Brown & Toland's HealthLink | Summer 2005 by davidpsu

HEALTHY CHOICES

Open Enrollment 2006:

Choosing the Right Medical Group I HealthLink Summer 2005

3 Technology The iHealthRecord is now available to help you store personal health data in a secure, online format. 4 Nutrition School lunches aren’t what they used to be, and experts say that’s good. 6 Planning It’s important to consider end-of-life issues and discuss them with your family and your physicians. 7 Women’s Health Stress is a particularly serious health risk for women. Fortunately, you can do something about it. 8 Healthy Seniors How to get the most from your medications.

Brown & Toland’s HealthLink editor: Richard Angeloni, Corporate Director, Communications and Public Relations, Brown & Toland Medical Group, 415.972.4307. Brown & Toland’s HealthLink is published quarterly and printed in the United States. Copyright 2005 by Health Ink Communications, 780 Township Line Road, Yardley, PA 19067, 267.685.2800. Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date health information. Our articles are reviewed by medical professionals for accuracy and appropriateness. No magazine, however, can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. Some images in this publication were provided by ©2005 PhotoDisc, Inc. PhotoDisc models used for illustrative purposes only. (305)

n the coming months, many people .will make health plan decisions during their employers’ open enrollment period. Finding a health plan that is affordable and provides you with adequate coverage is an important decision.

Selecting a medical group and choosing a physician is just as important a part of the benefitselection process during open enrollment. Here are some helpful hints: Use the telephone book or Internet to search for medical groups in your area. List a few questions to ask to help you select the medical group that fits your needs, such as: Do my family’s physicians participate in the medical group? Can the medical group’s doctors automatically refer a patient to a specialist, or does the HMO/insurance company have to review the referral (sometimes called a “consult”) in advance? Can women see any gynecologist they choose?

Does the medical group accept my insurance? What hospitals does the medical group use? Where are these hospitals located? Are they close to my work? My home? My children’s school? Try to narrow your choices down to three physicians by asking yourself the following questions: Do you have special needs? If you do, look for a primary care physician (PCP) who has expertise in those conditions. Do you want a doctor who speaks a language other than English? Do you prefer a male or female doctor? Is the doctor’s office conveniently located? Do you have an age preference?

Your PCP is responsible for preventive care, managing routine illness and minor injury, prescribing medication, and coordinating all the care you get from specialists, hospitals or caseworkers. You should do both formal and informal research so that you are familiar with your PCP’s background. ■

Learn More For more information about choosing a physician, and for a list of the physicians available at Brown & Toland, please visit Brown & Toland Medical Group on the Web at www. brownandtoland.com.

FTC NEWS

Brown & Toland to Resume PPO Contract Negotiations rown & Toland Medical Group received notice from B .the Federal Trade Commission (FTC) that it may resume negotiations on behalf of its Preferred Provider Organization (PPO) network physicians. Over the course of the past year, Brown & Toland worked collaboratively with the FTC to demonstrate features of its PPO product that are designed to improve quality and reduce costs to consumers. These features include implementation

Brown & Toland’s HealthLink, Summer 2005

of a utilization review program, disease and case management programs, and an electronic medical records system. The FTC’s April 5, 2005 notice represents an important change in how the agency views Brown & Toland’s PPO product. In July 2003, the FTC challenged in administrative litigation Brown & Toland’s PPO contract negotiations with health plans, alleging that the group’s PPO product was not sufficiently integrated to justify contract negotiations on behalf of network physicians. The FTC and Brown & Toland settled this dispute in January 2004. Brown & Toland has since enhanced the integrated features of its PPO product and now welcomes the opportunity to www.brownandtoland.com

TECHNOLOGY

Brown & Toland Brings Technology to the Bay Area

iHealthRecord Debuts in Northern California Free, online, secure personal health record available through the medical group’s Web site, www.brownandtoland.com rown & Toland Medical .Group in May unveiled an interactive and secure personal health record for all of Northern California. This historic new service, the iHealthRecord, is an online personal health record designed to improve patient education, quality of care and physician-patient communications. Brown & Toland is the only physician group in the Northern California to offer the service. Available to all Northern

California residents, regardless of insurance coverage, the iHealthRecord is the product of a coalition of leading national health care organizations and answers President Bush’s call to create a personal health record for every American within 10 years. The iHealthRecord is available at Brown & Toland’s Web site, www.brownandtoland.com. “The iHealthRecord brings numerous benefits to physicians and consumers,”

introduce this enhanced product to the market. The FTC recognized that Brown & Toland has taken “important steps” to offer an integrated PPO product to the market that will benefit consumers. “We have continued to enhance clinical integration for our PPO product and we have demonstrated the ability to improve care for our PPO patients. I am very pleased that the FTC recognizes the work that we have done,” says Gloria Austin, Brown & Toland Medical Group’s chief executive officer. “We believe that the medical group’s focus on coordinated medical care for the PPO product will ensure that consumers receive high quality, cost-effective care. This www.brownandtoland.com

says Gloria Austin, Brown & Toland Medical Group’s chief executive officer. “Brown & Toland is a leader in bringing technology to health care, so the iHealthRecord is a natural extension of our efforts and we are delighted to bring this innovative product to Northern California residents and physicians.” The iHealthRecord was created by San Franciscobased Medem, a leading physician-patient commu-

nication network, founded by a coalition of national medical societies, including the American Medical Association. The iHealthRecord empowers and educates Americans by electronically connecting them more closely with their physicians. It houses critical personal health data for use by physicians or emergency departments, including current medical conditions, medications, past surgeries and allergies, as well as end-of-life directives, in a secure, online environment. And the iHealthRecord also provides a suite of unique services to increase medication adherence, enhance continuity of care and improve patient-physician communication. Patients receive educational programs specific to their medical conditions, automated reminders about their medications and conditions, and FDArelated safety warnings and recalls. The iHealthRecord patient education programs are developed in conjunction with leading U.S. medical societies, the American Heart Association, American Cancer Society, the U.S. Centers for Disease Control and

Prevention, the U.S. Food and Drug Administration and other national experts. Another feature of the iHealthRecord is that it communicates electronically with an electronic medical record (EMR). Brown & Toland Medical Group became one of the first independent practice associations in the nation to introduce the EMR to its entire network of physicians last November, when it launched the clinical labs results module of the TouchWorks Electronic Health Record from Allscripts. “If you can go to the Internet to check your bank balance, pay your gas bill and purchase tickets for a movie, you should be able to have your health record available via the World Wide Web to anyone authorized to see it, especially, for example, during a medical emergency,” says Lin Ho, M.D., Brown & Toland Medical Group’s president and chairman of the board. “During most medical emergencies, seconds count. The iHealthRecord can help to literally save your life, or save the life of a loved one.” ■

is an important development for physicians, health plans and consumers, and I believe that our clinically integrated physician network will serve as a model of the right way to deliver and manage care for any health care product that consumers select.” Adds Jay M. Gellert, chairman of Health Net of California, “Brown & Toland is among the leading medical groups in California because it has combined its strong network of quality physicians with cutting-edge technology to benefit its patients in a unique way. We look forward to continuing to work with them to provide a broad range of quality, cost-efficient health products for our patients.” ■ Brown & Toland’s HealthLink, Summer 2005

NUTRITION

A Team Approach to Nutrition in Schools chool lunches have come a long way since you were slast in school. New terminology, new foods and a new emphasis on nutrition. The changes, says Althea Zanecosky, R.D., member of the American Dietetic Association, are “terrific.”

The “team” approach brings kids, parents and teachers into the nutrition program.

The Team Nutrition program has a threefold message: Offer kids a variety of foods; encourage them to eat more grains, fruits and vegetables; and persuade them to choose a diet low in fat, particularly saturated fat.

“There are many innovative things that have been done,” says Ms. Zanecosky. “They are serving foods that kids like.” Beginning three years ago, the U.S. Department of Agriculture launched a program called Team Nutrition. It was an attempt to get schools on the nutrition bandwagon, to encourage them to follow the Dietary Guidelines for Americans, and to involve everyone in the effort to get children to eat better. This “team” approach — to bring kids, parents and teachers into the nutrition program — was new, says Ronald J. Vogel, associate deputy administrator for child nutrition at the USDA. It came on the heels of 1995’s School Meals Initiative for Healthy Children, which updated the 30-year-old Child Nutrition Act. The Team Nutrition program has a threefold message: Offer kids a variety of foods; encourage them to eat more grains, fruits and vegetables; and persuade them to choose a diet low in fat, particularly saturated fat. Not all of the 92,000 schools in the school lunch program have followed all the guidelines. At one point, 24,000 schools had signed a pledge to participate, but today, the agency is less interested in signing on schools than it is in distributing information and helping educate food service staffs about good nutrition, says Mr. Vogel. Although some districts may be lagging behind in implementing changes, others have been ahead of the game. The Philadelphia school district has been monitoring school menus and tailoring them to meet the dietary guidelines for seven years, well before Team Nutrition got under way. “But we’re the exception to the rule,” says Joan Nachmani, coordinator of Dietary Service for the district’s food service program, which serves 123,000 lunches and 48,000 breakfasts each day. More variety So, what are kids getting these days? Much more variety, says Ms. Nachmani, who remembers well the standard meals served when she was going to school. “We serve more finger foods, more sandwiches. Kids’ eating habits have changed.” Ms. Zanecosky is also pleased at the change she’s seen in school lunches. “I remember commodity turkey,” she says of her school years. “They are now shaving turkey and

Brown & Toland’s HealthLink, Summer 2005

making turkey sandwiches like what they can get at a deli.” Food service staffs are serving healthier meals, but those meals must also attract the kids. That’s a fine line to walk, nutrition experts say. “Lunch must meet the needs of the kids and the needs of the parents and those in health care,” says Ms. Zanecosky. Schools today serve low-fat milk, lots of fresh fruit, multigrain buns, leaner burgers (enriched with soy protein, which also cuts the fat), and baked potato rounds instead of fries. “Kids love the fresh fruit,” says Ms. Nachmani. “We were hesitant at first [to serve it], but the kids really look forward to it.” Schools that participate in the school lunch program receive surplus commodity foods to use in their meal planning. Food service workers must juggle the free food that’s available with the need for a balanced menu and a desire to please the kids — a tall order. Ms. Nachmani says she tries to set the meals up in a pattern and repeat the pattern, depending on the commodities available. But she also involves the kids. “We do a survey and ask the kids to rate the entree items.” Those items that rate high are served more often. The importance of lunch How important is a good lunch for growing children? Very, says Ms. Zanecosky. “That’s one third of the calories for the day.” To that end, the Team Nutrition program seems to be doing its job. Lunch has become much more important in the school day, says Mr. Vogel of the USDA. “It’s not just a place to make a lot of noise and eat french fries,” he says. Although school lunches have improved dramatically, the same can’t always be said of their brown bag counterparts. Ms. Zanecosky has peeked into many a lunch box from home to find chips, cookies and juice boxes as the staples sent by parents. www.brownandtoland.com

SERVICE

Brown & Toland and

Patient Safety by Tammy Fisher, MPH Manager of Health and Quality Improvement Brown & Toland Medical Group

s consumers, we A . constantly worry about the quality of cars

“Three out of four were bringing cans of soda, when you can buy milk for 30 cents,” she says. If your child doesn’t want a sandwich, she says, try alternatives such as a bowl of cereal or cheese sticks and fruit. “Maybe they’re bored with peanut butter and jelly.” Educating parents is part of the education arm of the Team Nutrition program, says Ms. Nachmani. “We do a lot of community outreach and nutrition fairs” to reach the parents, she says. Next, the middle schools While elementary students have been the focus of Team Nutrition so far, next up is a program aimed at middle school students. The USDA program, called Yourself, reinforces the healthy eating aspects of the elementary school program, but also emphasizes physical activity. One of the major health problems identified for teens is inactivity, nutrition experts say. The USDA has also expanded the nutrition program the other way — into infancy — through the Tickle Your Appetite program, which began in January 1999 at WIC ( Women, Infant and Children) clinics. The agency pushed into childcare programs in the spring of 1999. “We’re still focusing on schools, but broadening the concept,” says Mr. Vogel. The agency is also revamping its food buying guide for cafeteria personnel. This culinary bible tells the staff how much food to buy if, say, they’re planning on serving quarter-pound hamburgers to 100 students. That new guide should be released this fall. Meanwhile, the USDA keeps pushing ahead to tell kids how important good nutrition is. The real proof of the program’s success, says Mr. Vogel, will come in the next few years, when he hopes all the hard work will begin to show up in the nutrition profiles of students. That’s when he’ll know the lessons are starting to sink in. ■ www.brownandtoland.com

we buy, the quality of shoes we wear and the quality of food we eat. But historically many of us have not wondered about the quality of care we receive from our personal doctors. This is because a lot of us have confidence in our doctors and trust in their abilities. But times are changing. Recent media coverage brought to the forefront reports that summarize the number of medical errors that occur annually in U.S. hospitals, and more and more consumers are now questioning the care they receive. It started with the Institute of Medicine (IOM) Report, To Err is Human, which uncovered the systemic gaps in our health care system. It brought to our attention the magnitude of medical errors in our country. Based on findings of one major study, medical errors kill some 44,000 people in U.S. hospitals each year. Another study puts the number much higher, at 98,000. More alarming than the sheer numbers is the fact that a larger number of people die from medical mistakes each year than from car accidents, breast cancer or AIDS.

Consumers rightfully took notice of these reports and started to hear that quality of health care in America may not be ideal. Quality varies widely from medical group to medical group and from health plan to health plan. Which brings us to a very important question: How do you know your health care is in good hands at Brown & Toland? The answer is simple. Brown & Toland Medical Group is recognized as one of the leading medical groups for quality in the Bay Area and throughout California.

At Brown & Toland Medical Group, we care about the quality of services we provide our members and strive to maintain the highest standard of care. To provide quality care, we stay at the cutting edge of clinical and treatment developments, and we use information technology to help reduce medical errors on a system level. Here are some key patient safety

initiatives that Brown & Toland has adopted: Electronic Medical Record at the point of care to minimize medical errors due to fragmented system Personal health records (iHealthRecord, available at our Web site, www.brownand toland.com) so that you can monitor the accuracy of your health information and enhance the exchange of information between you and your doctors Disease registries used to deliver clinical information to our doctors Monitoring of physician performance in preventive health screenings for asthma, cervical cancer, breast cancer, diabetes and cholesterol management Working with hospitals to monitor and act on quality issues that might occur when our members receive care in the hospital setting These initiatives have helped Brown & Toland finish in the top 10 percent among California medical groups in such important clinical measures as asthma management, diabetes management, childhood immunizations, cholesterol management, and breast and cancer prevention screenings. ■

Brown & Toland’s HealthLink, Summer 2005

PLANNING

End of Life: Inevitable, but not always discussed by Peter Alperin, M.D. Medical Director, Brown & Toland Medical Group

espite all of the medical advances . over the past decades, we still have not learned to avoid death.While this is obvious, I am constantly reminded by both patients and physicians that this most basic of truths — that death is inevitable — is often forgotten.

People with a longstanding illness, and those with the sudden onset of a terminal illness, often are unable to face the fact that they are going to die. The end of life is a profound time, emotionally and spiritually. The successes of medical science have turned death from a natural part of life to something that is often considered a treatment failure. Of course, this is not the case. This highlights the most important component of end-of-life

care — communication. Open communication needs to occur between the patient (and family) and the physician. While it is the responsibility of the physician to discuss treatment with the patient, the patient and family can contribute to a satisfactory interaction with a few simple steps: Insist on meeting with the physician to discuss the issues. What is the plan for further hospitalization? What needs to be done for

optimal pain management? Where is ongoing care going to occur? Determine resuscitation status. As a patient, have a discussion with your family to ensure that your desires regarding resuscitation (CPR and ventilators) are clearly articulated. Codify your wishes in a document called an Advanced Health Care Directive, or AHCD. This is the document where your wishes regarding health care are recorded; it also provides for the appointment of a health care agent, also known as a Power of

Putting on Weight? Your medications may be to blame by Joan Saxton, M.D.

number of commonly prescribed medications can A s result in weight gain. In some instances, this can lead to two frustrating outcomes: Either the patient may gain weight or may discontinue the medication. It is important for patients and doctors to be aware of this fact, to consider alternative therapy if appropriate, and to prepare for the weight gain if it is inevitable. Of course, the relative risk of weight gain versus the benefits of therapy must be evaluated. Categories of medications most often associated with weight gain are those used for diabetes, seizures, migraine prevention, depression and mood disorders. They cause weight gain by stimulating appetite as well as by interacting with the brain chemistry that controls appetite and satiety.

Brown & Toland’s HealthLink, Summer 2005

Attorney for Health Care, or PAHC. The PAHC becomes the legally responsible decision maker only if a patient becomes incapacitated and unable to make health care decisions. The surrogate decisionmaker must talk with the patient while he or she is still conscious, competent, and alert to best carry out the patient’s wishes. The paperwork is available from most hospitals, many doctors, or in bookstores (from Nolo Press, a legal publisher.) Consider hospice care. Eighty percent of

patients in the United States die in a hospital. However, when asked, most patients say they want to spend their final days at home or in a more private, intimate setting. Hospice care is delivered in the home or in dedicated settings. The goal is comfort and dignity for the patient, and a focus on the family. Until next time, stay healthy. ■

Peter Alperin, M.D., a medical director at Brown & Toland Medical Group, also is in active practice at Mills–Peninsula Hospital and is an assistant clinical professor of medicine at the University of California– San Francisco.

Potential weight gain should be considered when a prescription is written. If possible, medications that are less likely to result in weight gain could be considered. If overweight is already a problem, dietary counseling, exercise and monitoring would be appropriate as soon as the drug is started. In normal weight patients, baseline weight should be measured, and even small increases should be addressed before they become a larger problem. Preventing weight gain, if possible, is much easier than treating obesity! ■ Joan Saxton, M.D., directs the Weight Management Program of San Francisco, Inc., at California Pacific Medical Center in San Francisco. She founded the program more than 20 years ago and continues to be nationally recognized as a leader and speaker on obesity treatment. A member of Brown & Toland Medical Group, Dr. Saxton is board certified in both internal medicine and nephrology. www.brownandtoland.com

WOMEN’S HEALTH

Stress and You: The Endless Juggle Women will have longer, happier lives if they take action against stress omen experience symptoms of stress 30 percent more often than men, research has shown. And according to one study, women are more likely than men to maintain elevated levels of stress hormones in their system — even at night when they are sleeping.

You may think that being a woman and being stressed is a given. You’re worrying about your kids. You’re worrying about your marriage. You’re worrying about your career. And you’re worried about aging parents, volunteer work, keeping up with friends, paying bills … and the list goes on and on. Physical effects So why think about stress? It’s because if stress gets out of control, it can make you sick. Stress has been linked with heart disease, high blood pressure, stroke, ulcers, a weakened immune system, a reduced ability to heal, fertility problems and chronic colds. It may even play a role in some cancers and diabetes. “You need to take stress seriously,” says Tracy W. Gaudet, M.D., director of the Duke Center for Integrative Medicine. “It has very real physiological effects.” Dr. Gaudet, whose specialty is obstetrics/ gynecology, also serves as the medical expert for Oprah Winfrey’s Lifestyle Makeover Team, which helps women take control www.brownandtoland.com

of their lives so they can be healthier and happier in pursuit of their dreams. Dr. Gaudet notes that stress in and of itself is not harmful — it’s being in a chronic state of stress that is damaging.

“Our bodies were not designed to function this way all the time … it seems we spend more and more time in a crisis mode.” —Tracy W. Gaudet, M.D., director of the Duke Center for Integrative Medicine

Technology is a major contributor. Now most people have answering machines, as well as cell phones, pagers and e-mail. “This increased access means we’re ‘on’ to our demands all the time,” Dr. Gaudet says. “But the body needs downtime when you’re doing nothing. Women are especially vulnerable because they often juggle multiple demands, and our culture makes them feel a greater need to respond to those demands.

“You need to make mindful choices about giving yourself time off, and you need to be as disciplined about scheduling it as you are about the other things you do. It’s not selfish or self-indulgent, and it’s not a luxury — it’s essential. If you want to be around to take care of the people you love, you need to take care of your health.” Taking action So before stress sends you to the doctor, what should you do? First of all, Dr. Gaudet advises, remember that stress is about perception — it is how you perceive circumstances that make them stressful. This will help when you take the first step, which is writing down all the stressors in your life. Once you’ve put your list together, analyze it. Decide what you can get rid of or hand off. Let your kids load the dishwasher or walk the dog, let a co-worker chair a committee. Say no to a volunteer commitment. Then there are things you can’t do anything about — a child’s illness, a crumbling marriage, a project deadline at work,

getting caught in traffic. But you can change your perception of them. One way to cope is through laughter. In fact, researchers have found that laughter helps your immune system fight invading viruses and cancers. It lowers levels of the stress hormone cortisol, and can lower your blood pressure and decrease heart strain. You should also design releases for yourself. Be disciplined about stress reduction and do it every day. It can be as simple as deep breathing exercises during the day, a 10-minute stretch in the morning,

walking, listening to music or taking a hot bath. Try meditating or yoga. Dr. Gaudet also suggests keeping a journal to help you release anger, shake off worries, and figure out what’s important to you and where your passions lie. Just a paragraph or a few lines a day can make a difference. “The mechanism doesn’t matter, it’s the release,” Dr. Gaudet says. “It’s a matter of living in the moment.” And that means feeling better — not just for the moment — but for a lifetime that is longer and healthier. ■

LAUGH ABOUT IT “Laughter is a great way to release stress!” says Tracy W. Gaudet, M.D., director of health affairs for the Duke Center for Integrative Medicine. So the next time you find yourself on overload, humor yourself with these thoughts: “Don’t treat me any differently than the Queen!” “Well, this day was a total waste of makeup.” “Chaos, panic, disorder — my work here is done.” “Allow me to introduce myselves.” “I’m not tense — just terribly, terribly alert.”

Brown & Toland’s HealthLink, Summer 2005

HEALTHY SENIORS

Make Friends With Your Meds

rescription medications are more

powerful and beneficial than ever. One small tablet can help someone avoid a deadly stroke or heart attack by controlling blood pressure; another can keep a person with diabetes from having to administer daily insulin shots; still others can reduce anxiety — or stem suicidal thoughts. Yet 12 percent of Americans don’t take their prescriptions. Another 12 percent don’t even fill them. And nearly 75 percent of seniors prescribed cholesterol-lowering statin drugs weren’t taking them five years later, according to the American Heart Association (AHA). “Even people who have had organ transplants don’t have 100 percent adherence rates, which I find amazing,” says Douglas Hoey, R.Ph., vice president of practice affairs for the National Community Pharmacists Association (NCPA) in Alexandria, Va., and a part-time pharmacist. What makes some people sticklers for following through with their medications, and others haphazard at best? “It really comes down to how motivated the patient is,” says Mr. Hoey. “Ultimately, the decision about whether to take the medication resides with the patient. No matter

Brown & Toland’s HealthLink, Summer 2005

how good the team of doctor and pharmacist, it’s up to the patient to recognize the value of medication.” People give all sorts of misguided reasons for prematurely going off a medication regimen. Some stop because they begin feeling stronger and healthier — but feeling better could be the very reason to stay on a drug, not to discontinue it. Or perhaps they believe a drug is having no effect — when, in actuality, they must take it for weeks or months to relieve symptoms. Still others stop because of overly complex treatment regimens or worrisome or unpleasant side effects, or because they cannot afford the medication. Always check with your doctor about any of these concerns. Very often the doctor can switch you to a different medication that doesn’t cause the same side effects or a less expensive drug that will work. And with some drugs, side effects normally subside a few weeks after starting on them. “Understanding your medications, including how powerful they are, is essential,” Mr. Hoey says. “Doing so will help you understand they need to be taken properly, or you take the risk of negative consequences.” ■

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Brown & Tolandâ&#x20AC;&#x2122;s HealthLink, Summer 2005

SURVEY RESULTS

Brown & Toland Physicians Make A Difference in Patient Satisfaction

rown & Toland honors the time-

honored doctor-patient relationship. We strive to provide excellent service to our members. In a recent survey, more than 16,000 Brown & Toland members were asked to rate our most active doctors in the following areas: Overall recommendation of doctors Personal interaction and comfort level with their doctors Access to their physicians Overall coordination of their health care needs More than 90 percent of our members surveyed indicated that they would highly recommend their personal doctor. “It is important to note that what you say and what you feel is really important to us at Brown & Toland,” says Fiona Wilson,

M.D., Brown & Toland’s vice president of quality initiatives. “We surveyed a very large number of our members because we wanted to get a true reading of their experiences.” Brown & Toland wishes to recognize these doctors our patients regard as best of the best, the “People’s Choice” among Brown & Toland’s most active physicians. Of course, this list is just a small sampling of Brown & Toland Medical Group’s 1,500 physicians. Our physicians are Board certified in more than 40 specialties and practice at some of San Francisco’s finest hospitals, including California Pacific Medical Center and the University of California–San Francisco. For more about Brown & Toland’s physicians, please visit our Web site at www.brownandtoland.com. ■

Michael Abel, M.D. David Claman, M.D. Colon and Rectal Surgery Pulmonary Diseases 415.668.0411 415.885.7886

Wayne Fung, M.D. Ophthalmology 415.923.3007

Jacob Johnson, M.D. Otolaryngology 415.362.5443

David Senechek, M.D. Primary Care 415.751.3150

Maria Agleham, M.D. Primary Care 650.755.2192

James Clever, M.D. Primary Care 415.673.9511

Nima Grissom, M.D. General Surgery 415.292.8999

Gordon Katznelson, M.D. Primary Care 415.931.0440

Lawrence Shore, M.D. Primary Care 415.386.5388

Eileen Aicardi, M.D. Pediatrics 415.668.0888

Alan Coleman, M.D. Primary Care 415.929.0660

William Hagbom, M.D. James Klein, M.D. Obstetrics and Gynecology Otolaryngology 415.668.1560 415.923.3135

Christina Allen, M.D. Orthopaedic Surgery 415.353.7566

John Cranshaw, M.D. Primary Care 415.550.0811

Ziyad Hannon, M.D. Thomas Madland, M.D. Karen Suskiewicz, M.D. Obstetrics and Gynecology Obstetrics and Gynecology Primary Care 415.334.0999 415.781.5333 415.673.9511

John Arpels, M.D. Gynecology 415.925.9882

Jeffrey Davidson, M.D. Allergy and Immunology 415.433.6673

Gerald Harris, M.D. Pediatrics 415.242.5433

Rachel Malina, M.D. Pediatrics 650.992.4200

David Tejeda, M.D. Pediatrics 415.600.2403

Karina Arzumanova, M.D. James Davis, M.D. Primary Care Primary Care 415.440.0612 415.600.3700

Shawn Hassler, M.D. Primary Care 415.397.0700

Robert Mickel, M.D. Otolaryngology 415.751.4914

Frederic Whinery, M.D. Primary Care 415.673.9511

Philip Bartlett, M.D. Otolaryngology 415.751.4914

Jesse Dohemann, M.D. Primary Care 415.923.3673

Kevin Hiler, M.D. General Surgery 415.292.8999

Betty Miller, M.D. Allergy and Immunology 650.991.0405

John Wilson, M.D. Primary Care 650.994.9090

Alla Boykoff, M.D. Primary Care 415.447.0922

Thomas Engel, M.D. Otolaryngology 415.751.4914

Dean Hirabayashi, M.D. Ophthalmology 415.362.3364

Alan Newman, M.D. Oncology 415.885.8600

Rebecca Yee, M.D. Obstetrics and Gynecology 415.923.3123

Randolph Chase, M.D. Primary Care 415.668.2851

Mei-Ling Fong, M.D. Primary Care 415.751.1446

Katherine Hsiao, M.D. Mary Norton, M.D. Silvia Yuen, M.D. Obstetrics and Gynecology Maternal and Fetal Medicine Primary Care 415.876.8500 415.476.4080 415.986.4302

Brown & Toland’s HealthLink, Summer 2005

Michael Small, M.D. General Surgery 415.923.3866

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Brown & Tolandâ&#x20AC;&#x2122;s HealthLink, Summer 2005

Free Community Health Fair at St. Mary’s Medical Center Spend your morning learning how to stay healthy. Take advantage of free health screenings and keep tabs on your: ■ Cholesterol level ■ Blood pressure ■ Body fat ■ Sugar levels ■ Basic foot health

Making Healthy Choices Date: Saturday, Sept. 10, 2005 Time: 9 a.m.–2 p.m. Place: St. Mary’s Medical Center 450 Stanyan St., San Francisco

Also, don’t miss presentations from various physicians on health topics such as: ■ Patient-physician communications ■ Osteoporosis and treatments ■ Heart health and current treatments ■ Glaucoma and current treatments ■ Weight control and latest treatments Several community-based organizations will be on hand to answer your questions and provide information on a variety of health-related topics. Be sure to visit Brown & Toland’s booth and learn about the advantages of developing an online medical record for you or your family members. You can even set up your own free, secure iHealthRecord on the spot with Brown & Toland’s technology!

Call Health Net at 800.593.7892 to reserve your seat today! PRSRT STD U.S. POSTAGE The Doctors Behind Every Good Health Plan

P.O. Box 640469 San Francisco, CA 94164-0469

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