November December Bulletin

www.escambiacms.org

NovEmbEr/DEcEmbEr 2012

BULLETIN

volUmE 42, No. 6

Upcoming Events Saturday, January 19, 2013 ECMS Annual Inaugural Ball President-Elect: Wendy Osban, DO Paul’s on the Bay February 12, 2013 | 5:30p General Membership Meeting Risk Management 1.5 AMA PRA Category 1 CreditTM March 7, 2013 | Apple Annie’s | 5:30p Annual ECMS Doctors Day Celebration Wine around the World with ECMS Wine & food parings-trivia-prizes April 9, 2013 | 5:30p General Membership Meeting Domestic Violence 2 AMA PRA Category 1 CreditTM

RSVP: 478-0706 info@escambiacms.org

Founded in 1873

President’s Message

CLOSING REMARKS Dr. George A.W. Smith It is unbelievable that my year as president of the Escambia County Medical Society is coming to an end and this will be my last article for the newsletter. It has been an honor serving as your president and I would like to take this opportunity to thank you for your support and to recap some of the highlights of this year. Our Executive Director Erica Laxson now Huffman, (congratulations are in order) has completed her first year with the Medical Society and has done an outstanding job with marketing and networking in the community. We have continued to increase membership and raise positive awareness of our society through our bi-monthly newsletter, collaborative efforts with the local hospitals and healthcare facilities, monthly general membership meetings, event fliers and email communication. The Go Seniors Transportation Program was funded for the second year by the Fellows Memorial Fund in the amount of $30,000 allowing us to successfully continue to assist elderly patients with their healthcare transportation needs. In May we brought in twenty two vendors for our Annual Mini Health Vendor Fair where we also hosted our first ECMS Physician Speed Networking Event. This year the Annual ECMS Doctors Day celebration was hosted at a Pensacola Ice Flyers Hockey Game in March and was well attended. In July our delegation attended the FMA Annual Convention and hosted the Northwest Florida Caucus. Dr. Wendy Osban President Elect served on the Reference Committee II – Finance and Administration. She has since then been accepted into the FMA Physician Leadership Academy class of 2013. Our Secretary Treasurer Dr. Christopher Burton graduated with the Class of 2012 also at this meeting. We partnered with the Pensacola Chamber of Commerce to plan, organize and co-host a dinner meeting at the 6th Annual Strategic health Intelligence Summit. Laura Davis fourth year medical student at the Florida State University College of Medicine Pensacola Campus was the recipient of a $5,000 scholarship.

One of our ongoing programs which bring us a great deal of pride is the WeCare program and I will spend the rest of the time writing about this. WeCare was created in 1992 by the Escambia Medical Society as a program of the ECMS Foundation to coordinate the network of healthcare providers and assist in delivering medical services to the indigent residents of Escambia and Santa Rosa Counties. The mission of the program is to provide specialty medical care to as many financially and medically eligible patients as possible. It does this with a network of over three hundred providers who voluntarily donate all

Dr. George A.W. Smith services to the tune of over $3 million per year in contributed services. As such it has been one of the more successful WeCare programs in the state. The Escambia County Board of Commissioners provides approximately $70,000 in funding for a program coordinator/case manager and a clerk. Program oversight is provided by the staff of the Escambia County Health Department under the leadership of its director Dr. John Lanza.

Despite the distinct benefit that the WeCare program provides for the patients served and their referral sources, there are a number of short comings first and foremost of which is the inequity in the number of patients seen and the cost of uncompensated care provided by the participating healthcare facilities. Historically there are some specialties that have no or very few volunteers which makes it extremely difficult to get those patients seen and increases the risk of jeopardizing the specialists participation due to overload and burn out. Consequently there is always a waiting list sometimes as long as three or four months.There also tends to be over utilization of the more willing specialists and specialty groups and their affiliate healthcare facilities resulting in disparities in the value of care donated. The latter is also directly related to the uncompensated care programs offered by these healthcare facilities and how easily the patients feel that they can navigate these.

In May of this year a group of representatives from the Health Department, Escambia Community Clinics Inc., ECMS, Baptist HealthCare and Sacred Heart Health Systems met to discuss these very issues. Multiple ideas and suggestions were discussed but it was felt that one of the most urgent need was to ensure the sustainability of the program. One recommendation was that ECC starts some specialty clinics even one-half day a month with specialists who would be contracted at an hourly rate. In the meantime we continue to rely on volunteers and I would encourage all specialists to consider participating.

The State of Florida provides Sovereign Immunity Statute to provide protection from litigation, and Worker’s Compensation while donating services. Waiver of license renewal fees and 25 percent of the continuing education hours required for license renewal are available to those who donate 160 hours of services to low income recipients during the biennial licensure period.

I would like to thank all our members for your support of our programs and would like to remind you of our Medical Errors program in December and the Inauguration Royale – Installation of Officers in January.

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.

• Collaborate with the Alliance to bring together Escambia and Santa Rosa County medical families. To know the needs of the community and promote the healthcare needs.

• A powerful instrument to attract and induct members to organized medicine.

Views and opinions expressed in the Bulletin are those of the authors and are not necessarily those of the directors, staff or advertisers.

Editors: Christopher Burton, MD Erica Huffman, Executive Director

Ad placement Contact Erica Huffman at 478-0706 Ad rates 1/8 page: $100 • 1/4 page: $150 • 1/2 page: $300

Contents Page 3 - New Members Page 4 - Join Us for a Night of Fun Page 5 - Your Charitable Donation Page 6 & 7 - Coping with Stress Page 8 - Office Preparedness for Emergency Medical Care Page 9 - A special thank you Page 10 & 11- Hospital News

Membership

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

New Members Nicole Briley, M.D. 1000 W. Moreno Street Pensacola, FL 32501 Phone: 850-469-7406 Fax: 850-437-8283 Speciality: Internal Medicine

Nutan De Joubner, M.D. 1717 North E Street Ste 231 Pensacola, FL 32501 Phone: 850-469-7975 Fax: 850-469-2113 Specialty: Hematology Oncology Internal Medicine

Maureen Padden, M.D. 6000 West Highway 98 Pensacola, FL 32512 Phone: 850-505-6611 Fax: 850-505-6614 Specialty: Family Medicine

James Natalie, M.D. 1717 North E Street Ste 530 Pensacola, FL 32501 Phone: 850-437-8670 Fax: 850-437-8679 Specialty: Physical Medicine and Rehabilitation Electrodiagnostic Medicine

Tammy Pruse, D.O. 9400 University Parkway Ste 409 Pensacola, FL 32514 Phone: 850-208-6160 Fax: 850-208-6169 Specialty: Family Practice

Residents

Retired

Benjamin Osterrieder, M.D. FSU Sacred Heart OB/GYN Residency

Lornetta Epps, MD For medical records email: drepps8787@earthlink.net or fax: 850.477.2165

Brett Tidwell, D.O. FSU Sacred Heart OB/GYN Residency Lakeema Bruce, M.D. FSU Sacred Heart OB/GYN Residency Natasha Spencer, M.D. FSU Sacred Heart OB/GYN Residency

To place your ad here contact Erica Huffman at 478-0706

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Membership

Take a Chance & Join Us for a Night of Fun at the ECMS Annual Ball As we install our new ECMS Officers and 2013 President Wendy Osban, DO Saturday January 19, 2013 at half past six in the evening Paul’s on the Bay Attire: Semi-Formal Physicians & physician guest $65 Medical Students & Residents $50 ECMS Past Presidents: $55* *Only 1 additional ticket may be purchased for guest or spouse at discounted price Reserved table of 6: $390 $357 Reserved table of 8: $520 $455 Advance tickets must be purchased by January 4 (Payment options: cash or make check payable to ECMS) ECMS will also be holding a silent auction during the ECMS Ball on the same night to raise money for the Escambia County Medical Society Inc. Foundation 2013 Executive Committee Wendy Osban, DO - President Susan Laenger, MD - President-Elect Christopher Burton, MD - Vice-President Brian Kirby, MD - Secretary/Treasurer 3 Members at Large Thomas Westbrook, MD Hilary Hultstrand, MD Brett Parra, MD

Membership

ESCAMBIA ESCAMBIACOUNTY COUNTYMEDICAL MEDICALSOCIETY SOCIETYININCONJUNCTION CONJUNCTIONWITH WITHSANTA SANTAROSA ROSACOUNTY COUNTY

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Why not make your charitable donation to the Escambia County Medical Society Inc. Foundation (ECMSF) this year?

The Escambia County Medical Society Inc., Foundation (ECMSF) was founded in 1994 when the ECMS leadership recognized the lack of access to affordable medical care for indigent county residents. These physicians determined it was their professional responsibility to develop a program to care for this population. Since the ECMSF was founded we have met the need by financially assisting indigent patients with prescriptions, equipment, supplies, and patient travel for their healthcare needs.

You can make a donation on our website through paypal by clicking "Make a Donation Now" ECMS will also be holding a Silent Auction at the 2013 Inaugural Ball on January 19, 2013 and all donations and funds will go to support the ECMSF. If you would like to donate merchandise, sporting and entertainment tickets, or gift certificates you may call Erica Huffman 850.478.0706 x 2.

Our tax exempt number is: 59-1514947.

All donors will be recognized at the 2013 Inaugural Ball *Cash donations of $500 or more will receive 2 tickets to attend the Inaugural Ball

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Practice Management

Back from the Edge: Coping with Physician Stress Our culture expects doctors to be strong and stoic. Physicians do nothing to belie that impression— they rarely discuss their personal issues It’s an unspoken rule that if you’re ever feeling stressed, you put your head down and persevere. That’s why I didn’t know that my close friend and fellow surgeon was on the edge. One afternoon last year, he left after assisting me in a complicated spine surgery. We shook hands and he said, “Nice case.” It came as an incredible shock when I heard that three hours later, he was dead from a self-inflicted gunshot to his head.

I later found out that my colleague was under enormous personal stress. His problems were complicated, but I know that much of his stress stemmed from his habit of constantly beating himself up. This led to uncontrollable anxiety, which had been building for several years. The tragedy is that he didn’t seek help earlier. He didn’t feel that he could.

My colleague’s story is not an isolated case. In fact, one in 16 physicians reported having contemplated suicide, according to a study published in the Archives of Surgery.

This rate is higher than the general public (6.3 percent vs.

3.3 percent). Only 26 percent sought out help.1 Out of my 80 medical school classmates, four killed themselves within three years of completing their training. Another dozen colleagues have committed suicide.

I can imagine how those doctors felt before deciding to end their lives. About 10 years ago, I was driving home one evening after a busy day at the clinic. I was agitated. I was in my mid-40s and was experiencing crippling anxiety on a daily basis. My anxiety had begun to rear its head 12 years earlier, and for the past year, I had struggled. I saw no way out. I was done.

That night, I weighed all of my options and decided that was it—once I pulled into the garage, I would close the door behind me and leave the car running. But at the final moment, I turned off the car. I thought of two classmates whose physician fathers had taken their own lives during my classmates’ teenage years. I knew how devastating it was, how hard it had been on them. I had a young son. I felt that I couldn’t abandon him and leave a legacy of death.

If it weren’t for my family, I have no doubt that I would have left the motor running.

Burnout Burnout contributes to the stress that can drive physicians to thoughts of suicide. About 40 percent of physicians experience burnout, according to the California Medical Board.2 Doctors live with a combination of pressures that can result in burnout: suppressed anxiety, perfectionism, and massive amounts of stress.

Medical authorities have made some effort to limit stress on doctors. For example, there are now laws limiting residents’ work to 80 hours per week. Enforcement of these rules is spotty, though, and the older hierarchy feels that these guidelines are too lenient. Physicians face many stresses: running a business, angry patients, surgical complications, threat of litigation, partner problems, etc. As a surgeon, it’s not uncommon to operate for 10 or 12 hours and then go to the office for another four hours to catch up on paperwork.

Stress management skills are not part of the medical training process. No one provides physicians with the tools to assess their mental health. There are no preventative mental health resources, such as mental health professionals on staff; there’s no one to easily talk to about the stress. Any hint of mental distress causes the hospital to examine under a microscope the physician’s ability to practice.

Suppressed Anxiety Physicians are conditioned to be really tough. From the first day we walk into the anatomy lab of medical school, it’s understood that we are essentially in boot camp. The intention is to quickly weed out those who cannot cut it.

The ones who can suppress their anxiety are the ones who survive.

Early in my practice, I always thought I was in control. It didn’t matter what I encountered—angry patients, billing problems, even a malpractice suit—I remember thinking, “I can take it. Bring it on.” All physicians are used to being in control, especially when it comes to anxiety.

Anxiety cannot be suppressed forever. Research has shown that the more one tries not to think about something, the higher the chance it is thought about.3 Many physicians find themselves in a state of chronic anxiety. When this

Practice Management happens, surgeons may quit doing the bigger cases or stop doing surgery altogether. Addictions begin to surface.

Other dysfunctional coping mechanisms, such as aggressive behavior toward staff and residents, are common. And then there is suicide.

Perfectionism Doctors hold up perfectionism as one of the highest virtues of their profession. Most physicians would agree that “perfect” is the standard for our medical culture. It’s both implicitly and explicitly taught from the time they enter medical school. Unfortunately, many mentors react severely to their underlings when a given task is performed in a lessthan-perfect manner.

But what does perfectionism really accomplish? Nothing.

It’s a destructive trait. As doctors, our goal is 100 percent success for every patient. But that’s not humanly possible. If you torture yourself over every case that doesn’t turn out perfectly, you can’t do your job well. The energy burned up by judging yourself negatively is the energy you need to perform at the highest level.

Since there’s no such thing as perfection in the human experience, the difference between reality and expectation will determine the degree of your unhappiness. For many physicians, failure to meet the standard of perfection engenders growing anxiety, anger, and guilt that facilitate suicide.

Reprogramming I was able to escape the perfectionist trap by using a technique known as neuro-cognitive reprogramming, which involves writing down your thoughts to create new, alternate neurological pathways. These pathways connect the thoughts with sight and feel. In David Burns’s book, Feeling Good,4 one of his tools is to write down negative thoughts and then categorize them. By using Burns’s writing methods and facing my anger, I was able to work myself out of the abyss. For me, it has been life altering.

There are other reprogramming methods. They include mindfulness/meditation, awareness, group dialogue, auditory methods, art, role playing, music, and many other techniques. Broken down, each follows a pattern of three parts: (1) awareness, (2) detachment, (3) reprogramming.

Each person’s journey will be unique.

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Going Forward As a medical community, we must recognize that anxiety is not a dirty word and that it’s not a sign of weakness to admit that you have anxiety. Members of the medical community must engage in a dialogue about allowing doctors to speak openly about their stresses. Each of us is so good with our façade that we couldn’t imagine that the other physician is anything less than completely together.

We are human, too, however, and we are suffering—badly.

With an open dialogue, the medical community can start to heal its own members.

References 1. McCoy KL, Carty SE. Failure is not a fate worse than death. Arch Surg. 2011;146(1):62-63.

2. Duruisseau S, Schunke K. Physician wellness as constrained by burnout. Medical Board of California Newsletter. November 2007;104:1.

3. Wegner DM, Schneider DJ, Carter SR 3rd, White TL. Paradoxical effects of thought suppression. J Pers Soc Psychol. 1987;53:5-13.

4. Burns D. Feeling Good. New York, NY: HarperCollins; 2000.

By David Hanscom, MD, a board certified orthopedic surgeon practicing in Seattle, Washington.

This article originally appeared in The Doctor’s Advocate, fourth quarter 2011 (www.thedoctors.com/advocate).

J8467G 12/11 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 health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

By David Hanscom, MD, a board certified orthopedic surgeon practicing in Seattle, Washington.

Founded by doctors for doctors in 1976 to advance, protect, and reward the practice of good medicine, The Doctors Company is the nation’s largest insurer of physician and surgeon medical liability, For more information on our innovative patient safety products and services, please call (800) 421-2368, extension 1243, or visit us at www.thedoctors.com/patientsafety.

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Medical/Legal

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Office Preparedness for Emergency Medical Care It is estimated that 820 million patients will be seen in medical offices this year. From the sheer number of patient visits, you can be sure that some patients will experience sudden, unexpected, life-threatening emergencies, such as cardiac arrest or anaphylactic shock. Physicians and their staff should be prepared to provide emergency care and basic life support until EMS arrives. The ability to provide basic emergency care is an expectation of your patients and the courts. MAG Mutual Insurance Company has identified significant deficiencies in some offices, through risk management audits, such as AMBU bags with missing masks or emergency equipment scattered in different locations throughout the office with untrained staff that cannot locate or utilize critical equipment.

By Carol Wiseheart, RN, BS, LHRM, Risk Management Consultant

Ask yourself: 1. What is your patient population and age range? Do you see pediatrics? Geriatrics? Both?

2. What type of procedures do you perform in your practice, particularly invasive procedures and cardiac testing?

3. Do you give injectables?

4. How comfortable and skilled in emergency care are the physicians who practice in your office?

5. What is the training and competence of your office staff to assist with emergency care?

There are no set rules in regard to the training and equipment.

This article, on our website, provides some recommendations from our risk management perspective to guide your office in preparing for medical emergency situations. To read the full article, go to www.magmutual.com.

in the Community

ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

A special thank you to our 2012 Vested Vendors ECMS vendors of choice West Florida Area Health Education Centers Baptist Health Care BBVA Compass Bank Covenant Hospice Express Employment Professionals Fisher Brown Bottrell Insurance, Inc. Gilmore Services Guardian Life Insurance Landrum Professional Employer Service LANformaiton Mag Mutual Insurance Agency, LLC Mertins Wealth Services Regions Bank Servis1st Bank Underwood Anderson & Associates, Inc. Virginia College in Pensacola

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ESCAMBIA COUNTY MEDICAL SOCIETY IN CONJUNCTION WITH SANTA ROSA COUNTY

Hospital News

Sacred Heart News Sacred Heart Chest Pain Center Gains Accreditation Sacred Heart Hospital in Pensacola has earned accreditation from the Society of Cardiovascular Patient Care as a Cycle 4 Chest Pain Center. During an onsite review, Sacred Heart demonstrated a high level of expertise and ability to quickly assess and treat patients who arrive with chest pain and other symptoms of heart attack.

EECP Therapy for Chest Pain Now Offered Sacred Heart Cardiology is offering a newly acquired therapy for patients with chronic chest pain and heart failure. Enhanced external counterpulsation, or EECP, therapy has been shown to benefit patients who suffer from angina, fatigue and shortness of breath due to inadequate blood supply to the heart.

The treatment of seven- to nine-week hour-long therapy sessions will be conducted under the medical direction of Dr. James Williams. ''With this therapy, the heart gradually changes during a period of weeks, resulting in long-term improvement in

the blood supply to the heart,'' says Dr. Williams. “It reduces the symptoms associated with inadequate blood supply, especially angina and shortness of breath. EECP usually results in very significant improvement that can last for years.�

Chief Operating Officer Welcomed to Sacred Heart Sacred Heart Health System has named Kerry Eaton, RN, as its new Chief Operating Officer. Eaton has responsibility for Sacred Heart's hospitals in Pensacola, Destin and Port St. Joe, as well as its outpatient facilities in six counties from Baldwin County, Ala., to Gulf County, Fla. Kerry comes to Pensacola with more than 25 years of experience in hospital leadership. She served most recently as senior vice president and chief operating officer at St. Vincent's Medical Center in Bridgeport, Conn.

Hospital News

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Baptist News Baptist Hospital & Gulf Breeze Hospital recognized as Top Performers in Key Quality Measures™ by The Joint Commission.

Baptist Health Care is the only Pensacola-area health care system to have two hospitals recognized by The Joint Commission on its recently released 2011 list of Top Performers in Key Quality Measures™. Both Baptist Hospital Inc. and Gulf Breeze Hospital were recognized for care processes linked to positive patient outcomes.

Baptist Medical Group experiences record growth in new physicians and mid-level providers.

Over the past four months, Baptist Medical Group has added 19 skilled providers with expertise in family medicine, geriatrics, hospital medicine, oncology, neurosurgery, physical medicine and rehabilitation, and cardiology, among others. Learn more at BaptistMedicalGroup.org.

Baptist Urgent Care centers are open this holiday.

For physicians taking a well-deserved vacation this holiday, please note that Baptist Urgent Care centers, located at Baptist Medical Park – Nine Mile and Baptist Medical Park – Navarre, are available to help care for your patients. We’re open the day after Thanksgiving as well as Christmas Eve and New Year’s Eve. For hours and directions, please visit BaptistMedicalGroup.org or call 850.208.6413.

Baptist Urologist offer new non-invasive, non-surgical treatment for overactive bladder.

This innovative treatment, known as Urgent PC, is now available in the office of Dr. M. Elizabeth Cruit, board certified urologic surgeon, and includes placing a slim needle electrode near the ankle and utilizing a battery-powered stimulator to retrain the muscles in the pelvis in order to improve bladder control. It is a great alternative to surgical treatment that can benefit everyone from the elderly to young mothers who have lost bladder control due to childbirth. To learn more, call the office at 850.437.8711.

Baptist Cancer Institute opens new office at Baptist Medical Park – Nine Mile.

In addition to seeing patients on Baptist Hospital and Gulf Breeze Hospital campuses, The Baptist Cancer Institute physician team is pleased to announce the opening of their third clinic location at Baptist Medical Park – Nine Mile. New and existing patients, and referrals are now being accepted at all locations.

Learn more at BaptistMedicalGroup.org or by calling 850.469.7975.

www.escambiacms.org

8880 University Pkwy., Suite B Pensacola, FL 32514 Ph: 850-478-0706 Fx: 850-474-9783 Email: info@escambiacms.org Executive Director: Erica Huffman

PRSRT STD U.S. POSTAGE PAID PERMIT #258 PENSACOLA, FL RETURN SERVICE REQUESTED

mEcoP reminder Best Clinical Practice Symposium

Saturday, January 12, 2013 | 7 a.m. - 4 p.m.

Topics: Retina Disorders, Secondary Stroke Prevention, Prostate Cancer and the PSA Dilemma, Pancreatic Cancer, Managing Heart Rhythm Disorders in the Elderly, Fall Prevention and Healthy Joints, and Surgical Interventions for Reflux. t AMA PRA Category 1 CreditsTM visit www.mecop.org for topics and agenda Contact 850.477.4956 (option 1) to register

Member Benefit: The Health Care Attorney On Call Hotline (561) 306-5699 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.