the newly free time with more work. It was that decision which provided the genesis for this article. It is a standing joke to talk about how incompetent Southerners are when it comes to dealing with snow. The run on milk and bread when a snowflake is spotted in Tennessee, the salt trucks that wait until snow has finishing falling to begin their routes, the people who refuse to drive even in the lightest dusting, or those who believe barreling through snow is wisest, since your car spends less time in contact with the road. This makes for great social conversation, and as with all good humor, the basis lies in fact. Having grown up in Michigan, the typical Charlotte snowfall would not even be commented on by folks back home. We would just scrape off whatever was on our cars (bare-handed, of course) and go about our jobs and schooling. But maybe there is something to this self-imposed exile. Is it possible that
gearing down to a slower speed (to use a Detroit metaphor) affords us a better perspective than what our fast-paced lives give us? I think so. Not having to engage in my usual get-ready-for-work mad dash, I indulged myself and hit the snooze alarm, trying to remember the last time that happened on a workday. I didn’t stay long — our handsome black cat decided he needed more attention (and food)! Not that I minded though — pets are the best antihypertensives I know. When I went down to get the paper, the first thing I noticed was the quiet. The usual traffic sounds that have become background white noise for all of us were pleasantly absent. The birds seemed a little crisper in their calls, although they probably were working harder to find food. The crunch of snow underfoot brought back a flood of childhood memories. I stopped to look at a cluster of snow on a camellia leaf, marveling at how it seemed to defy the laws of physics and gravity. It brought to mind the poetry of William Blake: “To see a world in a grain of sand, and a heaven in a wild flower.” He easily could have said the same thing about a snowflake. Through pure serendipity, my husband found himself in the same situation, so he went about making breakfast. He says if he wants a good meal he either has to make reservations or the meal itself. I do not disagree with or argue that point. After all, how could I ever compete with his Italian mom? It was nice for once not to have both of us leave well before the sun rose, and to talk about something other than our daily agendas and who would be home first. The office was a typical “snow day” — fewer patients and a more manageable pace. It seemed almost every patient went out of his or her way to thank us for being open. The pharmacy authorizations
were less frequent. Even the email torrent slowed. With less time engaged in battle on our EHR and documenting everything, my partners and I actually had nonmedical conversations. What I was reminded of that day was that, in our hurried world, there is an even greater urgency for slowing our pace. We are so fiercely dedicated to our patients, our practice, our family and friends. We often neglect to be dedicated to ourselves and to take the time needed for self-care. Such time must be rooted in slowness. Not every patient requires an immediate diagnosis. Not every meeting requires an immediate solution. Not every email requires an immediate response. In fact, slowing to less than warp speed makes for clearer thought processes and better decision-making. Slow down sometimes, and you will find a buried perspective that resides in all of us, one we must allow to bubble to the surface. A perspective that I believe will make us better physicians, spouses and friends. Just don’t wait for the next snowfall to shovel out that perspective!
Dust of Snow By Robert Frost
The way a crow Shook down on me The dust of snow From a hemlock tree Has given my heart A change of mood And saved some part Of a day I had rued.
Mecklenburg Medicine • March 2013 | 5
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6 | March 2013 • Mecklenburg Medicine
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Feature
Fixing Health Care — Right Here At Home By Julian D. (“Bo”) Bobbitt, Jr., JD
W
ith the spending part of the “fiscal cliff” taxation/ spending discussion looming, Congress finally is being forced to confront the main drivers of our deficit dilemma: government “entitlement” programs, such as Social Security, Medicare and Medicaid. Meanwhile, there is broad consensus that many of our runaway healthcare costs are avoidable. Our current feefor-service healthcare payment system rewards higher-intensity care in greater volume, with no consequence for lack of coordination. It is a significant reason that our healthcare system is fragmented, inefficient and too costly. Federal government receipts total about 19 percent of our nation’s gross domestic product (GDP). And yet, if our healthcare spending trends remain unchecked, by 2035 Medicare and Medicaid alone are predicted to consume 13 percent of the GDP. By 2080, Medicare and Medicaid will consume all federal taxes, while total public and private health spending will claim almost 50 percent of the GDP. We will have to borrow to pay for the rest of the federal government’s obligations: defense, education, transportation, etc. As of 2012, our nation already is $16 trillion in the hole and counting. Sticking with the status quo would be a disastrous choice. However, if medical providers work together and accept new payment incentives that reward value instead of volume, we can help fix America’s broken healthcare system. That cannot be done remotely in Washington. It requires healthcare providers in each community cooperating to increase healthcare quality and cut cumulative costs. Quality, savings and patient satisfaction all must be achieved for providers to receive incentive payments under the new healthcare payment model, called “valuebased reimbursement.”
There is plenty of waste to be found and eliminated. This summer, the national Institute of Medicine concluded that America wastes about 30 percent of its healthcare spending — some $750 billion a year — on unneeded care, excessive paperwork, fraud and other inefficiencies. With basic health care becoming unaffordable for many ordinary working families and individuals, that amount of waste is unacceptable. Although no one can hope to eradicate it overnight, it’s time somebody did something about it. America is asking physicians to step up and form these teams, sometimes called “accountable care organizations” (ACOs). You can help ensure access, improve patient care, promote efficiency, stretch healthcare dollars and make patients more of a partner in their treatment. ACOs typically receive 50 percent of the savings they create, which should be considered compensation for professional services. As healers with a calling to serve, you have an opportunity to do your part to enhance patient care while helping to improve our nation’s fiscal health. Besides that it empowers and pays you to regain control of the physician/ patient relationship, your patients, your profession and your nation need you. Bo Bobbitt is a senior partner and head of the Health Law Group at the Smith Anderson law firm in Raleigh. He has many years’ experience assisting physicians form integrated delivery systems. He has spoken and written nationally to primary care physicians on the strategies and practicalities of forming or joining ACOs. This article is meant to be educational and does not constitute legal advice. For additional information, readers may contact the author at bbobbitt@smithlaw.com or 919-821-6612.
County / Regional Medical Societies Craven-Pamlico-Jones County Medical Society Durham-Orange County Medical Society Forsyth-Stokes-Davie County Medical Society Mecklenburg County Medical Society New Hanover-Pender County Medical Society Pitt County Medical Society Rutherford County Medical Society Wake County Medical Society Western Carolina Medical Society
Specialty Societies Carolinas Chapter, American Association of Clinical Endocrinology North Carolina Academy of Family Physicians North Carolina Chapter of the American College of Physicians North Carolina College of Emergency Physicians North Carolina Council on Child and Adolescent Psychiatry North Carolina Dermatology Association North Carolina Neurological Society North Carolina Obstetrical and Gynecological Society North Carolina Orthopaedic Association North Carolina Pediatric Society North Carolina Psychiatric Association North Carolina Radiologic Society North Carolina Society of Anesthesiologists North Carolina Society of Asthma, Allergy & Clinical Immunology North Carolina Society of Eye Physicians and Surgeons North Carolina Society of Otolaryngology – Head and Neck Surgery North Carolina Society of Pathologists North Carolina Society of Plastic Surgeons North Carolina Spine Society
State Societies / Organizations Carolinas Center for Hospice and End of Life Care Community Care of North Carolina North Carolina Academy of Physician Assistants North Carolina Medical Group Managers North Carolina Medical Society
Mecklenburg Medicine • March 2013 | 7
Feature
Fighting for More Funding for School Nurses in Charlotte By Teri Saurer, MSW, LCSW, and most importantly, mother and concerned citizen
D
id you know the CDC recommends one school nurse per 750 students, and Charlotte-Mecklenburg Schools has on average one nurse for 1,200 students? That means most elementary schools have a nurse two-three days a week. Some high schools have a nurse daily, but she is caring for hundreds of students. CMS has 143,000 students with an overwhelming 40,000 medical issues. Some 14,000 students in our schools have asthma and thousands of others have epilepsy, food allergies, diabetes and more. Our children need to be healthy and safe at school, and our nurses are vital. Funding always will be seen as an obstacle, but we cannot put a price on the life of a child. In 2006, the Junior League, the Mecklenburg County Medical Society and others came together to fight for this cause. The County Commissioners pledged their support and committed to adding 26 nurses per year until reaching the 1 in 750 ratio. The funding was increased for three years, bringing our nurses from 48 to 117, where they remain today. When 2009 came and the economy took a turn for the worse, the increased funding stopped. School enrollment has grown tremendously in the past five years, but not a single new school nursing position has been added. In the meantime, we continue to put our children’s health and safety at risk every day. School nurses are best qualified to handle emergencies and accidents, many of which happen daily to children with no known medical condition. Nurses are best equipped to administer medication and recognize the signs of a life-threatening food allergy, seizure or other medical need. They may be the only
8 | March 2013 • Mecklenburg Medicine
healthcare professional a homeless or uninsured child ever sees. They can provide valuable preventive services, as well as decrease epidemic spread of illnesses. Without nurses, we place the responsibility on teachers and other staff, who already are overburdened and not trained as healthcare professionals. Have you ever walked into a school when the nurse is not there? You will notice no one is staffing and securing the front office. That is because the office staff is tending to sick children instead of keeping our schools safe. There are so many reasons we need nurses in each school daily. There are countless mistakes being made by well-intentioned, but unqualified, staff when the nurse is not there. There was the boy who fell on the playground and instead of being assessed and sent home, he remained in school. Hours later, his mother took him to the ER to find out he had a concussion and short-term memory loss. There was the girl given a medication overdose by an overwhelmed school secretary. Will we have to wait until there is a tragedy in CMS to recognize the critical need our nurses play in keeping our kids safe? Concerned parents have formed a group called N.C. Parents Advocating for School Health, and we are on a mission to convince our elected officials how important this issue is to our community. Please contact us at schoolhealthadvocacy@yahoo.com if you are willing to help us with this important cause.
Member News 2013 MCMS Board Members The following Board members were inadvertently left out of our February issue introducing the new Board. Thomas Zweng, MD, is in his second term on the Board of Directors. Douglas Swanson, MD, is new to the Board as an ex-officio member.
Douglas Swanson, MD, FACEP Born near Cleveland, Ohio, Dr. Swanson graduated from the University of South Florida College of Medicine. He completed his internship and residency in emergency medicine and a fellowship in emergency medical services at Carolinas Medical Center. He has been a faculty member with the Department of Emergency Medicine at Carolinas Medical Center since 1995 and is the medical director of the Mecklenburg EMS Agency. Additionally, he is the medical director of MedCenter Air and a member of the North Carolina EMS Advisory Council.
Thomas N. Zweng, MD Born in Palo Alto, Calif., Dr. Zweng received his medical degree from the UCLA School of Medicine. At the University of Michigan Hospitals in Ann Arbor, he completed a surgery internship and residency, and a fellowship in thoracic surgery research. He is Senior Vice
The Mecklenburg County Medical Society congratulates the following practices that have paid 2013 annual dues for all physicians in their practice. We appreciate the continued support.
Carolina Family Physicians Charlotte Gastroenterology & Hepatology Charlotte Colon & Rectal Surgery Associates Charlotte Radiology Oncology Specialists of Charlotte Pediatric Surgical Associates Randolph OB/GYN President of Medical Affairs for Presbyterian Healthcare in Charlotte and Upstate Medical Center in Gaffney, S.C. Dr. Zweng is co-chair of the Media and Public Relations Committee and has served on the Membership Committee and the Community Medical Preparedness Task Force.
MCMS Board Highlights of Sept. 24, 2012 Meeting James B. Hall, MD, secretary, presented one application for active membership: Hadley Jean Scott, MD. The Board approved the application. Election Committee Update: Robert W. Schafermeyer, MD, reported James B. Hall, MD, had accepted the nomination for the 2013 president-elect. Sandi Buchanan, executive director, informed the Board the joint membership application between MCMS and NCMS was in its final stage and would be sent to non-members.
Ms. Buchanan reminded Board members of the Meck PAC Board meeting on September 25 at the Dilworth Neighborhood Grille, followed by a presentation by the North Carolina Medical Society.
MCMS Board Highlights of Nov. 29, 2012 Meeting James B. Hall, MD, secretary, presented three applications for active membership: Kevin S. Cahill, MD, PhD; John D. Hall, MD; and Scott D. Wait, MD. The Board approved the applications. Sandi Buchanan, executive director, informed the Board two dual memberships had been received from NCMS. She also reported MCMS dues invoices had been mailed to members. The Board requested practices that pay dues for all their physicians be acknowledged in the Mecklenburg Medicine magazine. Ms. Buchanan, in the absence of Simon V. Ward III, MD, treasurer, presented the proposed 2013 MCMS budget to the Board.
FOR SALE: 3 medical exam tables, MidMark, forest green, excellent condition, with stools............. $300 each set 2 Phlebotomy chairs, excellent condition..... $75 each 1 IV pole ................................................................................................................................... $35 Digital Scale ............................................................................................................... $400 Wheelchair ............................................................................................................................ $75
If interested, please email rheumatology@comporium.net
Save the Date! WOMEN PHYSICIANS SECTION GIRLS NIGHT OUT Thursday, April 11, 2013 The Comedy Zone at N.C. Music Factory 6:30 – Reception; 8:00 – Show Begins Featuring comedian Caroline Rhea, stand-up comedian and actress with roles on Sabrina the Teenage Witch, The Drew Carey Show and Pride & Joy. She hosted her own show, The Carolina Rhea Show, and was the original host of the reality television show The Biggest Loser.
Mecklenburg Medicine • March 2013 | 9
Member News AHEC Course Offerings
New Members
March 2013
Susanne P. Hawthorne, PA-C Family Medicine Cotswold Medical Clinic 200 Greenwich Road Charlotte, NC 28211 704-384-8664 Wingate University, 2012 Richard C. Herring, MD *Allergy/Immunology Carolina Asthma & Allergy Center 2630 E. 7th Street #100 Charlotte, NC 28204 704-372-7900 East Carolina University, 2004 Thomas M. Schmelzer, MD *General Surgery; Pediatric Surgery Pediatric Surgical Associates 1900 Randolph Road #210 Charlotte, NC 28207 704-370-0223 University of Louisville, 2004
Upcoming Meetings & Events
Meetings are at the MCMS office unless otherwise noted.
MARCH Saturday, March 2 Charlotte Pediatric Society “House Call Ball” Fundraiser for Ronald McDonald House. The Big Chill – 911 E. Morehead St. 6-10 p.m. n Saturday-Sunday, March 2-3 N.C. Society of Gastroenterology Annual Conference. Pinehurst Resort and Conference Center. n Tuesday, March 5 Charlotte Dental Society Board meeting. 6 p.m. n Tuesday, March 5 WPS/CWB Fundraiser Planning Committee meeting. Safe Alliance office. 6 p.m. n Wednesday, March 6 MCMS Celebrating Change 2013 Annual Dinner. Speaker: Dr. Pam Silberman, N.C. Institute of Medicine. Myers Park Country Club. 6 p.m. n
10
MARCH SUNDAY
Set your clocks ahead one hour! Tuesday, March 12 MedLink meeting. 8:30 a.m. n Tuesday, March 12 Charlotte Dental Society Membership meeting. Myers Park Country Club. 6 p.m. n Tuesday, March 12 AAFP Quarterly meeting. Speaker: Jonathan Rappaport, MD, Mountain Diabetes and Endocrine Center. Ruth’s Chris Steakhouse (Fairview Rd.) 6:30 p.m. n Thursday, March 14 Legislative Committee meeting. 4 p.m. n Friday, March 15 Child Health Committee meeting. 7:30 a.m. n Monday, March 18 MCMS Executive Committee meeting. 5:30 p.m. n Wednesday, March 20 MMAE Board meeting. 10 a.m. n Wednesday, March 20 David G. Welton, MD Society Spring Luncheon. Charlotte Country Club. 11:30 a.m. n Thursday, March 21 CAMGM meeting. Myers Park Baptist Church Cornwell Center. Noon. n Friday, March 22 May magazine deadline. n Monday, March 25 MCMS Board meeting. 5:30 p.m. n Friday, March 29 MCMS office closed for Good Friday. n
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Continuing Medical Education (CME) 3/1 Skills for Building Relationships and Enhancing Communication in a Medical Environment 3/1
Obesity Conference 2013: Defining Best Practices for Obesity and Co-Morbidity Management
3/4–6
Prevent Child Abuse, North Carolina Learning & Leadership Summit: Advancing Child Well-Being Through Effective Prevention
3/9–10 27th Annual Meeting of the Glomerular Disease Collaborative Network 3/13–15 37th Annual Internal Medicine Conference 3/16
Cardiac Electrophysiology – Arrhythmias & Heart Failure
Allied and Public Health Education 3/27 Parkinson’s Disease: New Perspectives from Clinical Research Mental Health Education 3/15 8th Annual Youth Violence Prevention Conference – “When Violence Turns Inward: Understanding & Preventing Youth Self-Injury” For more information or to register for these courses, call 704-512-6523 or visit us at www.charlotteahec.org.
NATIONAL HEALTH & WELLNESS OBSERVANCES March American Red Cross Month Brain Injury Awareness Month Hemophilia Month National Colorectal Awareness Month National Developmental Disabilities Awareness Month National Eye Donor Month National Kidney Month National Nutrition Month National Poison Prevention Month Save Your Vision Month Workplace Eye Health and Safety Month March 13–19
National Pulmonary Rehabilitation Week March 17-23
National Poison Prevention Week March 26
American Diabetes Alert Day
At the Hospitals Presbyterian Child Life Specialist Receives Olympic Bead of Courage Presbyterian Hemby Children’s Hospital child life specialist, Rebecca Brooks, received national recognition and an Olympic bead of courage for her dedication to caring for her pediatric patients. Out of hundreds of nominees across the country, she received one of only 56 beads worn by Olympians and is the only recipient in the Charlotte area. Brooks was nominated by Glen Stephens, father of former Hemby patient, Gabriel, who was a patient of Brooks’ for many years before he passed away in early 2012. Stephens nominated Brooks because of her “Olympic spirit,” work ethic, dedication to her patients and compassionate personality. This honor was born out of Beads of Courage, a national program that partners with hospitals to help children with serious illnesses record, tell and own their stories of survival. n n
Presbyterian Hospital Receives Advanced Certification in Heart Failure The Presbyterian Cardiovascular Institute recently earned The Joint Commission’s Advanced Certification in Heart Failure, meaning the hospital complied with The Joint Commission’s national standards for healthcare quality and safety in advanced heart failure care. Achieving Joint Commission certification demonstrates the hospital’s commitment to the highest level of care for its patients with advanced heart failure. The Presbyterian Cardiovascular Institute underwent a rigorous onsite survey by The Joint Commission surveyor. For advanced certification in heart failure, a program must demonstrate a commitment to continuous improvement, collect data on (at least) the four Joint Commission core measures for heart failure and use the information for ongoing performance improvement. The Joint Commission developed criteria in collaboration with the American Heart Association. n n
Presbyterian Orthopaedic Hospital Has Charlotte’s First High-Field, True Open n MRI System The leading-edge Oasis MRI scanner, developed by Hitachi, produces high-quality images and maximum patient comfort. Advantages of the system include: • High-quality images – 1.2 Tesla high-field strength • Open design accommodates patients up to 660 pounds, is ideal for claustrophobic patients and reduces need for sedation • Open setting with panoramic windows creates relaxing environment • Faster scan times minimize patient study and appointment time • Custom music with headphones and XM satellite radio provided for patient enjoyment Orthopaedic and non-orthopaedic imaging tests can be scheduled on the new scanner. A physician referral is required for all tests. To make a referral, call 704-384-7226. Free valet parking is provided. n n
Presbyterian Multidisciplinary Cancer Clinic Offers Patients Comprehensive n Expertise in One Appointment Patients at any stage of diagnosis or treatment can benefit from the Presbyterian Multidisciplinary Cancer Clinic, a specialty clinic where a team of oncology-trained physicians and clinicians review a patient’s case and then devise an individualized treatment plan, including the latest clinical trials, support services and survivorship programs. Clinics are available to patients with a breast, gastrointestinal, urologic, thoracic, melanoma or sarcoma cancer diagnosis. To make a referral, call 704-384-5373 or visit www. presbyterian.org/secondopinion. n n
Presbyterian Hospital Receives Medal of Honor for Organ Donation Presbyterian Hospital received a Medal of Honor for Organ Donation by the U.S. Department of Health and Human Services for its success in increasing the number of available and transplanted organs. Presbyterian Hospital became a first-time silver medal recipient for achieving and sustaining 75 percent or more of eligible donors, with at least 10 percent or more DCD (donation after cardiac death) donors for a period of two years. This achievement could not have been possible without the dedication of the neurosurgical ICU nursing staff and n n
the physicians of Presbyterian Pulmonary & Critical Care (PPCC) who care for the majority of Presbyterian Hospital’s organ donors and their families. Presbyterian received the award at the 7th National Learning Congress for the Organ Donation & Transplantation Community of Practice, a consortium of national organizations critical to the organ donation and transplant process. Physician and Leadership News Ted Clontz, MD, is the medical director of Presbyterian Hospice & Palliative Care. Dr. Clontz is board-certified in family medicine and brings over 30 years experience, including hospice medical director, hospitalist for Presbyterian Hospital’s inpatient care specialist team and family medicine practitioner. Clontz also serves as medical director for several long-term care facilities in the area. While continuing his work with Medical Plaza Family Physicians, Clontz will lead Presbyterian Hospice & Palliative Care’s inpatient and outpatient hospice and palliative programs. Lenora Berning, MD, also joined the Presbyterian Hospice & Palliative Care team and will work with Clontz to fully integrate palliative medicine within Presbyterian hospitals. Dr. Berning is board-certified in emergency medicine. She has experience in emergency medicine at Presbyterian and previously served as a medical director in hospice and palliative care. Berning also served in the U.S. Air Force as a research biologist with the School of Aerospace Medicine. Yele Aluko, MD, cardiologist with Mid Carolina Cardiology and long-standing physician executive with Presbyterian Healthcare, is senior vice president for Novant Health Heart and Vascular Services. Dr. Aluko will lead the ongoing relationship of the Cleveland Clinic with Presbyterian Hospital, Forsyth Medical Center and Novant Health. Regina Hartung is the vice president of cardiovascular services for the greater Charlotte market of Novant Health, and administrator for all cardiac services. Most recently, Hartung served as senior director of service lines for Presbyterian Healthcare, where she successfully led service line initiatives for Presbyterian Orthopaedic Hospital, sports medicine, neurosciences and spine. n
Mecklenburg Medicine • March 2013 | 11
At the Hospitals
CHS Doctor Involved in Groundbreaking Hepatitis C Study Dr. Herbert Bonkovsky, senior research advisor at Carolinas HealthCare System, is one of the primary investigators on a study that was published in January in the journal Nature Genetics. Working with the National Cancer Institute, the team discovered a gene explaining why African Americans with hepatitis C are more difficult to cure than Caucasians or Asians. African Americans have a higher prevalence of a genetic variation in the newly discovered Interferon Lambda 4 (IFNL4) gene that leads to poor responsiveness for the treatment of chronic hepatitis C. The newly discovered gene belongs to what is called a family of four interferon-lambda protein-encoding genes, three of which (IFNL1, IFNL2 and IFNL3) were discovered a decade or more ago. CHS’s Division of Education and Research, its Department of Research and Innovation, and the CHS Cannon Research Center make up one of several clinical sites involved in this ground-breaking study, funded by the U.S. National Institutes of Health. Dr. Bonkovsky notes this new discovery is exciting and further explains genetic influences on the severity of and treatment response to chronic hepatitis C. While better treatments for African Americans living with Hepatitis C need to be found, these results and the knowledge of IFNL4 provide opportunities to specifically target therapies to decrease the expression of the IFNL4 gene, which is a key determinant of responsiveness to anti-viral treatment. n n
Establishing Clinical Pathway Treatment Guidelines for Tumors Edward S. Kim, MD, chair of solid tumor oncology and investigational therapeutics, has recently implemented tumor clinical pathway treatment guidelines within CHS’s Levine n n
Cancer Institute. Since coming from MD Anderson Cancer Center to the Institute in July 2012, Dr. Kim has been instrumental in helping Institute physicians draft these guidelines. The guidelines cover 15 different tumor sites and are aimed at ensuring treatment is consistent for all Institute patients, no matter the facility in which they’re being treated. It’s a unique, unified model that brings comprehensive care and cuttingedge research directly to patients. “We don’t want the perception that medicine is better in one place than another,” Dr. Kim says of patients having to travel great distances to be treated. “The Institute has a lot of expertise spread throughout the system, and we want to make sure all doctors are treating patients with the same level of care, using one of several care plans.” These guidelines follow best practices and are adapted from national guidelines, society guidelines and current clinical practice, he says. Dr. Kim and others at the Institute have been working diligently to ensure the guidelines are effectively being used across all the Institute’s charter member facilities. Each week, a multidisciplinary team of oncologists and other cancer care experts, or “tumor boards,” meet to discuss patient cases. On a monthly basis, “tumor sections” convene and focus on specific cancers, including those of the lung, breast, genital/ urinary, gastrointestinal, neuro/brain and melanoma/immunotherapy. Guidelines are discussed, including the need for any changes, as well as current research, research protocols and potential clinical trials. Any provider, regardless of specialty, can participate. A major component to the guidelines moving forward will be giving patients greater access to the latest clinical trials, which, according to Dr. Kim, will help the Institute create its own identity as a leader in research excellence, both in the Carolinas and nationally. He foresees multiple Institute sites, conducting clinical research, as well as physicians writing their own studies and conducting them at a host of sites within the system.
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CHS Neurologist Recognized Internationally for ALS Discoveries Benjamin Rix Brooks, MD, director of Carolinas Neuromuscular/ALS-MDA Center at CMC and Adjunct Professor of Neurology at the UNC School of Medicine – Charlotte, recently received the International Forbes Norris Award from the International Alliance of ALS/ MND Associations and the World Federation of Neurology Research Group on Motor Neuron Diseases (MND). The award was presented to him during the 23rd International ALS-MND Symposium in Chicago. Dr. Brooks received the award due to his significant role in discovering a potential cause of all three types of ALS, or Lou Gehrig’s disease, reported in the journal Nature. He served as a lead investigator on a study that could lead to the development of drugs better targeted toward the treatment of ALS and other similar diseases, such as Parkinson’s and Alzheimer’s. The Forbes Norris Award is given annually to a physician recommended by his/her peers in the ALS/MND community for showing “exceptional care and compassion in the study and management of ALS/MND.” Dr. Brooks was the 19th recipient of this award (and the 10th American to win). The criteria require that the recipient is a major participant in the delivery of outstanding ALS/MND patient care, a significant contributor to the medical literature on ALS/MND clinical management or basic science, and a member of a team(s) undertaking ongoing research into ALS/MND care, management and/or basic science. Carolinas Neuromuscular Disease/ALSMDA Center is a premier program in the Southeast for the study and treatment of degenerative neuromuscular disease. His team provides access to the most current clinical trials for ALS patients in North and South Carolina, while emphasizing research in novel compounds, as well as new methods for respiratory and physical treatments. The center has introduced a rigorous internal audit framework providing testament to patient outcomes, which led to Carolinas Neuromuscular/ALS-MDA Center recently becoming the first clinic nationally and internationally to achieve Disease-Specific Certification in ALS from The Joint Commission. n n
Feature
The Other Side of the Stethoscope Understanding challenges as a Community Intern By Lee McCracken, contributing writer
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lood squirts and lives are saved. Getting complete access to exam rooms, catheterization labs and operating suites is an incredible privilege, and community leaders who participate in the MCMS Community Intern Program gain valuable insight into the everyday lives of local doctors. The experience is beneficial for physicians, too. Being shadowed by a person not familiar with hospitals and medical jargon affords physicians fresh awareness of what’s typically misunderstood by patients and their family members, and enables them to view their work through a different lens. James Hall, MD, co-chair of the Community Intern Program, is a longtime champion of this initiative that builds bridges between the medical and nonmedical community in Charlotte. “We are not Marcus Welby, MD, or Dr. Kildare (for you oldies), and hopefully, we are also not like Scrubs or Grey’s
Anatomy, but the Community Intern Program really opens the eyes of community leaders about the nitty-gritty day-to-day care we offer our patients, and why we do what we do; this is invaluable.” A past president of MCMS, William Poston, MD, advises those who have not participated in the program to step up this fall, or in 2014. “I think the Community Intern experience is important for physicians,” he says. “Hippocrates charged physicians to teach and share their knowledge, and to use their training and professional standing to improve the community in which they work. This is ever important in today’s world with technical advances, emerging infectious diseases and regulatory challenges on all levels.”
Hearts and Kidneys Since 1990, some 178 community interns and 225 physicians have participated in the educational program. Last November, as the freelance copy editor for “Mecklenburg Medicine” and a local journalist (editor of Pride Magazine), I spent two days with doctors affiliated with both Carolinas Medical Center and Presbyterian Hospital. I sat in on office visits and learned about kidney disease from Carl Fisher, MD, and I watched Tonya McLeod, MD, talk with patients about psoriasis, shave moles for biopsy and remove warts from kids’ knees. The next day. donning surgical scrubs, I was introduced to the amazing world of open-heart surgery with Charles Harr, MD, and experienced the sad reality of late-stage gynecologic cancers with Robert Higgins, MD.
The take-aways were numerous, but two stood out. I realized obesity not only is a serious problem for our society but also a huge headache for physicians who strive to encourage patients to comply with their recommendations for making lifestyle changes. And I celebrated (and shared with others) the incredible medical talent and technology that exists and continues to grow right here in Charlotte. The biggest surprise for me was that I wasn’t creeped out by anything I saw. As I recounted my experience to family members and friends in the days and weeks that followed, they couldn’t believe I had peered into an open chest cavity, watched as a cancerous ovary was extracted and witnessed a pathology technician slice ‘n’ dice a frozen section. Having been a surgical cancer patient myself a few years ago, I found every minute enthralling. Benjamin Peeler, MD, a first-time participating physician last year, said he was eager and excited to have an intern shadow him during the next program. “We have a rapidly developing congenital heart center at Levine Children’s Hospital/ Sanger Heart & Vascular Institute, and we want there to be a lot of awareness of the resource that is being developed here for children and adults with congenital heart disease ... Any opportunity to share the story of the tremendous progress in the treatment of congenital heart disease is valuable,” said Peeler. “The treatment of CHD is the greatest success story in modern medicine ... In the 1950s, the chance of a child being alive with CHD at the age of 1 was just 25 percent. After a six-decade period of amazing progress,
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we currently expect nearly 90 percent of these children to survive into adulthood.” As a faculty member at the School of Medicine at the University of Virginia before coming to Charlotte, teaching others in a crowded operating room has been commonplace for Dr. Peeler. “Having an intern in my room wasn’t a hindrance at all. It was a pleasure.” Sandi Buchanan, MCMS executive director, was by his side for an entire morning. “I have always had a healthy respect for physicians, having worked with them for many years. As I watched Dr. Peeler use his remarkable skills to change the life of an 18-month-old baby girl, I realized how precious life is to one so vulnerable,” she said. “I hope everyone in Mecklenburg County and the surrounding region realizes how very blessed we are to have the best physicians in the county and beyond. I am very thankful for the opportunity to witness healing from each of the experiences that were shared with me through the Community Intern Program.” Sandi and I crossed paths one afternoon at CMC, as she also shadowed Dr. Hall, and we compared notes about our experiences in the operating room.
Jon Kocmond, MD, Wyatt Fowler, MD, and Glenn Errington, MD, she experienced the ER, observed three surgeries, attended a tumor board meeting and was given a behindthe-scenes look at the internal operations and workflow of two medical offices. She said she enjoyed hearing the docs’ perspective on the patient experience and how they take the time to consider patient care in addition to “clinical considerations.” She added, “I was amazed at the time the doctors took to explain things to me, even though I am sure I slowed their pace way down. They seemed genuinely interested in
From Clinical to Camaraderie Annabelle Suddreth, executive director of A Child’s Place, discovered how valuable the experience is for community leaders from all sectors. “It was difficult to take two full days off work, but it was a once-in-a-lifetime learning opportunity — something I never would have gained through reading or watching television,” said Suddreth. “Spending time alongside such passionate physicians has given me personal insight into the people, the physicians, who take care of us and help us stay healthy.” Shadowing John “Chip” Clark, Jr., MD,
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helping me learn, even though I am not a medical student or intern, and I also was touched that they were interested in my work, as well.” Suddreth also was surprised at her ability to tolerate the “sights and smells,” noting, “I guess my years of being a mom really have paid off!” Working with homeless children, she vowed to pay more attention to language barriers, Medicaid processes and the issues surrounding the obesity epidemic. “I will advocate for my clients and their healthcare providers whenever possible.” The wrap-up to the Community Intern Program every year is a dinner, where the participating physicians, the interns and the MCMS staff recap their experiences in a relaxed atmosphere. Last year, in addition to discussing the impact of healthcare reform and other challenges for both doctors and their patients, we enjoyed a certain camaraderie. Dr. Harr commented on the rarity — but extreme importance — of physicians from both hospital systems sitting down together not in an environment of competition but rather cooperation. Poston said he hopes this article rouses more of his colleagues to participate in the next program, recognizing they are citizens of Charlotte beyond the stethoscopes and scalpels they wield. “Physicians have an unfortunate tendency to become isolated in their own worlds,” said Poston, “and to lose track of the other areas of endeavor that impact not only their life, but the life of the community in general.” If you are interested in taking part in the next Community Intern program, call the MCMS office at 704-376-3688.
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